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Cognitive Behavioral Model Of Obsessive Compulsive

Disorder (OCD) (Salkovskis, Forrester, Richards, 1998)
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 Description

The essential insight of the cognitive behavioral model An important treatment implication of the cognitive
of obsessive compulsive disorder (OCD) is that it is the behavioral model of OCD is that clinicians can work
client’s interpretation of the intrusion which drives at the level of the meaning of the intrusion. This can
the distress and maladaptive responses (Salkovskis, be contrasted with traditional exposure and response
Forrester & Richards, 1998). Intrusive thoughts, images, prevention, which can be framed as an intervention at
urges, and doubts are very common and entirely normal the level of the compulsion or neutralizing behavior.
(Purdon and Clark, 1993, 1994): what gives intrusions Clients can be helped to develop an alternative, less-
their emotional power in OCD is the meaning that threatening, interpretation of what the intrusions mean
clients assign to them. Individuals with OCD commonly (theory b), and then to test this alternative through a
interpret the occurrence or content of their intrusions as: process of information-gathering which might include
symptom monitoring, behavioral experiments, and
• Meaning something bad about them and/or that
exposure exercises. The Cognitive Behavioral Model
something bad will happen.
Of Obsessive Compulsive Disorder (OCD) presents the
• Believing that they are personally responsible for cognitive model of Salkovskis, Forrester & Richards
preventing harm to themselves and/or others. (1998) and provides a number of case examples and
Interpreting intrusions through the lens of responsibility worksheets for case conceptualization.
has a number of effects including: increased discomfort,
increased focus of attention on the intrusions, increased
accessibility of the intrusions, active attempts to reduce
the intrusions, and attempts to decrease or discharge
the responsibility that the individual perceives is
associated with them. Although these efforts can lead to
short-term reductions in anxiety, in the long-term they
increase preoccupation with the intrusive thoughts and
maintain the pattern of responses to them.
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 Instructions

3. Help the client to describe their responses to

interpreting the intrusion in this way:
Suggested Question “What do you do to cope?”
“What do you do to prevent the worst from happening?”
Some people’s OCD responses fit the pattern on
this diagram. I wonder if we could we explore “What do you pay extra attention to or look out for?”
some of your thoughts, feelings, and reactions and “What do you feel when you think about things in this
see what kind of pattern they follow? way?”
4. Explore the consequences of the client’s reactions
1. Ask the client to think of a recent time when they
and consider whether any of these reactions might
experienced an intrusion.
act to reinforce the cycle. A common pattern to look
2. Help the client to focus on the meaning of the for is that reactions lead to short-term improvements
intrusion: (e.g. feeling safer) but either no change to, or a
“What does it say about you that you had this intrusion worsening of, the sequence in the long-term.
/ thought / image / doubt / urge?”
“What would other people think of you if they knew you
had this thought?”
“How responsible do you feel for preventing this event
from happening?”
“If other people knew you had this thought how
responsible would they think you are for preventing
[negative outcome] from happening?”

References

Kuyken, W., Padesky, C. A., & Dudley, R. (2011). Collaborative case conceptualization: Working effectively with clients in
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cognitive-behavioral therapy. Guilford Press.

Purdon, C., & Clark, D. A. (1993). Obsessive intrusive thoughts in nonclinical subjects. Part I. Content and relation with
depressive, anxious and obsessional symptoms. Behaviour Research and Therapy, 31(8), 713-720.

Purdon, C., & Clark, D. A. (1994). Obsessive intrusive thoughts in nonclinical subjects. Part II. Cognitive appraisal,
emotional response and thought control strategies. Behaviour Research and Therapy, 32(4), 403-410.

Salkovskis, P. M., Forrester, E., & Richards, C. (1998). Cognitive–behavioural approach to understanding obsessional
thinking. The British Journal of Psychiatry, 173(S35), 53-63.

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 Cognitive Behavioral Model Of Obsessive Compulsive Disorder
(OCD: Salkovskis, Forrester, Richards, 1998)

Early experiences Critical incidents

(making you (what started
vulnerable to OCD) the OCD off )

Assumptions, general beliefs

(e.g. not preventing disaster is as bad as
making it happen; better safe than sorry)

Intrusive thoughts, images, urges, doubts

Neutralizing actions Attention and

(rituals, reassurance, reasoning biases
mental argument) (looking for trouble)

Misinterpretation of significance
of intrusions –
responsibility for actions
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Counterproductive Mood changes

safety strategies (distress, anxiety,
(thought suppression, depression)
impossible criteria,
avoidance)

Copyright © 1998. Reprinted with permission from Cambridge University Press.

Salkovskis, P. M., Forrester, E., Richards, C. (1998).
PSYCHOLOGYT LS
®
Cognitive-behavioural approach to understanding obsessional thinking. British Journal of Psychiatry, 173(suppl. 35), 53-63.
 Cognitive Behavioral Model Of Obsessive Compulsive Disorder
(OCD: Salkovskis, Forrester, Richards, 1998)

Explore experiences that

Early experiences relate to intrusions, client’s Critical incidents
(making you beliefs regarding (what started
vulnerable to OCD) responsibility. the OCD off )

Assumptions, general beliefs

Share information with (e.g. not preventing disaster is as bad as
clients that they may
not have – making it happen; better safe than sorry)
psychoeducation about
frequency of intrusive thoughts in the population.
Conduct surveys to Encourage experiments
test whether other Intrusive thoughts, images, urges, doubts comparing engaging in
people have similar ‘scanning’ versus
experiences. dropping this
attentional
strategy.
Neutralizing actions Attention and
(rituals, reassurance, reasoning biases
mental argument) (looking for trouble)

Confront situations /
triggers without engaging
in compulsions /
safety strategies. Misinterpretation of significance Explore these
of intrusions – interpretations
responsibility for actions and test their
validity.
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Counterproductive Mood changes

safety strategies (distress, anxiety,
(thought suppression, depression)
impossible criteria,
avoidance) Confront situations /
triggers without
engaging in compulsions /
safety strategies.
Copyright © 1998. Reprinted with permission from Cambridge University Press.
Salkovskis, P. M., Forrester, E., Richards, C. (1998).
PSYCHOLOGYT LS
®
Cognitive-behavioural approach to understanding obsessional thinking. British Journal of Psychiatry, 173(suppl. 35), 53-63.
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Resource details
Title: Cognitive Behavioral Model Of Obsessive Compulsive Disorder (OCD: Salkovskis, Forrester, URL: https://www.psychologytools.com/resource/cognitive-behavioral-model-of-obsessive-
Richards, 1998) compulsive-disorder-salkovskis-forrester-richards-1998/
Type: Information Handout Resource format: Professional
Language: English (US) Version: 20230721
Translated title: Cognitive Behavioral Model Of Obsessive Compulsive Disorder (OCD: Salkovskis, Last updated by: EB
Forrester, Richards, 1998)

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