A Theoretical Integration of Schema Therapy and Cognitive Therapy in OCD Treatment: Experiential Techniques and Cognitive-Based Interventions in Action (Part III)

Barbara Basile,Francesco Mancini,Katia Tenore,Olga Ines Luppino

doi:10.4236/psych.2018.99131

Abstract

This final article is part of the trilogy presenting a possible integration of Schema Therapy (ST) and Cognitive Therapy (CT) in Obsessive-compulsive disorder (OCD) treatment. It aims at describing how experiential and cognitive based acceptance techniques might be applied to treat this psychopathological condition. In the first article published in this special issue (Luppino et al., 2018) we reported the main data supporting the role of proximal psychological determinants in the genesis and maintenance of the obsessive symptomatology, highlighting the role of deontological guilt and disgust, and of the Not Just Right Experience. According to these, we described the internal profile of the disorder as conceptualized by Mancini’s (2018) cognitive model. In the second manuscript (Tenore et al., 2018) we proposed a conceptualization of OCD, in terms of schemas and modes (as proposed by ST), integrating it with the previously described cognitive model. In agreement with these two articles, the aim of this work is to explain how experiential and cognitive techniques can be integrated to explain obsessive functioning and to achieve a successful treatment. We first describe emotion focused-experiential procedures derived from the ST framework, specifically focusing on imagery techniques, such as diagnostic imagery, rescripting and Healthy Adult imagery. Secondly we explain how chairwork can be applied to change obsessive dysfunctional schema modes. Finally, we focus on cognitive based acceptance intervention aimed at reducing the typical feelings of deontological guilt and disgust, two core emotions in OCD. In the conclusion we briefly resume the major aspects proposed in the three articles, and we present some potential further applications of a joined approach applied to other psychopathological conditions.

Highlights

In this last paper of the trilogy published in this number of Psychology we propose an integrated model where cognitive (CT) and schema therapy (ST) elements and techniques are combined in order to facilitate a deeper understanding of Obsessive-compulsive disorder (OCD) functioning and treatment intervention
We suggest that a combination of the two might be helpful for several reasons, not least to help the patient obtain a deeper comprehension of the basis and the maintenance factors of his disorder
We focused on the main goals and beliefs of the obsessive patient, highlighting the role of deontological guilt and disgust in explaining the dynamics of the recursive processes involved in the maintenance of the disorder

Summary

Introduction

In this last paper of the trilogy published in this number of Psychology we propose an integrated model where cognitive (CT) and schema therapy (ST) elements and techniques are combined in order to facilitate a deeper understanding of OCD functioning and treatment intervention. Emotion-focused experiential techniques might be useful to explore and to manage early-life factors that might have sensitized patients towards actual obsessive pathology, while cognitive techniques might be applied to understand and treat actual OCD symptoms. In this view, the ST framework might be useful in the sense of giving a richer representation of the OCD mental state, in terms of early maladaptive schemas (Young et al, 2003), and of the early negative experiences that might have contributed to the development of such schemas, setting the basis for future symptomatic development. The cognitive model is useful (Luppino et al, 2018) to understand beliefs, goals, maintenance factors, and the general mind set, of obsessive patients

Objectives

Discussion

Conclusion