The obsessive compulsive disorder (DOC) is characterized by intrusive and recurrent thoughts, images or impulses (obsessions). These trigger unpleasant emotions (such as anxiety, disgust, fault) and lead the person to implement repetitive material or mental actions in order to calm down. The latter are precisely defined compulsions.
The doc affects 2 to 3% of the population without difference between gender, ethnicity and culture (Rasmussen & Eisen, 1992). It is strongly associated with other disorders such as depression or anxiety disorders. Over 66% of patients also show personality disorders in comorbidity.
Cognitive behavioral therapy, thanks also to the response exposure and prevention procedures (ERP) is the psychotherapy of election for this disorder.
It emerged that the percentage of patients who are beneficial varies between 40 and 80% (Foa et al., 2002; Abramowitz, 2006). But it has also been observed that about 50% do not respond satisfactorily to the treatment.
Analyzing in a more specific way, therapeutic outcomes, according to some authors, the factors related to therapeutic failure make one think of problems of a personological nature and suggest the use of tools that highlight these aspects in a more specific way.
Therapy scheme
The Therapy scheme is a therapy developed by Young in the early 90s. It consists of an articulated therapeutic approach, which integrates and expands cognitive behavioral theory, taking inspiration from different theoretical models such as:
- attachment theory and object relationships;
- constructivism;
- Gestalt;
- Psychodynamic therapy, in particular the transactional analysis.
The basic concept on which the Therapy scheme is based is the fact that all children have primary emotional needs, the frustration of which leads to the structuring of maladative patterns. That is, neuronal circuits present in our amygdala consisting of memories, emotions, behaviors and bodily aspects, which the individual uses to understand himself and the relationship with others.
These schemes express themselves through fashions, that is, parts of the personality of the subject, which are the expression of state of the activation of one or more patterns simultaneously.
The needs that can be frustrated are: safe attachment (connection, security, trust), autonomy, sense of competence and identity, freedom in the expression of emotions and desires, game and realistic limits.
The purpose of the Therapy scheme is to help the subject find functional strategies to meet needs. To hypersemplify, the key question is: “What would a good parent do for his beloved son?”.
Therapy scheme treatment for DOC
The Therapy scheme has for years has shown its effectiveness in personality disorders, but it has been hypothesized that every psychopathology shows a specific pattern of activations of patterns.
This “specific Hypothesys” has been widely applied in recent years to personality disorders or disorders such as depression, anxiety disorders and eating disorders. The same thing was done for obsessive compulsive disorder.
Patients who found treatment useful and who responded positively in terms of results, report the fact that they have worked on emotions as a more significant factor. This type of work, in fact, has greater measures than the exposures only and contributes more to the progress of the treatment and the quality of life (Kueltz et al., 2004).
Psychoeducation and gradual exposure
Even using the Therapy Scheme approach, to treat the DOC, the part of the knowledge of the disorder remain fundamental and how this is expressed within the patient’s functioning. Psychoeducation is essential for the patient to feel normalized and understand the rational of the intervention.
In addition, it is important to know in depth compulsive behaviors and avoidance in order to build an exhibition scale. He will ask the patient to refrain from implementing compulsions starting from unplosed-stimolo situations, to learn to accept the obsessive doubts and manage the emotions that derive from it.
Experiential and emotional work
In Therapy scheme, the exposure and prevention of the response (ERP) is a way to activate unwary patterns and related emotions. In fact, when the patient abstains from compulsion, emotions emerge that will be the target to be used for experiential work (Imagory Rescripting, role playing and work with chairs).
For example, a typical image of Imagery Rescripting with an obsessive patient involves the following steps:
- Ask the patient to close his eyes and imagine the moment when he felt the need to implement the compulsion;
- imagine not to implement it;
- Attention to the emotion that emerges by paying particular attention to where he feels it in the body;
- keeping this emotion well in mind letting a childhood image emerge;
- The therapist (and further on the patient) enters the image and the “rewrites” by responding to the primary emotional needs of the child (for example acceptance in the face of an error);
- After the emotional needs of the child have been satisfied, we return to the image of this by asking the patient if he still needs to implement the compulsion.
The therapeutic relationship
In general, the therapy therapy therapy must be authentically calorosis, genuine and prostheses towards the patient. Attention to any sign of emotional activation, leads to interest and desire for understanding: when the patient is emotionally activated the therapist puts aside the contents and tries to understand what is happening in the internal world of the person.
Specifically for the DOC, the therapist helps the patient to recognize his mistakes, his responsibilities, without making him feel wrong, but unconditionally accepted.
When the patient falls or persists in his mistakes, the therapist proves particularly close and supportive, possibly clearly explicitly explicitly explicitly explicit to help him in the moment of difficulty and his will in understanding what he needs to be able to overcome him. Frequently praises the patient, even when he cannot, for the fact of continuing to try.
The construction of patterns and functional beliefs
In the Therapy scheme, thanks to the work of exposure and prevention of the integrated response to experiential techniques, we come to internalize these healthy and functional beliefs such as those described later:
- The certainty is unattainable.
- Living means taking risks.
- It is possible to distinguish different levels of responsibility.
- Reasonable risks are taken, which are defined as such according to the elements of reality. The error is inevitable, admissible, understandable, repairable, forgotten, is not linked to the value of the person and does not make it lose amiability and the right to be respected.
- A thought concerning a danger is cultivated only if it can be translated into an action that can improve one’s life condition.
- To take care of something, it is enough to be careful, without the need to anguish.
- Thinking about something does not automatically mean wanting it.
- Wanting something does not automatically mean acting.
Bibliography
- Abramowitz, JS (2006). Undersanding and Treating Obsessive-Compulsive Disorder: A Cognitive-Behavoral Approach. Lawrence Erlbaum Associates Publishers.
- Foa, EB, Huppert, JD, Leiberg, S., Langner, R., Kichic, R., Hajcak, G., Salkovskis, PM (2002). The Obsessive-Compulsive Inventory: Development and Validation of a Short Version. Psychological Assessment. Vol 14(4), 485-496
- Kuelz, Ak, Hohagen, F. & Voderholzer, U., (2004). Neuropsychological performance in Obsessive-Compulsive Disorder: A Critical Review. Biological Psycholgy. 65 (3): 185-236.
- Rasmussen, Sa, & Eisen, JL (1992). The epidemiology and clinical features of compulsive obsessive disorder. Psychiatric Clinics of North America15(4), 743–758.
