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13 - Obsessive Compulsive Disorder:

Treating Obsessions and Associated Behavioral Responses

from Part Three - Cognitive Behavioral Therapy for Obsessive-Compulsive Disorder and Associated Disorders

Published online by Cambridge University Press:  06 January 2022

By
Gillian M. Alcolado
Edited by
Gillian Todd  and
Rhena Branch
Gillian Todd
Affiliation:
University of East Anglia
Rhena Branch
Affiliation:
University of East Anglia
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Summary

“Pure” obsessions were once considered untreatable. This chapter provides clarity on the definition of obsessive thoughts and their associated behavioral sequelae (mental and physical rituals, reassurance seeking, and avoidance). The reader will become familiar with the universality of intrusive thoughts and the mechanism by which they convert to obsessive thoughts in certain individuals. The most common misinterpretations of obsessive thoughts are outlined (including fears that one is crazy, immoral, and/or dangerous). Up-to-date research on evidence-based treatment for this symptom is reviewed. Structured assessment tools and options for open-ended questions are provided for measuring not only symptoms, but the maladaptive beliefs associated with these symptoms. A case vignette of a new mother who began having intrusive thoughts of harming her infant is used to illustrate the case formulation, as well as behavioral and cognitive interventions. The chapter ends with relapse prevention strategies and suggested further reading.

Keywords

obsessive-compulsive disordercognitive behavioral therapyobsessionspure obsessionscognitive therapyintrusive thoughtsexposure and response preventionbehavioral experimentsthought–action fusionreassurance seeking
Type
Chapter
Information
Evidence-Based Treatment for Anxiety Disorders and Depression
A Cognitive Behavioral Therapy Compendium
 , pp. 252 - 268
Publisher: Cambridge University Press
Print publication year: 2022

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References

Further Recommended Reading

Clark, D. A. (2003). Cognitive-behavioural therapy for OCD. Guilford.Google Scholar
Foa, E. B., Yadin, E., & Lichner, T. K. (2012). Exposure and response (ritual) prevention for obsessive-compulsive disorder: Therapist guide (Treatments that work) (2nd ed.). Oxford University Press.Google Scholar
Grayson, J. (2014). Freedom from obsessive-compulsive disorder. Berkley.Google Scholar
Rachman, S. (2003). The treatment of obsessions. Oxford University Press.Google Scholar
Wilhelm, S., & Steketee, G. S. (2006). Cognitive therapy for obsessive-compulsive disorder: A guide for professionals. New Harbinger.Google Scholar

