Alphabet Soup: ERP, CT, and ACT for OCD

The present article comments on the case conference presented in this issue, namely, Himle and Franklin's (Himle & Franklin, 2009) exposure and response prevention (ERP); Chosak and colleagues' (Chosak, Marques, Fama, Renaud, & Wilhelm, 2009) cognitive therapy (CT); and (Twohig, 2009) Acceptance and Commitment Therapy (ACT). Two questions are addressed: (1) How different are these treatments? (2) What are the active vs. inert ingredients of each treatment? With regard to the first question, it is concluded that ERP and ACT appear more similar than dissimilar in terms of actual therapist/patient behaviors. CT shows more substantial differences from ERP and ACT, primarily in the therapist's direct efforts to target antecedent cognitions. With regard to the second question, examination of the likely active ingredients of each treatment suggests that interventions that encourage direct behavioral change (described as a characteristic feature of ERP and ACT and an incidental feature of CT) are most likely responsible for improvement in all three treatments, whereas evidence for the importance of altering antecedent cognitions (a characteristic feature of CT and an incidental feature of ERP) is less clear. Additional controlled research is recommended to identify which aspects of treatment are truly efficacious for OCD and other conditions.