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Working with interpretations in cognitive behavioural therapy for obsessive compulsive disorder

Published online by Cambridge University Press:  06 June 2018

Gazal Jones ,
Abigail Wroe ,
Lucy Jezard ,
Georgina Jefferys  and
Gary Brown
Gazal Jones*
Affiliation:
Royal Holloway, University of London, Egham Hill, Egham, Surrey TW20 0EX
Abigail Wroe
Affiliation:
Royal Holloway, University of London, Egham Hill, Egham, Surrey TW20 0EX
Lucy Jezard
Affiliation:
Berkshire Healthcare NHS Foundation Trust, Fitzwilliam House, Skimped Hill Lane, Bracknell RG12 1BQ
Georgina Jefferys
Affiliation:
Berkshire Healthcare NHS Foundation Trust, Fitzwilliam House, Skimped Hill Lane, Bracknell RG12 1BQ
Gary Brown
Affiliation:
Royal Holloway, University of London, Egham Hill, Egham, Surrey TW20 0EX
*
*Author for correspondence: Dr Gazal Jones, Royal Holloway, University of London, Egham Hill, Egham, Surrey TW20 0EX (E-mail: gazalkhan12@gmail.com).
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Abstract

Cognitive behavioural therapy (CBT) is a highly effective treatment for obsessive compulsive disorder (OCD). Identifying, challenging and monitoring interpretations of intrusions is considered a key element of CBT for OCD but preliminary research suggests that treatment does not always include identification and modification of misinterpretations. The present investigation explored ‘OCD-expert’ and ‘non-OCD-expert’ clinicians’ views on key elements of CBT for OCD to determine whether identifying and modifying key interpretations were considered important in therapy and whether clinicians who do not have specific expertise in OCD found working with interpretations difficult. Study 1 used a qualitative approach to investigate OCD-expert and non-OCD-expert clinician's views on key elements of CBT for OCD. Study 2 used a questionnaire to investigate what non-OCD-expert clinicians viewed as important and difficult aspects of CBT for OCD. Study 1 results showed that OCD-expert and non-OCD-expert clinicians reported working with interpretations was a key element of CBT for OCD. However, OCD-expert clinicians linked interpretations more closely to a formulation and intervention plan and reported using more techniques and questionnaires when working with interpretations compared with non-OCD-expert clinicians. Study 2 results showed that non-OCD-expert clinicians rated interpretations as both important and difficult to work with but no more important or difficult than other key elements of CBT for OCD. OCD-expert and non-OCD-expert clinicians identify working with interpretations as a key element of CBT for OCD. Non-OCD-expert clinicians may benefit from additional training on formulation tools that help identify, monitor and challenge interpretations of intrusions.

Keywords

obsessive compulsive disordercognitive appraisalsqualitative methodsCBTcognitive behavioural therapypractitioner survey
Type
Original Research
Information
the Cognitive Behaviour Therapist , Volume 11 , 2018 , e6
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2018 

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References

Suggested follow-up reading

Solem, S, Hagen, K, Hansen, B, Ashild, T, Launes, G, Lewin, AB, Storch, EA, Vogel, PA (2015). Thought content and appraisals in cognitive behavioural therapy for obsessive-compulsive disorder. Journal of Cognitive Psychotherapy 29, 106–115.CrossRefGoogle ScholarPubMed
Stobie, B, Taylor, T, Quigley, A, Ewing, S, Salkovskis, PM (2007). ‘Contents may vary’: a pilot study of treatment histories of OCD patients. Behavioural and Cognitive Psychotherapy 35, 273–282.CrossRefGoogle Scholar
Zivor, M, Salkovskis, PM, Oldfield, VB (2013). If formulation is the heart of cognitive behavioural therapy, does this heart rule the head of CBT therapists? the Cognitive Behaviour Therapist 6, 1–11.CrossRefGoogle Scholar

