Obsessive-Compulsive Disorder According to the Inference-Based Approach

摘要

Background: Obsessive-compulsive disorder can be an important source of distress and disfunctionality to affected individuals. Its treatment is mainly pharmacological and psychotherapeutic (namely exposure with response prevention). The inference-based model appeared in the decade of 90, aiming to solve some of the limitations of the existing cognitive-behavioral formulations of obsessive-compulsive-disorder. Aims: To present a review of the inference-based model and inference-based therapy applied to obsessive-compulsive disorder. Methods: Non-systematic review of articles searched in PubMed and Medline, and scientific literature of reference. Results: The core element of the conceptualization of obsessive-compulsive disorder according to the inference-based model is inferential confusion, that is, confusion between possibility and reality. A narrative is constructed that is distant from the events of the here and now and from common sense,supported by specific inductive reasoning processes that are believed to be altered in OCD. From here will arise the first thought with the characteristics of obsessive thought, called primary inference, followed by anticipated consequences called secondary inferences, which result in anxiety and consequently compulsions. The inference-based therapy was outlined from this formulation of the obsessive-compulsive dyad. This therapy aims to invalidate the reasoning processes that lead to the doubt or primary inference and return the person to the world of senses and common sense. It showed efficacy in empirical studies, namely when compared to classic cognitive-behavioral therapy in two randomized controlled trials, with more efficacy in patients with over-investment in the obsessions or poor insight. Conclusions: Regarding its efficacy, inference-based therapy appears promising. It could be a hypothesis to consider in patients with obsessive-compulsive disorder, as well as in other disorders such as dysmorphophobia, eating disorders and hoarding disorder.