Obsessions, responsibility and guilt

doi:10.1016/0005-7967(93)90066-4

Behaviour Research and Therapy

Volume 31, Issue 2, February 1993, Pages 149-154

https://doi.org/10.1016/0005-7967(93)90066-4 Get rights and content

Abstract

Introduction of the concept of “inflated responsibility” into the so-called anatomy of obsessions gives rise to an elaborated analysis of obsessions, responsibility and guilt. The analysis touches on a range of phenomena including anger and guilt, control of thoughts, the fusion of thoughts and action, resistance to additional responsibility, procrastination and unfinished tasks, hypochondriasis, brief holidays.

Some clinical implications are deduced from the analysis.

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There are more references available in the full text version of this article.

Cited by (464)

Implicit aggressive self-concept in patients with obsessive-compulsive disorder: Results from an approach-avoidance task
2024, Journal of Behavior Therapy and Experimental Psychiatry
Patients with obsessive-compulsive disorder (OCD) have reported higher anger and aggression than healthy individuals in previous studies using explicit measures. However, studies using implicit measures have demonstrated mixed results. The aim of the present study was to investigate implicit aggressiveness in OCD using an approach-avoidance task (AAT).
Seventy-eight patients with OCD and 37 healthy controls underwent structured clinical interviews and measures of anger, OCD, and depressive symptoms as well as a computerized AAT that included aggressive, peaceful, negative, and positive stimuli.
In line with previous studies, patients with OCD reported higher scores on explicit anger. With respect to the implicit measure, repeated measures ANOVAs did not show any differences in mean reaction times for pushing compared to pulling aggressive versus peaceful and negative versus positive words. However, analyses of specific OCD symptom dimensions demonstrated significantly faster reaction times for pulling compared to pushing aggressive words for patients with high scores in the OCD symptom dimensions obsessing and hoarding.
Eighty percent of patients with OCD showed psychiatric comorbidities and all were seeking treatment.
The present study supports previous studies reporting the absence of higher aggressiveness in patients with OCD compared to healthy controls using implicit measures. However, in contrast to previous studies, we found an implicit approach bias towards aggressive self-statements for OCD patients scoring high in the symptom dimensions obsessing and hoarding compared to healthy controls. Future studies should further elucidate putative functional relationships between different OCD symptom dimensions and implicit aggressiveness.
Attention allocation in OCD: A systematic review and meta-analysis of eye-tracking-based research
2023, Journal of Affective Disorders
Cognitive models of obsessive-compulsive disorder (OCD) implicate heightened attention allocation to stimuli related to one's obsessions in the disorder. Recently, to overcome several limitations of reaction time-based measures, eye-tracking methodology has been increasingly used in attentional research.
A meta-analysis of studies examining attention allocation towards OCD-related vs. neutral stimuli, using eye-tracking methodology and a group-comparison design, was conducted conforming to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Separate meta-analyses were performed for attentional vigilance (both latency and location of first fixations) and maintenance (total dwell time and total fixation count, conjointly). Each meta-analysis was conducted twice – once including all studies (main analysis) and once only including studies using the free-viewing paradigm (secondary analysis).
The systematic search yielded a total of nine studies. Of those, eight provided the needed data to be included in the meta-analysis. No evidence emerged for vigilance via latency to first fixation. Vigilance reflected via first fixation location emerged in the main analysis, but not in the secondary one. Evidence for attentional maintenance was found only when analyzing free-viewing studies exclusively (the secondary analysis).
To increase the accuracy of the research question, correlational studies were excluded, resulting in a small number of available studies.
OCD may be characterized by vigilance, but mainly in tasks entailing specific demands and/or goals. Conversely, attentional maintenance may be evident only when using tasks that pose no requirements or demands for participants.
Anxiety sensitivity as a predictor, and non-specific therapeutic factors as predictors and mediators of CBT outcome for obsessive-compulsive disorder in a naturalistic mental health setting
2023, Journal of Affective Disorders
We examined the unique predictive strength of anxiety sensitivity (AS) and the role of expectancy, credibility, and therapeutic alliance (TA) as predictors and mediators of cognitive-behavioral treatment (CBT) outcomes in obsessive-compulsive disorder (OCD).
The current study is a prospective cohort study. Participants (N = 116) were treatment-seeking individuals with a primary diagnosis of OCD. Independent raters assessed patients on Yale-Brown Obsessive-Compulsive Scale (YBOCS) and Anxiety Sensitivity Index-3 at baseline, post-intervention, and three-month follow-up. Participants responded to the Credibility and Expectancy questionnaire and Working Alliance Inventory-Short revised at baseline, first-session, and mid-session.
The individual addition of AS, end-of-first-session credibility and expectancy, mid-session credibility and expectancy, and therapeutic alliance predicted significant CBT outcomes. There was a moderate positive correlation between baseline OCD severity and the global score of AS, but a weak one with AS dimensions. Both expectancy and credibility significantly improved from baseline to end-of-first-session treatment. End-of-first and third-session outcome expectancies, not credibility, have significant, indirect effects on OCD CBT outcomes.
