Many studies have demonstrated the efficacy of exposure therapy in the treatment of chronic post-traumatic stress disorder (PTSD). Despite the convincing outcome literature, a concern that this treatment may exacerbate symptoms and lead to premature dropout has been voiced on the basis of a few reports. In this paper, we examined the hypothesis that treatments that include exposure will be associated with a higher dropout rate than treatments that do not include exposure. A literature search identified 25 controlled studies of cognitive-behavioral treatment for PTSD that included data on dropout. The results indicated no difference in dropout rates among exposure therapy, cognitive therapy, stress inoculation training, and EMDR. These findings are consistent with previous research about the tolerability of exposure therapy.

although several cognitive theories have proposed specific types of appraisals hypothesized to increase fear and avoidance of contaminants, little research has tested these ideas. The current study utilized a prospective design to assess appraisals and dispositional traits in a normal sample several days prior to a behavioral approach task (BaT) involving commonly-encountered contamination stimuli. Danger appraisals significantly predicted behavioral avoidance and self-reported disgust, but not anxiety, during the BaT, even after accounting for neuroticism, disgust sensitivity, and subclinical obsessive-compulsive symptoms. The prospective design of the study establishes temporal precedence of danger appraisals, assessed during a period of low emotion, predicting subsequent emotional and behavioral response. results also point to the importance of disgust sensitivity and the experience of disgust in response to everyday contaminants. These findings are discussed in light of public health outbreaks including Severe acute respiratory Syndrome (SarS) and the h1N1 flu, which have caused novel contamination threats worldwide in recent years.

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This chapter describes methods and tools for assessing obsessive compulsive disorder (OCD). The chapter outlines the purposes of assessment and discusses special challenges presented by OCD, such as shame associated with socially unacceptable obsessional content. Several types of assessment tools are discussed, including structured diagnostic interviews, semistructured clinician interviews to assess OCD symptom profile and severity, self-report instruments, behavioral assessment and self-monitoring, assessment of appraisals and beliefs relevant to OCD, and functional impairment. The importance of linking assessment findings to an evidence-based treatment plan is discussed.