Science-Based Psychotherapy

Numerous studies have now shown that Exposure and Response (or Ritual) Prevention (ERP) remains  our most effective treatment for obsessive-compulsive disorder (OCD).  In ERP, clients deliberately confront feared stimuli while learning to refrain from engaging in compulsions.


Even with the effectiveness of ERP, the search continues for how to get even better results, as not everyone benefits from ERP and some clients are resistant to it. Recent research on Acceptance and Commitment Therapy (ACT) suggests that other approaches—such as learning to observe obsessions without engaging or “buying into” the content of the obsessions—can supplement ERP. One of the core ideas of ACT is helping clients to mindfully...

In a previous post, I linked to a blog post about therapist reluctance to use exposure therapy. Exposure therapy is one of the most effective interventions for anxiety-related problems but, sadly, remains under-utilized by clinicians.


A recent study out of Drexel University looks at the role of experiential avoidance in therapist reluctance to use exposure therapy to treat OCD. Experiential avoidance (EA) refers to a tendency to avoid uncomfortable thoughts, feelings, and bodily sensations...

Two recent randomized control trials seem to indicate that acceptance and commitment therapy (ACT) is a good option for people who have no benefitted from prior treatment. A lot of people don’t respond to their first round of treatment, so this is good news for a lot of people. This research adds to a growing list of studies showing that ACT is helpful across a large range of conditions and life difficulties. 


ACT outperforms CBT for people who had not previously responded to therapy

In a study published in July of 2014 the investigators compared group-based ACT to group-based CBT (treatment as usual) for 61 participants.  These participants came to the study with a range of diagnoses and all had participated in...

posted in ACT | RCT

Last week, University of Nevada - Reno professor Steve Hayes, PhD, came through Portland to conduct an intermediate Acceptance and Commitment Therapy (ACT) workshop. In anticipation of the visit, Dr. Hayes reached out to the Oregon chapter of the Association of Contextual Behavioral Science.


Through this outreach, Dr. Hayes agreed to be interviewed for the Oregon chapter. As president-elect of the Oregon chapter, I talked with Dr. Hayes about his thoughts on creating a strong and supportive community.


I think this interview will be of interest to anyone within the ACT community, and particularly those who, like Oregon, have created their own chapter or are thinking about creating a chapter. Dr. Hayes also...

posted in ACT

Eric Morris, PhD, a psychologist in Australia, wrote a really interesting blog post about therapist reluctance to use exposure.  As I’ve written about in previous posts, exposure therapy is one of the most effective interventions we have in treating anxiety-related disorders, such as OCD, phobias, and PTSD. Unfortunately, although exposure has been around for several decades, many therapists don’t use it.


As Dr. Morris writes:


Well, it isn’t just that many therapists use approaches that are not evidence-based. It seems that ...


Last Friday, Portland Psychotherapy research assistants Monica Bahan, Megan Cheslock, and Jackie Potter presented a research poster at the annual Western Psychological Association convention, which took place in Portland. Their poster detailed findings from one of our ongoing studies exploring the relationship between shame, guilt, and drinking behavior. The findings were based on the first 88 participants in the study, all volunteers from the Portland area.


Congratulations to Monica, Megan, and Jackie on their first presentation!

posted in shame

1. Insomnia can cause depression.

A collection of research suggests that untreated insomnia doubles the chance of developing depression, as a causal factor (4 sources – one, two, three, four)


2. Insomnia often does not resolve once the depression is treated or without focused insomnia treatment (...

posted in depression | insomnia

In a special issue of Behavior Therapy on “The Theory-Practice Gap in Cognitive Behavior Therapy,” Jonathan Abramowitz, PhD, authored an interesting paper on the importance of understanding theory when doing exposure therapy. Dr. Abramowitz is a well-respected OCD researcher, and I was attracted to this article as part of my ongoing interest in exposure therapy.


The article is lucid, well-written, and I think would be of value to anyone beginning to work with exposure therapy. He offers anecdotes about where therapists go wrong and makes a good argument for why understanding theory enhances exposure therapy. Dr. Abramowitz writes from a strictly cognitive behavior perspective, so this work does not cover...

posted in exposure | exposure therapy | OCD

A practice I’m seeing more often that concerns me is the addition of antipsychotic medications on top of antidepressants when the antidepressants aren’t working. If someone isn’t showing improvement on an antidepressant alone, a prescriber may add an antipsychotic medication—the idea being it will increase the effectiveness of the antidepressant. The research for this is a little questionable, especially as the side effects for antipsychotics can be pretty bad. I’ve felt strongly enough about this issue that I wrote an editorial about it that the Oregonian published in 2012.


Antipsychotics and obsessive-compulsive disorder

In previous post, I wrote about a study that found that giving an antipsychotic in people with...

Understanding factors that contribute to outcome are crucial as we continue to refine treatments and revise the theories that underlie them. In a study published in the Journal of Anxiety Disorders, Norton and colleagues (2011) examined the role of activation and habituation in exposure therapy. The rationale for study was based on the emotional processing theory, which I’ve written about previously.


By activation, the authors mean how distressed the person becomes during the exposure exercise. Habituation refers to the reduction in distress when someone is confronted with a fear inducing stimuli. I’ve...