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Cognitive–behavioural approach to understanding obsessional thinking

Published online by Cambridge University Press:  06 August 2018

Paul M. Salkovskis ,
Elizabeth Forrester  and
Candida Richards
Paul M. Salkovskis*
Affiliation:
University of Oxford Department of Psychiatry, Warneford Hospital, Oxford
Elizabeth Forrester
Affiliation:
University of Oxford Department of Psychiatry, Warneford Hospital, Oxford
Candida Richards
Affiliation:
University of Oxford Department of Psychiatry, Warneford Hospital, Oxford
*
Correspondence: Paul M. Salkovskis, University of Oxford Department of Psychiatry, Warneford Hospital Oxford OX3 7JX
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Abstract

Background Obsessional ruminations (obsessions without any accompanying overt compulsive behaviour) were previously considered especially difficult to treat.

Method Cognitive-behavioural theory regarding obsessional problems is discussed. Strategies for therapy developed on the basis of this theory are reviewed.

Results The cognitive-behavioural theory of obsessive-compulsive disorder proposes that obsessional problems occur as a consequence of the particular meaning or significance which patients attach to the occurrence and/or content of intrusive thoughts. When intrusions are interpreted (appraised) as indicating increased personal responsibility, this results in both distress and the occurrence of neutralising behaviour. Cognitive-behavioural treatment seeks to change responsibility beliefs and appraisals, and thereby reduce distress and eliminate neutralising responses which usually occur as covert neutralising (mental rituals). Evidence is emerging for the success of therapy developed on this theoretical basis.

Conclusions Recent developments in the psychological conceptualisation of obsessional ruminations have improved the prospects for successful therapy.

Type
Research Article
Information
The British Journal of Psychiatry , Volume 173 , Issue S35: New perspectives in research and treatment of obsessive-compulsive disorder , August 1998 , pp. 53 - 63
Copyright
Copyright © 1998 The Royal College of Psychiatrists 

