Psychodynamic/psychoanalytic and cognitive-behavioral approach to the understanding and treatment of Obsessive-Compulsive Disorder

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[...] Strachey (Ed & Trans.) The Complete Psychological Works Vol. 10: New York. Norton (1976) cited in Rosenhan & Seligman (1995). Hollander, E. & Stein, D.J. (1997) Obsessive-Compulsive Disorders: Diagnosis, Etiology and Treatment: New York. Marcel Dekker, Inc. Horowitz, M. (1975) Intrusive and repetitive thoughts after experimental stress. Archives of General Psychiatry 1457-1463 cited in Rosenhan & [...]

[...] When discussing the understanding of Obsessive-Compulsive disorder from the two aforementioned viewpoints, it is useful to note that they both have strengths and weaknesses, and these do not appear to overlap. Namely, the Psychodynamic viewpoint is particularly strong in its description of how and why the obsessions originate as well as explaining the form the obsessions and the compulsions take, but is rather week on the persistence of the disorder. The Cognitive behavioral viewpoint on the other hand is not as strong on the origins of the problems, but focuses on the behavior involved and so on the persistence of the illness. [...]

[...] The Cognitive-Behavioral approach is significantly different to this, suggesting that the development of Obsessive-Compulsive disorder is an extreme reaction to the obsessive thoughts that all people suffer from time to time. It is said that any thought or action that produces anxiety leads to focusing or obsessing on the issue for a short period, but ‘normal' people can usually dismiss this fairly quickly. The more upset an individual is made by an anxiety producing stimuli, the longer these intrusive and repetitive thoughts last (Horowitz, 1975). [...]

[...] As mentioned earlier, however, it is not necessary to therefore try and chose which one of these contrasting viewpoints is best, as they can be amalgamated to create one, much more comprehensive approach to understanding the disorder. For example, it could be said that the obsessions do indeed stem from unresolved internal conflicts. However, these conflicts are present to some extent in everyone and so it takes a combination of this and a period of emotional vulnerability such as depression to cause the issue to produce enough anxiety to be displaced onto a related but less threatening thought or item. [...]

[...] The Cognitive-Behavioral treatment of Obsessive-Compulsive disorder has, on the other hand, received the validation of a significantly high success rate, both immediately after treatment (with approximately 66% of patients loosing their symptoms) and in follow-ups of up to six years later (with over 90% of those patients who had improved maintaining their improvements)(Sue, Sue and Sue, 2000). The therapy involves a three stage system of modeling (showing them that their obsessive situation is actually safe), flooding (encouraging them to place themselves in that situation), and response prevention (not allowing them to carry out their compulsions). [...]