Olfield 2011

7
The
British
Psychological
British Journal of Clinical Psychology (2011), 50, 7–18
C 2010 The British Psychological Society
Society
www.wileyonlinelibrary.com
Time-intensive cognitive behaviour therapy for

obsessive-compulsive disorder: A case series and
matched comparison group
Victoria B. Oldfield1,2 ∗ , Paul M. Salkovskis1,2 and Tracey Taylor1,2
1
Centre for Anxiety Disorders and Trauma, South London and Maudsley NHS
Trust, London, UK
2
King’s College London, Institute of Psychiatry, London, UK
Objectives. A time-intensive format may be both useful and effective for the
delivery of cognitive behaviour therapy (CBT) for obsessive-compulsive disorder (OCD).
Intensive treatments also offer a pragmatic alternative to in-patient admission for
those in a geographically remote location. Published studies of intensive treatment
include pioneering exposure–response prevention (ERP) trials that emphasized the
requirement for high-intensity treatment; more recently several studies have used
treatment protocols with a heavy emphasis on ERP. This study compares intensive
versus standard weekly treatment format following the integrated formulation-driven
CBT approach widely used in UK adult mental health settings.
Design. An analysis of patients undertaking intensive CBT using a matched compari-
son group of those who undertook weekly CBT for OCD.
Methods. Twenty-two adult patients undertook intensive format treatment (matched
with a weekly group for age, gender, and initial symptoms). A range of self-report
measures were examined at the end of treatment and at a 3-month follow-up.
Results. Significant treatment effects were found on a range of self-report measures;
both conditions were found to be equally effective at the end of treatment and at
3-month follow-up. Uncontrolled effect sizes show that the intensive treatment was
comparable to other trials of CBT for OCD.
Conclusion. An intensive treatment format for the delivery of CBT for OCD was
found to be as effective as weekly treatment. This is consistent with the recommenda-
tions from the National Institute for Clinical Excellence guidelines. This study adds to
the growing literature on the effectiveness of intensive format treatment.
Obsessive-compulsive disorder (OCD) is a chronic and potentially disabling condition

