In 1977, psychologist Ron Ramsay described the origin of behavior therapy for OCD.
From about 1960 onwards behaviour therapy gained momentum in the treatment of various neurotic complaints [but] [i]n the early years of behaviour therapy the burgeoning literature contained little reference to the treatment of obsessive-compulsives. A comprehensive reference list (Peck, Bradshaw and Ashcroft) covering the 10 years 1960 to 1969 contains more than 1300 studies, of which only 10 refer to obsessive-compulsives. This almost negation of an important neurotic problem probably does not mean that behaviour therapists were not interested, but more likely that they were not getting good results. Failures are either not written up or articles containing no positive results are excluded from publication.
Since 1970 there has been an upsurge in the number of behaviour therapy articles devoted to the theory and treatment of obsessive-compulsive neurosis. In the English Journal Behaviour Research and Therapy there appear 6 articles in the years 1971-73.... At the first European Association for Behaviour Therapy in Munich, 1971, two papers were devoted to obsessive-compulsives, and now the topic has a regular place in the annual congresses, with panel discussions, free papers, and workshops. At the first International Symposium on Behaviour Modification in Minneapolis, Minnesota, in 1972 and at the sixth A.A.B.T. congress in New York in 1972, the topic of behaviour therapy for obsessive-compulsives was not even mentioned. It is possibly appropriate here to give credit to the small group of English therapists for pioneering the treatment methods which show such promise, and for stimulating others to take up the challenge in this field to that [sic] Western Europe seems to be leading the way for the rest of the world. (See Rachman, Hodgson and Marzillier, 1970; Rachman, Hodgson and Marks, 1971; Hodgson and Rachman, 1972; Rachman, Marks and Hodgson, 1973; Roper, Rachman and Hodgson, 1973; Roper, Rachman and Marks, 1975; Roper and Rachman, 1976).1
Many other researchers, including Edna Foa in the United States, also had a role in developing behavior therapy for OCD.
Psychologist Stanley "Jack" Rachman has pointed out that behavior therapy for OCD has roots in the work of Victor Meyer. His explanation of Meyer's role can be found in an article in the Obsessive Compulsive Foundation Newsletter.
"People whose problem is intense fear behave courageously on a day-to-day basis," Jack Rachman, Ph.D., professor emeritus at the University of British Columbia, said in the Keynote Address to the 12th Annual OCF Conference in San Diego on July 30, 2005.
...Ironically, it took the courage of British psychologist Victor Meyer almost 40 years ago to bring this courage-based therapy to OCD treatment.
"What he did was very brave," said Dr. Rachman. 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 [exposure-and-response-prevention 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, Rachman provided more detail about the origin of behavior therapy and cognitive behavior therapy for OCD and other anxiety disorders.
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
1Ron Ramsay, "Behavioural Approaches to Obsessive-Compulsive Neurosis," in J.C. Boulougouris & A.D. Rabavilas, The Treatment of Phobic and Obsessive Compulsive Disorders: Selected Papers from the Sixth Annual Meeting of the European Association of Behaviour Therapy (Oxford: Pergamon Press, 1977), pp. 102-3.
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.)
3S.J. Rachman, Psychological Treatment of Anxiety: The Evolution of Behavior Therapy and Cognitive Behavior Therapy, Annu. Rev. Clin. Psychol., 2009, 5:97-119.