Considerations for Modifying Exposure and Response Prevention: The Cases of Mr. H and Angela


  • David Austern
  • Tanya Farber
  • James Marinchak



exposure therapy, exposure and response prevention (ERP), obsessive-compulsive disorder (OCD), anxiety, distress tolerance (DT), comorbidity, case studies, clinical case studies


Exposure and response prevention (ERP) is considered the gold standard treatment for obsessive-compulsive disorder (OCD). However, when comorbidity or other clinically relevant issues arise, the standard ERP protocol may require modification. Golden and Holaway's (2013) case of "Mr. H" and Pontes and Pereira's (2013) case of "Angela" offer excellent examples of clients presenting with these clinical challenges.  Our commentary addresses some of the concerns raised by these authors by bringing in the emerging field of Distress Tolerance (DT) research.  Using examples from the authors’ cases, along with relevant research, we suggest that clinicians who wish to modify ERP consider the proposed alterations carefully by simultaneously thinking more broadly and more specifically about the psychopathology present. In addition, we stress the necessity of various forms of continual outcome monitoring.

Author Biographies

David Austern

Dan Fishman, Ph.D. Editor-in-Chief, Pragmatic Case Studies in Psychotherapy Professor of Clinical and Organizational Psychology Graduate School of Applied and Professional Psychology Rutgers University Mailing address: 57 Jaffray Court Irvington, NY 10533 914-693-8549 fax: 603-917-2567 email:

Tanya Farber

Tanya Farber

James Marinchak

James Marinchak




How to Cite

Austern, D., Farber, T., & Marinchak, J. (2013). Considerations for Modifying Exposure and Response Prevention: The Cases of Mr. H and Angela. Pragmatic Case Studies in Psychotherapy, 9(1), 98–106.



Cognitive-Behavior Therapy with Obsessive-Compulsive Disorder in Complex Contexts