with that may be extremely persistent and treatment refractory (Rasmussen & Eisen,
1997). Cognitive behaviour therapy (CBT) is currently recommended as a first line
∗ Correspondence should be addressed to Dr Victoria B. Oldfield, Centre for Anxiety Disorders and Trauma, 99 Denmark Hill,
Maudsley Hospital, London SE5 8AZ, UK (e-mail: victoria.oldfield@iop.kcl.ac.uk).
DOI:10.1348/014466510X490073
20448260, 2011, 1, Downloaded from https://bpspsychub.onlinelibrary.wiley.com/doi/10.1348/014466510X490073 by Universitat De Barcelona, Wiley Online Library on [15/08/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
8 Victoria B. Oldfield et al.
of treatment by the National Institute for Clinical Excellence (NICE, 2005) guideline
for OCD. The efficacy of CBT for OCD is well-established (e.g., Freeston et al., 1997).
However, not all patients respond to standard treatment. Recent guidelines on treatment
and research priorities (NICE, 2005) has formalized the need for continued innovation in
the delivery of effective treatment. One recommendation is that adults with OCD with
moderate functional impairment should be offered ‘more intensive’ CBT which is stated
to be more than 10 therapist hours per patient. One option, explored here, is to offer
concentrated time-intensive treatment, delivering higher levels of treatment over a short
time period as an alternative to weekly hourly sessions. In addition to meeting the needs
of ‘treatment refractory’ patients, there may also be pragmatic reasons to offer intensive
treatment, for example when travel time to the clinic is an issue, or when time cannot
be regularly taken off work. Providing treatment over the course of a shorter time period
may be valuable for individuals where immediate clinical improvement is important, as
when a job or relationship is at risk.
Whilst typically cognitive behaviour therapy (CBT) is delivered in weekly 60–90 min
sessions (e.g., Beck, 1995), this is to a certain extent an artifact of the psychodynamic
50 min ‘therapy hour’. Behavioural treatments often eschewed this format, with pio-
neering exposure–response prevention (ERP) trials emphasizing the requirement for
high-intensity treatment (e.g., Foa & Goldstein, 1978; Meyer, Levy, & Schnurer, 1974;
Rachman, Hodgson, & Marks, 1971; Thornicroft, Colson, & Marks, 1991). The rationale
for the schedule of treatment was based on the rationale from animal learning that
‘massed’ extinction trials increase the rate of extinction compared to ‘spaced’ trials
(Mackintosh, 1974) and on Rachman’s theoretical observations that avoidance and
limited practice of exposure to feared stimuli may impede emotional processing (e.g.,
Rachman, 1979).
Following this rationale, a small study by Emmelkamp, Van Linden Van den Heuvell,
Ruphan, and Sanderman (1989) compared massed versus spaced scheduling of exposure-
based therapy sessions during home-based treatment. Emmelkamp et al. (1989) also
considered whether self-controlled exposure would lead to better maintenance of
change. They used a 2 × 2 factorial design: massed (four times a week) versus spaced
(twice a week) and therapist-controlled versus self-controlled exposure. Thus in each
group, the same length of exposure (20 h) was used; in the massed group it was delivered
over half the time. The study found no difference between massed/spaced sessions or
therapist/self-controlled exposure. However, there were only seven patients in each main
condition; this lack of power means that the findings should be treated with great caution.
Foa et al. (2005) conducted a double-blind randomized placebo-controlled trial
comparing ERP, clomipramine, and their combination. ERP treatment consisted of 2-h
exposure sessions each weekday over a 3-week period plus up to 2 h of ERP homework
each day. After this initial intensive 3-week treatment, patients were visited at home
twice, and had weekly maintenance sessions for 8 weeks. Intensive ERP was found to
be more effective than clomipramine alone; combined treatment was found to be more
effective than clomipramine alone.
Recent research has compared intensive and weekly treatments using contemporary
treatment protocols of ERP with cognitive elements. Storch, Gelfand, Geffken, and
Goodman (2003) described two case studies of intensive treatment of individuals with
longstanding OCD who had previously had limited access to psychological treatments,
had not improved on receipt of pharmacotherapy, and were considered ‘treatment
refractory’. Treatment was undertaken over 3–4 weeks, 5 days per week. Both patients
reported clinically significant improvements in OCD-related impairment.
Time-intensive CBT for OCD 9
Abramowitz, Foa, and Franklin (2003) report a comparison of two groups of 20

