Process and outcome of exposure treatment with obsessive-compulsives: Psychophysiological indicators of emotional processing

Three indicators of emotional processing — peak response, habituation within sessions, and habituation across sessions — were examined in relation to therapy outcome with 14 obsessive-compulsives who were treated by 15 sessions of exposure in imagination and in vivo. Treatment outcome was evaluated by therapist, independent assessor, and self-ratings of target symptoms. Processes during therapy were assessed via self-report of anxiety as well as cardiac and electrodermal responses recorded during treatment sessions 6 and 14. Overall, the treatment was successful. As hypothesized, fear activation during exposure and habituation within sessions were evident in both self-report and physiological measures; habituation across sessions was observed in group means only for self-report. Also as hypothesized, both fear activation during exposure and greater habituation across sessions predicted better posttreatment ratings of obsessional fear. Habituation within sessions did not predict individual differences in outcome. These results support the theoretical formulation developed by Foa and Kozak (1986) to explain the effects of exposure therapy.

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