Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas.
The Houston OCD Program, Houston, Texas.
Depress Anxiety. 2020 May;37(5):418-428. doi: 10.1002/da.23000. Epub 2020 Feb 12.
Many therapists are reluctant to conduct exposure and response prevention (ERP) for obsessive-compulsive disorder (OCD). Negative beliefs about the safety and tolerability of ERP are common, especially for harm-related OCD symptoms. The study examined the nature and frequency of ERP-related serious negative consequences (SNC) and therapist attitudes and experiences providing ERP for harm-related OCD.
An anonymous survey was completed by 277 therapists with experience treating OCD using ERP. Questions assessed clinical experiences of harm-related exposures, the nature of SNC, and concerns and clinical considerations regarding ERP.
Therapist's willingness to treat harm-related OCD was high. SNCs were reported for 6 clients (per-client risk: adults 0.05%, youth 0.01%) and 13 therapists (per therapist risk 4.73%, therapist per-year risk 0.004%). Qualitative analysis identified themes relating to the conduct of treatment, specific exposure types, professional issues, and negative perceptions of ERP.
SNC associated with ERP for OCD are rare and primarily represent unintended secondary consequences of OCD or misunderstandings regarding the process and rationale behind ERP. Improving access to ERP will require good communication with clients, families, and other professionals regarding the rationale and safety of ERP.
许多治疗师不愿意对强迫症（OCD）进行暴露和反应预防（ERP）。人们普遍对 ERP 的安全性和耐受性存在负面看法，尤其是对与伤害相关的 OCD 症状。本研究考察了与 ERP 相关的严重负面后果（SNC）的性质和频率，以及治疗师对提供与伤害相关的 OCD 的 ERP 的态度和经验。
使用 ERP 治疗 OCD 经验丰富的 277 名治疗师完成了一项匿名调查。问题评估了与伤害相关的暴露的临床经验、SNC 的性质，以及对 ERP 的关注和临床考虑。
治疗师治疗与伤害相关的 OCD 的意愿很高。有 6 名患者（每位患者的风险：成年人 0.05%，青少年 0.01%）和 13 名治疗师（每位治疗师的风险 4.73%，治疗师每年的风险 0.004%）报告了 SNC。定性分析确定了与治疗实施、特定暴露类型、专业问题以及对 ERP 的负面看法有关的主题。
与 OCD 的 ERP 相关的 SNC 很少见，主要代表 OCD 的意外次要后果或对 ERP 的过程和原理的误解。改善对 ERP 的获取将需要与患者、家属和其他专业人员就 ERP 的原理和安全性进行良好沟通。
