Cognitive-Behavioral Therapy for Obsessive-Compulsive Disorder: 2021 Update.

In this update of a previous review, the authors discuss cognitive-behavioral therapy (CBT) with exposure and response prevention for obsessive-compulsive disorder (OCD). This efficacious modality avoids side effects common to psychotropic medication and reduces risk of relapse once treatment has ended. Psychotherapy involves identification and ranking of stimuli that provoke obsessions, exposure to these stimuli while preventing compulsions, and cognitive restructuring. The family of the OCD patient plays a significant role in treatment. This article includes expanded research on family-focused CBT and treatment of pediatric OCD. The family's accommodation and emotional response to a patient's symptoms may interfere with therapy and perpetuate the disorder. The treatment of pediatric OCD involves the same considerations. However, the form of obsessions and compulsions may differ and therapeutic techniques are modified to make them age appropriate.

Three-year-olds' difficulty with the appearance--reality distinction: is it real or is it apparent?

Four experiments investigated 3-year-olds' understanding of the appearance-reality distinction using both J. Flavell, F. Green, and J. Flavell's (1986) typical verbal response paradigm and a new, nonverbal response paradigm. Both paradigms require verbal questioning, but the former involves a verbal response and the latter a nonverbal one. In the nonverbal paradigm, children were shown a deceptive object and asked to respond, nonverbally, to 2 different functional requests, 1 concerning the object's apparent property and 1 its real property. In the verbal paradigm, children were asked to state what the object looked like and what it really was. In the verbal paradigm, children were about 30% correct (a rate matching that in the literature), whereas over 90% of the same children were correct in the nonverbal paradigm. Participating in the verbal paradigm first had a detrimental effect on the children's performance in the nonverbal paradigm, but the reverse order had no effect. These results suggest that 3-year-olds can represent two conflicting properties of a deceptive object and thus understand the appearance-reality distinction in the nonverbal domain.