Journal
CURRENT PSYCHOLOGY
Volume 42, Issue 10, Pages 7837-7840Publisher
SPRINGER
DOI: 10.1007/s12144-021-02161-0
Keywords
Obsessive-compulsive disorder; Cognitive-behaviour therapy; Exposure and response prevention; Repugnant obsessions; In vivo exposure; Imaginal exposure
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This study examined therapist preferences for in vivo and imaginal exposure for different types of repugnant obsessions in obsessive-compulsive disorder (OCD). The results showed that therapists were less likely to conduct in vivo exposures related to intentional/accidental harm, religion, and sexual orientation.
Repugnant obsessions are a common theme of intrusions in obsessive-compulsive disorder and are typically ego-dystonic. Exposure and response prevention (ERP) is the first-line intervention and involves in vivo and/or imaginal exposures. Many therapists are however reluctant to conduct ERP and the reasons remain unclear. Similarly, little is known about therapist preference for in vivo versus imaginal exposure for repugnant obsessions. To address these gaps, 200 therapists read vignettes of an in vivo and imaginal exposure for each repugnant obsession subtype and indicated whether they would have clients complete it. If not, they selected their primary refusal reason. Therapists were more likely to refuse in vivo (versus imaginal) exposures related to intentional/accidental harm, religion, and sexual orientation. There were no differences in willingness for pedophilic obsessions, with both forms receiving more refusals than approvals. Dangerous/harmful to client/others and not necessary for therapeutic success were most frequently selected as refusal reasons.
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