Skip to main content Accessibility help
×
×
Home

CBT for OCD: habituation or cognitive shift?

  • Lottie Morris (a1) and Jim Nightingale (a2)

Abstract

Cognitive Behavioural Therapy (CBT) including Exposure and Response Prevention (ERP) is recommended by NICE as the psychological treatment of choice for obsessive compulsive disorder (OCD). Twenty-five percent of OCD patients refuse ERP, and many psychologists advocate formulation-driven cognitive therapy, including ERP, as opposed to ERP alone. However, a recent meta-analysis suggested there is insufficient evidence to suggest ERP is improved by cognitive methods. This paper proposes to contribute to this debate by providing a detailed description of the treatment of a patient with intrusive cognitions of a sexual nature, who was treated successfully using behavioural experiments designed to test cognitions, rather than ERP. This is, arguably, the way in which most cognitive behavioural therapists would work with someone with OCD. However, this approach is not reflected in the literature at present. The authors report the patient's feedback that therapeutic change was brought about through cognitive shift, as a result of the formulation-driven behavioural experiments.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      CBT for OCD: habituation or cognitive shift?
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      CBT for OCD: habituation or cognitive shift?
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      CBT for OCD: habituation or cognitive shift?
      Available formats
      ×

Copyright

Corresponding author

*Author for correspondence: L. Morris, Department of Psychology, 6W 0.9, University of Bath, Claverton Down, Bath BA2 7AY, UK (email: lottie.morris@nhs.net)

