Using Cognitive-Behavioral Therapy to Treat Obsessive-Compulsive Disorder With Co-Occurring Depression

Many individuals with obsessive-compulsive disorder (OCD) also experience co-occurring depression, which may complicate OCD treatment. Some data suggest that OCD patients with comorbid depression experience less improvement with cognitive-behavioral therapy (CBT), the recommended psychotherapy for OCD. In particular, depression may interfere with an individual's adherence to the tasks of CBT, particularly exposure and response prevention (ERP). However, successful interventions exist for depression within CBT, including both cognitive therapy and behavioral activation, which can be added in treating OCD patients with depression. This article reviews the literature on the impact of comorbid depression on OCD treatment and then describes the treatment of an adult with both conditions. This case history demonstrates how depression-specific interventions can be incorporated into standard ERP to maximize OCD treatment gains. We also review important practice points for treating clinicians and areas for future research.