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Cognitive–behavioural approach to understanding obsessional thinking

Published online by Cambridge University Press:  06 August 2018

Paul M. Salkovskis ,
Elizabeth Forrester  and
Candida Richards
Paul M. Salkovskis*
Affiliation:
University of Oxford Department of Psychiatry, Warneford Hospital, Oxford
Elizabeth Forrester
Affiliation:
University of Oxford Department of Psychiatry, Warneford Hospital, Oxford
Candida Richards
Affiliation:
University of Oxford Department of Psychiatry, Warneford Hospital, Oxford
*
Correspondence: Paul M. Salkovskis, University of Oxford Department of Psychiatry, Warneford Hospital Oxford OX3 7JX
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Abstract

Background Obsessional ruminations (obsessions without any accompanying overt compulsive behaviour) were previously considered especially difficult to treat.

Method Cognitive-behavioural theory regarding obsessional problems is discussed. Strategies for therapy developed on the basis of this theory are reviewed.

Results The cognitive-behavioural theory of obsessive-compulsive disorder proposes that obsessional problems occur as a consequence of the particular meaning or significance which patients attach to the occurrence and/or content of intrusive thoughts. When intrusions are interpreted (appraised) as indicating increased personal responsibility, this results in both distress and the occurrence of neutralising behaviour. Cognitive-behavioural treatment seeks to change responsibility beliefs and appraisals, and thereby reduce distress and eliminate neutralising responses which usually occur as covert neutralising (mental rituals). Evidence is emerging for the success of therapy developed on this theoretical basis.

Conclusions Recent developments in the psychological conceptualisation of obsessional ruminations have improved the prospects for successful therapy.

Type
Research Article
Information
The British Journal of Psychiatry , Volume 173 , Issue S35: New perspectives in research and treatment of obsessive-compulsive disorder , August 1998 , pp. 53 - 63
Copyright
Copyright © 1998 The Royal College of Psychiatrists 

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