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References

American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders (4th edn) (DSM-IV). Washington, DC: APA.Google Scholar
Beck, A. T. (1976) Cognitive Therapy and the Emotional Disorders. New York: International Universities Press.Google Scholar
Beck, A. T., Emery, G. & Greenberg, R. L. (1985) Anxiety Disorders and Phobias. New York: Basic Books.Google Scholar
Clark, D. M. (1983) On the induction of depressed mood in the laboratory: evaluation and comparison of the Velten and musical procedures. Advances in Behaviour Research and Therapy, 5, 27–49.CrossRefGoogle Scholar
Clark, D. M. (1986a) A cognitive approach to panic. Behaviour Research and Therapy, 24, 461–470.CrossRefGoogle ScholarPubMed
Clark, D. M. (1986b) Cognitive therapy for anxiety. Behavioural Psychotherapy, 14, 283–294.Google Scholar
Clark, D. M. & Beck, A. T. (1988) Cognitive approaches. In Handbook of Anxiety Disorders (eds Last, C. G. & Hersen, M.), pp. 362–385. New York: Pergamon.Google Scholar
Edwards, S. & Durkerson, M. (1987) Similarity of positive and negative intrusions. Behaviour Research and Therapy, 25, 207–211.CrossRefGoogle ScholarPubMed
England, S. L. & Dickerson, M. (1988) Intrusive thoughts: unpleasantness is notthe major cause of uncontrollability. Behaviour Research and Therapy, 26, 279–282.CrossRefGoogle Scholar
Freeston, M. H. (1994) Characteristics and Treatment of Obsessions without Overt Compulsions. Doctoral thesis: School of Psychology, University of Laval, Quebec. Canada.Google Scholar
Goodman, W. K., Price, L. H., Rasmussen, S. A., et al (1989) The Yale-Brown Obsessive-Compulsive Scale. Archives of General Psychiatry, 46, 1006–1011, 1012–1016.CrossRefGoogle ScholarPubMed
Marks, I. M. (1981) Cure and Care of Neurosis. Chichester: Wiley.Google Scholar
Nisbett, R. E. & Ross, L. (1980) Human Inference: Strategies and Shortcomings of Social judgement. Englewood Cliffs, NJ: Prentice Hall.Google Scholar
Rachman, S. J. (1978) An anatomy of obsessions. Behavioural Analysis and Modification, 2, 253–278.Google Scholar
Rachman, S. J. (1993) Obsessions, responsibility and guilt. Behaviour Research and Therapy, 31, 149–154.CrossRefGoogle ScholarPubMed
Rachman, S. J. & de Silva, P. (1978) Abnormal and normal obsessions. Behaviour Research and Therapy, 16, 233–248.CrossRefGoogle ScholarPubMed
Rachman, S. J. & Hodgson, R. J. (1980) Obsessions and Compulsions. Englewood Cliffs, NJ: Prenctice Hall.Google Scholar
Roth, A. D. & Church, J. A. (1994) The use of revised habituation in the treatment of obsessive-compulsive disorders. British journal of Clinical Psychology, 33, 201–204.CrossRefGoogle ScholarPubMed
Salkovskis, P. M. (1983) Treatment of an obsessional patient using habituation to audiotaped ruminations. British Journal of Clinical Psychology, 22, 311–313.Google Scholar
Salkovskis, P. M. (1985) Obsessional-compulsive problems: A cognitive-behavioural analysis. Behaviour Research and Therapy, 23, 571–583.CrossRefGoogle ScholarPubMed
Salkovskis, P. M. (1988) Phenomenology, assessment and the cognitive model of panic. In Panic: Psychological Perspectives (eds Rachman, S. J. & Maser, J.), pp. 111–136. Hillsdale, NJ: Erlbaum.Google Scholar
Salkovskis, P. M. (1989) Cognitive-behavioural factors and the persistence of intrusive thoughts in obsessional problems. Behaviour Research and Therapy, 27, 677–682.Google Scholar
Salkovskis, P. M. (1991) The importance of behaviour in the maintenance of anxiety and panic: a cognitive account. Behavioural Psychotherapy, 19, 6–19.Google Scholar
Salkovskis, P. M. (1996a) Cognitive-behavioural approaches to the understanding of obsessional problems. In Current Controversies in the Anxiety Disorders (ed. Rapee, R.), pp. 103–133. New York: Guildford.Google Scholar
Salkovskis, P. M. (1996b) The cognitive approach to anxiety: threat beliefs, safety seeking behaviour, and the special case of health anxiety and obsessions. In Frontiers of Cognitive Therapy (ed. Salkovskis, P. M.), pp. 48–74. New York: Guilford.Google Scholar
Salkovskis, P. M. (1996c) Resolving the cognition-behaviour debate. In Trends in Cognitive-Behaviour Therapy (ed. Salkovskis, P. M.), pp. 25–42. Chichester: John Wiley.Google Scholar
Salkovskis, P. M. & Campbell, P. (1994) Thought suppression induces intrusion in naturally occurring negative intrusive thoughts. Behaviour Research and Therapy, 32, 1–8.CrossRefGoogle ScholarPubMed
Salkovskis, P. M. & Harrison, J. (1984) Abnormal and normal obsessions – a replication. Behaviour Research and Therapy, 22, 549–552.Google Scholar
Salkovskis, P. M. & Kirk, J. (1989) Obsessional disorders. In Cognitive-Behavioural Treatment for Psychiatric Disorders: A Practical Guide (eds Hawton, K., Salkovskis, P. M., Kirk, J., et al), pp. 129–168. Oxford: Oxford University Press.Google Scholar
Salkovskis, P. M., Richards, C. & Forrester, E. (1995) The relationship between obsessional problems and intrusive thoughts. Behavioural and Cognitive Psychotherapy, 23, 281–299.CrossRefGoogle Scholar
Salkovskis, P. M. & Westbrook, D. (1989) Behaviour therapy and obsessional ruminations: can failure be turned into success? Behaviour Research and Therapy, 27, 149–160.Google Scholar
Spranca, M., Minsk, E. & Baron, J. (1991) Omission and commission in judgement and choice. Journal of Experimental Social Psychology, 27, 76–105.CrossRefGoogle Scholar
Trinder, H. & Salkovskis, P. M. (1994) Personally relevant intrusions outside the laboratory: long-term suppression increases intrusion. Behaviour Research and Therapy, 32, 833–842.CrossRefGoogle ScholarPubMed
Woody, S. R., Stekette, G. & Chambless, D. L. (1995) Reliability and validity of the Yale-Brown Obsessive-Compulsive Scale. Behaviour Research and Therapy, 33, 597–605.Google Scholar
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