Mechanisms of Response Prevention and the Use of Exposure as Therapy for Obsessive-Compulsive Disorder
Abstract
Habibollah Ghassemzadeh, Mary K. Rothbart and Michael I.Posner
The combination of exposure therapy and response prevention (ERP) is the most widely used and to date the most effective treatment for obsessive-compulsive disorder. We review the two main theoretical mechanisms proposed to account for the effectiveness of ERP: (1) habituation of anxiety due to exposure and (2) extinction due to withholding reinforcement of behaviors undertaken to decrease anxiety. Both of these mechanisms have their origin in behavior theory based upon classical and instrumental conditioning, and relate to the view that OCD is an anxiety-related or anxiety- based disorder. DSM- 5, however, no longer lists OCD as an anxiety disorder, instead positing an obsessive - compulsive disorder spectrum (OCDS), and emphasizing the diversity of OCD symptoms. More recent cognitive and neuroscience approaches have also stressed mechanisms involved in the control of emotional and behavioral responses. In this paper we review habituation and extinction accounts and attempt to integrate the newer neuroscience perspectives, moving toward a more complete framework for understanding OCD treatment.