Obsessive-Compulsive Disorder According to the Inference-Based Approach
DOI:
https://doi.org/10.25752/psi.18543Keywords:
Obsessive-compulsive disorder, Cognitive Behavioral Therapy, Inference-based ApproachAbstract
Background: Obsessive-compulsive disorder can be an important source of distress and disfunctionality to affected individuals. Its treatment is mainly pharmacological and psychotherapeutic (namely exposure with response prevention). The inference based model appeared in the decade of 90, aiming to solve some of the limitations of the existing cognitive-behavioral formulations of obsessive-compulsive-disorder.
Aims: To present a review of the inference based model and inference based therapy applied to obsessive-compulsive disorder.
Methods: Non systematic review of articles searched in PubMed and Medline, and scientific literature of reference.
Results: The core element in the conceptualization of obsessive-compulsive disorder according to the inference based model is the obsessive doubt, which is seen as an inference, that results from a inductive reasoning process. The obsessions originate from a internal imaginary narrative, far from the events of “here and now”, based on logical arguments. By a process called inferential confusion, this leads to the primary inference, which is the first though with the characteristics of obsessive doubt (obsession). The secondary inferences (anticipated consequences) follow, provoking anxiety and discomfort, and resulting in compulsive actions. The inference based therapy was outlined from this formulation of the obsessive-compulsive dyad. This therapy aims to invalidate the reasoning processes that lead to the doubt or primary inference and return the person to the world of senses and common sense. It showed efficacy in empirical studies, namely when compared to classic cognitive-behavioral therapy in two randomized controlled trials, with more efficacy in patients with over-investment in the obsessions or poor insight.
Conclusions: Regarding its efficacy, inference based therapy appears promising. It could be an hypothesis to consider in patients with obsessive-compulsive disorder, as well as in other disorders such as dysmorphophobia, eating disorders and hoarding disorder.
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