So, today I thought I’d write a bit about my PhD.
Last year, I completed an honours thesis on the topic of self-determination theory (SDT), more specifically on subjective vitality and its relationship with our basic psychological needs for autonomy, competence and relatedness. I have to admit I am quite enthusiastic about SDT, have been since I discovered it over 4 years ago, and continue to be. I think it has great potential for being an integrative theory of motivation, and it’s getting increasing support and attention from the research community. With this interest in mind, I was quite keen on using SDT as a basis for my PhD research topic.
However, since I am doing a PhD in clinical psychology, my topic needs to be related to clinical psychology. There is currently little linkage between SDT and clinical psychology, so it’s possible I may have to let go of that theory while I work on my dissertation. While I was musing on this earlier this year, I was struggling to come up with an appropriate theme for my research, until I attended one of Clare Rees‘ lectures on OCD, and she unwittingly gave me a great idea.
She talked about the best evidence-based treatment for OCD, namely Exposure/Response Prevention (ERP), which gradually exposes the patient to anxiety-provoking objects (toilet seat, car..) or situations (having dirty hands…), helping them experience the anxiety without engaging in their usual ritualistic Response (such as hand-washing, checking etc.). This is much more effective than any other known types of treatment, and has been shown to be superior for quite a number of years now. However, most therapists do not use it, or if they do, they do it incorrectly. Therefore, many OCD patients end up in therapy for longer, suffer from their condition for longer, and spend more money on treatments that are less effective. Clare said that she wasn’t sure why therapists don’t offer ERP to OCD patients, although a few obvious ideas readily come to mind.
This sounded a lot to me like an issue of motivation. Here are some of the reasons I thought about:
- Exposure therapy always involves subjecting your patient to some amount of distress and anxiety. It is not a “nice” therapy. Therapists may be afraid it could damage their relationship with their clients, or that they may possibly even lose their clients if they suggest exposure treatment. They may instead prefer being a “nice” therapist, talking through problems and providing short-term relief and relaxation without necessarily confronting the enduring problems at the core of OCD and other anxiety-related disorders.
- Therapists may not know that this treatment is the best. Nowadays there really is no excuse for this, but realistically many therapists don’t keep up with the research, and this needs to be acknowledged and addressed
- Therapists may not know how to properly administer this treatment, therefore leading to poor outcomes and lack of faith in its efficacy, despite the research-based evidence
There may be other reasons too. My idea was that I could look into this, by first interviewing a small number of practicing clinical psychologists, looking for themes in their explanations, then conducting a larger-scale experiment to examine the efficacy of a possible intervention to help therapists provide the best possible treatment for OCD patients.
I’m not 100% excited or passionate about this subject, which, according to some, is a good thing for a PhD. Being overly emotionally involved in a PhD is said to lead to real problems down the track, especially if the results of the research don’t support the hypotheses. However, I’m very interested in the answer to this question, not much research has looked at this subject, and I can see how it would make a substantial contribution to the field of clinical psychology, and to the individual lives of people who suffer from anxiety disorders.
I’m sure I’ll have a lot more to write about this research project in the next few years, and I’ll probably keep a record of what’s happening using this service. It’s very difficult to find out about the experience of other people while they’re working on their PhD, because it takes so much of their time they probably never take the time to record their emotions, feelings, frustrations and successes. I would like to record all this because I will most likely never have this opportunity again, and I think it could help many people in their decision to embark on this wonderful journey.
- How to Use Exposure Response Prevention for OCD (brighthub.com)
- Spotlight on OCD Orderers and the Urge to Organize (brighthub.com)
- Perepletchikova, F., Hilt, L. M., Chereji, E., & Kazdin, A. E. (2009). Barriers to implementing treatment integrity procedures: Survey of treatment outcome researchers. Journal of Consulting and Clinical Psychology, 77(2), 212-218. doi:10.1037/a0015232
- Shafran, R., Clark, D. M., Fairburn, C. G., Arntz, A., Barlow, D. H., Ehlers, A., . . . Ost, L. G. (2009). Mind the gap: improving the dissemination of CBT. Behaviour Research and Therapy, 47(11), 902-909. doi:10.1016/j.brat.2009.07.003
- Stobie, B., Taylor, T., Quigley, A., Ewing, S., & Salkovskis, P. M. (2007). “Contents may vary”: A pilot study of treatment histories of OCD patients. Behavioural and Cognitive Psychotherapy, 35(03), 273-282. doi:10.1017/S135246580700358X
- Waller, G. (2009). Evidence-based treatment and therapist drift. Behaviour Research and Therapy, 47(2), 119-127. doi:10.1016/j.brat.2008.10.018