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Exposure and ritual prevention reduces symptoms more than stress management training in OCD treated with SSRIs

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Is exposure and ritual prevention more effective than stress management for controlling symptoms in people with obsessive–compulsive disorder (OCD) already taking adequate doses of serotonin reuptake inhibitors (SSRIs)?


108 people with moderate to severe DSM-IV OCD (aged 18–70 years, 57% male) despite a therapeutic SSRI dose for at least 12 weeks. Exclusions: OCD not the primary diagnosis; psychosis, mania, suicidal, substance abuse or dependence in previous 6 months; subclinical OCD (Yale–Brown Obsessive Compulsive Scale score <16); taking SSRI but receiving no benefit; unstable medical condition; or prior cognitive behavioural therapy (CBT) or stress management training while taking SSRI.


Outpatient setting, Philadelphia, USA; recruitment November 2000–November 2005.


Exposure and ritual prevention or stress management training CBT. Exposure and ritual prevention involved two treatment planning sessions and then 15 in vivo and imaginal exposure sessions in which participants faced their fears without ritualisation. Participants were asked to stop ritualising after the first exposure session. Stress management involved two treatment planning sessions …

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  • Source of funding: National Institute of Mental Health, USA.


  • Competing interests: None.

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