References

Bouchard, C, Rheaume, J, Ladouceur, R (1999). Responsibility and perfectionism in OCD: an experimental study. Behaviour Research and Therapy 37, 239–248.CrossRefGoogle ScholarPubMed
Braun, V, Clarke, V (2006). Using thematic analysis in psychology. Qualitative Research in Psychology 3, 77–101.CrossRefGoogle Scholar
De Haan BKL, Lee CW (2014). Therapists’ thoughts on therapy: clinicians’ perceptions of the therapy processes that distinguish schema, cognitive behavioural and psychodynamic approaches. Psychotherapy Research 24, 538–549.CrossRefGoogle Scholar
Department of Health (2008). Improving Access to Psychological Therapies. Implementation Plan: National Guidelines for Regional Delivery. London: Department of Health.Google Scholar
Department of Health (2011). No Health Without Mental Health: a Cross-Government Mental Health Outcomes Strategy for People of All Ages. London: Department of Health.Google Scholar
Dudley, R, Ingham, B, Sowerby, K, Freeston, M (2015). The utility of case formulation in treatment decision making; the effect of experience and expertise. Journal of Behavior Therapy and Experimental Psychiatry 48, 66–74.CrossRefGoogle ScholarPubMed
Eells, TD, Lombart, KG, Kendjelic, EM, Turner, CL, Lucas, CP (2005). The quality of psychotherapy case formulations: a comparison of expert, experienced, and novice cognitive-behavioral and psychodynamic therapists. Journal of Consulting and Clinical Psychology 73, 579–589.CrossRefGoogle ScholarPubMed
Fisher, PJ, Wells, A (2005). How effective and cognitive and behavioral treatments for obsessive-compulsive disorder? A clinical significance analysis. Behaviour Research and Therapy 43, 1543–1558.CrossRefGoogle ScholarPubMed
Foa, EB, Kozak, MJ, Salkovskis, PM, Coles, ME, Amir, N (1998). The validation of a new obsessive-compulsive disorder scale: The Obsessive-Compulsive Inventory. Psychological Assessment 10, 206–214.CrossRefGoogle Scholar
Goodman, WK, Price, LH, Rasmussen, SA, Mazure, C, Fleischmann, RN, Hill, CL, Heninger, GR, Charney, DS (1989). The Yale-Brown Obsessive-Compulsive Scale. I. Development, use, and reliability. Archives of General Psychiatry 46, 1006–1011.CrossRefGoogle ScholarPubMed
Greenhalgh, J, Meadows, K (1999). The effectiveness of the use of patient-based measures of health in routine practice in improving the process and outcomes of patient care: a literature review. Journal of Evaluation in Clinical Practice 5, 401–416.CrossRefGoogle ScholarPubMed
Harmon, C, Hawkins, EJ, Lambert, MJ, Slade, K, Whipple, JS (2005). Improving outcomes for poorly responding clients: the use of clinical support tools and feedback to clients. Journal of Clinical Psychology 61, 175–185.CrossRefGoogle ScholarPubMed
Hawkins, EJ, Lambert, MJ, Vermeersch, DA, Slade, KL, Tuttle, KC (2004). The therapeutic effects of providing patient progress information to therapists and patients. Psychotherapy Research 14, 308–327.CrossRefGoogle Scholar
Kroese, BS, Jahoda, A, Pert, C, Trower, P, Dagna, D, Selkirk, M (2014). Staff expectations and views of cognitive behaviour therapy (CBT) for adults with intellectual disabilities. Journal of Applied Research in Intellectual Disabilities 27, 145–153.CrossRefGoogle Scholar
Kuyken, W, Fothergill, CD, Musa, M, Chadwick, P (2005). The reliability and quality of cognitive case formulation. Behaviour Research and Therapy 43, 1187–1201.CrossRefGoogle ScholarPubMed
Lambert, MJ, Whipple, JL, Hawkins, EJ (2003). Is it time for clinicians to routinely track patient outcome? A meta-analysis. Clinical Psychology: Science and Practice 10, 288–301.Google Scholar
Lambert, MJ, Whipple, JL, Smart, DW, Vermeersch, DA, Nielsen, SL (2001). The effects of providing therapists with feedback on patient progress during psychotherapy: are outcomes enhanced? Psychotherapy Research 11, 49–68.CrossRefGoogle ScholarPubMed
Lambert, MJ, Whipple, JL, Vermeersch, DA, Smart, DW, Hawkins, EJ, Nielsen, SL (2002). Enhancing psychotherapy outcomes via providing feedback on client progress: a replication. Clinical Psychology and Psychotherapy 9, 91–103.CrossRefGoogle Scholar
Landis, JR, Koch, GG (1977). The measurement of observer agreement for categorical data. Biometrics 33, 159–174.CrossRefGoogle ScholarPubMed
Lopatka, C, Rachman, S (1995). Perceived responsibility and compulsive checking: an experimental analysis. Behaviour Research and Therapy 33, 673–684.CrossRefGoogle ScholarPubMed
Morrison, AP, Barratt, S (2010). What are the components of CBT for psychosis? A Delphi study. Schizophrenia Bulletin 36, 136–142.CrossRefGoogle ScholarPubMed
