{"id":420,"date":"2020-07-27T15:18:42","date_gmt":"2020-07-27T15:18:42","guid":{"rendered":"https:\/\/courses.lumenlearning.com\/abnormalpsych\/?post_type=chapter&#038;p=420"},"modified":"2022-07-26T20:05:58","modified_gmt":"2022-07-26T20:05:58","slug":"treatments-for-ocd-and-related-disorders","status":"publish","type":"chapter","link":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/chapter\/treatments-for-ocd-and-related-disorders\/","title":{"raw":"Treatment for OCD and Related Disorders","rendered":"Treatment for OCD and Related Disorders"},"content":{"raw":"<div class=\"textbox learning-objectives\">\r\n<h3>Learning Objectives<\/h3>\r\n<ul>\r\n \t<li>Examine methods used in treating OCD and related disorders, including habit reversal training<\/li>\r\n<\/ul>\r\n<\/div>\r\n<h2>Treating OCD<\/h2>\r\nOCD is typically treated with medication, psychotherapy, or a combination of the two. Although most patients with OCD respond to treatment, some patients continue to experience symptoms.\r\n<h3>Medication<\/h3>\r\nSerotonin reuptake inhibitors (SRIs), which include selective serotonin reuptake inhibitors (SSRIs), are used to help reduce OCD symptoms. SRIs often require higher daily doses in the treatment of OCD than of depression and may take eight to 12 weeks to start working, but some patients experience more rapid improvement.\r\n\r\nIf symptoms do not improve with these types of medications, research shows that some patients may respond well to antipsychotic medication. Although research shows that an antipsychotic medication may help manage symptoms for people who have both OCD and a tic disorder, research on the effectiveness of antipsychotics to treat OCD is mixed.\r\n<h3>Psychotherapy<\/h3>\r\nPsychotherapy can be an effective treatment for adults and children with OCD. Research shows that certain types of psychotherapy, CBT and other related therapies (e.g., habit reversal training) can be as effective as medication for many individuals.\r\n<div class=\"textbox examples\">\r\n<h3>Watch It<\/h3>\r\nThis video shows how clinical psychologist and the clinical director of the Centre for Anxiety Disorders and Trauma (CADAT), Paul Salkovskis, worked with Karen Robinson in treating her OCD with CBT.\r\n\r\n<iframe src=\"\/\/plugin.3playmedia.com\/show?mf=5572744&amp;p3sdk_version=1.10.1&amp;p=20361&amp;pt=375&amp;video_id=ds3wHkwiuCo&amp;video_target=tpm-plugin-p3ky0ai5-ds3wHkwiuCo\" width=\"800px\" height=\"450px\" frameborder=\"0\" marginwidth=\"0px\" marginheight=\"0px\"><\/iframe>\r\n\r\nYou can view the <a href=\"https:\/\/course-building.s3-us-west-2.amazonaws.com\/Abnormal+Psychology\/transcripts\/AGuideToCognitiveBehaviouralTherapyCBT_transcript.txt\" target=\"_blank\" rel=\"noopener\">transcript for \"A guide to Cognitive Behavioural Therapy (CBT)\" here (opens in new window)<\/a>.\r\n\r\n<\/div>\r\n<h3>Exposure and Response Prevention<\/h3>\r\nResearch also shows that a type of CBT called <strong>exposure and response prevention<\/strong> is effective in reducing compulsive behaviors in OCD, even in people who did not respond well to SRI medication.\u00a0In ERP, the patient first identifies the things that trigger obsessive thoughts, such as external situations like people, places, and thoughts. Therapists then examine the distress caused in those situations and what the feared outcome will be if they do not perform rituals to lower the distress. For example, a person may lock the door ten times after coming inside because they fear an intrusion. The patient will work with the clinician to discuss this fear, evaluate and rank its severity, and practice imagining ways to tolerate the distress. Eventually, the patient is exposed to the anxiety-provoking situation (keeping the doors unlocked) without performing a response and they learn strategies to cope with the distress.