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Outline and evaluate psychological explanations for OCD The cognitive approach assumes that OCD is a consequence of faulty and irrational ways of thinking taken to an extreme. Patients with OCD have different thinking patterns and more intrusive thoughts. The cognitive explanation stresses that everyone has unwanted thoughts from time to time, but OCD sufferers cannot ignore these thoughts and they are often misinterpreted, leading to self-blame and the obsessive symptoms of OCD. So that the negative thoughts and concerns associated with a particular anxiety do not come to pass, compulsions arise in an attempt to ?neutralise? the anxiety. The sufferer becomes more wary of having intrusive thoughts and their fear of them increases. As these ideas are constantly thought about, they become obsessive and a pattern of ritualistic, repetitive behaviour begins. A strength of this theory is that there is supporting evidence. For example, Wegner found that a group of students asked not to think of a white bear were more likely to do so than a group allowed to think about it. ...read more.
We therefore cannot prove cause and effect to show that suppressing thoughts lead to symptoms in OCD, so there are other factors the cognitive approach needs to consider in order to offer a causal explanation. However, although there are issues with self-report methodologies, they can provide a greater insight into the participant?s thoughts and a greater level of detail. They are allowing the participants to describe their own experiences rather than inferring this from observing participants. It therefore provides access to a high level of quantitative data. The behavioural approach assumes OCD is a result of a learnt association between a stimulus and anxiety. Firstly, a neutral stimulus becomes associated with a particular learned response and whenever the stimulus is present, the individual carries out the response. For example, dirty objects became associated with anxiety and this is called classical conditioning. This response is furthered by avoidance of the stimulus, so positive outcomes are achieved. The anxiety is maintained over time by negative reinforcement which leads to the obsessions and the compulsive behaviours are then developed as the person believes that by performing them, the anxiety will decrease. ...read more.
Despite this, the fact that the study used participants who haven?t been diagnosed OCD means that ethical guidelines haven?t been breached, particularly protection of psychological harm. Causing such participants to suppress thoughts could worsen their symptoms of OCD, whereas participants without the disorder will be less affected. These approaches sit on the reductionist side of the debate. For example, the behavioural approach only focuses on environmental factors and doesn?t take into account cognitions, biological factors such as biochemistry, genetics and brain dysfunction and psychodynamic factors. The cognitive approach draws attention to cognitions, ignoring behavioural, psychodynamic and biological factors. This is a strength because the reductionist nature of the approach means a higher level of detail is given because only one idea is taken into consideration. These approaches also only focus on one variable in an attempt to establish causal relationships, as opposed to looking at a variety of variables. However, this could also be seen as a weakness of the approach, because it leads to a limited theory overall and therefore, any treatments developed from the assumptions of these approaches solely may not treat the whole of the OCD sufferer, and there may not be a correct diagnosis. ...read more.
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Description
The essential insight of the cognitive behavioural model of obsessive compulsive disorder [OCD] is that it is the client’s interpretation of the intrusion which drive the distress and maladaptive responses [Salkovskis, Forrester & Richards, 1998]. Intrusive thoughts, images, urges, and doubts are very common and entirely normal [Purdon and Clark, 1993, 1994]: what gives intrusions their emotional power in OCD is the meaning that clients assign to them. Individuals with OCD commonly interpret the occurrence or content of their intrusions as:
- Meaning something bad about them and/or that something bad will happen, and
- Believing that they are personally responsible for preventing harm to themselves and/or others
Interpreting intrusions through the lens of responsibility has a number of effects including: increased discomfort, increased focus of attention on the intrusions, increased accessibility of the intrusions, active attempts to reduce the intrusions, and attempts to decrease or discharge the responsibility that the individual perceives is associated with them. Although these efforts can lead to short-term reductions in anxiety, in the long-term they increase preoccupation with the intrusive thoughts and maintain the pattern of responses to them.
An important treatment implication of the cognitive behavioural model of OCD is that clinicians can work at the level of the meaning of the intrusion. This can be contrasted with traditional exposure and response prevention, which can be framed as an intervention at the level of the compulsion or neutralising behaviour. Clients can be helped to develop an alternative, less-threatening, interpretation of what the intrusions mean [theory b], and then to test this alternative through a process of information-gathering which might include symptom monitoring, behavioural experiments, and exposure exercises. The Cognitive Model Of Obsessive Compulsive Disorder [OCD] presents the cognitive model of Salkovskis, Forrester & Richards [1998] and provides a number of case examples and worksheets for case conceptualisation
Instructions
“Some people’s OCD responses fit the pattern on this diagram. I wonder if we could we explore some of your thoughts, feelings, and reactions and see what kind of pattern they follow?”.
- Ask the client to think of a recent time when they experienced an intrusion
- Help the client to focus on the meaning of the intrusion:
“What does it say about you that you had this intrusion / thought / image / doubt / urge?”
“What would other people think of you if they knew you had this thought?”
“How responsible do you feel for preventing this event from happening?”
“If other people knew you had this thought how responsible would they think you are for preventing [negative outcome] from happening?” - Help the client to describe their responses to interpreting the intrusion in this way:
“What do you do to cope?”
“What do you do to prevent the worst from happening?” “What do you pay extra attention to or look out for?”
“What do you feel when you think about things in this way?” - Explore the consequences of the client’s reactions and consider whether any of these reactions might act to reinforce the cycle. A common pattern to look for is that reactions lead to short-term improvements [e.g. feeling safer] but either no change to, or a worsening of, the sequence in the long-term.
References
- Kuyken, W., Padesky, C. A., & Dudley, R. [2011]. Collaborative case conceptualization: Working effectively with clients in cognitive-behavioral therapy. Guilford Press.
- Purdon, C., & Clark, D. A. [1993]. Obsessive intrusive thoughts in nonclinical subjects. Part I. Content and relation with depressive, anxious and obsessional symptoms. Behaviour Research and Therapy, 31[8], 713-720.
- Purdon, C., & Clark, D. A. [1994]. Obsessive intrusive thoughts in nonclinical subjects. Part II. Cognitive appraisal, emotional response and thought control strategies. Behaviour Research and Therapy, 32[4], 403-410.
- Salkovskis, P. M., Forrester, E., & Richards, C. [1998]. Cognitive–behavioural approach to understanding obsessional thinking. The British Journal of Psychiatry, 173[S35], 53-63.