Beyond Exposure: Innovations in the Treatment of Obsessive–Compulsive Disorder

Obsessive-compulsive disorder (OCD) is a profoundly heterogeneous condition, encompassing a wide spectrum of symptom presentations, from contamination fears to sexual obsessions, moral scrupulosity, and pathological doubt. While cognitive-behavioral therapy (CBT) incorporating exposure and response prevention (ERP) and challenging of dysfunctional obsessive beliefs remains the gold standard treatment, a growing body of literature has drawn attention to the limitations of traditional approaches. These include high drop-out rates, partial or nonresponse, and difficulty in addressing trauma-related or value-conflicted obsessional content through traditional fear-based exposure hierarchies. Continual refinement and innovation of psychotherapeutic approaches to OCD is therefore essential, not only for enhancing clinical efficacy, but also for increasing engagement, retention and meaning in therapy. This issue of Journal of Clinical Psychology: In Session brings together five in-depth clinical case studies, each exemplifying a distinct yet complementary advance in the treatment of OCD. Taken together, these cases provide a rich, practice-based insight into the diversity, complexity, and personalization of effective therapy, challenging us to expand our understanding of what constitutes successful treatment for OCD.