The theory was that the presentation of the fear stimuli together with relaxation will dissipate the fear. Compulsions are not addressed directly because, according to the theory, once the anxiety dissipates, the patient will not need to perform the rituals. Systematic desensitization had only limited success with OCD and its use with this disorder has been extensive. Aversion therapy, another behavioral therapy that was used in OCD, consists of punishment for an undesirable response. The idea behind this therapy is that an Inhibitors,research,lifescience,medical activity that is repeatedly paired with an unpleasant experience will be extinguished. Aversive experiences that have been

used to change behaviors include drugs that induce Inhibitors,research,lifescience,medical nausea (eg, disulfiram for alcohol dependence, electrical shocks for paraphilias or addictions), or any other stimuli aversive to the patient. The most common application of aversive therapy in OCD has been the “rubber-band snapping technique,” whereby the patient wears a rubber band on the wrist and is instructed to snap it every time he or she has an obsessive thought, resulting in a sharp pain; Inhibitors,research,lifescience,medical thus the pain and obsession become connected.15 This method was not very effective.16 A variant of aversive therapy is thought-stopping, in which the therapist or patient shout “Stop” immediately after an obsessional thought had

been elicited, but this was also not effective in reducing OCD symptoms.17 The breakthrough: exposure and see more ritual prevention As noted above, systematic desensitization, as well as operant-conditioning procedures aimed at blocking or punishing obsessions and compulsions,

Inhibitors,research,lifescience,medical were used in OCD with limited or no success. The first real breakthrough came in 1966, when Meyer described two patients successfully treated with a behavioral therapy program that included prolonged exposure to distressing Inhibitors,research,lifescience,medical objects and situations, combined with strict prevention of rituals – exposure and ritual prevention (EX/RP).18 Meyer and his colleagues continued to implement EX/RP with additional OCD patients, and found that the treatment program was highly successful in 10 of 15 cases, and partially effective in the remaining patients. Moreover, 5 years later, only two of the Ketanserin patients in the case series had relapsed.19 All patients were hospitalized during their EX/RP treatment. Description of EX/RP components As noted above, treatment programs vary with respect to the components that they include. For example, Meyer and colleagues included exposure in vivo and ritual prevention only. Foa and colleagues include imaginal exposure, in vivo exposure, ritual prevention, and processing. Below are descriptions of each component. Exposure in vivo (ie, exposure in real life), involves helping the patient confront cues that trigger obsessive thoughts.