individuals; one group had 15 twice-weekly 2-h sessions and the other group 15 daily
2-h sessions over 3 weeks. In both groups, short- and long-term reductions in OCD and
depression symptoms were found. The intensive (daily) group showed superior gains
in the short term but not at 3-month follow-up. This was due to some deterioration of
treatment gains in intensive group rather than continued improvement in twice-weekly
group.
Similar findings were reported by Storch et al. (2007) in a paediatric study of intensive
and weekly CBT. The intensive treatment consisted of 14 daily 90 min sessions over a
3-week period; weekly treatment consisted of 14 weekly individual 90 min sessions. The
intensive group showed greater gains at the end of treatment, but both groups showed
similar outcomes at a 3-month follow-up. Most recently, Storch et al. (2008) conducted
a comparison of intensive and weekly treatment with adults using a non-randomized
design. Both treatment conditions were found to be similar in efficacy at the end of
treatment and at follow-up.
Storch et al. (2008) postulate that the low number of OCD patients who have access to
a CBT trial is due to therapist reluctance to follow exposure-based manualized treatment
approaches. There is evidence to suggest that even when patients are offered CBT, key
elements of treatment may not take place. In a study of patients who had received CBT,
only 22% recalled going ‘into situations outside the therapy room where you had to
face whatever you were afraid of with your therapist present’ and only 36% recalled
‘changing the meaning attached to thoughts’ (Stobie, Taylor, & Quigley, 2007). The
treatment approach used here, based on the ‘staged’ approach described by Salkovskis
and colleagues (Salkovskis, 1999; Salkovskis, Forrester, Richards, & Morrison, 1998),
emphasizes the way in which the therapist works to support patients who ‘choose to
change’. Such choices include (but are not confined to) confronting feared situations,
ERP, and the use of behavioural experiments to challenge beliefs. Note that, almost by
definition, patients participating in intensive treatment can be supported for a longer
period after they have undertaken exposure. This longer period of support by their
therapist can make it easier for the patient to expose themselves to feared situations,
bolsters their efforts at response prevention, and allows the ‘chaining’ of progressively
more challenging behavioural experiments with the knowledge that their taking risks
will be matched by support offered.
This present study aims to add to the existing literature by identifying any differences
in effectiveness between standard weekly treatment and time-intensive treatment as
delivered in an out-patient specialist cognitive behaviour therapy service in the UK.
There are some differences between the studies described above and the treatment
provided in this case series. A relevant contribution of this study is the short-term nature
of treatment (12–18 h); generally this is all that is available to a patient in the National
Health System (NHS) in the UK which can put considerable pressure on the therapist
and patient. In the existing literature, ‘short term’ can describe any time period up to
3 months in residential treatment and can include having an ERP ‘coach’ (Osgood-Hynes,
Riemann, & Björgvinsson, 2003). Of further relevance, the treatment delivered in this
case series is an integrated formulation-driven cognitive behavioural treatment (based on
the cognitive model of OCD of Salkovskis 1985, described in detail in Salkovskis et al.,
1998). This treatment format is different from treatment programmes reported in many
of the above studies which describe modular treatments using separable behavioural and
cognitive elements delivered by several members of a team.
Method
Participants
The intensive group was drawn from referrals to the Centre for Anxiety Disorders and
Trauma at the Maudsley Hospital during the period of 2004–2005. This is a National
Health Service specialist out-patient service accepting local and national referrals (the
latter when treatment is unavailable locally or local treatment has not led to adequate
recovery). The individuals referred had been assessed by a member of the team as having
OCD as their main problem using Diagnostic and Statistical Manual of Mental Disorders –
Fourth Edition (DSM-IV) criteria (American Psychiatric Association, 1994) and were on
the waiting list for treatment.
Intensive sample
From this pool (N = 41) of potential participants, a team decision was made to exclude
17 people from the intensive option for the following reasons: severe depression (due to
the inability to engage in sessions; comorbid depression was not an exclusion criterion),
significant history of very poor attendance, significant alcohol or drug use, obsessive-
compulsive personality disorder as the main problem. Also excluded were those who
had previously undertaken high-quality CBT. This was not to exclude treatment non-
responders – exclusion took place regardless of response to previous treatment. Without
exception previous CBT was done in a standard out-patient format thus intensive CBT
would be perceived as highly novel and different. This is considered as a potential
confound, thus potential participants were excluded on that basis.
Following a procedure granted full ethical approval, potential participants were sent
an information sheet/letter, and were subsequently phoned by the first author who
answered any questions about the different treatments. Participants opted in to the
intensive treatment option at this stage; 22 did so in the period concerned.
For ethical reasons, there was no requirement for the patient to state a reason why
intensive treatment was not chosen. However, often a reason was spontaneously offered
and this was recorded. Reasons for opting out included not wanting two therapists or
work or family commitments precluding attendance.
Matched sample
On completion of treatment of all those in the intensive group, a matched sample was
identified from treatment completers from the pool of weekly cases seen over the same
time period by the same clinicians. All of the matched cases had followed a typical
course of standard weekly treatment. The individual cases were first matched on total
Obsessive-Compulsive Inventory (OCI) distress score (see below) at the start of treatment
and gender. The closest match was found with the most contemporary case. If a suitable
match could not be found, cases treated up to 2 years previously were considered.
The mean age of the matched sample was calculated as the final stage of the matching
process. This group can be considered a ‘historical control’.
Measures
At all time points a number of self-report standardized questionnaires were
administered.
Beck Anxiety Inventory

This 21-item self-report measure assesses an individual’s level of anxiety. Each question
has four possible answers ranging from 0 – ‘not at all’, 1 – ‘mildly’, 2 – ‘moderately’, and
3 – ‘severely’ and individuals are asked to rate each symptom of anxiety listed using
this scale. The Beck Anxiety Inventory (BAI) has been reported to have high internal
consistency and good test–retest reliability (Beck, Epstein, Brown, & Steer, 1988).
Answers are scored out of a total of 63, with a score of 0–9 indicating anxiety within the
normal range, 10–18 mild/moderate anxiety, 19–28 moderate/severe, and 29–63 severe
anxiety.
Beck Depression Inventory – 2nd Edition

