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Do attachment-informed EMDR interventions, used in conjunction with a CBT protocol, improve treatment outcomes for individuals with OCD? A mixed methods study

Blake, J. (2023). Do attachment-informed EMDR interventions, used in conjunction with a CBT protocol, improve treatment outcomes for individuals with OCD? A mixed methods study. (Unpublished Doctoral thesis, City, University of London)


Introduction: Whilst evidence shows that cognitive behavioural therapy (CBT) and/or pharmacological interventions are the most effective treatments for obsessive-compulsive disorder (OCD), around 25% of individuals refuse treatment or fail to benefit. Further research suggests that individuals who have experienced frequent adverse childhood events (ACE) may be more susceptible to OCD. OCD and post-traumatic stress disorder (PTSD) have been conceptualised as two disorders on the same continuum, with OCD behaviours undertaken as a coping strategy to avoid trauma-related symptoms. It may prove beneficial, therefore, to directly target trauma in OCD treatment. Attachment-informed eye movement desensitization (AI-EMDR) developed from EMDR and integrates an attachment-based modification to the EMDR approach. Within this paradigm the focus is on the processing and repair of early ruptures from childhood. The aim in this study was to use AI-EMDR to process childhood trauma in order to soothe the participants’ threat system and facilitate them in undertaking exposure and response prevention (ERP) activities.

Methods: This mixed methods study included a single-case experimental design (SCED) across eight participants with OCD, conducted over a twelve-week period. All participants had previously undertaken CBT/ERP treatment with limited success. Measures included participants’ subjective daily ratings of severity of their OCD, their mood and their ability to undertake ERP tasks. The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and the Obsessive-Compulsive Inventory-Revised (OCI-R) outcome measures were also completed at the commencement and at the end of the trial. Four weeks after completion of treatment, a semi-structured interview was conducted with all participants and a template analysis was undertaken in order to add nuance to the quantitative results.

Results: Assessment reports showed that seven of the eight participants presented in the ‘responsibility for harm’ and ‘unacceptable thoughts’ OCD dimensions. In keeping with the rationale for this study, they had higher than average ACE scores. They all reported frequent parental verbal abuse and all presented with anxious and/or avoidant attachment styles. One participant’s data was excluded from the final analysis as he did not complete treatment as intended. Of the remaining seven participants, six showed an overall improvement in their subjective ratings of the severity of their OCD and they all showed an improvement in mood over the course of the trial. Three participants showed an improved ability to engage in ERP activities during the AI-EMDR treatment phase. These findings were endorsed in the standardised measures where all participants showed an overall improvement on their OCI-R and Y-BOCS scores, with five showing reliable improvement on the Y-BOCS obsessions measure. However, whilst there was good evidence to suggest that treatment was effective overall, the specific hypothesis regarding the mechanisms and impact of AI-EMDR were not supported by the majority, as some participants showed greater improvement during the assessment and/or CBT phases of treatment. The qualitative analysis suggested an overall positive response to treatment, with three participants reporting that their OCD was more manageable that it had ever been and attributing this to the AI-EMDR interventions. These findings were further endorsed by participants’ high level of engagement and low attrition rate throughout the study. Discussion: These mixed results do not directly endorse the hypothesis that AI-EMDR interventions improve treatment outcomes when used alongside a CBT protocol. However, there was evidence to suggest that AI-EMDR may be effective as a stand-alone intervention for some individuals with treatment-resistant OCD. It may also prove a helpful augmentation to CBT treatment in general, with the qualitative analysis suggesting that AI-EMDR provided participants with helpful grounding resources and a more compassionate conceptualisation of their OCD which appeared to enhance their ability to self-soothe.

Publication Type: Thesis (Doctoral)
Subjects: B Philosophy. Psychology. Religion > BF Psychology
Departments: School of Health & Psychological Sciences > Psychology
School of Health & Psychological Sciences > School of Health & Psychological Sciences Doctoral Theses
Doctoral Theses
[thumbnail of Blake thesis 2023 PDF-A.pdf] Text - Accepted Version
This document is not freely accessible until 10 July 2024 due to copyright restrictions.


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