https://doi.org/10.1177/1534650119838628 Clinical Case Studies 1–15 © The Author(s) 2019 Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/1534650119838628 journals.sagepub.com/home/ccs Article Treatment of Violent and Sexual Obsessions Using Exposure and Response Prevention During a Concurrent Depressive Episode Amanda M. Palmer 1,2 , Robert C. Schlauch 1 , and Jack Darkes 1 Abstract Obsessive-compulsive disorder (OCD) frequently co-occurs during a major depressive episode (i.e., Major depressive disorder, MDD). Concurrent depressive episodes may present additional challenges and barriers in OCD treatment; therefore, clinicians should address both symptom domains simultaneously. The present case study illustrates an example of an individual presenting with OCD symptoms falling under aggressive and sexual domains. The treatment utilized was exposure and response prevention (ERP), which is empirically supported to address OCD symptoms. Additional treatment elements, such as behavioral activation, building self- concept through mastery, and emotional processing were incorporated to specifically address depression symptoms, which enhanced the efficacy of ERP. The current case presentation provides evidence that the utilized combination of treatment modalities is feasible to implement and may effectively reduce OCD symptoms during a depressive episode. Keywords obsessive-compulsive disorder (OCD), depression/major depression, exposure and response prevention (ERP), integrated treatment 1 Theoretical and Research Basis for Treatment Obsessive-compulsive disorder (OCD) affects roughly 1.2% of adults in their lifetime (American Psychiatric Association, 2013). This disorder is characterized by intrusive, distressing thoughts and images (obsessions) which may fall under various themes, such as aggression, sexual, con- tamination, and religion/superstition (McKay et al., 2004). In addition, individuals engage in repetitive rituals related to these themes (compulsions) which are believed to relieve the anxiety and distress associated with the obsessions. As such, this disorder can result in a great deal of functional impairment in those experiencing symptoms. OCD has high comorbidity than other disorders, thus prompting a need for treatments to address both sets of symptomology (e.g., 1 University of South Florida, Tampa, USA 2 Moffitt Cancer Center, Tampa, FL, USA Corresponding Author: Jack Darkes, Psychology Department, University of South Florida, 4202 East Fowler Ave., PCD 4118G, Tampa, FL 33620, USA. Email: darkes@usf.edu 838628CCS XX X 10.1177/1534650119838628Clinical Case StudiesPalmer et al. research-article 2019