A cognitive theory of obsessions

  • Type:#article
  • Author: Stanley Rachman
  • Year read:#read2019
  • Subject: (in brackets, can also bracket keywords in text)
  • Bibtex: @rachman1997
  • Bibliography: Rachman, S. A cognitive theory of obsessions. Behav. Res. Ther. 35, 793–802 (1997)

Why and when I was reading this

I was doing a deep dive into cognitions and their role in OCD

Key takeaways

  • Patients with OCD exhibit cognitive biases
  • Treatment should therefore focus on modifying the cognitive biases and catastrophic thinking

Notes & Comments

It is proposed that obsessions are caused by catastrophic misinterpretations of the significance of one’s thoughts (images, impulses). The obsessions persist as long as these misinterpretations continue and diminish when the misinterpretations are weakened.

  • “People who experience recurrent obsessions are far more likely than people who do not experience them, to attach important, personal significance to their intrusive thoughts”
  • “Among those who experience recurrent obsessions, intrusive thoughts that are interpreted by them as being highly significant will feature in their obsessions, and those that are interpreted as being of minimal significance will not feature in their obsessions”

He uses experimental and clinical research on panic disorder as a basis for the formulation, can this be problematic? Important differences between panic and OCD?

The misinterpretation of the intrusive thoughts as being very important, personally significant, revealing and threatening or even catastrophic, has the effect of transforming a commonplace nuisance into a torment.

Cognitive biases in OCD

  • The probability of a bad outcome is increased when they are responsible
  • They, but not others, can be held responsible for misfortunes over which they have no control whatsoever
  • Thought-action fusion (increased probability of event, and moral equivalence between thinking and doing)

Previous attempts to treat obsessions were unsuccessful because they did not target the misinterpretations of obsessions.

Patients get caught up in a vicious cycle where Stress → Obsessions → Interpretation as significant → Stress…

Risk factors for obsessions

  • High moral standards
  • Proneness to fall into cognitive biases
  • Depression
  • Anxiety proneness