Background: Behavior therapy [exposure and response prevention (ERP)] and cognitive therapy (CT) have proven effective in the treatment of obsessive-compulsive disorder. Direct comparisons between these treatment modalities have exposed no differences in efficacy. However, very little research has been conducted into the differences between the change processes in ERP and CT. This investigation is a first attempt to study change by measuring scores on a weekly basis rather than at specific stages in the treatment and follow-up. Methods: We used the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) at weekly intervals to rate and compare the severity of the obsessions and compulsions of 61 completers of either CT or ERP. The aim was to ascertain whether the process of change in CT is different from the process of change in ERP. We expected that ERP would primarily affect behavior, thus reducing compulsions first, while CT would primarily affect thought, thus reducing obsessions first. Results: Firstly, no differences were found between ERP and CT with respect to the change process for obsessions and compulsions. Secondly, it emerged that changes in compulsions predicted all treatment effects better than changes in obsessions. Conclusions: These results suggest that reduction of compulsions is the process through which both ERP and CT affect change.

Hollander E, Kwon JH, Stein DJ, Broatch J, Rowland CT, Himelein CA: Obsessive-compulsive and spectrum disorders: overview and quality of life issues. J Clin Psychiatry 1996;57(suppl 8):3–6.
Meyer V: Modification of expectations in cases with obsessive rituals. Behav Res Ther 1966;4:73–280.
Foa EB, Franklin ME, Kozak MJ: Psychosocial treatments for obsessive-compulsive disorder: a literature review; in Swinson RP, Antony MM, Rachman S, Richter MA (eds): Obsessive-Compulsive Disorder. Theory, Research and Treatment. New York, Guilford, 1998.
Wetzel C, Bents H, Florin I: High-density exposure therapy for obsessive-compulsive inpatients: a 1-year follow up. Psychother Psychosom 1999;68:186–192.
Nakatani E, Nakagawa A, Nakao T, Yoshizato C, Nabeyama M, Kudo A, Isomura K, Kato N, Yoshioka K, Kawamoto M: A randomized controlled trial of Japanese patients with obsessive-compulsive disorder – effectiveness of behavior therapy and fluvoxamine. Psychother Psychosom 2005;74:269–276.
Park L, Jefferson J, Greist J: Obsessive-compulsive disorder. CNS Drugs 1997;7:188–202.
Clark DA: Cognitive behavioral treatment of obsessive-compulsive disorders: a commentary. Cogn Behav Pract 1999;6:408–415.
Biondi M, Picardi A: Increased maintenance of obsessive-compulsive disorder remission after integrated serotonergic treatment and cognitive psychotherapy compared with medication alone. Psychother Psychosom 2005;74:123–128.
Whittal ML, Thordarson DS, McLean PD: Treatment of obsessive-compulsive disorder: cognitive behavior therapy vs. exposure and response prevention. Behav Res Ther 2005;43:1559–1576.
Emmelkamp PM, Visser S, Hoekstra RJ: Cognitive therapy vs. exposure in vivo in the treatment of obsessive-compulsives. Cogn Ther Res 1988;12:103–114.
Emmelkamp PM, Beens H: Cognitive therapy with obsessive-compulsive disorder: a comparative evaluation. Behav Res Ther 1991;29:293–300.
Van Oppen P, de Haan E, van Balkom AJ, Spinhoven P, Hoogduin K, van Dyck R: Cognitive therapy and exposure in vivo in the treatment for obsessive-compulsive disorder. Behav Res Ther 1995;33:379–390.
Cottraux J, Note I, Yao SN, Lafont S, Note B, Mollard E, Bouvard M, Sauteraud A, Bourgeois M, Dartigues JF: A randomized controlled trial of cognitive therapy versus intensive behavior therapy in obsessive- compulsive disorder. Psychother Psychosom 2001;70:288–297.
Simons M, Schneider S, Herpertz-Dahlmann B: Metacognitive therapy versus exposure and response prevention for pediatric obsessive-compulsive disorder: a case series with randomized allocation. Psychother Psychosom 2006;75:257–264.
Van Balkom AJ, de Haan E, van Oppen P, Spinhoven P, Hoogduin KA, van Dyck R: Cognitive and behavioral therapies alone versus in combination with fluvoxamine in the treatment of obsessive compulsive disorder. J Nerv Ment Dis 1998;186:492–499.
De Haan E, van Oppen P, van Balkom AJLM, Spinhoven P, Hoogduin CAL, Van Dyck R: Prediction of outcome and early versus late improvement in OCD patients treated with cognitive behaviour therapy and pharmacotherapy. Acta Psychiatr Scand 1997;96:354–361.
Goodman WK, Price LH, Rasmussen SA, Mazure C, Fleischmann R, Hill CL, Heninger GR, Charney DS: The Yale-Brown Obsessive-Compulsive Scale. I. Development, use, and reliability. Arch Gen Psychiatry 1989;46:1006–1011.
Goodman WK, Price LH, Rasmussen SA, Mazure C, Delgado P, Heninger GR, Charney DS: The Yale-Brown Obsessive Compulsive Scale. II. Validity. Arch Gen Psychiatry 1989;46:1012–1016.
DiNardo PA, O’Brien GT, Barlow DH, Waddell MT, Blanchard EB: Reliability of DSM-III anxiety disorders categories using a new structured interview. Arch Gen Psychiatry 1983;40:1070–1075.
Beck AT: Cognitive Therapy and the Emotional Disorder. New York, International Universities Press, 1976.
Salkovskis PM: Obsessional-compulsive problems: a cognitive-behavioral analysis. Behav Res Ther 1985;23:571–583.
Twisk J, de Vente W: Attrition in longitudinal studies: how to deal with missing data. J Clin Epidemiol 2002;55:329–337.
Stata: STATA Reference Manual, release 7. College Station, Stata Press, 2001.
Wagner AR: SOP: a model of automatic memory processing in animal behavior; in Spear NE, Miller RR (eds): Information Processing in Animals. Memory Mechanisms. Hillsdale, Erlbaum, 1981, pp 5–47.
Wolpe J: Commentary: the cognitivist oversell and comments on symposium contributions. J Behav Ther Exp Psychiatry 1993;24:141–147.
Deacon BJ, Abramowitz JS: Cognitive and behavioral treatments for anxiety disorders: a review of meta-analytic findings. J Clin Psychol 2004;60:429–441.
Van Balkom AJ, van Oppen P, Vermeulen AW, van Dyck R, Nauta MC, Vorst HC: A meta-analysis on the treatment of obsessive compulsive disorder: a comparison of antidepressants, behavior, and cognitive therapy. Clin Psychol Rev 1994;14:359–381.
Van Oppen P, Emmelkamp PM, van Balkom AJ, van Dyck R: The sensitivity to change of measures for obsessive-compulsive disorder. J Anxiety Disord 1995;9:241–248.
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