The Efficacy Of Anxiety Ratification Therapy In Patients With Obsessive-compulsive Disorder

OCD is recognized as a severely refractory mental illness(Mangas &Moreira, 2013). Recent epidemiological survey suggest that OCD has a high prevalence: while the full clinical picture affects up to 3% of the world population, subclinical forms are observed in approximately 8% of the people(Adam, Meinlschmidt, Gloster, & Lieb, 2012). Survey in China also found that 9% of teenagers(12-18) show the clinical symptoms of OCD(Sun et al., 2014). OCD can interfere with social function, being the 10 th most common cause of disability in the world(Murray & Lopez, 1997). Compared with other anxiety disorders or emotional disorder, OCD are less likely to get married or be hired(Jacoby et al., 2014). With declining of quality of life, the death rate significantly increased. It is estimated that 10–27% of OCD attempt suicide(Alonso et al., 2010). OCD was associated with the longest latency to treatment(90.57-94.5 months)(Altamura & Dell’Osso, 2010; Dell’Osso et al., 2013). A recent study found negative treatment responses among patients with a long duration of untreated illness(DUI). Not seeking for a proper treatment in time is a serious public health problem associated with substantial costs for the individual, family, and society.A lot of researches focusing on its psychopathology have been generated several influential theories. Many researchers explored the mechanism of the arise and maintain of OCD, trying to explain its psychopathology from the perspective of cognitive-behavioral theory, psychoanalysis, humanism, behaviorism and the like. On the basis of theories, researchers put forward a lot of treatments. However, the treatment of OCD is not satisfactory at present. Notwithstanding their undisputed efficacy for OCD, the dissemination of first line therapy(SSRIs and CBT) remains suboptimal(Moritz & Russu, 2013). As Taylor et al. noted, although each of these theories has some capacity in explaining some particular aspects of OCD, no leading model exists(Taylor et al., 2005). Zhang et al.(2010) analyze the relation of OCD with psychological trauma and emotion regulation, and propose a double conflicts model which provides alternative explanations for obsession and compulsion. Based on double conflicts model hypothesis, they put forward a novel therapy named anxiety ratification which is a tailored strategy of anxiety regulation for OCD. OCD symptoms, including obsessions and compulsions, are considered to arise and maintain in two related loops called ―Obsession Loop‖ and ―Compulsion Loop‖. Double conflicts model received great support of the follow-up studies. Though the therapy is feasible in theory, its efficacy remains to lack of clinical verification. May the anxiety ratification therapy be useful in OCD clinical therapy? On the base of double conflicts model, the aim of the present paper is to discuss the effect of anxiety ratification therapy in the treatment of OCD.The first experimental study tests the immediate efficacy of anxiety ratification therapy compared to mindfulness during brief exposure to obsession in patients with OCD. The results showed that:(1) participants experienced a greater decline in anxiety, urge to neutralize and distress after having engaged in anxiety ratification therapy.(2) the results of comparing the efficacy of anxiety ratification therapy with mindfulness showed different effect on OCD. For anxiety and urge to neutralize, the curative effect of anxiety ratification therapy was the same as mindfulness; for distress, anxiety ratification therapy was better than mindfulness; the effect sizes of anxiety ratification therapy were all above moderate intensity and greater than mindfulness.(3) individuals who used the anxiety ratification therapy experienced a significant improvement of the acceptance of anxiety, whereas mindfulness and exposure did not. Data offered initial evidence that OCD patients are likely benefited from anxiety ratification therapy immediately.Applying multiple-baseline design, the second experimental study analyzed changes of the obsessive-compulsive symptom during the stages of therapy to test the efficacy of anxiety ratification therapy as a self-help intervention in patients with OCD. After a month participants were re-assessed to test the lasting effect. The results demonstrated that:(1) from the baseline observation period to the intervention period, participants experienced a greater decline trend in the frequency and duration of obsession, anxiety and distress. And the effect kept when re-assessed after a month.(2) patients improved strongly on the Y-BOCS and DOCS scores after intervention. And the effect kept when re-assessed after a month.(3) the prompt improvement emerged for the obsessive-compulsive symptom but not for the quality of life. However, the subscale of SF-36, named physical functioning(PF), role limitations due to physical health(RP), vitality(VT), social functioning(SF), role limitations due to emotional problems(RE), mental health(MH), and total score were significantly higher than before the intervention when re-assessed after a month.The first and second experimental study accordantly demonstrated the effectiveness of anxiety ratification therapy. Data offered an initial evidence that using anxiety ratification therapy may be a useful clinical treatment to OCD. This paper not only enriched and developed the double conflicts model, but also provided a new direction for the clinical treatment of OCD.