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Clinical Case Studies, Vol. 5, No. 6, 455-476 (2006)
DOI: 10.1177/1534650105275968

The Use of Exposure and Ritual Prevention in the Treatment of Harm Obsessions With Covert Compulsions

Michael R. Ritter

University of Nevada, Reno

Holly Hazlett-Stevens

University of Nevada, Reno

This case study illustrates the use of exposure and ritual prevention in the treatment of obsessive-compulsive disorder (OCD) involving obsessional thoughts but without overt compulsions. Such presentations, once considered rare and treatment resistant, are now thought to represent a considerable portion of OCD sufferers. Recently, innovative treatment approaches with exposure and ritual prevention have shown encouraging treatment outcomes for this population. Successful treatment requires careful assessment of cognitive misappraisals and covert compulsions. A theoretical and research basis for obsessions is discussed along with a cognitive behavioral conceptualization of the problem. A detailed discussion of the course of treatment, complicating factors, managed-care issues, and recommendations to clinicians is included.

Key Words: obsessive-compulsive disorder • mental rituals • cognitive-behavioral theory • obsessional thoughts


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