Methods for Managing Intrusive Thoughts

A Translational Study of the Mechanisms of Exposure Therapy for Obsessions: Gradual vs. Variable Exposure Intensity

The current study sought to translate laboratory research on learning and memory to better understand the mechanisms and methods for implementing exposure therapy for unwanted obsessional thoughts. Specifically, we compared the processes and the short- and long-term outcomes of: (a) gradual exposure (EXP-G), emphasizing hierarchical exposure completion, versus (b) variable exposure (EXP-V), emphasizing variability in exposure intensity.

Although preliminary research suggests that learning to tolerate varying levels of fear during exposure enhances outcomes for some anxiety-related problems, no previous study has examined this possibility in the context of unwanted obsessions. Adults with a moderately distressing obsessional thought were randomly assigned to four twice-weekly sessions of either: (a) gradual exposure (EXP-G), emphasizing hierarchical exposure completion, or (b) variable exposure (EXP-V), emphasizing variability in exposure intensity.

Inclusion Criteria:

• At least 18 years old
• Willing to attend and audiotape all study sessions
• Fluent in English
• Presence of one or more obsessional thoughts that cause marked distress
• If on a psychiatric medication (e.g., SSRI), willing to remain at a fixed dose while participating in the study (and stabilized on medication for 30 days before beginning the intervention).

Exclusion Criteria:

• Previous cognitive behavioral therapy (CBT) for anxiety
• Current suicidal ideation
• Current substance use disorder
• Current mania or psychosis
• Currently taking an anxiolytic (e.g., Ativan) or stimulant (e.g., Ritalin) medication
• Heart, respiratory, or neurological condition
• Current pregnancy