Emotional Schemas and Self-Help: Homework Compliance and Obsessive-Compulsive Disorder

Many patients will either refuse to enter treatment or will drop out of treatment where exposure and response prevention (ERP) are employed. Patients may have a number of “good reasons” for noncompliance with ERP. For example, they may view their intrusions as conveying responsibility, reflecting higher threat, as personally relevant, and as requiring perfect and certain solutions. Inducing anxiety, from this perspective, only exacerbates the “problem.” Moreover, patients may employ beliefs about emotion and anxiety that conflict with exposure—such as the belief that anxiety should always be avoided or decreased because it is assumed to rise indefinitely and cause psychological harm. Homework or between-session self-help necessarily involves exposure with increased anxiety and discomfort. In the current case study, both meta-cognitive and meta-emotional conceptualization and strategies were employed in the treatment of a previously treatment-resistant case of OCD, and homework compliance was improved through the use of an emotional schema approach.