A Theoretical Integration of Schema Therapy and Cognitive Therapy in OCD Treatment: Conceptualization and Rationale (Part II)

Abstract

Cognitive Behavioral Therapy has been identified as the first choice treatment for Obsessive Compulsive Disorder (OCD). Although a significant proportion of patients benefit from Cognitive Behavioral Therapy, another still fails to respond to CBT. To improve outcomes, new targets of intervention have been broadened, but no clear and comprehensive conceptualizations of the disorder have been suggested. In the last few years, in the context of Schema Therapy (ST), several specific models have been proposed for the treatment of Axis I diagnostic categories (according to the classification of DSM IV), in addition to the more well-known conceptualizations related to Personality Disorders. Concerning OCD, several studies have investigated the effectiveness of ST in the treatment of OCD, but only few have tried to elaborate a conceptualization of the disorder in terms of modes. This lack of knowledge and shared conceptualization might lead to difficulties in planning and evaluating effective interventions. The aim of this work is to present a conceptualization of the Obsessive Compulsive Disorder that results from the integration between the Cognitive Therapy framework, as proposed by Mancini and collaborators, and the framing in terms of modes, in line with ST, starting from the research data available. In particular, the rationale of the intervention will be proposed, aimed at accepting the risk of committing mistakes or of coming into contact with disgusting substances. This general aim will then be articulated in sub-aims, which may direct it, in a more specific way, on the basis of the different modes that characterize the experience of obsessive patients.