Adding CT to ERPTo examine whether

Adding CT to ERP
To examine whether adding elements of CT would improve
response to ERP, Vogel, Stiles, and Gotestam (35) conducted
a controlled study in which 35 individuals with OCD were
randomly assigned to receive either ERP plus CT (« = 16) or
ERP plus relaxation therapy {n = 19). Relaxation therapy was
added as a placebo procedure to control for the effects of adding
additional techniques to ERP. Results indicated that both
therapy programs were superior to the wait-list condition.
Among treatment completers, Y-BOCS scores were reduced
from 25.1 (ERP + CT) and 23.4 (ERP + relaxation) at pretreatment
to 16.4 (ERP + CT) and 11.3 (ERP + relaxation) at
posttreatment and to 13.3 (ERP + CT) and 10.2 (ERP + relaxation)
at 1-year follow-up. Statistical analyses indicated a
nonsignificant trend toward superiority of ERP + relaxation
therapy at posttreatment, but this difference disappeared at the
follow-up assessment. In addition, the inclusion of CT was
useful in reducing dropout. Thus there appear to be benefits to
incorporating CT techniques along with ERP.
Clinically speaking, just as exposure adds to the benefits of
CT (34), CT probably adds to the effects of ERP. It is unfortunate
that most published accounts of ERP (for example, 36)
fail to fully describe the informal cognitive procedures that
likely contribute to its efficacy. For example, during ERP,
patients often need to be persuaded that exposure to fear cues
will be beneficial for them. This typically requires discussion
of fear-related beliefs and assumptions (for example, overestimates
of danger). Nonetheless, although CT techniques are
important during ERP, the research suggests that CT should
accompany, rather than replace, systematic prolonged and
repeated therapist-supervised ERP. That is, cognitive interventions
are best used to "tenderize" distorted cognitions that
underlie obsessional fears, thereby creating the conditions for
patients to comply with ERP procedures.