[footnote]Hezel, D. M., &amp; Simpson, H. B. (2019). Exposure and response prevention for obsessive-compulsive disorder: A review and new directions. <em>Indian journal of psychiatry<\/em>, 61(Suppl 1), S85\u2013S92. https:\/\/doi.org\/10.4103\/psychiatry.IndianJPsychiatry_516_18[\/footnote] Ultimately, ERP means spending time in the very situation that triggers compulsions (e.g. touching dirty objects) but then being prevented from undertaking the usual resulting compulsion (e.g. handwashing).\r\n\r\nAs with most mental disorders, treatment is usually personalized and might begin with either medication or psychotherapy, or with a combination of both. For many patients, ERP is the add-on treatment of choice when SRIs or SSRIs medication does not effectively treat OCD symptoms or vice versa for individuals who begin treatment with psychotherapy.\r\n<div class=\"textbox exercises\">\r\n<h3>Link to learning<\/h3>\r\n<span style=\"color: #33cccc;\"><a href=\"https:\/\/www.youtube.com\/watch?v=jYRlAW9KdBI\" target=\"_blank\" rel=\"noopener\">Visit this site to watch a video explanation of ERP.<\/a><\/span>\r\n\r\n<\/div>\r\n<h2>Treating Hoarding Disorder<\/h2>\r\nCognitive-behavioral therapy\u00a0(CBT) is a commonly implemented therapeutic intervention for compulsive hoarding. As part of cognitive behavior therapy, the therapist may help the patient to\r\n<ul>\r\n \t<li>discover why they are compelled to hoard.<\/li>\r\n \t<li>learn to organize possessions in order to decide what to discard.<\/li>\r\n \t<li>develop decision-making skills.<\/li>\r\n \t<li>declutter\u00a0the home during <em>in-home visits<\/em> by a therapist or\u00a0professional organizer.<\/li>\r\n \t<li>gain and perform relaxation skills.<\/li>\r\n \t<li>attend family and\/or group therapy.<\/li>\r\n \t<li>be open to trying psychiatric hospitalization if the hoarding is serious.<\/li>\r\n \t<li>have periodic visits and consultations to keep a healthy lifestyle.<\/li>\r\n<\/ul>\r\n<sup id=\"cite_ref-56\" class=\"reference\"><\/sup>CBT usually involves\u00a0exposure and response prevention\u00a0to situations that cause anxiety and\u00a0cognitive restructuring\u00a0of beliefs related to hoarding. Furthermore, research has also shown that certain CBT protocols have been more effective in treatment than others. CBT programs that specifically address the motivation of the sufferer, organization, acquiring new clutter, and removing current clutter from the home have shown promising results. CBT typically involves in-home work with a therapist combined with between-session\u00a0homework, the completion of which is associated with better treatment outcomes.\u00a0<sup id=\"cite_ref-Tolin_D.F.,_Frost_R.O.,_Steketee_G._2007_1461\u20131470_10-1\" class=\"reference\"><\/sup>Research on internet-based CBT treatments for the disorder (where participants have access to educational resources, cognitive strategies, and chat groups) has also shown promising results both in terms of short- and long-term recovery.\r\n<h2>Habit Reversal Training<\/h2>\r\nHabit reversal training\u00a0(HRT) has the highest rate of success in treating trichotillomania and other BFRRs.\u00a0<b>Habit reversal training<\/b>\u00a0(<b>HRT<\/b>) is a \"multicomponent behavioral treatment package originally developed to address a wide variety of repetitive behavior disorders.\"[footnote]Piacentini JC, Chang SW (2006). \"Behavioral treatments for tic suppression: habit reversal training\". Advances in Neurology. 99: 227\u201333. PMID 16536370[\/footnote] It consists of five components: awareness training, competing response training, contingency management, relaxation training, and generalization training.\u00a0HRT has also been shown to be a successful adjunct to\u00a0medication\u00a0as a way to treat trichotillomania.