Adapting and Integrating Exposure Therapies for Obsessive-Compulsive Disorder and Posttraumatic Stress Disorder: Translating Research Into Clinical Implementation

Despite a growing literature on co-occurring obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD), and the interesting etiological, phenotypic, and functional intersections of OCD and PTSD, formal treatment recommendations are lacking. Currently, no robust, controlled treatment outcomes research exists to inform clinician delivery of treatment for OCD and PTSD; however, extant research and theory may help guide assessment, case conceptualization, and treatment for these co-occurring conditions. This article translates extant research and theory into clinically useful, concrete, and accessible suggestions for case conceptualization and treatment adaptation and offers several case examples to further illustrate use of these approaches. In particular, this article reviews research and theory regarding differential diagnosis, connections between OCD and trauma, outcomes for OCD and PTSD exposure therapies, the purported theoretical underpinnings of these exposure-based treatments, reassurance seeking and intolerance of uncertainty, working with disgust during exposures, and treating stressful life events that may impact symptoms but do not meet the definition for trauma.Public Health Significance StatementExtant literature on differential diagnosis, OCD and trauma conceptualization, exposure therapy, intolerance of uncertainty and reassurance seeking, disgust, and stressful life events is reviewed, and findings are interpreted and synthesized into concrete, accessible treatment recommendations. Despite an absence of robust treatment outcomes research, existing literature can provide guidance for treating co-occurring OCD and PTSD with exposure therapy.