This 21-item self-report measure is a well-validated measure of depression severity in
adults and adolescents, although it is not diagnostic. The inventory assesses cognitive,
behavioural, and somatic features of depression over the past week. Items are scored on
a 0–3 scale with total scores out of 63, where a score of 0–9 represents a normal range,
10–18 mild/moderate, 19–28 moderate/severe, and 29–63 severe/extremely severe
depression. The Beck Depression Inventory – Second Edition (BDI-II) is reported to
have high internal consistency in student and clinical samples, high test–retest reliability
over 1 week and high convergent and discriminant validity (Beck, Ward, Mendelson,
Mock, & Erbaugh, 1961).
Obsessive-Compulsive Inventory
The OCI (Foa, Kozak, Salkovskis, Coles, & Amir, 1998) consists of 42 items composing
7 subscales: washing, checking, doubting, ordering, obsessing (i.e., having obsessional
thoughts), hoarding, and mental neutralizing. Each item is rated on a five-point (0–4)
Likert scale of associated distress (in the original version each item is rated on frequency
and distress; in this study only the distress scale was used).
Responsibility Attitude Scale

This 26-item self-report measure investigates general assumptions, attitudes, and beliefs
held about responsibility. Every item consists of a statement about responsibility and
asks individuals to rate how much they agree with it on a scale ranging from ‘totally
agree’ to ‘totally disagree’. Scores are calculated by summing all of the assigned values
that range from a score of 1 for answers of ‘totally disagree’ increasing to a score of 7
for answers of ‘totally agree’. Salkovskis et al. (2000) reported that the Responsibility
Attitude Scale (RAS) effectively discriminates between people with OCD and individuals
with other anxiety disorders and non-clinical controls. The RAS has also been found to
have high reliability and internal consistency (Salkovskis et al., 2000).
Responsibility Interpretations Questionnaire

This 22-item self-report measure was created to investigate the frequency and beliefs
about individuals’ interpretations of their intrusions about harm coming to themselves
or others. The original version has four subsections; each subsection has been found to
have high internal consistency, reasonable test–retest reliabilities, internal consistency,
and criterion validities (Salkovskis et al., 2000). The belief subsection only was used in
this study.
Measurement points
Data were collected at assessment (immediately prior to start of treatment), end of
treatment, and follow-up 3 months after the end of treatment.
Statistical analyses
Treatment of missing data
In the event of missing single items on questionnaires, they were replaced by the mode
of the scale items. In the event of a missing set of questionnaires, data were carried
forward from the last point of observation.
Statistical tests
Comparisons between groups in terms of descriptive and demographic information
were carried out using a one-way ANOVA. Outcome was analysed using a repeated
measures ANOVA with baseline, post-treatment, and follow-up as repeated measures,
with treatment type as the grouping variable. Where there was a significant treatment by
time interaction, a follow-up analysis of covariance was conducted. Pre-treatment scores
were used as the covariate, with the repeated measures being end of treatment and
follow-up scores. Where there was evidence of serial dependency, Epsilon adjustment
was made and Greenhouse–Geisser significance used.
Uncontrolled effect sizes were calculated using the post-treatment standard deviations
separately for the two groups using Cohen’s d.
Procedure
Assessment
All patients were assessed by experienced trained clinicians using the Structured Clinical
Interview for DSM-IV.
Treatment
Intensive CBT
In the time-intensive treatment condition, sessions were delivered over 5 days, spread
within a 10-day period. The typical structure was 3 days in the first week (typically 6–10 h
of treatment), and 2 days in the second week (typically 6–8 h). The distribution of time
was designed to have the intervening weekend as a time for listening to recordings of
therapy sessions, behavioural experiments, and other homework. Home or field visits
were conducted with all patients.
Weekly CBT
In weekly treatment, sessions of 60–90 min took place weekly over 12–18 weeks. In most
cases, a longer session was included for a home visit or longer behavioural experiment.
Elements common to both conditions