\u00a0<sup id=\"cite_ref-Chamberlain_7-18\" class=\"reference\"><\/sup><sup id=\"cite_ref-Woods_28-0\" class=\"reference\"><\/sup>With HRT, the individual is trained to learn to recognize their impulse to pull and also teach them to redirect this impulse. In comparisons of behavioral versus pharmacologic treatment,\u00a0CBT (including HRT) has shown significant improvement over medication alone.<sup id=\"cite_ref-Chamberlain_7-19\" class=\"reference\"><\/sup><sup id=\"cite_ref-Sah_8-16\" class=\"reference\"><\/sup> HRT has also proven effective in treating children.<sup id=\"cite_ref-Sah_8-17\" class=\"reference\"><\/sup>\u00a0Biofeedback<em><strong>,<\/strong><\/em> cognitive-behavioral methods, and\u00a0hypnosis\u00a0may improve symptoms.\u00a0<sup id=\"cite_ref-Shenefelt2003_29-0\" class=\"reference\"><\/sup>Acceptance and Commitment Therapy\u00a0(ACT) is also demonstrating promise in trichotillomania treatment.\u00a0<sup id=\"cite_ref-30\" class=\"reference\"><\/sup>A systematic review from 2012 found tentative evidence for \"movement decoupling,\" a self-help variant of HRT.[footnote]Sarris, Jerome; Camfield, David; Berk, Michael (May 2012). \"Complementary medicine, self-help, and lifestyle interventions for Obsessive Compulsive Disorder (OCD) and the OCD spectrum: A systematic review\". Journal of Affective Disorders. 138 (3): 213\u2013221. doi:10.1016\/j.jad.2011.04.051. PMID 21620478[\/footnote]\r\n<div class=\"textbox tryit\">\r\n<h3>Try It<\/h3>\r\nhttps:\/\/assess.lumenlearning.com\/practice\/8f88eb41-abff-4717-ab41-0b3752a7f9fd\r\n\r\nhttps:\/\/assess.lumenlearning.com\/practice\/86091319-26bb-41df-9db6-3a8ce87e67b6\r\n\r\n<\/div>\r\n<div class=\"textbox learning-objectives\">\r\n<h3>Glossary<\/h3>\r\n<strong>exposure and response prevention:<\/strong> a type of CBT treatment in which a patient first identifies the things that trigger obsessive thoughts, such as external situations like people or places and thoughts, then spending time facing those fears to lower stress levels\r\n\r\n<strong>habit reversal training:<\/strong>\u00a0a multicomponent behavioral treatment package developed to address a wide variety of repetitive behavior disorders that focuses on re-training responses to habits\r\n\r\n<\/div>","rendered":"<div class=\"textbox learning-objectives\">\n<h3>Learning Objectives<\/h3>\n<ul>\n<li>Examine methods used in treating OCD and related disorders, including habit reversal training<\/li>\n<\/ul>\n<\/div>\n<h2>Treating OCD<\/h2>\n<p>OCD is typically treated with medication, psychotherapy, or a combination of the two. Although most patients with OCD respond to treatment, some patients continue to experience symptoms.<\/p>\n<h3>Medication<\/h3>\n<p>Serotonin reuptake inhibitors (SRIs), which include selective serotonin reuptake inhibitors (SSRIs), are used to help reduce OCD symptoms. SRIs often require higher daily doses in the treatment of OCD than of depression and may take eight to 12 weeks to start working, but some patients experience more rapid improvement.<\/p>\n<p>If symptoms do not improve with these types of medications, research shows that some patients may respond well to antipsychotic medication. Although research shows that an antipsychotic medication may help manage symptoms for people who have both OCD and a tic disorder, research on the effectiveness of antipsychotics to treat OCD is mixed.<\/p>\n<h3>Psychotherapy<\/h3>\n<p>Psychotherapy can be an effective treatment for adults and children with OCD. Research shows that certain types of psychotherapy, CBT and other related therapies (e.g., habit reversal training) can be as effective as medication for many individuals.