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Summary WEEK 7: OCD Literature summaries
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Literature for week 7: 1) DSM-5 OCD; 2) Radomsky et al., 2014; 3) Salkovskis, 2007; 4) Van den Hout et al., 2012; 5) Rachman, 2002
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WEEK 7: OCD1. You can run but you can’t hide: intrusive thoughts on six continents (Radomsky et al., 2014)
The main point of contemporary cognitive behavioral theories of OCD: intrusive thoughts, images
and impulses are normative and commonly experienced by an overwhelming majority of
individuals. The crucial difference in patients with an OCD diagnosis is their
interpretation/appraisal of these thoughts, which consequently cause a lot of distress, guilt and
shame (their response to intrusive thoughts is problematic, not thoughts themselves) and
because they try to get rid of, minimize or control them (using compulsions or avoidance), their
frequency and duration increase..
Findings from previous studies:
o most tested participants experienced some intrusive thoughts
o no age or sex related differences were observed
o the content of intrusions were largely indistinguishable between clinical and nonclinical
participants (even clinicians poorly discerned which intrusions belonged to which group)
o there are important differences between clinical and nonclinical participants in the duration
and frequency of intrusions (not clear whether this is a direct result of obsessively focusing on
them, or whether people with OCD experienced more and longer intrusions in the beginning,
but I think the authors mean the first)
o some studies found different results, showing less universality of intrusive thoughts
Conclusion: obsessions are caused by catastrophic misinterpretations of the significance of
one’s intrusive thoughts (images, or impulses), not an elevated frequency, duration, or
pathological content compared to people without OCD. This is a crucial info for guiding
treatment. If patients with OCD in fact suffered from a greater frequency, duration, and different
(more distressing) content than nonclinical population, treatment would be very different
compared to if the obsessions are caused by misinterpretation of normal, common intrusions.
The question remains why are these intrusive thoughts only problematic for some and not for
others? Studies trying to answer this question were done in a single city without regard to
international and cultural differences that could influence the nature and/or number of intrusions.
Hence, the aim of this study:
1. To test the hypothesis that unwanted intrusions are present and common in nonclinical
populations, across cultures, around the world.
2. To test and assess the nature of the interpretations of intrusions and control strategies.
Results
Overall: 94% had at least 1 intrusive thought in the past 3 months, min 80%, max 100%.
Mean number of intrusions was 2.77 intrusive thought content areas (but that’s still incredibly few
compared to someone with OCD!), but there were sig. cultural differences.
Most distressing intrusive thoughts: doubt
The least common: sexual and religious/immoral intrusions
Sig. sex difference in category of intrusions
,Discussion
Consistent with earlier work, nearly all (94%) participants had at least one intrusion in the past 3
months (but this is almost nothing!).
The sorts of appraisals and control strategies were also endorsed across all sites.
This provides some degree of confidence that cognitive models of obsessions may hold cross-
nationally and cross-culturally (well not really, since 1 intrusive thought is almost nothing – it
seems that patients with OCD in fact differ not only in their appraisal but also frequency of
intrusions after all).
The most frequently reported were doubting intrusions and the least reported were sexual,
religious and immoral intrusions, but the latter were the most difficult to control.
2. Psychological treatment of OCD (Salkovskis, 2007)
Psychological treatment of OCD is highly effective only when it takes the form of behavior therapy or
CBT, which are closely related to / stem from learning theories and cognitive behavioral theories of
maintenance of OCD.
Cognitive-behavioral understanding of obsessions
In this context obsessions are conceptualized as normal intrusive thoughts that are
misinterpreted as a sign the patient wants to harm themselves or others and that they are
responsible for prevention of this.
The interpretation of intrusions causes:
o increased discomfort, including anxiety and depression
o focusing of attention on the intrusions themselves
o increased accessibility to and preoccupation with the original thought
o behavioral responses to reduce or escape responsibility
Patients experience an inflated sense of responsibility which leads them to mental and
behavioral effort characterized by over-control and preoccupation but this increases distress:
o Efforts to deliberately control a range of mental activities result in failure.
o Attempts to prevent harm and responsibility for harm increase the salience and accessibility of
the patients’ concerns with harm.
Modifying beliefs
o Treatment requires modification of the beliefs causing misinterpretation of intrusive thoughts.
o And modification of behaviors maintaining these beliefs (compulsions).
Specific elements of treatment
o Detailed identification and self-monitoring of obsessional thoughts.
o Discussion techniques and behavioral experiments intended to challenge assumptions about
the person’s own personal responsibility. Behavioral experiments to directly test appraisals.
o The aim is modification of the patient’s negative beliefs about the extent of their own
personal responsibility.
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