Idiographic considerations in the behavioral treatment of obsessional thoughts

doi:10.1016/0005-7916(93)90054-Z

Journal of Behavior Therapy and Experimental Psychiatry

Volume 24, Issue 4, December 1993, Pages 301-310

https://doi.org/10.1016/0005-7916(93)90054-Z Get rights and content

Abstract

Despite impressive improvement in the behavioral treatment of obsessive-compulsive disorder over the last 15 years, progress has been slower for obsessional thoughts with few or no overt rituals. Encouraging case reports suggest that exposure to obsessional thoughts combined with covert response prevention is an effective treatment. Three cases are presented that required adaptation from the guidelines laid out by Salkovskis and Westbrook (1989). They provide clear evidence of the need to adopt a creative and flexible approach to exposure that enables access and activation of fear structures.

References (32)

M.H. Freeston et al.
Cognitive intrusions in a non-clinical population. I. Response style, subjective experience, and appraisal
Behavior Research and Therapy
(1991)
J.B. Milby et al.
Videotaped exposure: a new treatment for obsessive-compulsive disorders
Journal of Behavior and Experimental Psychiatry
(1981)
S. Moergen et al.
Habituation to fear stimuli in a case of obsessive compulsive disorder: Examining the generalization process
Journal of Behavior Therapy and Experimental Psychiatry
(1987)
S. Rachman
Obsessional ruminations
Behaviour Research and Therapy
(1971)
S. Rachman
Emotional processing
Behaviour Research and Therapy
(1980)
S. Rachman et al.
Abnormal and normal obsessions
Behavior Research and Therapy
(1978)
P.M. Salkovskis
Obsessional-compulsive problems: a cognitive-behavioural analysis
Behaviour Research and Therapy
(1985)
L.L. Tynes et al.
Toward a new nosology of obsessive compulsive disorder
Comprehensive Psychiatry
(1990)
P.M.G. Emmelkamp
Obsessive-compulsive disorder
E.B. Foa et al.
Emotional processing of fear: exposure to corrective information
Psychological Bulletin
(1986)

E.B. Foa et al.

Behavior therapy with obsessive compulsives

F. Gagnon et al.

Health-related thoughts: The role of appraisal

Canadian Psychology

(1992)

K. Headland et al.

Rapid audio-tape treatment of obsessional ruminations: a case report

Behavioural Psychotherapy

(1987)

M. Hersen et al.

Single-case experimental designs: strategies for studying behavior change

(1976)

J. Himle et al.

Clinical social work and obsessive compulsive disorder: a single-subject investigation

Behavior Modification

(1989)

M.A. Jenike

Illness related to Obsessive Compulsive Disorder

Cited by (22)