In both conditions, patients received 12–18 h of CBT delivered by experienced cog-
nitive behaviour therapists (with a core profession in clinical psychology or nurs-
ing) with weekly peer supervision. Treatment was an integrated formulation-driven
cognitive-behavioural treatment (based on the cognitive model of OCD of Salkovskis

1985, described in detail in Salkovskis et al., 1998). Generally, within the initial 2 h
of treatment, a shared formulation was drawn up with the patient. This collaborative
formulation would consist of a key responsibility appraisal of an intrusive thought
and maintenance factors (including safety seeking behaviours such as physical or
mental rituals, rumination, mental argument, reassurance seeking, attentional processes,
avoidance, and mood changes). An alternative less-threatening belief would be explored;
in addition to discursive techniques, behavioural experiments would be agreed to
facilitate belief change. Treatment took place in the out-patient service; home visits
or field trips were included in the majority of cases. The patient’s goals were established
at an early stage; these were reviewed at regular intervals. In the latter sessions, there
was a focus on potential setbacks and relapse prevention. Three 1-h booster sessions
took place at 1, 2, and 3 months after the end of treatment. All sessions were videotaped
for supervision purposes and audiotaped for the patient. The rationale for listening
to the tape in between sessions was given in the first session. Family members were
encouraged to attend some of the sessions, be present during home visits, and to listen
to the tapes. Therapists did not follow a rigid protocol for sessions – the most appropriate
treatment strategies were negotiated between patient and therapist. The number of hours
of treatment was intentionally allowed to vary as would take place in standard clinical
practice.
Integrity checks
Therapists delivering both the weekly and intensive treatment were experienced
specialists in cognitive behaviour therapy. Integrity of treatment was preserved by
weekly supervision where cases were discussed and video excerpts were observed.
Results
Description of sample
Both the intensive and weekly sample were 36% male. The age of the intensive group
at the start of treatment was 33.5 years (SD 8.8) and the weekly group 35.0 (SD 9.9).
Of both groups, 36.4% were married or living as married. Of the intensive group, 27.3%
and of the weekly group, 40.9% were unemployed. Of the intensive group, 50% and of
the weekly group, 22.7% had degree level qualifications.
Overview
Using one-way ANOVA for all measures, a similar pattern emerged: a significant main
effect of time with no evidence of a group × time interaction or group effect on any
measure (see Table 1).
Effect sizes
Uncontrolled effect sizes were calculated using the post-treatment standard deviations
separately for the two groups using Cohen’s d. Effect sizes were calculated for each
group for the OCI distress total score, BAI, and BDI at the end of treatment and the end
of follow-up. At the end of treatment, for the OCI distress total score, effect sizes were
1.57 for the intensive group and 0.92 for the weekly group; for the BAI 0.69 for the
Victoria B. Oldfield et al.
Table 1. Intensive and weekly groups mean scores on self-report measures and ANOVA results
14
intensive group and 0.42 for the weekly group; for the BDI 1.00 for the intensive group
and 0.29 for the weekly group. At the end of follow-up, for the OCI distress total score,
effect sizes were 0.95 for the intensive group and 1.21 for the weekly group; for the
BAI 0.76 for the intensive group and 0.69 for the weekly group; for the BDI 0.64 for the
intensive group and 0.60 for the weekly group.
Discussion
Despite a variety of studies supporting the use of an intensive format of behavioural
treatment, recent practice in cognitive behaviour therapy has been to offer standard
out-patient treatment with once-weekly sessions spread over many weeks with the
almost complete abandonment of intensive treatment formats in the UK and Europe.
The potential pros and cons of intensive and weekly/standard treatment are noted by
Abramowitz et al. (2003), Osgood-Hynes et al. (2003), and Storch et al. (2003, 2008).
An intensive format treatment appears to meet a need for those who are geographically
distant from a treatment centre, and for those who have not responded to weekly
sessions. Of those diagnosed with OCD, a recent audit of UK specialist clinic referrals
indicated that less than 40% had been able to access minimally adequate CBT close to
where they were living (Stobie et al., 2007). This means that, pending improved access
to psychological therapies, many patients will have to travel considerable distances to
obtain evidence-based treatments. Options for this are largely confined to expensive in-
patient treatments (which can carry other disadvantages) or intensive treatments such
