Home-based cognitive-behavioral treatment of chronic, refractory obsessive-compulsive disorder can be effective. Single case analysis of four patients.
Home-based CBT cracked severe, treatment-proof OCD in three of four adults.
01Research in Context
What this study did
Four adults with severe OCD tried home-based CBT. All had failed many past treatments.
Therapists came to their houses. They did exposure and response prevention in real-life spots like kitchens and bathrooms.
What they found
Three of the four people got much better. Two stayed well a year and a half later.
The fourth person dropped out early. The paper shows home work can beat tough OCD.
How this fits with other research
Veeger et al. (2025) extends this idea to kids. They give parents SPACE training at home when child CBT fails.
Saini et al. (2018) warns that clinic-only work can crash at home. Johan’s team skipped that risk by starting at home.
Winett et al. (1991) and Sanberg et al. (2018) both show the same lesson: teach the skill where it will live. Home delivery beats clinic-only every time.
Why it matters
If your adult client has tried everything, pack your exposure kit and go to their house. Hit the real triggers—stove, lock, faucet—and you may finally see change. Use the same logic for kids: train parents on SPACE or bedtime plans right in the home. Skip the extra step of clinic generalization.
Want CEUs on This Topic?
The ABA Clubhouse has 60+ free CEUs — live every Wednesday. Ethics, supervision & clinical topics.
Join Free →Schedule one home visit and run the first exposure in the client’s actual trigger spot.
02At a glance
03Original abstract
Four patients with obsessive-compulsive disorder (OCD) were referred for home-based cognitive-behavioral therapy. All patients had failed extensive trials of behavioral and cognitive therapy and pharmacotherapy in a variety of settings (e.g., outpatient, inpatient, and day program) and were generally considered chronic and refractory to treatment. Generalization from treatment sites to natural settings in which they lived did not occur. They were evaluated at baseline, after treatment, and at an 18-month follow-up using the Yale-Brown Obsessive Compulsive Scale. Conducting end-state functioning and reliable change assessment according to the methods specified by Jacobson and Truax, the authors found that 3 patients achieved clinically significant gains after treatment and 2 patients maintained those gains at the 18-month follow-up. Data suggested better overall adjustment for 3 of the patients at follow-up. This study demonstrates the effectiveness of home-based cognitive-behavioral therapy for chronic, refractory OCD; implications for further, controlled trials are discussed.
Behavior modification, 2002 · doi:10.1177/0145445502026002005