Obsessive Compulsive Disorder (OCD) Formulation
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Introduction & Theoretical Background
The essential insight of the cognitive behavioral model of obsessive compulsive disorder (OCD) is that it is the client’s interpretation of the intrusion which drive the distress and maladaptive responses (Salkovskis, Forrester & Richards, 1998). Intrusive thoughts, images, urges, and doubts are very common and entirely normal (Purdon and Clark, 1993, 1994): what gives intrusions their emotional power in OCD is the meaning that clients assign to them. Individuals with OCD commonly interpret the occurrence or content of their intrusions as:
- Meaning something bad about them and/or that something bad will happen, and
- Believing that they are personally responsible for preventing harm to themselves and/or others
Interpreting intrusions through the lens of responsibility 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
Therapist Guidance
This worksheet is designed as a case conceptualization tool for therapists. If it is used with clients it can help to structure a discussion about how the client’s experiences and reactions interact. Case conceptualization is considered to be most effective when it is collaborative exploration of a client’s difficulties rather than presented as a ‘completed solution’ (Kuyken, Padesky, Dudley, 2011). If the worksheet is used in session with a clients, it is best introduced as a tentative tool for exploration.
The therapist might introduce it by saying “some people’s OCD responses fit the pattern on this diagram. I wonder if we could we explore some of your thoughts, feelings, and reactions and see what kind of pattern they follow?”.
- Ask the client to think of a recent time when they experienced an intrusion
- Help the client to focus on the meaning of the intrusion: “What does it say about you
References And Further Reading
- Kuyken, W., Padesky, C. A., & Dudley, R. (2011). Collaborative case conceptualization: Working effectively with clients in 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.