as that described here.
In this preliminary investigation, CBT for OCD is shown to be effective whether
delivered in a weekly or a time-intensive format. This builds on recent studies of the
effectiveness of intensive treatment; what this study adds is evidence supporting the
use of an intensive format short-term integrated cognitive-behavioural treatment in an
out-patient NHS setting, as routine clinical practice. This finding is particularly relevant
to the recent guidelines for treatment and research published in the NICE guidelines
(2005). In terms of more recent developments, the emergence of the ‘Increased Access
to Psychological Therapies’ initiative in the UK has increased the need for validation of
flexibly delivered CBT for common mental health problems. The present study addresses
this issue, and the issue of the feasibility of ‘stepping up’ to intensive treatment in OCD.
In the recommendations for research in the NICE guidelines (NICE, 2005), it is suggested
that a trial should be conducted to examine the relative efficacy of intensive versus spaced
treatment for adults with OCD who have not responded to treatment. This matched case
series provides the necessary basis for such a study, by allowing the calculation of effect
sizes and by raising issues relevant to these comparisons. Clearly, what is now required
are randomized control trials (RCTs) which seek to identify predictors of response to
each treatment format.
There are some limitations to the findings. As noted by Storch et al. (2008)
randomization in such a study is problematic due to the different practical demands
of the different treatment conditions – many patients may not have been willing or able
to attend weekly if they lived far away, similarly many patients may have been able to
attend for the lengthy sessions involved in intensive treatment. An RCT design may have
potentially obscured a key strength of this study – that this is an evaluation of routine
clinical practice. However, these practical considerations are not insurmountable; these
findings need replication using an RCT. There are other possible remedies to the problem
of inaccessibility; for example, some patients may prefer to have telephone sessions.
Lovell et al. (2006) suggest that telephone delivery of CBT for OCD is equivalent to face
to face treatment. Such treatment may be preferred by some patients whilst in others
it may be less appropriate due to a need for in vivo work to overcome motivational
obstacles. Future research is needed into different methods of delivery and the way
these methods interact with patient characteristics.
A further limitation is the hetereogeneity of the sample. The pool of potential
participants for both groups included national referrals and local referrals. Within the
national referrals there were individuals who had not responded to other treatment
available locally (i.e., behaviour therapy, drug treatment) and those who were referred
due to a paucity of locally available services. Thus, there was considerable heterogeneity
within both groups in terms of initial severity. However, this does reflect routine clinical
practice.
A further consideration is that the time-intensive treatment was delivered by two
therapists whereas the weekly treatment was delivered by a single therapist. Two
therapists were used to mitigate against some of the pressures of the intensive format.
In weekly treatment, there is greater time for supervision, preparation, and reflection.
Allocating two therapists allows for peer supervision/discussion and for ‘thinking on
your feet’ in session. Another advantage of two therapists is as a training/learning
opportunity – pairing a trainee or new member of staff with a more experienced
colleague. The next stage in investigating the relative efficacy of these delivery styles
would be intensive treatment delivered by a single therapist. Longer term follow-up
would reveal any differences in maintenance of gains. Further considerations in future
research would include the therapist experience of intensive treatment. The impact on
the therapists of the time-intensive delivery has not been assessed and would provide
essential information on the feasibility of delivery of this treatment format. Monitoring
of the experience of each treatment method would provide useful information on the
advantages and disadvantages of each treatment modality.
The experience of treatment from the patient perspective has been investigated in
this sample; after treatment six of the participants in each of the intensive and matched
groups took part in a separate qualitative study on their views of the treatment format
(Bevan, Oldfield, & Salkovskis, 2009). A limitation of this qualitative study is that only
six in each group rather than all of the patients were interviewed. Weekly treatment
completers were concerned that intensive treatment could be overwhelming or too
