Obsessional-compulsive problems: A cognitive-behavioural analysis.
- Type:#article
- Year read:#read2019
- Bibtex: @salkovskis1985
- Bibliography: Salkovskis, P. M. Obsessional-compulsive problems: A cognitive-behavioural analysis. Behav. Res. Ther. 23, 571–583 (1985)
Why and when I was reading this
I was doing a deep dive into cognitions in OCD
Key takeaways
- Intrusive thoughts are cognitive stimuli
- OCD problems stem from beliefs of responsibility or blame for harm to self or others
Notes
Distraction and dismissal may be counter therapeutic, since they could become “neutralizing” in themselves or interfere with exposure to the conditioned stimuli.
Three reasons to clarify the relationship between automatic and obsessional thoughts: 1. Intrusions or obsessions are part of normal experience 2. Stanley Rachman suggests that depressive mood worsens obsessions and increases a patient’s resistance to beharioval treatment 3. By specifying the mechanism of obsessions, we are better suited to understand treatment failures
Stanley Rachman definition of intrusive unwanted thoughts: Repetitive thoughts, images or impulses that are unacceptable and/or unwanted Main differences: Obsessional thoughts intrude into conciousness, are easy to access and perceived as irrational and ego dystonic.
Suggested mechanism
I would like to argue that obsessional thoughts function as stimuli which may provoke a particular type of automatic thought.
It seems likely that they [obsessions] may become a persistent source of mood disturbance only when they result in negative automatic thoughts…
Negative evaluation of the intrusive thought (“this is a bad thing to be thinking”). The specific evaluation in OCD revolve around personal responsibility, “the possibility that if things go wrong it might well be the persons’ own fault.” This can also extend to having had the thought itself.
The affective disturbance usually described as arising from the obsession or intrusion actually arises from such automatic thoughts about the intrusion rather than from the intrusion itself.
The role of compulsions
Neutralization can therefore be regarded as attempts to avoid or recude the possibility of being responsible for harm to oneself or others.
- Reduced discomfort → Becomes a strategy for coping with stress
- Followed by non-punishment → Negative reinforcement and increased credibility of beliefs (“I acted on my belief and felt better, therefore the belief must have some basis in truth”)
- The compulsion is a triggering stimulus for new intrustions
Model of OCD
Some qualifications of the model
-
Sometimes patients have enough avoidance to never encounter the intrusion, and may not report any distress. This is likely to happen when there is an elaborate, long-standing, compulsion with high stereotypy.
-
Some depressed patients will cease to have obsessions during bouts of depression. Salkovskis predict that these patients have thoughts of hopelessness and helplessness, rather than self-blame and guilt.
Notes
``` Page 1: Highlight annotation by Oskar Flygare on January 5th 2018, 9:39:53 am: A close examination of cognitive and behavioural models leads to the suggestion that intrusive thoughts are best regarded as cognitive stimuli rather than responses. Cognitive responses (negative automatic thoughts) to these stimuli are typically linked to beliefs concerning responsibility or blame for harm to self or others. A cognitive-behavioural model based on this view is outlined and illustrated by clinical material derived from a case series. Page 1: Highlight annotation by Oskar Flygare on January 5th 2018, 9:41:41 am: Although the cognitive model has provided useful info~ation on the nature and treatment of depression and anxiety disorders in general, it has so far failed to offer a comprehensive approach to the understanding and treatment of obsessional disorders. Page 3: Highlight annotation by Oskar Flygare on January 5th 2018, 9:53:48 am: The major differences between these negative automatic thoughts and obsessions seem to lie in the perceived intrusiveness, immediate accessibility to consciousness and the extent to which they are seen as being consistent with the individual’s belief system. This last difference is particularly important, insofar as Beck’s view of cognitions producing affective disturbance rests on their perceived realistic and plausible nature, and their acceptance by the individual experiencing them. By contrast, obsessions are unacceptable, irrational and implausible. Obsessions are incongruent with the