Special Series: Treatment Of Obsessive-Compulsive Disorder: Progress, Prospects, And Problems
Integrative cognitive therapy for obsessive-compulsive disorder: A focus on multiple schemas

https://doi.org/10.1016/S1077-7229(99)80055-8Get rights and content

This paper describes integrative cognitive therapy for obsessive-compulsive disorder (OCD), which focuses on schemas. This treatment was developed by Sookman, Pinard, and Beauchemin (1994) for patients resistant to existing approaches. Multiple cognitive domains and levels of cognition, ranging from appraisals to core beliefs, are targeted. In addition to targeting domains such as inflated responsibility, perfectionism, and overimportance of thoughts (Obsessive Compulsive Cognitions Working Group, 1997), this approach also targets domains that the authors (Sookman & Pinard, 1995) have proposed to be relevant to OCD: vulnerability; response to unpredictability, newness, and change; and view of response to strong affect. Developmental theory, role of attachment experiences, notion of schemas, emotional-interpersonal foci, and the structural dimension are integrated in the conceptualization and treatment of each case. Change in OCD symptoms, secondary depression, and dysfunctional cognitions are reported for seven treatment-resistant cases. On average, symptoms improved from a moderately severe to subclinical level. In some cases the strength of dysfunctional beliefs across multiple domains was reduced to the normal range. Preliminary results support the use of this integrative approach for patients resistant to existing approaches.

References (49)

  • Diagnostic and statistical manual of mental disorders

    (1994)
  • BeckA.T.

    Beyond belief: A theory of modes, personality, and psychopathology

  • BeckA.T. et al.

    Anxiety disorders and phobias: A cognitive perspective

    (1985)
  • BeckA.T. et al.

    Cognitive therapy of personality disorders

    (1990)
  • BeckA.T. et al.

    Cognitive therapy of depression

    (1979)
  • BeckJ.S.

    Cognitive therapy: Basics and beyond

    (1995)
  • BowlbyJ.

    The role of childhood experience in cognitive disturbance

  • BurnsD.

    Feeling good: The new mood therapy

    (1980)
  • CarrA.

    Compulsive neurosis: A review of the literature

    Psychological Bulletin

    (1974)
  • ClarkD.A. et al.

    Symptom differences in major depression, dysthymia, panic disorder, and generalized anxiety disorder

    American Journal of Psychiatry

    (1994)
  • ClarkD.A. et al.

    Empirical status of the cognitive model of anxiety and depression

  • FoaE.B. et al.

    Emotional processing of fear: Exposure to corrective information

    Psychological Bulletin

    (1986)
  • FreestonM.H. et al.

    Beliefs about obsessional thoughts

    Journal of Psychopathology and Behavioural Assessment

    (1993)
  • FreestonM.H. et al.

    Cognitive-behavioral treatment of obsessive thoughts: A controlled study

    Journal of Consulting and Clinical Psychology

    (1997)
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