Self-Ambivalence in the Cognitive-Behavioural Treatment of Obsessive-Compulsive Disorder

Despite emerging interest in the role of self-concept in obsessive-compulsive disorder (OCD), current research has failed to consider the role of self-perceptions in the cognitive-behavioural treatment of OCD. This study examined the relationship between ambivalence about self-worth and treatment outcomes in patients diagnosed with OCD.

Sixty-two volunteers (59.7% female, mean age = 36.05 years, standard deviation, SD = 11.58) with a primary diagnosis of OCD were assigned to 16 sessions of face-to-face cognitive-behavioural treatment delivered in an individual format. Symptom severity, self-ambivalence, depressive symptoms and anxiety were measured using self-report measures at 5 time points: prewaitlist, pretreatment, midtreatment, posttreatment and 6- month follow-up.

All variables improved significantly at the posttreatment compared to the earlier time points, inclusive of OCD severity and self-ambivalence, and improvements were maintained at follow-up. As revealed through a series of logistical and stepwise regression analyses, controlling for various pretreatment levels of symptom severity and/or changes in mood severity, pre-post changes in self-ambivalence were predictive of lower posttreatment OCD severity and recovery from OCD. Of particular note, participants who changed by 1 SD in self-ambivalence were 2.5-3.9 times more likely to be recovered in OCD symptoms at the posttreatment time point, depending on what factors were entered first in the regression analysis.

These results suggest that resolution of self-ambivalence predicts positive treatment outcomes in the cognitive-behavioural treatment of OCD. Assisting patients resolve self-ambivalence may be an important target in the psychological treatment of OCD.