This chapter investigates the cognitive changes in patients with obsessive compulsive rituals treated with exposure in vivo and response prevention. Obsessive compulsive disorder (OCD) is related to perfectionism, but it does seem more likely that perfectionism is a dispositional trait for the development of psycho-pathology in general, rather than for OCD in particular. Further, indecisiveness, magical thinking, aversion to risk-taking, and guilt have also been found to be related to OCD. Although some have proposed that cognitive therapy may be inappropriate for treating obsessive compulsives, because these patients already over-emphasize their thoughts, there is evidence that cognitive therapy may be effective in treating OCD. On the obsessive compulsive targets (Maudsley obsessional compulsive inventory and anxiety/discomfort scale), the results of cognitive therapy were about equally effective as self-controlled exposure in vivo. Both treatments led to a reduction of social anxiety. On depressed mood, cognitive therapy led to significant improvement, whereas self-controlled exposure did not.