References

Abramowitz, J. S., Deacon, B. J., Olatunji, B. O., Wheaton, M. G., Berman, N. C., Losardo, D., … & Hale, L. R. (2010). Assessment of obsessive-compulsive symptom dimensions: Development and evaluation of the Dimensional Obsessive-Compulsive Scale. Psychological Assessment, 22, 18019–8.Google Scholar
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.) (DSM-5). American Psychiatric Association.Google Scholar
Andersson, E., Ljotsson, B., Hedman, E., Hesser, H., Enander, J., Kalod, V., … & Ruck, C. (2015). Testing the mediating effects of obsessive beliefs in internet-based cognitive behaviour therapy for obsessive-compulsive disorder: Results from a randomized controlled trial. Clinical Psychology and Psychotherapy, 22, 722–732.CrossRefGoogle ScholarPubMed
Anholt, G. E., Kempe, P., de Haan, E., van Oppen, P., Cath, D. C., Smit, J. H., & van Balkom, A. J. L. M. (2008). Cognitive versus behavior therapy: Processes of change in the treatment of obsessive-compulsive disorder. Psychotherapy and Psychosomatics, 77, 38–42.CrossRefGoogle ScholarPubMed
Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression. Guilford Press.Google Scholar
Belloch, A., Cabedo, E., Carrio, C., & Larsson, C. (2010). Cognitive therapy for autogenous and reactive obsessions: Clinical and cognitive outcomes at post-treatment and 1-year follow-up. Journal of Anxiety Disorders, 24, 573–580.CrossRefGoogle ScholarPubMed
Brown, T. A., & Barlow, D. H. (2014). Anxiety and Related Disorders Interview Schedule for DSM-5 (ADIS-5) – Lifetime Version. Oxford University Press.Google Scholar
Brown, T. A., Di Nardo, P. A., Lehman, C. L., & Campbell, L. A. (2001). Reliability of DSM-IV anxiety and mood disorders: Implications for the classification of emotional disorders. Journal of Abnormal Psychology, 110, 49–58.Google Scholar
Chambless, D. L., Baker, M. J., Baucom, D. H., Beutler, L. E., Calhoun, K. S., Crists-Christoph, P., … & Woody, S. R. (1998). Update on empirically validated therapies. II. The Clinical Psychologist, 51, 3–16.Google Scholar
Chase, T., Wetterneck, C. T., Bartsch, R. A., Leonard, R. C., & Riemann, B. C. (2015). Investigating treatment outcomes across OCD symptom dimensions in a clinical sample of OCD patients. Cognitive Behaviour Therapy, 44, 365–376.CrossRefGoogle Scholar
Clark, D. A. (2000). Cognitive behavior therapy for obsessions and compulsions: New applications and emerging trends. Journal of Contemporary Psychotherapy, 30, 129–147.CrossRefGoogle Scholar
Clark, D. A. (2004). Cognitive-behavioural therapy for OCD. Guilford.Google Scholar
Clark, D. A., Abramowitz, J., Alcolado, G. M., Alonso, P., Belloch, A., Bouvard, M., … & Wong, W. (2014). Part 3. A question of perspective: The association between intrusive thoughts and obsessionality in 11 countries. Journal of Obsessive-Compulsive and Related Disorders, 3, 292–299.Google Scholar
Clark, D. A., & Purdon, C. (1993). New perspectives for a cognitive theory of obsessions. Australian Psychologist, 28, 161–167.Google Scholar
Farrell, N. R., Ouimet, A. J., Rowa, K., Soreni, N., Swinson, R. P., & McCabe, R. E. (2016). Who gets better when? An investigation of change patterns in group cognitive behavioral therapy for obsessive-compulsive disorder. Journal of Obsessive Compulsive and Related Disorders, 10, 35–41.Google Scholar
Foa, E. B., Huppert, J. D., Leiberg, S., Lagner, R., Kichic, R., Hajcak, G., & Salkovskis, P. M. (2002). The obsessive-compulsive inventory: Development and validation of a short version. Psychological Assessment, 14, 485–495.CrossRefGoogle ScholarPubMed
Foa, E. B., Yadin, E., & Lichner, T. K. (2012). Exposure and response (ritual) prevention for obsessive-compulsive disorder: Therapist guide (Treatments that work) (2nd ed.). Oxford University Press.CrossRefGoogle Scholar