individuals belief system, unlike negative automatic thoughts which are an expression of it. Page 3: Highlight annotation by Oskar Flygare on January 5th 2018, 9:54:21 am: I would like to argue that obsessional thoughts function as stimuli which may provoke a particular type of automatic thought. Page 4: Highlight annotation by Oskar Flygare on January 5th 2018, 9:57:41 am: Such automatic thoughts in response to intrusions appear to relate specifically to ideas of being responsible for damage or harm coming to oneself or to others, or associated imagery of a similar nature Page 4: Highlight annotation by Oskar Flygare on January 5th 2018, 9:57:57 am: That is. obsession-provoked automatic thoughts or images revolve around personal responsibility. the possibility that if things go wrong it might well be the persons’ own fault. Such responsibility may be indirect as well as direct, so that the possibility of preventing harm caused by external agents is equally potent. Page 4: Highlight annotation by Oskar Flygare on January 5th 2018, 9:59:12 am: Such ideas of responsibility can extend to having had the thought itself: that is. if the person believes that they are responsible for their own thoughts (Borkovec. Robinson. Pruzinsky and DePree, 1983; Borkovec, 1984), the content of which is abhorrent to them. then they presumably regard themselves as being responsible for being a bad or evil person unless they take steps to ensure their blamelessness. Page 4: Highlight annotation by Oskar Flygare on January 5th 2018, 9:59:48 am: The affective disturbance usually described as arising from the obsession or intrusion actually arises from such automatic thoughts about the intrusion rather than from the intrusion itself. Page 4: Highlight annotation by Oskar Flygare on January 5th 2018, 10:01:04 am: Impulses are similarly not particularly disturbing unless there is some belief in the possibility that they might be carried through, and blame being likely to fall on the individual as a result of failing to control the impulse. Page 4: Highlight annotation by Oskar Flygare on January 5th 2018, 10:01:16 am: Neutralization, either as compulsive behaviour or cognitive strategies (e.g. thinking a ‘good thought’ after having a ‘bad thought’) can be understood easily in this context as attempts to put things right, and avert the possibility of being blamed by self or others. Page 5: Highlight annotation by Oskar Flygare on January 5th 2018, 10:08:52 am: A further important implication is for the wq,’ in which treatment is carried out. That is, therapist-directed exposure could. under some circumstances, act to provide inappropriate reassurance and hence unwittingly lead to failure of response prevention. Examples of this include repeated unnecessary therapist modelling and excessive use of specific instructions without a shift in the emphasis towards self-directed exposure. Page 5: Highlight annotation by Oskar Flygare on January 5th 2018, 10:09:35 am: Neutralization can therefore be regarded as attempts to avoid or reduce the possibility of being responsible for harm to oneself or others. Page 5: Highlight annotation by Oskar Flygare on January 5th 2018, 10:10:49 am: It is possible to go on to argue that the cognitive distortion involved in obsessional-compulsive problems relates to an inflated belief in the probability of being the cause of serious harm to others or self, or failing to avert harm where this may have been possible rather than an increased belief in the probability of harm per se. Page 8: Highlight annotation by Oskar Flygare on January 5th 2018, 10:16:42 am: This avoidance may be overt or covert-that is, it may involve keeping out of particular environments and not allowing contact with particular stimuli. or may involve attempts to steer their thoughts off particular topics. Page 8: Highlight annotation by Oskar Flygare on January 5th 2018, 10:17:05 am: There is no reason to believe that the processes governing the triggering of unpleasant intrusive thoughts are different from those involved in any other type of thought. Page 9: Highlight annotation by Oskar Flygare on January 5th 2018, 10:21:50 am: Specifically it can be predicted that increases in anxiety will result in more frequent intrusions, while depression will result in an increased probability of negative automatic thoughts and hence discomfort. Page 9: Highlight annotation by Oskar Flygare on January 5th 2018, 10:22:19 am: Thus, for the obsessional patient threat and loss are to be avoided, but responsibility more so. ```