Effectiveness of exposure and ritual prevention for obsessive-compulsive disorder: Randomized compared with nonrandomized samples.

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Abstract
The efficacy of exposure and ritual prevention (EX/RP) for reducing symptoms of obsessive—compulsive disorder (OCD) has been demonstrated in several randomized controlled trials (RCTs). However, procedures used in these studies to maximize experimental control may have limited their generalizability to typical clinical practice. Treatment outcome data from 110 clinical patients receiving EX/RP on an outpatient fee-rbr-service basis were compared with findings from 4 RCTs of EX/RP. Adult patients in the clinical sample were not excluded because of treatment history, concomitant pharmacotherapy, psychiatric comorbidity, age, or OCD severity. Clinical patients achieved substantial and clinically meaningful reductions in their OCD and depressive symptoms following EX/RP, which were comparable with those reported in the RCTs. Findings indicate that EX/RP is a potent treatment for OCD, and its benefits are not limited to select patient samples. The lifetime prevalence of obsessive—compulsive disorder (OCD) in the United Stales is approximately 2.5% (Karno, Gold- ing, Sorenson, & Burnam, 1988), which is largely consistent with transcultural estimates (Angst, 1994). Individuals with OCD typ- ically report substantial social and work dysfunction; indeed, a recent study found that OCD outpatients were almost four times more likely to be unemployed than were people in the general population (Koran, Thienemann, & Davenport, 1996). OCD suf- ferers are also at increased risk for social phobia, panic disorder, and simple phobia (Rasmussen & Tsuang, 1986), as well as major depression (Karno et al., 1988). Clearly, OCD is a serious public health concern that warrants the attention of both mental health service providers and the clinical research community.

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