1). Step 1. Information collecting. Collecting enough clinical information and establishing a good therapeutic alliance were two major goals in this step. The purpose of information collection was to clarify the main problems, including the clinical manifestations and/or any obstacles that the patients encountered during the treatment. Step 2. Identifying and coping with fear. The first goal in this step was to use discussion to help patients identify their fear and its role in the onset of OCD. In CCT, fear was considered an important factor in the onset of OCD. In essence, OCD Inhibitors,research,lifescience,medical patients usually feared that negative XAV-939 in vitro events (e.g., death) will happen to them or their

loved ones. It was the fear of imagined, dreaded negative events that invoked anxiety and resulted in the neutralizing or avoidance behaviors Inhibitors,research,lifescience,medical (compulsions). Discussing in detail the role of fear helps patients prepare to cope with fear. The second goal is to reduce the extent of fear, using appraisal-focused coping

strategies (e.g., rational or denial) to cope with the imagined negative events. Step 3. Coping with intrusive thoughts. First, it was necessary to Inhibitors,research,lifescience,medical identify the roles of intrusive thoughts in the causation of OCD. In CCT, intrusive thoughts symbolized the imaged, dreaded negative event the OCD patient feared. Second, using cognitive reconstruction, the therapist helped Inhibitors,research,lifescience,medical the patient recognize there was no association between intrusive thoughts and the negative events. Third, the therapist encouraged the patient to cope with intrusive thoughts by using appraisal-focused coping strategies, such as acceptance, ignorance, and/or sublimation. The goal was to teach patients to allow intrusive thoughts to exist in their minds, pay no attention to them, ignore

them, and experience meaningful daily activities by practicing proper coping strategies, instead of ERP of CBT. Step 4. Coping with compulsions. The goal in this step was to eliminate compulsions. When steps 2 and 3 were completed successfully, patients would understand it was unnecessary to neutralize Inhibitors,research,lifescience,medical the fear. Thus, it would be easier for patients to cope with and to avoid the compulsions. Patients with OCD were encouraged to practice using proper coping strategies in the therapy room. During this process, it was very important to avoid using ERP. In each therapy session, patients moved through all four steps. When the OCD symptoms were eliminated after several sessions, the patient TCL habitually urged to check if the intrusive thoughts were still in their mind, which generally resulted in the immediate emergence of intrusive thoughts. To prevent relapse, the therapist reminded the patient that the urge to check should be considered an intrusive thought to be coped with. Patients undergoing PCCT received 14 weekly 40- to 60-min sessions of CCT and then one or two phone calls monthly for nine months.