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Clomipramine, Self-exposure and Therapist-aided Exposure for Obsessive–Compulsive Rituals

Published online by Cambridge University Press:  02 January 2018

I. M. Marks ,
P. Lelliott ,
M. Basoglu ,
H. Noshirvani ,
W. Monteiro ,
D. Cohen  and
Y. Kasvikis
I. M. Marks*
Affiliation:
Institute of Psychiatry, Bethlem and Maudsley Hospitals
P. Lelliott
Affiliation:
Institute of Psychiatry, Bethlem and Maudsley Hospitals
M. Basoglu
Affiliation:
Institute of Psychiatry
H. Noshirvani
Affiliation:
Institute of Psychiatry, Bethlem and Maudsley Hospitals
W. Monteiro
Affiliation:
Institute of Psychiatry, Bethlem and Maudsley Hospitals
D. Cohen
Affiliation:
Lady Chichester Hospital, Hove
Y. Kasvikis
Affiliation:
Institute of Psychiatry
*
∗Institute of Psychiatry, De Crespigny Park, Denmark Hill, London SE5 8AF
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Abstract

A randomised treatment design for 49 chronically obsessive–compulsive ritualising patients was devised and three controlled comparisons were made. 1. During 7 weeks of self-exposure instructions, clomipramine treatment improved some measures of rituals and depression significantly more than did placebo medication; this effect was transient and disappeared as drug treatment and exposure were continued for a further 15 weeks. 2. During 11–16 weeks of clomipramine treatment, self-exposure instructions yielded highly significantly more patient improvement than did anti-exposure instructions on nearly all measures of rituals and some of social adjustment. 3. Adding therapist-aided exposure (1.3 hours) to self-exposure instructions (3 hours) after 8 weeks had a barely significant transient effect of dubious clinical value, which was lost by the end of exposure (at week 23) and during follow-up assessments to week 52. We conclude that of the three therapeutic factors tested, self-exposure was the most potent; clomipramine played a limited adjuvant role, and therapist-aided exposure a marginal one.

Type
Research Article
Information
The British Journal of Psychiatry , Volume 152 , Issue 4 , April 1988 , pp. 522 - 534
Copyright
Copyright © Royal College of Psychiatrists, 1988 

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