Idiographic considerations in the behavioral treatment of obsessional thoughts

Despite impressive improvement in the behavioral treatment of obsessive-compulsive disorder over the last 15 years, progress has been slower for obsessional thoughts with few or no overt rituals. Encouraging case reports suggest that exposure to obsessional thoughts combined with covert response prevention is an effective treatment. Three cases are presented that required adaptation from the guidelines laid out by Salkovskis and Westbrook (1989). They provide clear evidence of the need to adopt a creative and flexible approach to exposure that enables access and activation of fear structures.