Cognitive therapy of obsessive thoughts
2001, Cognitive and Behavioral Practice
Six people with obsessive thoughts without overt compulsions received cognitive therapy based on a comprehensive cognitive-behavioral account of obsessive-compulsive behavior using techniques developed specifically for OCD (Freeston, Rhéaume, & Ladouceur, 1996). They were treated within a multiple-baseline, experimental single-case design supplemented by a standardized assessment battery using both clinician assessment and self-report. The treatment targeted faulty beliefs specified by the model in a flexible manner based on a case-formulation approach. Participants did not receive instructions or practice in systematic exposure and response prevention. They were encouraged to act in a way that was coherent with their new understanding of obsessive thoughts. Participants received an average of 16.2 sessions of therapy. Follow-up assessment was conducted at 6 and 12 months following the end of treatment. Using a double criteria for clinically significant change, 4 participants (66%) were improved on the Yale-Brown Obsessive-Compulsive Scale at posttreatment, and 5 (83%) were improved at 6- and 12-month follow-up. These results indicate that alternative strategies to structured exposure and response prevention can be effective. The possibility of integrating structured exposure techniques within this treatment framework is discussed.
The cognitive mediation of obsessive-compulsive handwashing
1997, Behaviour Research and Therapy
The potential mediating roles of danger expectancies, responsibility, perfectionism, anticipated anxiety and self-efficacy on obsessive-compulsive handwashing were examined. Ratings were obtained from 27 obsessive-compulsive patients before and during a behavioural avoidance test involving a compound stimulus of potting soil, animal hair, food scraps and raw meat. Correlation and partial correlation analyses were conducted to examine the relationships between the cognitive predictor variables and anxiety, urge to wash, time in task and duration of post-test washing. Large and significant relationships between danger expectancies and the dependent measures were obtained, even when alternative mediators were held constant. No other variable remained significantly related to any of the dependent measures when severity of disease ratings were held constant. Results suggest that of the cognitive variables examined, danger expectancies are the most likely mediator of washing-related behaviour in obsessive-compulsive disorder.
What do patients do with their obsessive thoughts?
1997, Behaviour Research and Therapy
Current models of Obsessive-Compulsive Disorder (OCD) accord a key role to neutralization in the maintenance of obsessional thoughts. Although overt compulsions are well known and have frequently been described in the literature, their cognitive equivalents have not been described to any great extent. This study systematically described the repertoire of strategies used by 29 OCD patients with dominant obsessive thoughts. Extensive repertoires were reported, characterized by low to moderate mean efficacy in removing the thoughts. The majority of strategies were not cognitive rituals nor neutralization in the narrow sense of ‘attempts at putting right’, even though they were effortful, intentional, and deployed in a strategic way. The results are discussed in terms of the need for a broad definition of neutralization that includes all strategies including coping strategies. Clinical implications are discussed and comprehensive response prevention is recommended for the treatment of obsessive thoughts.
Correction of inflated responsibility in the treatment of obsessive-compulsive disorder
1996, Behaviour Research and Therapy
This study evaluates the efficacy of a cognitive treatment for obsessive-compulsive disorder (OCD). Four patients with OCD whose major complaints were checking rituals were treated in a multiple baseline across subjects design. Cognitive correction targeted inflated responsibility, without any exposure or response prevention. All subjects reported a clinically significant decrease in interference caused by rituals, a 52–100% reduction in Y-BOCS scores, and a decrease in perceived responsibility. Therapeutic gains were maintained at follow-up (6 and 12 months) for three patients. Results suggest that cognitive therapy targeting inflated responsibility is a promising alternative to exposure-based treatment.
Correcting faulty appraisals of obsessional thoughts
1996, Behaviour Research and Therapy
Cognitive techniques are becoming more widely established in the treatment of obsessive-compulsive disorder (OCD). This paper extends previous work by van Oppen and Arntz (1994, Behaviour Research and Therapy, 33, 79–87) on overestimation of threat and excessive responsibility by discussing other types of appraisals that may be involved in OCD, particularly when overt compulsions are absent. Examples are given of types of intervention that may be useful to correct faulty appraisals concerning the overestimation of the importance of thoughts such as thought-action fusion, excessive responsibility, perfectionistic concerns such as the need for absolute certainty, and expectations about anxiety and its consequences.
Strategies used with intrusive thoughts: Context, appraisal, mood, and efficacy
1995, Journal of Anxiety Disorders
Neutralization and avoidance play a key role in current models of OCD and GAD. This study examines strategies used when intrusive thoughts occur as a function of potential discriminative stimuli (sequences, context, thought appraisal), mood state, and efficacy. Structured interviews identified strategies used by 53 normal subjects when the most frequent intrusive thought occurred. The seven major strategies used to cope with the thoughts were physical action, thought replacement, analyzing the thought, talking to others, thought stopping, attempts to convince that the thought has no importance, and doing nothing. Results suggest that the choice of a strategy is not random; some strategies were used in particular situations, in specific sequences, and according to the intensity and appraisal of the intrusive thought. All strategies were equally efficient (or inefficient) and efficacy was not associated with thought characteristics. Thought appraisal was related to mood intensity, whereas depressed mood was associated with lower efficacy of strategies. The specific and differential effects of mood intensity and type need to be integrated into current models of intrusive cognition and OCD.

View all citing articles on Scopus

View full text

Idiographic considerations in the behavioral treatment of obsessional thoughts

Abstract

Behavior Research and Therapy

Journal of Behavior and Experimental Psychiatry

Journal of Behavior Therapy and Experimental Psychiatry

Behaviour Research and Therapy

Behaviour Research and Therapy

Behavior Research and Therapy

Behaviour Research and Therapy

Comprehensive Psychiatry

Obsessive-compulsive disorder

Emotional processing of fear: exposure to corrective information

Psychological Bulletin

Behavior therapy with obsessive compulsives

Health-related thoughts: The role of appraisal

Canadian Psychology

Rapid audio-tape treatment of obsessional ruminations: a case report

Behavioural Psychotherapy

Single-case experimental designs: strategies for studying behavior change

Clinical social work and obsessive compulsive disorder: a single-subject investigation

Behavior Modification

Illness related to Obsessive Compulsive Disorder