<\/p>\n<div class=\"textbox examples\">\n<h3>Watch It<\/h3>\n<p>This video shows how clinical psychologist and the clinical director of the Centre for Anxiety Disorders and Trauma (CADAT), Paul Salkovskis, worked with Karen Robinson in treating her OCD with CBT.<\/p>\n<p><iframe loading=\"lazy\" src=\"\/\/plugin.3playmedia.com\/show?mf=5572744&amp;p3sdk_version=1.10.1&amp;p=20361&amp;pt=375&amp;video_id=ds3wHkwiuCo&amp;video_target=tpm-plugin-p3ky0ai5-ds3wHkwiuCo\" width=\"800px\" height=\"450px\" frameborder=\"0\" marginwidth=\"0px\" marginheight=\"0px\"><\/iframe><\/p>\n<p>You can view the <a href=\"https:\/\/course-building.s3-us-west-2.amazonaws.com\/Abnormal+Psychology\/transcripts\/AGuideToCognitiveBehaviouralTherapyCBT_transcript.txt\" target=\"_blank\" rel=\"noopener\">transcript for &#8220;A guide to Cognitive Behavioural Therapy (CBT)&#8221; here (opens in new window)<\/a>.<\/p>\n<\/div>\n<h3>Exposure and Response Prevention<\/h3>\n<p>Research also shows that a type of CBT called <strong>exposure and response prevention<\/strong> is effective in reducing compulsive behaviors in OCD, even in people who did not respond well to SRI medication.\u00a0In ERP, the patient first identifies the things that trigger obsessive thoughts, such as external situations like people, places, and thoughts. Therapists then examine the distress caused in those situations and what the feared outcome will be if they do not perform rituals to lower the distress. For example, a person may lock the door ten times after coming inside because they fear an intrusion. The patient will work with the clinician to discuss this fear, evaluate and rank its severity, and practice imagining ways to tolerate the distress. Eventually, the patient is exposed to the anxiety-provoking situation (keeping the doors unlocked) without performing a response and they learn strategies to cope with the distress.<a class=\"footnote\" title=\"Hezel, D. M., &amp; Simpson, H. B. (2019). Exposure and response prevention for obsessive-compulsive disorder: A review and new directions. Indian journal of psychiatry, 61(Suppl 1), S85\u2013S92. https:\/\/doi.org\/10.4103\/psychiatry.IndianJPsychiatry_516_18\" id=\"return-footnote-420-1\" href=\"#footnote-420-1\" aria-label=\"Footnote 1\"><sup class=\"footnote\">[1]<\/sup><\/a> Ultimately, ERP means spending time in the very situation that triggers compulsions (e.g. touching dirty objects) but then being prevented from undertaking the usual resulting compulsion (e.g. handwashing).<\/p>\n<p>As with most mental disorders, treatment is usually personalized and might begin with either medication or psychotherapy, or with a combination of both. For many patients, ERP is the add-on treatment of choice when SRIs or SSRIs medication does not effectively treat OCD symptoms or vice versa for individuals who begin treatment with psychotherapy.<\/p>\n<div class=\"textbox exercises\">\n<h3>Link to learning<\/h3>\n<p><span style=\"color: #33cccc;\"><a href=\"https:\/\/www.youtube.com\/watch?v=jYRlAW9KdBI\" target=\"_blank\" rel=\"noopener\">Visit this site to watch a video explanation of ERP.<\/a><\/span><\/p>\n<\/div>\n<h2>Treating Hoarding Disorder<\/h2>\n<p>Cognitive-behavioral therapy\u00a0(CBT) is a commonly implemented therapeutic intervention for compulsive hoarding. As part of cognitive behavior therapy, the therapist may help the patient to<\/p>\n<ul>\n<li>discover why they are compelled to hoard.<\/li>\n<li>learn to organize possessions in order to decide what to discard.<\/li>\n<li>develop decision-making skills.<\/li>\n<li>declutter\u00a0the home during <em>in-home visits<\/em> by a therapist or\u00a0professional organizer.<\/li>\n<li>gain and perform relaxation skills.<\/li>\n<li>attend family and\/or group therapy.<\/li>\n<li>be open to trying psychiatric hospitalization if the hoarding is serious.<\/li>\n<li>have periodic visits and consultations to keep a healthy lifestyle.