References

Hide All
Bennet-Levy, J, Butler, G, Fennell, M, Hackmann, A, Mueller, M, Westbrook, D (eds) (2004). Oxford Guide to Behavioural Experiments in Cognitive Therapy. Oxford: Oxford University Press.
Rachman, SJ (2003). The Treatment of Obsessions. New York: Oxford University Press.
Salkovskis, PM (1985). Obsessional-compulsive problems: a cognitive behavioural analysis. Behaviour Research and Therapy 23, 571583.
Abramowitz, JS, Franklin, ME, Foa, EB (2002). Empirical status of cognitive behavioural therapy for obsessive-compulsive disorder: a meta-analytic review. Romanian Journal of Cognitive Behavioural Psychotherapy 2, 89104.
APA (2000). Diagnostic and Statistical Manual of Mental Disorders, 4th edn, Text Revision (DSM-IV-TR). Washington DC: American Psychiatric Association.
Clark, DM (1986). Cognitive therapy for anxiety. Behavioural Psychotherapy 14, 283294.
Clark, DM, Wells, A (1995). A cognitive model of social phobia. In: Social Phobia: Diagnosis, Assessment, and Treatment (ed. Heimbery, R. G., Liebowitz, M. R., Hope, D. A. and Schneier, F. R.), pp. 6993. New York: Guilford Press
Cornelissen, PL, Hancock, PJB, Kiviniemi, V, George, HR, Tovee, MJ (2009). Patterns of eye movements when male and female observers judge female attractiveness, body fat and waist-to-hip ratio. Evolution and Human Behaviour 30, 417428.
Daniels, J, Wearden, AJ (2011). Socialization to the model: the active component in the therapeutic alliance? A preliminary study. Behavioural and Cognitive Psychotherapy 39, 221227.
Darwin, C (1955). The Expression of the Emotions in Man and Animals. New York, NY: Philosophical Library.
Dollard, J, Miller, NE (1950). Personality and Psychotherapy: An Analysis in Terms of Learning, Thinking and Culture. New York: McGraw-Hill.
Drummond, LM, Pillay, A, Kolb, PJ, Fogg, R, Jones-Thomas, E, Rani, S (2008). Community model in treating obsessive-compulsive and body dysmorphic disorders. The Psychiatrist 32, 336340.
Foa, EB, Kozak, MJ (1986). Emotional processing of fear: exposure to corrective information. American Journal of Psychiatry 152, 9096.
Foa, EB, Kozak, MJ, Salkovskis, PM, Coles, ME, Amir, N (1998). The validation of a new obsessive compulsive disorder scale: The Obsessive Compulsive Inventory (OCI). Psychological Assessment 10, 206214.
Foa, EB, Liebowitz, MR, Kozak, MJ, Davies, S, Campeas, R, Franklin, ME, Huppert, JD, Kjernisted, K, Rowna, V, Schmidt, AB, Blair Simpson, H, Tu, X (2005). Randomised, placebo-controlled trial of exposure and response prevention, clomipramine, and their combination in the treatment of obsessive-compulsive disorder. American Journal of Psychiatry 162, 151161.
Franklin, ME, Foa, EB (1998). Cognitive behavioural treatments for obsessive compulsive disorder. In: A Guide to Treatments That Work (ed. Nathan, P. E. and Gorman, J. M.), pp. 339–357. New York: Oxford University Press.
Horvarth, AO, Greenberg, LS (1989). Development and validation of the Working Alliance Inventory. Journal of Counselling Psychology 36, 223233.
Jonsson, H, Hougaard, E (2009). Group cognitive behavioural therapy for obsessive compulsive disorder: a systematic review and meta-analysis. Acta Psychiatrica Scandinavica 119, 98106.
Keijsers, GPJ, Schaap, CPDR, Hoogduin, CAL (2000). The impact of interpersonal patient and therapist behaviour in cognitive behaviour therapy: a review of empirical studies. Behaviour Modification 24, 264297.
Kroenke, K, Spitzer, RL, Williams, JBW (2001). The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine 16, 606613.
LeDoux, J (1998). The Emotional Brain. London: Phoenix.
Llewelyn, SP (1988). Psychological therapy as viewed by clients and therapists. British Journal of Clinical Psychology 27, 223237.
Marks, I (1986). Behavioural Psychotherapy. Bristol: John Wright.
Martin, DJ, Garske, JP, Davis, MK (2000). Relation of the therapeutic alliance with outcome and other variables: a meta-analytic review. Journal of Consulting and Clinical Psychology 68, 438450.
Mundt, J, Marks, I, Shear, MK, Greist, JM (2002). The work and social adjustment scale: a simple measure of impairment in functioning. British Journal of Psychiatry 180, 461464.
NICE (2005). Obsessive compulsive disorder: core interventions in the treatment of obsessive compulsive disorder and body dysmorphic disorder. London: National Institute for Health and Clinical Excellence.
Obsessive Compulsive Cognitions Working Group (1997). Cognition assessment of obsessive-compulsive disorder. Behaviour Research and Therapy 35, 667681.
Polman, A, Bouman, TK, van Hout, WJPJ, de Jong, PJ, den Boer, JA (2010). Processes of change in cognitive-behavioural treatment of obsessive compulsive disorder: current status and some future directions. Clinical Psychology and Psychotherapy 17, 112.
Ponniah, K, Magiati, I, Hollon, SD (2013). An update on the efficacy of psychological therapies in the treatment of obsessive-compulsive disorder in adults. Journal of Obsessive-Compulsive Related Disorders 2, 207218.
Purdon, C (2004). Empirical investigations of thought suppression in OCD. Journal of Behavior Therapy and Experimental Psychiatry 35, 121136.
Rachman, SJ (1997). A cognitive theory of obsessions. Behaviour Research and Therapy 35, 793802.
Rachman, SJ (1998). A cognitive theory of obsessions: elaborations. Behaviour Research and Therapy 36, 385401.
Rachman, SJ (2003). The treatment of obsessions. New York (NY): Oxford University Press.
Rachman, SJ, DeSilva, P (1978). Abnormal and normal obsessions. Behaviour Research and Therapy 16, 233238.
Radomsky, AS, Shafran, R, Coughtrey, AE, Rachman, S (2010). Cognitive behaviour therapy for compulsive checking in OCD. Cognitive and Behavioural Practice 17, 119131.
Rogers, CR (1957). The necessary and sufficient conditions of therapeutic personality change. Journal of Consulting Psychology 21, 95103.
Salkovskis, PM (1991). The importance of behaviour in the maintenance of anxiety and panic: a cognitive account. Behavioural Psychotherapy 19, 619.
Salkovskis, PM (1985). Obsessional-compulsive problems: a cognitive behavioural analysis. Behaviour Research and Therapy 23, 571583.
Salkovskis, PM (1989). Cognitive-behavioural factors and the persistence of intrusive thoughts in obsessional problems. Behaviour Research and Therapy 27, 677682.
Salkovskis, PM, Shafran, R, Rachman, SJ, Freeston, MH (1999). Multiple pathways to inflated responsibility beliefs in obsessional problems: Possible origins and implications for therapy and research. Behaviour Research and Therapy 37, 10551072.
Shafran, R, Radomsky, AS, Coughtrey, AE, Rachman, S (2013). Advances in the cognitive behavioural treatment of obsessive compulsive disorder. Cognitive Behaviour Therapy 42, 265274.
Spitzer, RL, Kroenke, K, Williams, JBW, Lowe, B (2006). A brief measure for assessing generalised anxiety disorder: the GAD-7. Archives of Internal Medicine 166, 10921097.
Wegner, DM, Schneider, DJ, Carter, SR, White, TL (1987). Paradoxical effects of thought suppression. Journal of Personality and Social Psychology 53, 513.
Wells, A (1997). Cognitive Therapy of Anxiety Disorders: A Practice Manual and Conceptual Guide. Chichester, UK: Wiley.
Wells, A (2000). Emotional Disorders and Metacognition: Innovative Cognitive Therapy. Chichester: John Wiley & Sons.
Wilhelm, S (2001). Obsessive-compulsive disorder. In Empirically Supported Cognitive Therapies: Current and Future Applications (ed. Lyddon, W. J. and Jones, J. V. Jr.), pp. 118133. New York, NY: Springer Publishing Co.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

the Cognitive Behaviour Therapist
  • ISSN: -
  • EISSN: 1754-470X
  • URL: /core/journals/the-cognitive-behaviour-therapist
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

CBT for OCD: habituation or cognitive shift?

  • Lottie Morris (a1) and Jim Nightingale (a2)
Submit a response

Comments

No Comments have been published for this article.

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *