Cognitive-based therapy for OCD: Role of behavior experiments and exposure processes

• We describe the pragmatics for conducting behavioral experiments in Cognitive Therapy (CT) for OCD.
• Behavioral experiments serve to modify maladaptive interpretations and produce symptom reduction.
• We outline how to prepare for, and operationalize, the behavioral experiment.
• We describe patient and therapist-related behaviors that will facilitate the experiment’s success.
• We discuss how to integrate other CT strategies to process the findings of the behavioral experiment.

The current manuscript describes the rationale and pragmatics for conducting exposures (termed “behavioral experiments”) in Cognitive Therapy (CT) for OCD. Given that the cognitive model of OCD focuses upon the assumptions and belief systems (e.g., threat perception) that underlie the misinterpretation of unwanted intrusions, CT employs cognitive strategies, such as behavioral experiments, to modify maladaptive interpretations and produce symptom reduction. We outline how to prepare for behavioral experiments through psychoeducation and empirically supported assessment procedures. Next, we describe how to operationalize the behavioral experiment and propose patient and therapist-related behaviors that will facilitate (or interfere with) the experiment׳s success. Lastly, we discuss how to process the findings of the behavioral experiment by integrating other CT strategies, such as calculation of harm and the downward arrow, to consolidate learning and ultimately strengthen and generalize skills use.