<\/li>\n<\/ul>\n<p><sup id=\"cite_ref-56\" class=\"reference\"><\/sup>CBT usually involves\u00a0exposure and response prevention\u00a0to situations that cause anxiety and\u00a0cognitive restructuring\u00a0of beliefs related to hoarding. Furthermore, research has also shown that certain CBT protocols have been more effective in treatment than others. CBT programs that specifically address the motivation of the sufferer, organization, acquiring new clutter, and removing current clutter from the home have shown promising results. CBT typically involves in-home work with a therapist combined with between-session\u00a0homework, the completion of which is associated with better treatment outcomes.\u00a0<sup id=\"cite_ref-Tolin_D.F.,_Frost_R.O.,_Steketee_G._2007_1461\u20131470_10-1\" class=\"reference\"><\/sup>Research on internet-based CBT treatments for the disorder (where participants have access to educational resources, cognitive strategies, and chat groups) has also shown promising results both in terms of short- and long-term recovery.<\/p>\n<h2>Habit Reversal Training<\/h2>\n<p>Habit reversal training\u00a0(HRT) has the highest rate of success in treating trichotillomania and other BFRRs.\u00a0<b>Habit reversal training<\/b>\u00a0(<b>HRT<\/b>) is a &#8220;multicomponent behavioral treatment package originally developed to address a wide variety of repetitive behavior disorders.&#8221;<a class=\"footnote\" title=\"Piacentini JC, Chang SW (2006). &quot;Behavioral treatments for tic suppression: habit reversal training&quot;. Advances in Neurology. 99: 227\u201333. PMID 16536370\" id=\"return-footnote-420-2\" href=\"#footnote-420-2\" aria-label=\"Footnote 2\"><sup class=\"footnote\">[2]<\/sup><\/a> It consists of five components: awareness training, competing response training, contingency management, relaxation training, and generalization training.\u00a0HRT has also been shown to be a successful adjunct to\u00a0medication\u00a0as a way to treat trichotillomania.\u00a0<sup id=\"cite_ref-Chamberlain_7-18\" class=\"reference\"><\/sup><sup id=\"cite_ref-Woods_28-0\" class=\"reference\"><\/sup>With HRT, the individual is trained to learn to recognize their impulse to pull and also teach them to redirect this impulse. In comparisons of behavioral versus pharmacologic treatment,\u00a0CBT (including HRT) has shown significant improvement over medication alone.<sup id=\"cite_ref-Chamberlain_7-19\" class=\"reference\"><\/sup><sup id=\"cite_ref-Sah_8-16\" class=\"reference\"><\/sup> HRT has also proven effective in treating children.<sup id=\"cite_ref-Sah_8-17\" class=\"reference\"><\/sup>\u00a0Biofeedback<em><strong>,<\/strong><\/em> cognitive-behavioral methods, and\u00a0hypnosis\u00a0may improve symptoms.\u00a0<sup id=\"cite_ref-Shenefelt2003_29-0\" class=\"reference\"><\/sup>Acceptance and Commitment Therapy\u00a0(ACT) is also demonstrating promise in trichotillomania treatment.\u00a0<sup id=\"cite_ref-30\" class=\"reference\"><\/sup>A systematic review from 2012 found tentative evidence for &#8220;movement decoupling,&#8221; a self-help variant of HRT.<a class=\"footnote\" title=\"Sarris, Jerome; Camfield, David; Berk, Michael (May 2012). &quot;Complementary medicine, self-help, and lifestyle interventions for Obsessive Compulsive Disorder (OCD) and the OCD spectrum: A systematic review&quot;. Journal of Affective Disorders. 