Journal club vintage series: Rituals, anxiety reduction and the role of the therapist

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Röper, G., & Rachman, S. (1976). Obsessional-compulsive checking: experimental replication and development. Behaviour research and therapy, 14(1), 25–32.

We have dug out some old milestone studies that have been crucial in understanding OCD. This article is a replication of previous findings of experiments conducted in 1972-1973 that found that rituals are associated with anxiety reduction in OCD patients. This study also tested if it matters whether an experimenter is present. Twelve patients with checking OCD carried out an anxiety provoking act followed by their compulsive checking ritual, in natural situations. These were conducted under two different two conditions; experimenter present or absent.

Results showed that rituals indeed reduces anxiety. Furthermore, it seems that the OCD checkers had less anxiety when an experimenter was present. The authors conclude: ” This experiment produced evidence to support an anxiety/discomfort reduction hypothesis… The presence of another person dampens the discomfort associated with checking rituals. One reason for this effect may be the transfer of some responsibility from the checker to the other person.”

How is this relevant to clinicians?

If presence of a therapist could be associated with transfer of responsibility, then perhaps the best treatment effects are achieved in the patient´s natural environment (without any therapist present). The authors state that: “In treating obsessional checkers, it probably is even more important than usual to take steps to facilitate the generalisation of improvements from the clinical situation to the patient’s natural environment. In the course of our therapeutic work with compulsive checkers we frequently make use of ‘telephone control’ in which the therapist’s instructions are relayed directly into the patient’s home. He in turn carries out the required tasks and, where necessary, reports back immediately by telephone.“

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