The role of memory modification in the treatment of childhood obsessive-compulsive disorder
Though exposure therapy is a well-established treatment for OCD and believed to involve processes related to learning and extinction, specific mechanisms of action that contribute to symptom reduction remain unconfirmed. Rather than focusing on habituation to anxiety, newer models of exposure therapy emphasize the role of learning and memory, such as the alteration of symptom-related memories or the formation of new safer memories that compete for expression with older memories of feared stimuli. In other words, successful treatment outcomes may be the result of memory change rather than anxiety reduction. Connectionism is a new paradigm that combines several disciplines such as neuroscience, cognitive science, and computer science to provide a modern account of learning theory based upon models of neural networks, and may also serve to explain why exposure works. The present study investigated the role of memory modification in the treatment of childhood OCD through the use of a novel interview that elicited verbal descriptions of OCD compulsions. Thirteen child and adolescent participants with OCD were enrolled in a treatment study investigating the efficacy of an intensive 5-day exposure-based treatment were administered this interview. Participants were videotaped while being asked to describe three of their most salient rituals in detail at three times: at baseline, after a one-month wait period, and after treatment had occurred. Videos were coded by independent raters along several dimensions. Results indicated that compared to baseline, videos recorded after treatment were less consistent in descriptions related to emotions and overall consistency, while videos recorded after a one-month wait period showed no differences. No differences were found in other ratings, or in the number of steps described in each ritual. When videos were presented in randomly ordered pairs, coders were able to correctly identify pairs that contained post-treatment videos whereby memory decay was theorized to occur. These results suggest that memory change may serve as a marker for symptom reduction. Additionally, emphasizing the role of memory may help enrich our understanding of what is happening when successful exposure takes place and help refine methods by integrating findings from cognitive science or neuroscience related to memory processes.
Pilecki, Brian C, "The role of memory modification in the treatment of childhood obsessive-compulsive disorder" (2014). ETD Collection for Fordham University. AAI3643081.