AS, within-session credibility and expectancies and TA independently predict CBT outcomes. Within-sessions outcome expectancies mediate CBT outcomes in OCD, not credibility. Expectancy and credibility both include state-like elements that can be influenced to enhance the outcomes of CBT. Proposals for reducing treatment barriers in CBT for OCD are offered.
Identity – A critical but neglected construct in cognitive-behaviour therapy
2023, Journal of Behavior Therapy and Experimental Psychiatry
In cognitive-behaviour therapy attention paid to the self and identity has primarily involved self-representations (the Me-Self) rather than how the self is experienced (the I-Self). Within the I-Self experiences vary on a continuum from pre-reflective consciousness (raw experienced perceptions and states of being) to self-awareness (permitting reflection on and evaluation of subjective experience). There is considerable evidence that the I-Self is affected in many if not all disorders, and I review illustrative studies of OCD, eating disorders, body dysmorphic disorder, PTSD, and personality disorder. These indicate that patients often experience themselves as being defective in various ways, or as having an unstable or contradictory I-Self. Recognition of this neglected aspect of patients’ experience has major implications for assessment and treatment. For example, acknowledgment that their sense of self may fluctuate dramatically from moment to moment, may be fragmented, or may consist of a sense of emptiness, may help to build a more empathic therapeutic relationship. If frightening or distressing pre-reflective experiences are the cause of avoidance or other maladaptive coping strategies, conscious attention paid to them in therapy may help to better integrate the I-Self and Me-Self, restoring a sense of predictability and control.
Dr. Jack Rachman's contributions to our understanding and treatment of obsessive-compulsive disorder
2023, Journal of Behavior Therapy and Experimental Psychiatry
Citation Excerpt :
Meanwhile, Rachman and colleagues identified a type of appraisal they labelled “thought-action fusion”. Rachman (1993, 1997; Rachman, Thordarson, Shafran, & Woody, 1995) observed that in addition to beliefs about responsibility people with OCD are more likely to believe that the more one has an unacceptable thought the more likely the negative event represented in the thought is of coming true, and that having a morally repugnant thought is the moral equivalent to committing a morally repugnant deed. This sense of “thought action fusion” also manifests in beliefs that “Obsessional thoughts indicate something significant about oneself (e.g., that one is terrible, weird, abnormal)” and “Negative intrusive thoughts must be important merely because they have occurred” (Thordarson & Shafran, 2002 p. 15).
This paper reviews the development of the cognitive-behavioural model of obsessive-compulsive disorder (OCD) through the work of Dr. Jack Rachman and the research his ideas inspired or shaped.
A narrative review of Rachman's work and important developments in related areas was conducted.
Rachman was highly responsive to theoretical and empirical developments in the field, and continuously developed his model of OCD over the course of his career. Key developments in his thinking and of those in related areas are described.
This is a narrative review that highlights important developments in the cognitive behavioural model of OCD only.
The CBT model of OCD has strong empirical support and CBT treatment is the most effective psychotherapy. Continued development in our understanding of attachment and in the persistence of compulsions is warranted.
The effectiveness of metacognitive therapy in comparison to exposure and response prevention for obsessive-compulsive disorder: A randomized controlled trial
2023, Journal of Obsessive-Compulsive and Related Disorders
The recommended psychological treatment of choice for obsessive-compulsive disorder (OCD) is exposure with response prevention (ERP). Although this treatment is quite effective, recovery rates are modest and attrition rate is relatively high. Also, ERP treatment requires amounts of therapist time. A possible way to improve OCD treatment is by taking into account key cognitive processes involved in the development and maintenance of the disorder. The metacognitive model is such an account and pilot findings suggest that the associated metacognitive therapy (MCT) might be an effective treatment for OCD.
In the present study, a randomized controlled trial (RCT) is used to assess the effectiveness of MCT in comparison to ERP in an outpatient clinical sample of patients with OCD.
Both MCT and ERP produced significant pre-treatment to post-treatment decreases in obsessive-compulsive, comorbid psychological symptoms and metacognitive beliefs, both with moderate to large within-group effect sizes and high proportions of significant clinical change. Drop-out rates were low and treatment gains were maintained at six-month follow-up. There were no differences in efficacy observed between MCT and ERP treatments.
MCT proves to be a promising treatment of OCD.

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View full text

Obsessions, responsibility and guilt

Abstract

Advances in Behaviour Research and Therapy

Behaviour Research and Therapy

Obsessive compulsive disorders

Cognitive intrusions in a non-clinical population. II. Associations with depressive, anxious, and compulsive symptoms

Behaviour Research and Therapy

General psychopathology

Some similarities and differences between obsessional ruminations and morbid preoccupations

Canadian Psychiatric Association Journal