138 (3): 213\u2013221. doi:10.1016\/j.jad.2011.04.051. PMID 21620478\" id=\"return-footnote-420-3\" href=\"#footnote-420-3\" aria-label=\"Footnote 3\"><sup class=\"footnote\">[3]<\/sup><\/a><\/p>\n<div class=\"textbox tryit\">\n<h3>Try It<\/h3>\n<p>\t<iframe id=\"assessment_practice_8f88eb41-abff-4717-ab41-0b3752a7f9fd\" class=\"resizable\" src=\"https:\/\/assess.lumenlearning.com\/practice\/8f88eb41-abff-4717-ab41-0b3752a7f9fd?iframe_resize_id=assessment_practice_id_8f88eb41-abff-4717-ab41-0b3752a7f9fd\" frameborder=\"0\" style=\"border:none;width:100%;height:100%;min-height:300px;\"><br \/>\n\t<\/iframe><\/p>\n<p>\t<iframe id=\"assessment_practice_86091319-26bb-41df-9db6-3a8ce87e67b6\" class=\"resizable\" src=\"https:\/\/assess.lumenlearning.com\/practice\/86091319-26bb-41df-9db6-3a8ce87e67b6?iframe_resize_id=assessment_practice_id_86091319-26bb-41df-9db6-3a8ce87e67b6\" frameborder=\"0\" style=\"border:none;width:100%;height:100%;min-height:300px;\"><br \/>\n\t<\/iframe><\/p>\n<\/div>\n<div class=\"textbox learning-objectives\">\n<h3>Glossary<\/h3>\n<p><strong>exposure and response prevention:<\/strong> a type of CBT treatment in which a patient first identifies the things that trigger obsessive thoughts, such as external situations like people or places and thoughts, then spending time facing those fears to lower stress levels<\/p>\n<p><strong>habit reversal training:<\/strong>\u00a0a multicomponent behavioral treatment package developed to address a wide variety of repetitive behavior disorders that focuses on re-training responses to habits<\/p>\n<\/div>\n\n\t\t\t <section class=\"citations-section\" role=\"contentinfo\">\n\t\t\t <h3>Candela Citations<\/h3>\n\t\t\t\t\t <div>\n\t\t\t\t\t\t <div id=\"citation-list-420\">\n\t\t\t\t\t\t\t <div class=\"licensing\"><div class=\"license-attribution-dropdown-subheading\">CC licensed content, Original<\/div><ul class=\"citation-list\"><li>Modification, adaptation, and original content. <strong>Authored by<\/strong>: Christina Hicks for Lumen Learning. <strong>Provided by<\/strong>: Lumen Learning. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY: Attribution<\/a><\/em><\/li><\/ul><div class=\"license-attribution-dropdown-subheading\">CC licensed content, Shared previously<\/div><ul class=\"citation-list\"><li>Compulsive Hoarding Treatments. <strong>Provided by<\/strong>: Wikipedia. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/en.wikipedia.org\/wiki\/Compulsive_hoarding\">https:\/\/en.wikipedia.org\/wiki\/Compulsive_hoarding<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA: Attribution-ShareAlike<\/a><\/em><\/li><li>Habit Reversal Training. <strong>Provided by<\/strong>: Wikipedia. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/en.wikipedia.org\/wiki\/Habit_reversal_training\">https:\/\/en.wikipedia.org\/wiki\/Habit_reversal_training<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA: Attribution-ShareAlike<\/a><\/em><\/li><\/ul><div class=\"license-attribution-dropdown-subheading\">All rights reserved content<\/div><ul class=\"citation-list\"><li>A guide to Cognitive Behavioural Therapy (CBT). <strong>Provided by<\/strong>: OCD-UK. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/www.youtube.com\/watch?v=ds3wHkwiuCo&#038;feature=emb_logo\">https:\/\/www.youtube.com\/watch?v=ds3wHkwiuCo&#038;feature=emb_logo<\/a>. <strong>License<\/strong>: <em>Other<\/em>. <strong>License Terms<\/strong>: Standard YouTube License<\/li><\/ul><div class=\"license-attribution-dropdown-subheading\">Public domain content<\/div><ul class=\"citation-list\"><li>Obsessive-Compulsive Disorder. <strong>Provided by<\/strong>: NIMH. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/www.nimh.nih.gov\/health\/topics\/obsessive-compulsive-disorder-ocd\/index.shtml#part_145348\">https:\/\/www.nimh.nih.gov\/health\/topics\/obsessive-compulsive-disorder-ocd\/index.shtml#part_145348<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/about\/pdm\">Public Domain: No Known Copyright<\/a><\/em><\/li><\/ul><\/div>\n\t\t\t\t\t\t <\/div>\n\t\t\t\t\t <\/div>\n\t\t\t <\/section><hr class=\"before-footnotes clear\" \/><div class=\"footnotes\"><ol><li id=\"footnote-420-1\">Hezel, D. M., &amp; Simpson, H. B. (2019). Exposure and response prevention for obsessive-compulsive disorder: A review and new directions. <em>Indian journal of psychiatry<\/em>, 61(Suppl 1), S85\u2013S92. https:\/\/doi.org\/10.4103\/psychiatry.IndianJPsychiatry_516_18 <a href=\"#return-footnote-420-1\" class=\"return-footnote\" aria-label=\"Return to footnote 1\">&crarr;<\/a><\/li><li id=\"footnote-420-2\">Piacentini JC, Chang SW (2006). \"Behavioral treatments for tic suppression: habit reversal training\". Advances in Neurology. 