Cognitive therapy (CT) for obsessive compulsive disorder (OCD), which targets rigidly-held beliefs, has growing evidence as an effective treatment. Willhelm and colleagues (2015) have recently found evidence that the therapy works specifically by helping clients change their beliefs about the need to be perfect and have certainty, as well as their schemas about being incompetent. Although CT for OCD seems to work, there have been few studies such as this on why it works. The theory is that the treatment works via helping patients change the way they think. However, CT targets many different kinds of thoughts that have been associated to OCD, including thoughts about how important it is to be in control of one’s thoughts, as well as having a sense that one must be very responsible. In a sample of 36 patients, Willhelm and colleagues administered questionnaires throughout therapy that were meant to assess different types of OCD beliefs, as well as early maladaptive schemas. Their analyses suggest that the most important thoughts to target in therapy for reducing OCD severity include thoughts like “I should be 100% certain that everything around me is safe” (certainty beliefs) and “no matter what I do, it won’t be good enough” (perfectionistic belief). They also found that changes in clients’ perceptions that they are competent and don’t need to depend on others was related to their improvement. The authors interpreted these findings to mean that to the extent that clients feel more capable in therapy, they may be more likely to face their fears outside of therapy.
Society for Psychotherapy Research (SPR)
Marna S. Barrett, Ph.D.
Mood & Anxiety Disorders Treatment Research Unit
University of Pennsylvania Perelman School of Medicine
3535 Market St., Suite 670
Philadelphia, PA 19104