Neurocognitive Modulation of Obsessive-Compulsive Symptoms Through Sequential Integration of Intensive Short-Term Dynamic Psychotherapy, Cognitive Behavioral Therapy, and Transcranial Direct Current Stimulation

Abstract

Background: Obsessive-compulsive disorder (OCD) is a persistent psychiatric condition characterized by intrusive thoughts, repetitive behaviors, impaired emotional regulation, and difficulties in cognitive control. Although cognitive behavioral therapy (CBT) is an established psychological intervention for OCD, a considerable proportion of patients experience incomplete symptom remission or residual emotional and cognitive difficulties. Intensive short-term dynamic psychotherapy (ISTDP) provides a complementary framework that focuses on maladaptive emotional processes, defensive patterns, and underlying affective conflicts. Transcranial direct current stimulation (tDCS), meanwhile, offers a non-invasive neuromodulatory approach capable of influencing cortical excitability and cognitive-emotional processing. The present study developed and evaluated a sequential therapeutic framework integrating ISTDP, CBT, and tDCS to examine its potential neurocognitive and clinical effects in individuals with OCD.

Methods: A structured evidence-based analytical framework was developed using quantitative findings reported in recent randomized controlled trials, systematic reviews, meta-analyses, and neuroimaging research. The framework examined changes in obsessive-compulsive symptom severity, emotional regulation, anxiety, depressive symptoms, and cognitive control following psychological and neuromodulatory interventions. Particular attention was given to the complementary therapeutic mechanisms associated with dynamic emotional processing, cognitive restructuring, exposure-based learning, and modulation of prefrontal neural networks. Comparative analyses were organized to identify convergent patterns across the three intervention domains and to determine clinically meaningful dimensions for an integrated treatment sequence.

Results: The evidence synthesis indicated that CBT produces consistent reductions in obsessive-compulsive symptoms, while psychodynamic interventions may contribute to improvements in emotional processing and underlying psychological organization. Evidence from tDCS studies further suggests that targeted neuromodulation can produce clinically relevant changes in OCD symptoms, with effects extending to broader anxiety and depressive dimensions in some populations. Neurocognitive findings indicate that frontoparietal and prefrontal systems are particularly relevant to cognitive control and compulsive symptom expression. The integrated framework therefore identifies complementary therapeutic targets across emotional processing, cognitive control, and cortical modulation.

Conclusion: Sequential integration of ISTDP, CBT, and tDCS provides a theoretically coherent framework for addressing multiple interacting mechanisms underlying OCD. Rather than treating obsessive-compulsive symptoms as an isolated behavioral phenomenon, the proposed model incorporates emotional regulation, cognitive control, and neurobiological modulation within a unified therapeutic pathway. This framework may provide a basis for future controlled clinical investigations examining personalized sequencing, treatment response, and neurocognitive mechanisms in OCD.