Schema Therapy for Treatment-Resistant Obsessive-Compulsive Disorder with Childhood Trauma and Comorbid Personality Pathology: A Prospective Single-Group Repeated-Measures Study

Abstract

This study examined whether schema therapy reduces symptom severity in treatment-resistant young adult patients with obsessive-compulsive disorder (OCD) with a history of childhood trauma and personality pathology. A prospective, single-group, repeated-measures design was used, without a control group. Of 26 eligible young adults who began treatment, 24 completed approximately one year of schema therapy and a three-month follow-up and were analyzed as completers. OCD severity, anxiety, disgust sensitivity, and guilt were assessed as outcomes at pre-treatment, mid-treatment, post-treatment, and three-month follow-up. Mal adaptive personality domains were also tracked. One-way repeated-measures analyses of variance with Bonferroni-corrected comparisons tested change over time. OCD severity fell sharply from pre- to post-treatment, with a very large effect. Anxiety, disgust sensitivity, and state and trait guilt showed parallel reductions with large effects, while moral standards and the personality domains changed more modestly. Across measures, the largest shifts occurred during the active phases of therapy, with no significant change detected between post-treatment and follow-up. The reductions concentrated in the affective and guilt-related processes that schema therapy targets directly, whereas personality-domain change was smaller and appeared to follow symptom improvement. Within this uncontrolled completer sample, the findings provide preliminary evidence consistent with within-person improvement during schema therapy for complex, treatment-resistant OCD because there was no control group, the design cannot establish effectiveness, durability, or treatment-specific mechanisms, and the results require replication in controlled trials. However, schema therapy might be a promising treatment for complex, treatment-resistant OCD.