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Intrusion Record

What differentiates intrusive congitions in OCD is the meaning that clients with OCD attach to them. The Intrusion Record is a CBT worksheet for capturing the incidence and meaning of intrusive thoughts and images.

Worksheet

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Description

The Intrusion Record is a form for capturing the content and meaning of intrusive thoughts and images. A key concept when working with cognitive intrusions is that it is often not the intrusion itself which is bothersome, but the meaning that the individual ascribes to the intrusion. For example, a client with OCD may have an intrusion of their children getting ill, but be most bothered by the idea that they would be responsible were that to happen. This worksheet can be used to train clients to capture both the content of an intrusion, and the meaning that they associate with that intrusion. The intrusion record was designed for working with OCD-type intrusions (thoughts, images, urges, or obsessions), but may be equally appropriate for working with intrusions in PTSD where peri-traumatic or post-traumatic meanings may be attached to an image. The original idea for this worksheet was submitted to Psychology Tools by Carlos Velazquez.

Instructions

  1. Start by identifying the situation or trigger for the cognitive intrusion. When trying to recall past intrusions the process of eliciting information about where and when the intrusion occurred can aid memory elaboration. Record this information in the first column.
  2. Record details about the content of the cognitive intrusion. Intrusions can be thoughts, images, memories, urges, doubts, or other forms of obsession. Encourage the client to record as much information as possible. Record this information in the second column.
  3. In the third column record the client’s interpretation of the intrusion. Helpful questions to ask include “what does that thought/image/memory say about you?”, “if that thought were true what would it say about you?”, “if other people knew you had that thought what do you worry they would think of you?”
  4. Use the fourth column to record information about how the client coped with that intrusion. Did they attempt to avoid or suppress it? Did they feel the urge to perform an action or behavior (compulsion) to neutralize it?

References

  • Brewin, C. R., Gregory, J. D., Lipton, M., & Burgess, N. (2010). Intrusive images in psychological disorders: characteristics, neural mechanisms, and treatment implications. Psychological Review, 117(1), 210.
    Rachman, S. (2007). Unwanted intrusive images in obsessive compulsive disorders. Journal of Behavior Therapy and Experimental Psychiatry, 38(4), 402-410.