In the early years of behavior therapy it was not at all apparent how to treat OCD. A variety of techniques to help OCD sufferers "learn" different behavior were tried. For example, a behavioral psychologist named Arnold Lazarus described how he treated one OCD patient by administering her small electric shocks whenever she engaged in her compulsive handwashing.1
Eventually it was discovered that a more effective behavioral treatment method was to convince OCD patients to expose themselves to the situations that triggered their OCD and then work with them on not responding with compulsions. This technique came to be known as exposure and response prevention (ERP). A central figure in the development of ERP therapy, Stanley "Jack" Rachman, has spoken about the history of the technique. In a 2005 speech, reported in the Obsessive Compulsive Foundation Newsletter, he pointed out that ERP therapy can trace its roots to work done in the 1960s by Victor Meyer.
"What he did was very brave," said Dr. Rachman [in his speech on the history of ERP therapy]. Dr. Meyer applied to humans what studies had shown applied to frightened animals: if they were exposed to what scared them for a prolonged time and prevented from leaving the situation, they became less scared.
"Therapists were scared to do it with patients," Dr. Rachman said. But Dr. Meyer, a former World War II fighter pilot shot down in France and taken as a prisoner of war, was willing to take a risk. In 1966, he began ERP therapy with two hospitalized patients. One of them incapacitated by fears of disease and dirt spent most of the day cleaning. She had not been helped by shock treatment, drugs, or supportive therapy and was being considered for surgery, according to Dr. Rachman. Dr. Meyer, and later a nurse, exposed her to objects that triggered her anxiety and prevented her from carrying out her cleaning rituals. They turned off the water in her room and severely limited her access to cleaning agents.
"She was very frightened at times but she managed to cooperate with treatment," said Dr. Rachman. After four weeks of intensive therapy, she was less anxious and, after eight, even less so. Her compulsive cleaning dropped to tolerable levels.
Meyer's second patient was incapacitated by recurrent, disruptive blasphemous thoughts about sex. It took her up to six hours to get dressed each day. Shock therapy, drugs, eleven years of psychoanalysis and then psychosurgery all had failed her; and she was being considered for a second surgery.
Instead, she underwent this new behavior therapy. Her anxiety was heightened through exposure to triggering items and imaginal scenes while she was prevented from performing any anxiety-reducing behaviors. After nine weeks of difficult and distressing intensive therapy, her OCD symptoms dropped to manageable levels. Neither was cured; but both regained normal lives.
"The consequence of Victor Meyer's success was spectacular. He had broken the ice," said Dr. Rachman.
Over the decades, clinicians and researchers have continued to study and experiment with ways to improve ERP techniques and better understand how to help people with OCD....2
In a 2009 article, Dr. Rachman provided more detail about the origin of behavior therapy and, later, cognitive behavior therapy for OCD.
The new methods went through three stages of development: behavior therapy (BT) started to emerge in the mid 1950s, cognitive therapy in the 1960s, and the two approaches merged into CBT [cognitive behavior therapy] in the 1980s. . . .
[In the early days of behavior therapy, OCD] did not lend itself to behaviorist treatment, not least because BT was absolutely behavioral and cognitions were not on the agenda. Wolpe (1958) had limited success in treating OCD, and the application of his method of desensitization was lengthy and laborious. In 1966, Victor Meyer tried out an exploratory treatment in the management of two patients in the Middlesex Hospital (London) who were severely disturbed by OCD. They were treated during protracted inpatient care by a method that later acquired the label of "exposure and response prevention" (ERP). Meyer was an extraordinarily committed and conscientious clinician who had a good deal of experience treating agoraphobia, and he took the bold step of trying out a "total" treatment that consisted of exposing the patient to the most upsetting OCD items/situations and then preventing them from carrying out any of their anxiety-reducing compulsions, such as repetitive washing or checking. This required intensive, continuous care in order to ensure that the patients completely refrained from the compulsive acts (e.g., in order to prevent compulsive washing, the water supply was cut off when necessary). They were given sympathetic support and encouragement throughout. The ERP was partially successful, and Meyer's example was followed, albeit in a less-demanding, less-intensive form, in the treatment of outpatients (Rachman et al. 1979, Rachman & Hodgson 1980). Meyer was influenced by the success of so-called flooding treatments in extinguishing fears in animals and had the boldness to try it on patients where other clinicians hesitated. His results aroused attention, and the method was refined. . . . Further progress [in treating OCD came with] the adoption of cognitive concepts and methods.3
1Arnold Lazarus (1965).
2Laurie Krauth, Fear and courage during psychological treatment of OCD, Obsessive Compulsive Foundation Newsletter, Fall 2005, 19:1. (The Foundation later changed its name to the International OCD Foundation.) See also Victor Meyer, Modification of expectations in cases with obsessional rituals, Behaviour Research and Therapy, Nov. 1966, 4(4):273-80.
3S.J. Rachman, Psychological treatment of anxiety: the evolution of behavior therapy and cognitive behavior therapy, Annu. Rev. Clin. Psychol., 2009, 5:97-119.
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