Mechanisms of change in cognitive therapy for obsessive compulsive disorder: Role of maladaptive beliefs and schemas
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The present study aimed to identify mechanisms of change in individuals with moderately severe obsessive-compulsive disorder (OCD) receiving cognitive therapy (CT). Thirty-six adults with OCD received CT over 24 weeks. At weeks 0, 4/6, 12, 16/18, and 24, independent evaluators assessed OCD severity, along with obsessive beliefs and maladaptive schemas. To examine mechanisms of change, we utilized a time-varying lagged regression model with a random intercept and slope. Results indicated that perfectionism and certainty obsessive beliefs and maladaptive schemas related to dependency and incompetence significantly mediated (improved) treatment response. In conclusion, cognitive changes in perfectionism/certainty beliefs and maladaptive schemas related to dependency/incompetence precede behavioral symptom reduction for OCD patients. Targeting these mechanisms in future OCD treatment trials will emphasize the most relevant processes and facilitate maximum improvement.
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Substantial uncertainty remains about the psychological mechanisms that mediate the effects of CBT treatment.
“Finally, substantial uncertainty remains about the psychological mechanisms that mediate the effects of CBT treatment (Schubert et al., 2022; Wilhelm et al., 2015; Wolters et al., 2019).”
From TREATING GUILT-INDUCING SELF-TALK IN OCD WITH DRAMATIZED SOCRATIC DIALOGUE: A STEP BY STEP INTERVENTION (2024) · cites this paper as Wilhelm et al., 2015
The Discussion reports that 84% of variance in OCD symptom scores was unexplained by the mechanisms studied and calls for further research. It also identifies a specific belief change that mediated response. These passages support remaining uncertainty about mechanisms in cognitive therapy for OCD, but not the broader claim about CBT treatment generally. (LLM, conf=0.85)
Experimental — accuracy not yet measuredIn cognitive therapy for OCD, amelioration of beliefs mediated treatment success.
“For example, investigating mechanisms of change in a cognitive therapy (CT) for patients with OCD indicated that the amelioration of beliefs mediated treatment success [17].”
From Metacognitive Training for Obsessive-Compulsive Disorder: A study protocol for a randomized controlled trial (2020) · cites this paper as [17]
These inhibitory deficits are consistently reported across OCD symptom dimensions.
“These inhibitory deficits are consistently reported across OCD symptom dimensions [56].”
From Neural correlates of response inhibition following cognitive behavioral therapy in obsessive–compulsive disorder: a randomized controlled EEG study (2026) · cites this paper as [56]
The Methods (Participants; page unavailable) list several OCD symptom types, but do not assess inhibitory deficits across them. The Discussion (page unavailable) addresses cognitive changes during therapy and says that relationships between presenting symptoms and treatment response require further study. Searches for inhibitory deficits, inhibitory control, and symptom dimensions found no passage supporting the attributed claim. (LLM, conf=0.76)
Experimental — accuracy not yet measured
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Self-citation
- Authors
- Wilhelm, S., Berman, N. C., Keshaviah, A., Schwartz, R. A., & Steketee, G.
- Affiliations
- Harvard University (US)
- Boston University (US)
- Corresponding author
- Wilhelm, Sabine
- Venue
- Behaviour Research and Therapy
- Publisher
- Elsevier BV
- Published
- 2015-02
- Volume
- 65
- Pages
- 5-10
- ISSN
- 0005-7967 (ISSN-L)
- PMC
- PMC4313532
- OpenAlex
- W2020581855
- Cited by
- 102
- References
- 41
- Citations by year
- 2026: 8 · 2025: 7 · 2024: 6 · 2023: 14 · 2022: 5 · 2021: 8 · 2020: 8 · 2019: 14 · 2018: 11 · 2017: 6 · 2016: 9 · 2015: 6
- FWCI
- 8.28
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Behaviour Research and Therapy (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- NIMH (R21 MH058804)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Perfectionism, Procrastination, Anxiety Studies
- Keywords
- obsessive-compulsive disorder, cognitive therapy, mechanisms of change, maladaptive schemas, obsessive beliefs, perfectionism, treatment response, symptom relief
- MeSH terms
- Adult, Cognition, Culture, Female, Humans, Male, Obsessive-Compulsive Disorder, Psychiatric Status Rating Scales, Cognitive Behavioral Therapy, Treatment Outcome, Young Adult
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