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Exposure and response prevention (ERP) is considered the gold standard treatment for obsessivecompulsive 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.

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