brief for real change to take place. However, intensive treatment completers valued the
high pressure and pace and felt that it improved motivation, engagement, and eventual
outcome. In summary, when initially considered credible by the service user, delivered by
a trusted therapist, and including adequate follow-up and subsequent support, intensive
treatment was found to be a highly motivating and acceptable format for the delivery of
CBT for OCD.
Acknowledgements
We acknowledge with thanks the contributions of Anna Bevan, Elizabeth Forrester, Blake
Stobie, and Paul Wheble. The third author received support from the NIHR Biomedical
Research Centre at South London and Maudsley NHS Foundation Trust/Institute of Psychiatry
(King’s College London).
References
Abramowitz, J. S., Foa, E. B., & Franklin, M. E. (2003). Exposure and ritual prevention for obsessive-
compulsive disorder: Effects of intensive versus twice-weekly sessions. Journal of Consulting
and Clinical Psychology, 71, 394–398. doi:10.1037/0022-006X.71.2.394
American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders
(4th ed.). Washington, DC: Author.
Beck, A. T., Epstein, N., Brown, G., & Steer, R. A. (1988). An inventory for measuring clinical
anxiety: Psychometric properties. Journal of Consulting and Clinical Psychology, 56, 893–
897. doi:10.1037/0022-006X.56.6.893
Beck, A. T., Ward, C. H., Mendelson, M., Mock, J., & Erbaugh, J. (1961). An inventory for measuring
depression. Archives of General Psychiatry, 4, 561–571.
Beck, J. S. (1995). Cognitive therapy: Basics and beyond. New York: Guilford.
Bevan, A., Oldfield, V. B., & Salkovskis, P. M. (2009). A qualitative study of the acceptability
of an intensive format for the delivery of cognitive-behavioural therapy for obsessive-
compulsive disorder. British Journal of Clinical Psychology. Advance online publication.
doi:10.1348/014466509X447055
Emmelkamp, P. M., Van Linden Van den Heuvell, C., Ruphan, M., & Sanderman, R. (1989). Home-
based treatment of obsessive-compulsive patients: Intersession interval and therapist involve-
ment. Behaviour Research and Therapy, 27, 89–93. doi:10.1016/0005-7967(89)90124-1
Foa, E. B., & Goldstein, A. (1978). Continuous exposure and complete response preven-
tion in the treatment of obsessive-compulsive neurosis. Behavior Therapy, 9, 821–829.
doi:10.1016/S0005-7894(78)80013-6
Foa, E. B., Kozak, M. J., Salkovskis, P. M., Coles, M. E., & Amir, N. (1998). The validation of a
new obsessive-compulsive disorder scale: The Obsessive-Compulsive Inventory. Psychological
Assessment, 10, 206–214. doi:10.1037/1040-3590.10.3.206
Foa, E. B., Liebowitz, M. R., Kozak, M. J., Davies, S., Campeas, R., Franklin, M. E., . . . Tu, X. (2005).
Randomized, placebo-controlled trial of exposure and ritual prevention, clomipramine, and
their combination in the treatment of obsessive-compulsive disorder. American Journal of
Psychiatry, 162, 151–161. doi:10.1176/appi.ajp.162.1.151
Freeston, M. H., Ladouceur, R., Gagon, F., Thibodeau, N., Rhéaume, J., Letarte, H., & Bujold, A.
(1997). Cognitive-behavioural treatment of obsessive thoughts: A controlled study. Journal of
Consulting and Clinical Psychology, 65, 405–413. doi:10.1037/0022-006X.65.3.405
Lovell, K., Cox, D., Haddock, G., Jones, C., Raines, D., Garvey, R., . . . Hadley, S. (2006).
Telephone administered cognitive behaviour therapy for treatment of obsessive compulsive
disorder: Randomised controlled non-inferiority trial. British Medical Journal, 333, 883–887.
doi:10.1136/bmj.38940.355602.80
Mackintosh, N. J. (1974). The psychology of animal learning. New York: Academic Press.
Meyer, V., Levy, R., & Schnurer, A. (1974). The behavioural treatment of obsessive-compulsive
disorder. In H. R. Beech (Ed.) Obsessional states (pp. 233–258). London: Methuen.
National Institute for Clinical Excellence [NICE] (2005). Obsessive-compulsive disorder: Core
interventions in the treatment of obsessive-compulsive disorder and body dysmorphic
disorder. London: Author.
Osgood-Hynes, D., Riemann, B., & Björgvinsson, T. (2003). Short-term residential treatment
for obsessive-compulsive disorder. Brief Treatment and Crisis Intervention, 3, 413–435.
doi:10.1093/brief-treatment/mhg028
Rachman, S. (1979). The return of fear. Behaviour Research and Therapy, 17, 164–166.
doi:10.1016/0005-7967(79)90028-7
Rachman, S., Hodgson, R., & Marks, I. M. (1971). The treatment of chronic obsessive compulsive
neurosis. Behaviour Research and Therapy, 9, 237–247. doi:10.1016/0005-7967(71)90009-X
Rasmussen, S. A., & Eisen, J. L. (1997). Treatment strategies for chronic and refractory obsessive-
compulsive disorder. Journal of Clinical Psychiatry, 58, 9–13.
Salkovskis, P. M. (1985). Obsessional-compulsive problems: A cognitive behavioural analysis.
Behaviour Research and Therapy, 23, 571–583. doi:10.1016/0005-7967(85)90105-6
Salkovskis, P. M. (1999). Understanding and treating obsessive-compulsive disorder. Behaviour

