5 - (OP27) A Case Study of Counseling for an OCD Client Using Verbal Value Discounting Within the eRP Approach

Background:
Exposure and Response Prevention (ERP) is recommended as a standard cognitive behavioral treatment for obsessive–compulsive disorder (OCD). However, many clients show resistance to exposure tasks, making motivation difficult, and there is also a shortage of therapists sufficiently trained in ERP. In contrast to ERP, which requires high-intensity exposure, eRP (Okajima, 2025), termed “emphasized Rumination Prevention,” includes low-intensity exposure with Verbal Value Discounting (VVD). VVD is a simple verbal cognitive defusion technique that helps clients reduce the meaning and threat value associated with obsessive thoughts.

Objective:
To describe the application of VVD in an OCD case and explore its clinical utility.

Methods:
Between year X and X+1, 15 sessions were conducted with a woman in her 40s with contamination-related OCD. Symptoms began 21 years before year X, worsened 5 years prior, and SSRI treatment started 2 years prior. Counseling began in X−1. Although she made small attempts to reduce compulsions, progress remained limited by the ninth session one year later, and she wished to reduce session frequency. At that point, eRP including VVD was introduced.
After VVD introduction, 6 sessions were conducted over 10 months. Measures included Y-BOCS, GAD-7, and PHQ-9 assessed at (1) the initial session, (2) start of VVD, and (3) 9 months later. VVD exercises involved responding to obsessive thoughts with phrases such as “Sure, sure” or “Well” to reduce their meaning. Simplified exposure tasks included intentionally leaving small portions of activities unfinished to induce mild discomfort.

Results
Y-BOCS total scores were (1) 28, (2) 32, and (3) 20. GAD-7 improved from 18 to 1, and PHQ-9 from 19 to 7. Although fear remained and she was unable to fully engage in eRP tasks, improvement was observed. Four months after starting VVD, the client reported that feared cues outside the home felt “unpleasant rather than frightening.” By the fifth session after VVD introduction, she was able to engage in cleaning tasks previously avoided.

Discussion:
Following VVD introduction, she engaged actively and her functioning expanded. She appeared to understand VVD readily and applied it effectively; however, because fear remained, she was unable to fully engage in eRP tasks. Even so, because VVD and eRP require no specialized training and have minimal adverse effects, therapists can adopt them safely and smoothly, even when intensive ERP is difficult.

Conclusion:
VVD may be useful for reducing fear associated with obsessive thoughts, even when clients are unable to fully engage in eRP tasks due to residual fear. Its simplicity and low burden suggest that it can serve as a practical first step or alternative when implementing standard ERP is difficult.