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

Background/Aims: 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. Methods: 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. Results: 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. Conclusion: 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.