Targeting attachment in the cognitive behavioural therapy of obsessive compulsive disorder : using single case time series experiments to assess efficacy

Repeated time series single case experiments were used to test if attachment-related interventions added to the efficacy of cognitive behavioural therapy (CBT) for treatment-resistant obsessive compulsive disorder (OCD) in two insecurely attached individuals. We developed a method for formulating cases with respect to attachment, and delineating specific, attachment-related interventions. The baseline treatment phase consisted of standard CBT and the intervention phase featured the addition of attachment-related interventions. Clinically significant change was assessed using Jacobson's method, and times series data was analyzed using overfitted ARIMA modeling.Both participants improved symptomatically with standard CBT. Attachment-related interventions did not add to efficacy of symptom reduction, but did facilitate cognitive change, especially core beliefs about vulnerability, and reduced daily levels of anxiety in both participants. For resistant individuals with OCD, the targeting of attachment-related thoughts, behaviour and feelings in therapy may facilitate change---a finding consistent with hypothetical links between attachment insecurity, core views about one's vulnerability and predisposition to anxiety