On the other hand, the application of EX/RP involves processing that help patients question their unrealistic beliefs and irrational thoughts. It is possible that EX/RP is more effective than CT, but the studies that compare EX/RP with CT have taken special care to avoid the use of cognitive elements in EX/RP, resulting in an incomplete application of EX/RP, whereas CT in research studies usually includes elements of exposure.39 Conclusion Over 40 years of published research has led to the

wide consensus among researchers and clinicians that CBT is an effective treatment for OCD.13,40,41 Exposure-based treatments have the largest evidence base to support their use for OCD. EX/RP which Inhibitors,research,lifescience,medical includes processing appears to be most effective, whereas exposure without processing and CT produced equivalent improvement. Based on the large empirical evidence for EX/RP it is recommended as the first-line treatment for OCD, with CBT as an alternative. While EX/RP has strong support for its efficacy in reducing OCD symptom severity, Inhibitors,research,lifescience,medical 20% of patients drop out prematurely. Although about 80% of patients Inhibitors,research,lifescience,medical respond well to EX/RP, 20% do not; therefore about 40% of patients with OCD are not helped by existing treatments.42 Clinical researchers should continue to refine CBT programs to maximize improvement and make treatment more palatable to those in need of help. It is difficult to determine the usefulness of psychological interventions other

than EX/RP and CBT because of lack of control studies. There has been one published RCT on an alternative therapy, yogic meditation, in the treatment of OCD,43 but no RCTs have been published on any other psychological interventions, such as hypnosis, virtual reality therapy, homeopathy, or

Inhibitors,research,lifescience,medical an integrated psychological approach. Furthermore, no welldesigned single case studies have been published on interventions other than CBT13 Further work is needed to validate alternative treatments for OCD. More work also needs to be done to determine how to best tailor treatment to individual needs. Most Inhibitors,research,lifescience,medical studies do not have sufficient power to break down treatment response by OCD subtype such as “washers,” “checkers,” “orderers,” and “hoarders.” Some subtypes have been studied more than others, and some subtypes are typically excluded from RCTs. Most OCD sufferers the have comorbid disorders, but studies typically exclude participants with substance abuse, psychosis, or bipolar disorder; thus we do not know how effective treatments are for comorbid populations. Acknowledgments The author wishes to acknowledge the excellent contribution of Samantha G. Farris to this paper by careful reading of the manuscript and check details putting together the references. Many thanks also to numerous colleagues with whom I coauthored many papers and chapters over the years; their work is summarized in this paper.
According to the Merriam-Webster online dictionary (http://www.merriam-webster.