99: 227\u201333. PMID 16536370 <a href=\"#return-footnote-420-2\" class=\"return-footnote\" aria-label=\"Return to footnote 2\">&crarr;<\/a><\/li><li id=\"footnote-420-3\">Sarris, Jerome; Camfield, David; Berk, Michael (May 2012). \"Complementary medicine, self-help, and lifestyle interventions for Obsessive Compulsive Disorder (OCD) and the OCD spectrum: A systematic review\". Journal of Affective Disorders. 138 (3): 213\u2013221. doi:10.1016\/j.jad.2011.04.051. PMID 21620478 <a href=\"#return-footnote-420-3\" class=\"return-footnote\" aria-label=\"Return to footnote 3\">&crarr;<\/a><\/li><\/ol><\/div>","protected":false},"author":29,"menu_order":15,"template":"","meta":{"_candela_citation":"[{\"type\":\"cc\",\"description\":\"Compulsive Hoarding Treatments\",\"author\":\"\",\"organization\":\"Wikipedia\",\"url\":\"https:\/\/en.wikipedia.org\/wiki\/Compulsive_hoarding\",\"project\":\"\",\"license\":\"cc-by-sa\",\"license_terms\":\"\"},{\"type\":\"cc\",\"description\":\"Habit Reversal Training\",\"author\":\"\",\"organization\":\"Wikipedia\",\"url\":\"https:\/\/en.wikipedia.org\/wiki\/Habit_reversal_training\",\"project\":\"\",\"license\":\"cc-by-sa\",\"license_terms\":\"\"},{\"type\":\"copyrighted_video\",\"description\":\"A guide to Cognitive Behavioural Therapy (CBT)\",\"author\":\"\",\"organization\":\"OCD-UK\",\"url\":\"https:\/\/www.youtube.com\/watch?v=ds3wHkwiuCo&feature=emb_logo\",\"project\":\"\",\"license\":\"other\",\"license_terms\":\"Standard YouTube License\"},{\"type\":\"original\",\"description\":\"Modification, adaptation, and original content\",\"author\":\"Christina Hicks for Lumen Learning\",\"organization\":\"Lumen Learning\",\"url\":\"\",\"project\":\"\",\"license\":\"cc-by\",\"license_terms\":\"\"},{\"type\":\"pd\",\"description\":\"Obsessive-Compulsive Disorder\",\"author\":\"\",\"organization\":\"NIMH\",\"url\":\"https:\/\/www.nimh.nih.gov\/health\/topics\/obsessive-compulsive-disorder-ocd\/index.shtml#part_145348\",\"project\":\"\",\"license\":\"pd\",\"license_terms\":\"\"}]","CANDELA_OUTCOMES_GUID":"08171a5d-3f44-48bc-a986-de927f976f4c, 101a1165-a752-4aab-9ba6-01fece531730","pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[],"contributor":[],"license":[],"class_list":["post-420","chapter","type-chapter","status-publish","hentry"],"part":138,"_links":{"self":[{"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/pressbooks\/v2\/chapters\/420","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/wp\/v2\/users\/29"}],"version-history":[{"count":32,"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/pressbooks\/v2\/chapters\/420\/revisions"}],"predecessor-version":[{"id":7499,"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/pressbooks\/v2\/chapters\/420\/revisions\/7499"}],"part":[{"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/pressbooks\/v2\/parts\/138"}],"metadata":[{"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/pressbooks\/v2\/chapters\/420\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/wp\/v2\/media?parent=420"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/pressbooks\/v2\/chapter-type?post=420"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/wp\/v2\/contributor?post=420"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/wp\/v2\/license?post=420"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}