Mumma, GH, Mooney, SR (2007). Comparing the validity of alternative cognitive case formulations: a latent variable, multivariate time series approach. Cognitive Therapy and Research 31, 451–481.CrossRefGoogle Scholar
Naeem, F, Gobbi, M, Ayub, M, Kingdon, D (2010). Psychologists experience of cognitive behaviour therapy in a developing country: a qualitative study from Pakistan. International Journal of Mental Health Systems 4, 1–9.CrossRefGoogle Scholar
National Institute for Health and Clinical Excellence (NICE) (2005). Obsessive-compulsive Disorder and Body Dysmorphic Disorder: Treatment (http://www.nice.org.uk/CG31).Google Scholar
NHS Digital (2017). Psychological Therapies: Annual Report on the Use of IAPT Services 2015–2016 (http://www.content.digital.nhs.uk/catalogue/PUB22110).Google Scholar
Obsessive Compulsive Cognitions Working Group (1997). Cognitive assessment of obsessive-compulsive disorder. Behaviour Research and Therapy 35, 667–681.CrossRefGoogle Scholar
Obsessive Compulsive Cognitions Working Group (2003). Psychometric validation of the Obsessive Beliefs Questionnaire and the Interpretation of Intrusions Inventory: Part I. Behaviour Research and Therapy 41, 863–878.CrossRefGoogle Scholar
Persons, JB, Bertagnolli, A (1999). Inter-rater reliability of cognitive-behavioral cases formulations of depression: a replication. Cognitive Therapy and Research 23, 271–283.CrossRefGoogle Scholar
Rakovshik, SG, McManus, F (2013). An anatomy of CBT training: trainees’ endorsements of elements, sources and modalities of learning during a postgraduate CBT training course. the Cognitive Behaviour Therapist 6, 1–12.CrossRefGoogle Scholar
Roth, AD, Pilling, S (2007). The competences required to deliver effective cognitive and behavioural therapy for people with depression and with anxiety disorders. London: Department of Health.Google Scholar
Salkovskis, PM (1985). Obsessive-compulsive problems: a cognitive-behavioural analysis. Behaviour Research and Therapy 23, 571–583.CrossRefGoogle ScholarPubMed
Salkovskis, PM (1989). Cognitive-behavioural factors and the persistence of intrusive thoughts in obsessional problems. Behaviour Research and Therapy 27, 677–682.CrossRefGoogle ScholarPubMed
Salkovskis, PM (1999). Understanding and treating obsessive-compulsive disorder. Behaviour Research and Therapy 37, 29–52.CrossRefGoogle ScholarPubMed
Salkovskis, PM, Wroe, AL, Gledhill, A, Morrison, N, Forrester, E, Richards, C, Reynolds, M, Thorpe, S (2000). Responsibility attitudes and interpretations are characteristic of obsessive compulsive disorder. Behaviour Research and Therapy 38, 347–372.CrossRefGoogle ScholarPubMed
Solem, S, Hagen, K, Hansen, B, Ashild, T, Launes, G, Lewin, AB, Storch, EA, Vogel, PA (2015). Thought content and appraisals in cognitive behavioural therapy for obsessive-compulsive disorder. Journal of Cognitive Psychotherapy 29, 106–115.CrossRefGoogle ScholarPubMed
SPSS Incorporated (2008). SPSS Statistics for Windows, version 17.0. Chicago, IL: SPSS Inc.Google Scholar
Stobie, B, Taylor, T, Quigley, A, Ewing, S, Salkovskis, PM (2007). ‘Contents may vary’: a pilot study of treatment histories of OCD patients. Behavioural and Cognitive Psychotherapy 35, 273–282.CrossRefGoogle Scholar
Thew, GR, Fountain, L, Salkovskis, PM (2015). Service user and clinician perspectives on the use of outcome measures in psychological therapy. the Cognitive Behaviour Therapist 8, 1–15.CrossRefGoogle Scholar
Unsworth, G, Cowie, H, Green, A (2012). Therapists’ and clients’ perceptions of routine outcome measurement in the NHS: a qualitative study. Counselling and Psychotherapy Research 12, 71–80.CrossRefGoogle Scholar
Whittal, ML, McLean, PD (1999). CBT for OCD: the rationale, protocol, and challenges. Cognitive and Behavioral Practice 6, 383–396.CrossRefGoogle Scholar
Widdicombe, S, Wooffitt, R (1995). The Language of Youth Subcultures: Social Identity in Action. London: Harvester Wheatsheaf.Google Scholar
Wilhelm, S, Steketee, G (2006). Cognitive Therapy Obsessive-Compulsive Disorder: A Guide for Professionals. Oakland, CA: New Harbinger Publications.Google Scholar
Zivor, M, Salkovskis, PM, Oldfield, VB (2013a). If formulation is the heart of cognitive behavioural therapy, does this heart rule the head of CBT therapists? the Cognitive Behaviour Therapist 6, 1–11.CrossRefGoogle Scholar
Zivor, M, Salkovskis, PM, Oldfield, VB, Kushnir, J (2013b). Formulation in cognitive behavior therapy for obsessive-compulsive disorder: aligning therapists, perceptions and practice. Clinical Psychology: Science and Practice 20, 143–151.Google Scholar
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