Exposure and Response Prevention in the Treatment of Distressing and Repugnant Thoughts and Images

Repugnant thoughts are often described as intrusive and distressing thoughts that are not acceptable to one's own, and society's, morals and values. They can occur in a small number of sufferers with obsessive-compulsive disorder. The following case study describes a young woman who experienced a number of distressing and repugnant thoughts and images. Her presenting most distressing obsessive thought was about committing suicide when she had no desire or intent to do so; however, her most repugnant thoughts centered around thoughts of harming her children. Psychological treatment sessions initially focused on psychoeducation and relaxation to prepare the client for more intense therapy. Exposure and response prevention methods were then used in a graded exposure method to help the client confront her feared obsessions and to help the client to overcome her subsequent strong emotional responses. Following 11 psychological treatment sessions, the client demonstrated significant improvements, including decreased distress from her obsessions, as well as a general decline in stress and anxiety.