Freeston, M. H., Ladouceur, R., Gagnon, F., Thibodeau, N., Rhéaume, J., Letarte, H., & Bujold, A. (1997). Cognitive-behavioral treatment of obsessive thoughts: A controlled study. Journal of Consulting and Clinical Psychology, 1997, 405–413.CrossRefGoogle Scholar
Freeston, M. H., Léger, E., & Ladouceur, R. (2001). Cognitive therapy of obsessive thoughts. Cognitive and Behavioral Practice, 8, 61–78.CrossRefGoogle Scholar
Goodman, W. K., Price, L. H., Rasmussen, S. A., Mazure, C., Delgado, P., Heniger, R., et al. (1989a). The Yale–Brown Obsessive Compulsive Scale. II. Validity. Archives of General Psychiatry, 46, 1012–1016.CrossRefGoogle ScholarPubMed
Goodman, W. K., Price, L. H., Rasmussen, S. A., Mazure, C., Fleishman, R. L., Hill, C. L., et al. (1989b). The Yale–Brown Obsessive Compulsive Scale. I. Development, use, and reliability. Archives of General Psychiatry, 46, 1006–1011.Google Scholar
Grayson, J. (2014). Freedom from obsessive-compulsive disorder. Berkley.Google Scholar
Kim, S. W., Dysken, M. W., & Katz, R. (1989). Rating scales for obsessive compulsive disorder. Psychiatric Annals, 9, 74–79.CrossRefGoogle Scholar
Meyer, V. (1966). Modification of expectations in cases with obsessional rituals. Behaviour Research and Therapy, 4, 273–280.CrossRefGoogle ScholarPubMed
Moulding, R. M., Coles, M. E., Abramowitz, J., Alcolado, G. M., Alonso, P., Belloch, A., … & Wong, W. (2014). Part 2. Do we all dislike intrusive thoughts for the same reasons? Links between appraisals, control strategies and intrusions across countries. Journal of Obsessive-Compulsive and Related Disorders, 3, 280–291.Google Scholar
Obsessive Compulsive Cognitions Working Group [OCCWG]. (2005). Psychometric validation of the obsessive belief questionnaire and interpretations of intrusions inventory – Part 2: Factor analyses and testing of a brief version. Behaviour Research and Therapy, 43, 1527–1542.Google Scholar
O’Connor, K., & Aardema, F. (2011). Clinician’s handbook for obsessive compulsive disorder: Inference based therapy. Wiley-Blackwell.CrossRefGoogle Scholar
O’Connor, K. P., Aardema, F., Bouthillier, D., Fournier, S., Guay, S., Robillard, S., Pelissier, M. C., … & Pitre, D. (2005). Evaluation of an inference-based approach to treating obsessive-compulsive disorder. Cognitive Behaviour Therapy, 34, 148–163.CrossRefGoogle ScholarPubMed
O’Connor, K. P., Freeston, M. H., Gareau, D., Careau, Y., Dufour, M. J., Aardema, F., & Todorov, C. (2005). Group versus individual treatment in obsessions without compulsions. Clinical Psychology and Psychotherapy, 12, 87–96.Google Scholar
O’Connor, K. P., Koszegi, N., Aardema, F., van Niekerk, J., & Taillon, A. (2009). An inference-based approach to treatment obsessive-compulsive disorders. Cognitive and Behavioral Practice, 16, 420–429.Google Scholar
O’Connor, K. P. & Robillard, S. (1999). A cognitive approach to the treatment of primary inferences in obsessive-compulsive disorder. Journal of Cognitive Psychotherapy: An International Quarterly, 13, 359–375.CrossRefGoogle Scholar
Polman, A., Bouman, T. K., van Hout, W. J. P. J., de Jong, P. J., & den Boer, J. A. (2010). Progress of change in cognitive-behavioural treatment of obsessive-compulsive disorder: Current status and some future directions. Clinical Psychology and Psychotherapy, 17, 1–12.Google Scholar
Rachman, S. (1997). A cognitive theory of obsessions. Behaviour Research and Therapy, 35, 793–802.Google Scholar
Rachman, S. (1998). A cognitive theory of obsessions: Elaborations. Behaviour Research and Therapy, 36, 385–401.Google Scholar
Rachman, S. (2003). The treatment of obsessions. Oxford University Press.Google Scholar
Rachman, S., & de Silva, P. (1978). Abnormal and normal obsessions. Behaviour Research and Therapy, 16, 233–238.CrossRefGoogle ScholarPubMed
