Evid Based Mental Health: first published as 10.1136/ebmh.1.2.44 on 1 May 1998. Downloaded from 
                       Exposure and response prevention reduced
                       obsessive compulsive disorder symptoms
                       Lindsay M,Crino R,Andrews G.Controlled trial of exposure and response prevention in obsessive-compulsive disorder. Br J
                       Psychiatry 1997;171:135–9.
                       Objective                                                                    Main outcome measures
                       To compare exposure and response prevention with general                     Change in severity of obsessions, compulsions, anxiety, and
                       anxiety management in patients with obsessive compulsive                     depression using the following scales: Padua Inventory, Mauds-
                       disorder (OCD).                                                              ley Obsessional-Compulsive Inventory (MOCI), Yale-Brown
                                                                                                    Obsessive-Compulsive Scale, State-Trait Anxiety Inventory, and
                       Design                                                                       aninterference rating scale.
                       Randomised controlled trial witha3weekinterventionperiod.                    Main results
                       Setting                                                                      Patients in both groups rated their therapists as supportive and
                                                                                                    understanding.A principal components analysis yielded 2 com-
                       Outpatient clinic in New South Wales, Australia.                             ponents, the first accounting for 62.6% of the variance in scores
                                                                                                    onindividual measures and the second accounting for 16.7% of
                       Patients                                                                     the variance. The first component gave a combined measure of
                       18patients(meanage33y,67%women)whomettheDiagnostic                           OCDsymptom severity, and the second a general measure of
                       and Statistical Manual of Mental Disorders,4th edition diagnosis of          anxiety and depression.After treatment,when scores on the first
                       OCDandhadameandurationofOCDof11years(range1to                                principal component were combined, an overall reduction in
                       26y).                                                                        scores occurred in patients in the exposure and response
                                                                                                    prevention group whereas no change in scores occurred in
                       Intervention                                                                 patients in the anxiety management group (p<0.006). No
                       Patients were allocated to exposure and response prevention                  differences existed between the groups on the second principal
                       (n=9) or a control group involving general anxiety manage-                   component, but when pretreatment and post-treatment scores
                       ment (n=9). Exposure and response prevention consisted of                    were combined differences between the groups in favour of the
                       graded exposure to situations that were previously associated                exposure group were seen on the MOCI (p<0.006) and
                       with obsessional thoughts or impulses. Patients then imple-                  interference ratings (p<0.006).
                       mented self imposed prevention of compulsive rituals. The                    Conclusions
                       treatment programme included outpatient clinic sessions and                  A reduction in obsessional symptoms in obsessive compulsive
                       daily homework exposure tasks. General anxiety management                    disorder occurred aftera3weekprogrammeofexposure and
                       consisted of learning breathing techniques in response to                    response prevention techniques. No improvement was seen
                       hyperventilation, muscle relaxation, and problem solving about
                       non-OCD life stressors. No instruction was given about                       after a programme of general anxiety management.                                         http://ebmh.bmj.com/
                       exposure to triggers or prevention of rituals. Patients in both              Source of funding:no external funding.
                       groups received about 15 hours of face to face therapy sessions              For article reprint:Dr R Crino,Clinical Research Unit for Anxiety Disorders,299 Forbes Street,Dar-
                       over the 3 week intervention period.                                         linghurst,New South Wales 2010,Australia.Fax +61 2 9332 4316.
                       Commentary                                                                                                                                                             on September 26, 2022 by guest. Protected by copyright.
                       Barlow has described generalised anxiety           for the efficacy of the total package but             The findings are of considerable rel-
                       disorder as being the “basic anxiety disor-        not for the individual parts. Anxiety man-         evance for clinical practice. Many patients
                       der” characterised by intense, uncontrol-          agementhasbeenshowntobeeffectivein                 with OCD are still treated primarily with
                                    1
                       lableworry. TherelationofOCDtoother                generalised anxiety disorder.                      attemptstoreduceanxietyratherthanwith
                       anxiety disorders has been in question for            The study addresses the issue of                techniques that directly target the major
                       many years. In North America, OCD is               whether anxiety management, an active              symptoms and behaviours of the disorder.
                       included as one of the anxiety disorders           anxiety treatment, is as effective in reduc-       This study confirms the need for the appli-
                       whereas OCDiscategorised separately in             ingtheseverityofsymptomsinoneofthe                 cation of exposure and response preven-
                       the International Classification of Disease,       anxiety disorders as exposure and re-              tion in the optimal management of OCD.
                       10th edition.                                      sponsepreventionwhichhasusuallybeen                                      Richard Swinson,MD
                          The study by Lindsay et al compares 2           comparedwithinert psychological place-                                      McMaster University
                       treatments,each of which has been found            bos. The outcome of the study is quite                               Hamilton,Ontario,Canada
                       to be effective in various specific anxiety        clear in this small sample. Exposure plus
                       disorders. Exposure plus response pre-             response prevention reduces the symp-
                       vention has become the standard treat-             toms of OCD whereas anxiety manage-                 1BarlowDH.Anxiety and its disorders: the nature
                                                                                                                                 and treatment of anxiety and panic.NewYork:
                       ment for OCD with consistent evidence              mentdoesnot.                                           Guilford Press, 1988.
                       44 Therapeutics                                                                               Evidence-Based Mental Health       May 1998 Vol 1 No 2