Research and Therapy, 37(Suppl. 1). S29–S52. doi:10.1016/S0005-7967(99)00049-2
Salkovskis, P. M., Forrester, E., Richards, H. C., & Morrison, N. (1998). The devil is in the detail:
Conceptualising and treating obsessional problems. In N. Tarrier, A. Wells & G. Haddock
(Eds.), Treating complex cases: The cognitive behavioural therapy approach (pp. 46–79).
Chichester: Wiley.
Salkovskis, P. M., Wroe, A. L., Gledhill, A., Morrison, N., Forrester, E., Richards, C., . . . Thorpe, S.
(2000). Responsibility attitudes and interpretations are characteristic of obsessive compulsive
disorder. Behaviour Research and Therapy, 38, 347–372. doi:10.1016/S0005-7967(99)00071-
6
Stobie, B., Taylor, T., Quigley, A., Ewing, S., & Salkovskis, P. M. (2007). ‘Contents may vary’: A pilot
study of treatment histories of OCD patients. Behavioural and Cognitive Psychotherapy, 35,
273–282. doi:10.1017/S135246580700358X
Storch, E. A., Geffken, K. M., Merlo, L. J., Mann, G., Duke, D., Munson, M., . . . Goodman, W. K.
(2007). Family-based cognitive-behavioral therapy for pediatric obsessive-compulsive disorder:
A comparison of intensive and weekly approaches. Journal of the American Academy of Child
and Adolescent Psychiatry, 46, 469–478. doi:10.1097/chi.0b013e31803062e7
Storch, E. A., Gelfand, K. M., Geffken, G. R., & Goodman, W. K. (2003). An intensive outpatient
approach to the treatment of obsessive-compulsive disorder: Case exemplars. Annals of the
American Psychotherapy Association, 6, 14–19.
Storch, E. A., Merlo, L. J., Lehmkuhl, H., Geffken, G. R., Jacob, M., Ricketts, E., . . . Goodman, W.
K. (2008). Cognitive-behavioral therapy for obsessive-compulsive disorder: A non-randomised
comparison of intensive and weekly approaches. Journal of Anxiety Disorders, 22, 1146–
1158. doi:10.1016/j.janxdis.2007.12.001
Thornicroft, G., Colson, L., & Marks, I. (1991). An in-patient behavioural psychotherapy unit
description and audit. British Journal of Psychiatry, 158, 362–367. doi:10.1192/bjp.158.3.362
Received 19 December 2008; revised version received 18 December 2009

Olfield 2011

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Olfield 2011

Uploaded by

Copyright:

Available Formats

7

Time-intensive cognitive behaviour therapy for

Obsessive-compulsive disorder (OCD) is a chronic and potentially disabling condition

Abramowitz, Foa, and Franklin (2003) report a comparison of two groups of 20

Beck Anxiety Inventory

Beck Depression Inventory – 2nd Edition

Responsibility Attitude Scale

Responsibility Interpretations Questionnaire

Elements common to both conditions

cognitive-behavioural treatment (based on the cognitive model of OCD of Salkovskis

Salkovskis, P. M. (1999). Understanding and treating obsessive-compulsive disorder. Behaviour

Received 19 December 2008; revised version received 18 December 2009

You might also like