Rachman, S., & Shafran, R. (1999). Cognitive distortions: Thought–action fusion. Clinical Psychology and Psychotherapy, 6, 80–85.Google Scholar
Radomsky, A. S., Alcolado, G. M., Abramowitz, J., Belloch, A., Bouvard, M., Clark, D. A., et al. (2014). Part 1. You can run but you can’t hide: Intrusive thoughts across 13 cities on 6 continents. Journal of Obsessive-Compulsive and Related Disorders, 3, 269–279.CrossRefGoogle Scholar
Rapp, A. M., Bergman, L., Piacentini, J., & McGuire, J. F. (2016). Evidence-based assessment of obsessive-compulsive disorder. Journal of Central Nervous System Disease, 8, 13–29.Google Scholar
Rowa, K., & Purdon, C. (2003). Why are certain intrusive thoughts more upsetting than others? Behavioural and Cognitive Psychotherapy, 31, 1–11.Google Scholar
Salkovskis, P. M., Wroe, A. L., Gledhill, A., Morrison, N., Forrester, E., Richards, C., … & Thorpe, S. (2000). Responsibility attitudes and interpretations are characteristic of obsessive compulsive disorder. Behaviour Research and Therapy, 38, 347–372.Google Scholar
Shafran, R., Radomsky, A. S., Coughtrey, A. E., & Rachman, S. (2013). Advances in the cognitive behavioural treatment of obsessive-compulsive disorder. Cognitive Behaviour Therapy, 42, 265–274.CrossRefGoogle ScholarPubMed
Shafran, R., Thordarson, D. S., & Rachman, S. (1996). Thought action fusion in obsessive compulsive disorder. Journal of Anxiety Disorders, 10, 379–391.CrossRefGoogle Scholar
Steketee, G., Frost, R., & Bogart, K. (1996). The Yale–Brown Obsessive Compulsive Scale: Interview versus self-report. Behavior Research and Therapy, 34, 675–684.CrossRefGoogle ScholarPubMed
Su, Y.-J., Carpenter, J. K., Zandberg, L. J., Simpson, H. B., & Foa, E. B. (2016). Cognitive mediation of symptom change in exposure and response prevention for obsessive-compulsive disorder. Behavior Therapy,47, 474–486.CrossRefGoogle ScholarPubMed
Thordarson, D. S., Radomsky, A. S., Rachman, S., Shafran, R., Sawchuk, C. N., & Hakstian, A. R. (2004). The Vancouver Obsessional Compulsive Inventory (VOCI). Behaviour Research and Therapy, 42, 1289–1314.Google Scholar
Van Oppen, P. (1994). Cognitive therapy for obsessive-compulsive disorder. Clinical Case Studies, 3, 333–349.Google Scholar
Wetterneck, C. T., Siev, J., Adams, T. G., Slimcowitz, J., & Smith, A. H. (2015). Assessing sexually intrusive thoughts: Parsing unacceptable thoughts on the Dimensional Obsessive-Compulsive Scale. Behaviour Therapy, 46, 544–556.Google Scholar
Whittal, M. L., Woody, S. R., McLean, P. D., Rachman, S. J., & Robichaud, M. (2010). Treatment of obsessions: A randomized controlled trial. Behaviour Research and Therapy, 48, 295–303.CrossRefGoogle ScholarPubMed
Whittal, M. L., Thordardson, D. S., & McLean, P. D. (2005). Treatment of obsessive-compulsive disorder: Cognitive behavior therapy vs. exposure and response prevention. Behaviour Research and Therapy, 43, 1559–1576.CrossRefGoogle ScholarPubMed
Wilhelm, S., Berman, N. C., Keshaviah, A., Schwartz, R. A., & Steketee, G. (2015). Mechanisms of change in cognitive therapy for obsessive compulsive disorder: Role of maladaptive beliefs and schemas. Behavior Research and Therapy, 65, 5–10.Google Scholar
Wilhelm, S., & Steketee, G. S. (2006). Cognitive therapy for obsessive-compulsive disorder: A guide for professionals. New Harbinger.Google Scholar
Williams, M. T., Farris, S. G., Turkheimer, E. N., Franklin, M. E., Simpson, H. B., Liebowitz, M., & Foa, E. B. (2014). The impact of symptom dimensions on outcome for exposure and ritual prevention therapy in obsessive-compulsive disorder. Journal of Anxiety Disorders, 28, 553–558.CrossRefGoogle ScholarPubMed
Woody, S. R., Whittal, M. L., & McLean, P. D. (2011). Mechanisms of symptom reduction in treatment for obsessions. Journal of Consulting and Clinical Psychology, 79, 653–664.Google Scholar

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