Behavioral, cognitive, and family therapy for obsessive-compulsive and related disorders.

Behavioral therapy and cognitive therapy, individually and combined, are a solid base in any therapy, the goal of which is to decrease the maladaptive behaviors associated with obsessive-compulsive spectrum disorders. Future research into this area involves two branches: (1) better resolution in what components of current treatments are effective and (2) a better understanding of the cause of OCD. The therapies of choice are behavioral therapy and cognitive therapy, but often what is described as behavioral therapy and cognitive therapy varies. Further refinement of the specific components of behavioral therapy and cognitive therapy that directly apply to OCD is needed. The specific components likely include the use of ERP and rational emotive behavioral therapy but often even these therapies can be parceled into smaller discrete parts. Many facets still have not been explored thoroughly (e.g., the extent of exposure to adverse situations needed, ideal length of therapy, time needed for exposure, and the use of virtual reality versus traditional exposures). A better understanding of the biological basis for OCD also would further the field. A better understanding of the basis of this disorder also would help clinicians to treat it with medication and behavioral therapy. Research into how behavioral therapy and cognitive therapy makes neurophysiologic changes would show the effectiveness of the treatment and a biological basis. Such studies could include the use of MR imaging during different stages in behavioral therapy and the use of functional during therapy to observe changes in the brain. Although OCD still is not fully understood, researchers are now beginning to understand how to treat it, and a solid base of empiric data now exists. The authors hope that investigators will continue research toward a better understanding of this disorder so that clinicians can better help their patients.