Double conflicts model and anxiety ratification therapy hypotheses of obsessive–compulsive disorder

SummaryIn-depth researches on the psychopathology of obsessive–compulsive disorder (OCD) have been made in the cognitive-behavioral domain. However, some questions about the symptoms have not been properly answered yet. Studies from other domains also shed light on the psychopathology of OCD. The most inspiring ones are studies on psychological trauma which have probed into the mechanism of intrusions, and studies on emotion regulation which have investigated how behavioral emotion expressions are shaped. In this paper, we analyze the roles of psychological trauma and emotion regulation in OCD and propose a double conflicts model. In the model, it is hypothesized that information conflict and motivational conflict, which are called “core conflicts”, are key factors in the psychopathology of OCD, and that obsessions and compulsions arise within two associated loops. Anxiety ratification therapy hypothesis is further put forward, which emphasizes the acceptance of all aspects of anxiety, including the behavioral responses and the accompanying new information, and sets the modification of the basic assumptions as the goal of treatment. Although the model provides comprehensive explanation for many symptoms, the assumptions on which the model is based are in need of confirmation. The therapy is tailored for OCD, but its operability and effect should be monitored closely.