The Behavioural Treatment of Obsessional Neurosis

Abstract

It is generally agreed that obsessional neurosis has a poor prognosis. In one large series of 82 patients who were followed up for a period of 13–20 years, significant improvement in symptoms was observed in only 21 cases (Kringlen, 1965). Systematic desensitisation, which in the 1960s was giving such satisfactory results in specific phobic states, was on the whole ineffective in the treatment of both obsessional rituals and ruminations (see for example Furst and Cooper, 1970). This gloomy outlook has considerably improved since 1966, when Meyer developed a novel approach to the behaviour therapy of compulsive rituals. His method was influenced by reports in the animal experimental literature of response prevention (Lomont, 1965) and was partly derived from the patients’ own explanation for the urge to carry out ritual checking, cleaning or washing. Some patients say that they feel compelled to perform rituals in order to avert eventual disaster to themselves or their families Meyer (1966) predicted that the compulsive behaviour would stop if one could modify the patient’s own expectation of the disastrous effects of failing to wash or to check. ‘Cognitive restructuring’ would occur if the patient could be persuaded to remain in intimate contact with ‘contaminated’ or ‘dangerous’ objects or situations. Two patients with severe chronic handwashing rituals were encouraged to handle contaminating objects while excessive washing was prevented by continuous supervision from nurses.