Treating Guilt-Inducing Self-Talk in Ocd with Dramatized Socratic Dialogue: A Step by Step Intervention.

Objective: Fear of moral guilt and conseque:nt increased attention to personal actions and intentions are the main ingredients of the self-criticism in patients suffering from obsessive-compulsive disorder (OCD). This pathogenic attitude takes shape in a typical guilt-inducing self-talk.The purpose of this work is to describe in detail a novel cognitive therapeutic procedure for OCD called "Dramatized Socratic Dialogue" (DSD). Method: DSD is a theory-oriented intervention that combine elements of Socratic dialogue, chairwork, and cognitive acceptance strategies derived from Mancini's model, which posits that obsessive-compulsive (OC) symptoms stem from a fear of deontological guilt. Results: DSD appears to have many strengths, being a theory-oriented treatment and focusing, as a therapeutic target, on the cognitive structures that determine pathogenic processes and OC symptoms. Furthermore, it is a short, flexible and tailor-made intervention. Conclusions: Detailed description of the intervention could foster future research perspectives and thus be used in evidence-based effectiveness studies to establish whether DSD reduces OC symptoms and to investigate its mechanism of action.

The therapeutic alliance in cognitive-behavioral therapy for obsessive-compulsive disorder: A systematic review and meta-analysis.

Background: The therapeutic alliance has been recognized as one of the most researched key elements of treatment across different therapeutic approaches and diagnostic domains. Despite its importance, our current understanding of its clinical relevance in patients with obsessive-compulsive disorder (OCD) is still debated. This study aimed to examine empirical evidence on the effect of alliance on treatment outcomes in Cognitive Behavioral Therapy (CBT) in patients with OCD in a systematic review and meta-analysis. Methods: Original peer-reviewed articles until March 2022 were included if they were (1) written in English; (2) included a clinical group with a current primary OCD diagnosis; (3) involved individual CBT; (4) used a validated therapeutic alliance scale that was related to the outcome measurement; (5) reported an effect size. Results: Thirteen studies were included, six of which contained sufficient statistical information to be included in the meta-analysis. A total of 897 patients took part in all reviewed studies. We found a modest effect of alliance on post-treatment outcome [Tau 2 = -0.1562 (C.I. 95%: -0.2542 to -0.0582)]. Discussion: The results show the existence of considerable variability and methodological inconsistencies across studies. We discuss the role of methodological factors that could account for this divergence, the research limitations, and the implications for current research. Systematic review registration: [https://osf.io/dxez5/?view_only=bc2deaa7f0794c8dbef440255b2d4b3b].

Guilt Feelings in Obsessive Compulsive Disorder: An Investigation between Diagnostic Groups.

Guilt plays a role in various forms of psychopathology. However, different types of guilt might be involved in different mental disorders. Obsessive-compulsive (OC) patients are prone to a type of guilt in which the violation of an internalized moral norm is necessary and sufficient, whereas data suggest that depression might be linked to more interpersonal types of guilt. However, the extent to which a specific guilt phenomenology is involved in each condition is yet to be determined. Here we assessed the association between different types of guilt and different diagnostic groups. Two clinical samples (33 OCD and 35 non-OCD) filled in the Moral Orientation Guilt Scale (MOGS) along with other OCD and depression measures. Regression was employed to test group differences in the MOGS subscales and to test the influence of MOGS subscales on OCD and depression levels. Results confirm that different types of guilt might be implicated in different psychopathological conditions. Specifically, moral norm violation guilt is more present in OC patients than in other disorders. Depression seems to be associated with different guilt feelings depending on the psychopathological condition, specifically in non-OC patients, with types of guilt involving a "victim", supporting the accounts viewing interpersonal guilt as involved in the emergence of depressive symptomatology and hyper-altruistic behavior as a vulnerability factor for depression.

A Schema Therapy approach to complex dissociative disorder in a cross-cultural setting: a single case study.

Complex dissociative disorders (CDD) include dissociative identity disorder (DID) and the most common other specified dissociative disorder (OSDD, type 1). While consensus-based treatments for CDD are lacking in several international guidelines, patients suffering from CDD show high levels of impairment, treatment utilization and costs. Migrants and refugees often present risk factors for trauma-related and dissociative disorders and need effective and culturally adapted treatments. Schema Therapy (ST) is an integrative psychotherapy that has been recently proposed as a treatment for CDD. This case study examined the process of individual ST, in a three phases-based approach, with a 38-year-old male Yemeni refugee with OSDD, type 1, posttraumatic stress disorder and borderline personality disorder. The treatment was provided in a Western country and the setting included two Western therapists (co-therapy) and an Arabic interpreter/cultural mediator. We assessed the patient's change by using self-report assessments of dissociative and PTSD symptoms, cognitive schemas over 2-year and 4-months treatment periods and a 6-months follow-up. Posttreatment and follow-up reliable change analyses showed significant improvements in dissociative and PTSD symptoms as well as in some cognitive schemas. Despite any firm conclusion cannot be drawn due to the limitations of this study (i.e., single case study), the findings suggest that ST integrated in a phase-oriented approach may be an effective treatment for CDD. Additionally, our study provides some preliminary elements about cross-cultural validity of the schema modes construct as well as cross-cultural effectiveness of ST. More research based on larger samples and specific cross-cultural focused design is needed to confirm these assumptions.

Cognitive-Behavioral Treatment of Obsessive-Compulsive Disorder: The Results of a Naturalistic Outcomes Study.

Cognitive−behavioral therapy is a well-established treatment for obsessive−compulsive disorder (OCD). There are a variety of cognitive and behavioral strategies, and it is necessary to analyze the outcomes of the treatments. The aim of the present study is to verify the effectiveness of a treatment that combines evidence-based procedures and specific cognitive interventions highlighting the issue of acceptance. Forty patients with OCD were recruited and underwent a specific treatment procedure. All patients had a psychodiagnostic assessment for OCD using the Y−BOCS (Yale−Brown obsessive−compulsive scale) performed twice: before treatment (t0) and after nine months (t1). Data analysis showed a decrease in the scores between t0 and t1 according to the Y−BOCS in terms of the interference, severity, and impairment of obsessive−compulsive symptoms. A repeated-measures ANOVA showed a significant reduction in symptoms after treatment, with values of F (1, 39) = 137.56, p < 0.001, and η2 = 0.78. The ANOVA results were corroborated by a Wilcoxon signed-rank test. A reliable change index analysis indicated that 33 participants reported improvements in symptoms, of which 23 were clinically significant. The results showed clinical relevance for OCD treatment and highlighted how this cognitive procedure favored positive outcomes.