UT PSY 394q - Cognitive—Behavioral Treatment of Obsessive Thoughts A Controlled Study

Unformatted text preview:

Page 1 of 17http://spider.apa.org/ftdocs/ccp/1997/june/ccp653405.html 10/12/2000Cognitive—Behavioral Treatment of Obsessive Thoughts A Controlled Study Mark H. FreestonÉcole de Psychologie Université Laval Robert LadouceurÉcole de Psychologie Université Laval Fabien GagnonCentre Hospitalier de l'Université Laval Nicole ThibodeauCentre Hospitalier de l'Université Laval Josée RhéaumeÉcole de Psychologie Université Laval Hélène LetarteÉcole de Psychologie Université Laval Annie BujoldÉcole de Psychologie Université Laval ABSTRACTTwenty-nine patients with obsessive-compulsive disorder as diagnosed in accordance with the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., revised; American Psychiatric Association, 1987 ) who did not have overt compulsive rituals were randomly assigned to treatment and waiting-list conditions. Patients in the treatment condition received cognitive—behavioral therapy consisting of a detailed explanation of the occurrence and maintenance of obsessive thoughts, exposure to obsessive thoughts, response prevention of all neutralizing strategies, cognitive restructuring, and relapse prevention. Compared with waiting-list patients, treated patients improved significantly on measures of severity of obsessions, current functioning, self-report obsessive-compulsive symptoms, and anxiety. When waiting-list patients were subsequently treated, the combined group improved on all outcome measures. Treatment gains were maintained at 6-month follow-up. Results indicate that cognitive—behavioral therapy is effective in the treatment of patients with obsessive thoughts, a group that has often been considered resistant to treatment. This study was supported by le Fonds de la Recherche en Santé du Québec (FRSQ) and by a Medical Research Council of Canada Studentship. Correspondence may be addressed to Mark H. Freeston, École de Psychologie, Université Laval, Québec, Canada, G1K 7P4. Received: February 16, 1996 Revised: August 17, 1996 Accepted: September 10, 1996 Journal of Consulting and Clinical Psychology © 1997 by the American Psychological Association June 1997 Vol. 65, No. 3, 405-413 For personal use only--not for distribution.Page 2 of 17http://spider.apa.org/ftdocs/ccp/1997/june/ccp653405.html 10/12/2000Exposure and response prevention typically produces improvement in about 90% of patients with overt compulsive rituals, but there is no established treatment for patients who have no overt compulsive rituals ( Riggs & Foa, 1993 ). These patients, variously described as ruminators, pure obsessionals, and so forth, were once thought to be rare. Several well-established treatment programs in Europe and the United States report a substantial proportion of patients who do not report overt compulsions ranging from 17% to 44% (e.g., Baer & Minichiello, 1990 ; Hoogduin, de Haan, Schaap, & Arts, 1987 ; Kirk, 1983 ; Welner, Reich, Robins, Fishman, & Van Doren, 1976 ). Furthermore, cross-national epidemiological studies have established that the proportion of cases of obsessive-compulsive disorder (OCD) in the community reporting obsessions only may be much higher, even up to 50%—60% ( Weissman et al., 1994 ). Thought stopping was the treatment of choice for obsessive thoughts during the late 1960s and 1970s, although there was no compelling evidence that it was an effective treatment (see Beech & Vaughn, 1978 ; Foa, Steketee, & Ozarow, 1985 ). Rachman (1971 , 1976; see also Rachman & de Silva, 1978 ) laid down a solid basis for understanding and developing exposure-based treatments for obsessive thoughts. There was little translation of his pioneering work into widely used clinical techniques. However, one case series deserves special mention, as it is the largest published series to date. Hoogduin et al. (1987) reported on outpatient treatment of 26 patients with obsessions alone. Treatment consisted of self-observation and self-monitoring, exposure (in vivo and in imagination), and response prevention (distraction with an incompatible action and self-punishment if cognitive rituals were carried out). On the basis of greater than 30% improvement in self-monitored obsessions as treatment response, 73% responded and 61.5% remained improved at 12- to 36-month follow-ups. This report, although presenting a number of methodological weaknesses, does provide encouraging support for the efficacy of cognitive—behavioral treatment of obsessions. An important turning point in the treatment of obsessional thoughts was Salkovskis's (1985) theoretical analysis of obsessional thoughts and a later report describing treatment procedures ( Salkovskis & Westbrook, 1989 ). His work has led to a number of applications of the original package (e.g., Ladouceur, Freeston, Gagnon, Thibodeau, & Dumont, 1993 , 1995; Martin & Tarrier, 1992 ; O'Kearney, 1993 ). The original cases reported by Salkovskis and the later applications consistently report positive results but are either case reports or experimental single-case designs. The present study is a controlled trial of a cognitive—behavioral package for obsessional thoughts comparing exposure and response prevention combined with cognitive restructuring to a waiting-list control group. The package is based on Salkovskis's (1985) model, which identifies two key cognitive phenomena during obsessive episodes. First, an obsessive thought about an unacceptable action or event is appraised by the patient as indicating responsibility for danger or harm to oneself or others. Negative affective disturbance arises from an exaggerated and erroneous sense of responsibility. To reduce the perception of responsibility and the associated anxiety, the individual tries to neutralize the obsession by different responses or strategies. The neutralizing strategies may be cognitive rituals when they are quite stereotyped or constant, such as forming a counterimage (the person dead—the person alive), forming the original unwanted sexual image five times, using a counting sequence, or using a ritualized internal dialogue sequence to convince oneself that the thought is not true. Other less structured neutralizing strategies may also be used such as distraction, rational self-talk, replacing the negative thought by any positive thought, cognitively checking, "rerunning the film," and so forth, that are not easily described as cognitive rituals ( Freeston & Ladouceur, 1996 ). Finally, reassurance seeking may also be used to


View Full Document

UT PSY 394q - Cognitive—Behavioral Treatment of Obsessive Thoughts A Controlled Study

Download Cognitive—Behavioral Treatment of Obsessive Thoughts A Controlled Study
Our administrator received your request to download this document. We will send you the file to your email shortly.
Loading Unlocking...
Login

Join to view Cognitive—Behavioral Treatment of Obsessive Thoughts A Controlled Study and access 3M+ class-specific study document.

or
We will never post anything without your permission.
Don't have an account?
Sign Up

Join to view Cognitive—Behavioral Treatment of Obsessive Thoughts A Controlled Study 2 2 and access 3M+ class-specific study document.

or

By creating an account you agree to our Privacy Policy and Terms Of Use

Already a member?