L’efficacia dell’esposizione con prevenzione della risposta nel trattamento del DOC: una tecnica “comportamentale” o “cognitiva”?

Exposure and response prevention (ERP) is the evidence based golden standard in the treatment of OCD and from a behavioural perspective its efficacy is based on an extinction/habituation rationale. In cognitive therapy (CT), Fisher and Wells (2005) reported that explicitly challenging beliefs about the threatening meaning of intrusions by behavioural experimentations was more effective compared with ERP. However, it is very difficult to distinguish in ERP between the therapeutic effect that can be ascribed to extinction/habituation (associative level) and the one due to cognitive mechanisms (propositional level). Additionally, a behavioural experiment possesses an extinction/habituation component in that it, by definition, exposes the patient to feared situations without the usual protective actions (compulsions). Consequently, they both are mixed techniques with cognitive (i.e. propositional) and behavioural (i.e. associative) components: “… it is possible that the exposure component of behavioural experiments is key to the efficacy of CT” (Abramowitz, Taylor and McKay, 2012, p. 336).