Should treatment distinguish anxiogenic from anxiolytic obsessive-compulsive ruminations? Results of a pilot controlled study and of a clinical audit.

In a small pilot controlled study over 8 weeks, 12 obsessive-compulsive ruminators listened for 2 h daily to their own audiotaped voice either (1) describing their anxiogenic thoughts (exposure) but omitting anxiolytic thoughts (mental/cognitive rituals), or (2) reading neutral prose or poetry. Taking all patients, both groups improved similarly. However, exposure patients who became anxious early in exposure slightly more improved. Consistent with this, in a clinical audit of 57 ruminators treated by trainee clinicians over 12 years, outcome improved significantly once practice changed so that exposure only involved anxiogenic thoughts, not anxiolytic thoughts, the latter being stopped.