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Treatment of Chronic Obsessive-Compulsive Neurosis by in-vivo Exposure

A Two-Year Follow-up and Issues in Treatment

Published online by Cambridge University Press:  29 January 2018

I. M. Marks ,
R. Hodgson  and
S. J. Rachman
I. M. Marks
Affiliation:
Department of Psychology, Institute of Psychiatry, De Crespigny Park, London, SE5 8AF
R. Hodgson
Affiliation:
Department of Psychology, Institute of Psychiatry, De Crespigny Park, London, SE5 8AF
S. J. Rachman
Affiliation:
Department of Psychology, Institute of Psychiatry, De Crespigny Park, London, SE5 8AF
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Summary

Twenty patients with chronic obsessive-compulsive rituals were treated in a partially controlled design by in-vivo (real life) exposure with self-imposed response prevention. Treatment included 4–12 weeks as in-patients, and lasted a mean of 23 sessions. All patients were followed-up for at least two years. No patients dropped out during the trial, though one refused domiciliary treatment after discharge. Significant improvement in compulsions was found after three weeks of real-life exposure, and continued during follow-up. At two years follow-up 14 patients were much improved, one improved and 5 unchanged; in a third year of follow-up the improved patient became symptom-free after further exposure treatment. Improvement after three weeks exposure predicted good outcome at 6 and 12 months follow-up.

Muscular relaxation treatment had no significant effect on rituals. Modelling of exposure conferred no advantage over exposure alone for the group as a whole, though it may help selected patients. The role of response prevention is unknown. Patients' commitment to treatment facilitates exposure. Domiciliary treatment with involvement of family members in therapy seems crucial in some cases. Pilot group treatment of patients and families together suggests that this may be a useful adjuvant to individual treatment by increasing motivation and aiding follow-up.

Compulsive slowness presents special treatment problems but can be improved by a prompting and pacing approach.

The course of rituals was often independent of that of agoraphobia, marital problems and depression where these had initially coexisted with rituals. Depressive episodes were common before, during and after treatment, and required tricyclic medication.

The trial sample was predominantly female but was otherwise typical of patients with compulsive rituals. Of the 125 obsessive-compulsives seen in the first author's unit over four years 96 per cent were offered behavioural or antidepressant treatment. One quarter refused behavioural treatment after it was offered.

Real-life exposure with self-imposed response prevention is usually an effective procedure for lasting reduction of chronic compulsive rituals in well motivated patients.

Type
Papers
Information
The British Journal of Psychiatry , Volume 127 , Issue 4 , October 1975 , pp. 349 - 364
Copyright
Copyright © Royal College of Psychiatrists, 1975 

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References

Cooper, J. E. (1970) The Leyton Obsessional Inventory. Psychol. Med., 1, 48–64.Google Scholar
Eysenck, S. B. G. & Eysenck, H. J. (1969) Scores on three personality variables as a function of sex and social class. Brit. J. soc. clin. Psychol., 8, 69–76.CrossRefGoogle ScholarPubMed
Gelder, M. G. & Marks, I. M. (1966) Severe agoraphobia: a controlled prospective therapeutic trial. Brit. J. Psychiat., 112, 309–19.Google Scholar
Hafner, R. J. & Marks, I. M. Exposure in vivo of agoraphobics: the contributions of diazepam, group exposure and anxiety association. Psychol. Med. (In press).Google Scholar
Hand, I., Lamontaone, Y. & Marks, I. M. (1974) Group exposure (flooding) in vivo for agoraphobics. Brit. J. Psychiat., 124, 588–602.CrossRefGoogle ScholarPubMed
Hare, E. H. (1968) The Bethlem Royal and Maudsley Hospitals. Triennial Review.Google Scholar
Hodgson, R. & Rachman, S. (1975) The modification of compulsive behaviour. In Case-Histories in Behaviour Therapy (ed. H. J. Eysenck). London: Routledge and Kegan Paul.Google Scholar
Hodgson, R. & Marks, I. M. (1972) The treatment of obsessive-compulsive neurosis: follow-up and further findings. Behav. Res. & Ther., 10, 181–9.Google Scholar
Lipsedge, M. S. (1974) Therapeutic approaches to compulsive rituals: pilot study. Unpublished M.Phil. Dissertation, Univ. of London.Google Scholar
Marks, I. M. (1965) Patterns of Meaning in Psychiatric Patients. Maudsley Monograph No. 13. Oxford Univ. Press.Google Scholar
Marks, I. M. (1975) Behavioural treatments of phobic and obsessive-compulsive disorders: a critical appraisal. Chapter in Progress in Behaviour Modification (ed. R. Hersen et al.). Academic Press.Google Scholar
Meyer, V., Levy, R. & Schurer, A. (1974) The behavioural treatment of obsessive-compulsive disorder. Chap. 10, pp. 234–58 in H. R. Beech (ed.) Obsessional States. London: Methuen.Google Scholar
Rachman, S. (1973) Primary obsessional slowness. Behav. Res. & Ther., 12, 9–18.Google Scholar
Rachman, S., Hodgson, R. & Marks, I. M. (1971) Treatment of chronic obsessive-compulsive neuroses. Behav. Res. & Ther., 9, 237–47.Google Scholar
Rachman, S., Marks, I. M. & Hodgson, R. (1973) The treatment of obsessive-compulsive neurotics by modelling and flooding in vivo . Behav. Res. & Ther., 11, 463–71.Google Scholar
Roper, G., Rachman, S. & Marks, I. M. (1975) Passive and participant modelling in exposure treatment of obsessive-compulsive neurotics. Behav. Res. & Ther. (In press.) Google Scholar
Stern, R. S. & Marks, I. M. (1973) A comparison of brief and prolonged flooding in agoraphobics. Arch. gen. Psychiat., 28, 270–6.CrossRefGoogle Scholar
Stern, R. S., Lipsedge, M. S. & Marks, I. M. (1973) Thought-stopping of several obsessive thoughts: a controlled trial. Behav. Res. & Ther., 11, 659–62.Google Scholar
Watson, J. P. & Marks, I. M. (1971) Relevant vs. irrelevant flooding in the treatment of phobias. Behavior Therapy, 2, 275–93.CrossRefGoogle Scholar
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