In vivo versus imaginal: Comparing therapists’ willingness to engage in both forms of exposure therapy for repugnant obsessions

• Published in: Current psychology (New Brunswick, N.J.) Vol. 42; no. 10; pp. 7837 - 7840
• Main Authors: Gagné, Jean-Philippe, Puccinelli, Christina, Gavric, Dubravka, Milosevic, Irena, McCabe, Randi, Soreni, Noam, Alcolado, Gillian, Wong, Shiu F., Rowa, Karen
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-04-2023; Springer; Springer Nature B.V
• Subjects: Behavioral Science and Psychology; Care and treatment; Cognitive therapy; Comparative analysis; Exposure therapy; Methods; Neuroses; Obsessive compulsive disorder; Pedophilia; Practice; Psychology; Psychotherapists; Religion; Sexual orientation; Social Sciences; Success; Therapists; Canada; Cognitive-behaviour therapy; Obsessive-compulsive disorder; Repugnant obsessions; Exposure and response prevention; In vivo exposure; Imaginal exposure
• ISSN: 1046-1310; 1936-4733
• DOI: 10.1007/s12144-021-02161-0

Repugnant obsessions are a common theme of intrusions in obsessive-compulsive disorder and are typically ego-dystonic. Exposure and response prevention (ERP) is the first-line intervention and involves in vivo and/or imaginal exposures. Many therapists are however reluctant to conduct ERP and the reasons remain unclear. Similarly, little is known about therapist preference for in vivo versus imaginal exposure for repugnant obsessions. To address these gaps, 200 therapists read vignettes of an in vivo and imaginal exposure for each repugnant obsession subtype and indicated whether they would have clients complete it. If not, they selected their primary refusal reason. Therapists were more likely to refuse in vivo (versus imaginal) exposures related to intentional/accidental harm, religion, and sexual orientation. There were no differences in willingness for pedophilic obsessions, with both forms receiving more refusals than approvals. “Dangerous/harmful to client/others” and “not necessary for therapeutic success” were most frequently selected as refusal reasons.