Belief that it is necessary and possible to
be completely certain that negative
outcomes will not occur
A major contemporary cognitive model is that developed by
the Obsessive Compulsive Cognitions Working Group (26-
28), This intemational group of over 40 investigators shares
an interest in understanding the role of cognitive factors in
OCD, Extending the work of Salkovskis and others, they have
reached a consensus regarding the most important underlying
beliefs in OCD (26), They identified responsibility beliefs and
other belief domains (listed in Table 1) that were said to give
rise to corresponding appraisals. Two self-report measures—
the Obsessional Beliefs Questionnaire and the Interpretations
of Intmsions Inventory—were developed to assess these
domains (27),
Erom Theory to Practice
Typically, at the beginning of CT, the therapist presents a
rationale for treatment incorporating the notion that intmsive
obsessional thoughts are normal experiences and not harmftil
or indicative of anything important. Rather, OCD arises
because the patient appraises the intrusions as significant in a
way that is distressing (for example, "Thoughts of violence
are equivalent to committing violent acts"), Misappraisal of
intrusions in this way leads to preoccupation with the
unwanted thought as well as with responses, such as avoidance
and compulsive rituals, that unwittingly maintain the
obsessional preoccupation and anxiety (10),
Various techniques are used to help patients correct their erroneous
beliefs and appraisals, such as didactic presentation of
educational material and Socratic dialogue aimed at helping
patients recognize and correct dysfunctional thinking pattems.
Behavioural experiments, in which patients enter and
observe situations that exemplify their fears, are often used to
facilitate the collection of information that will allow patients
to revise their judgments about the degree of risk associated
with obsessions. Although the rationale for behavioural
experiments in CT is somewhat different fi-om the rationale
for exposure exercises in ERP, there is often procedtiral overlap,
and fundamental differences between the 2 techniques
may be difficult to discem,
A few specific cognitive techniques used in the treatment of
OCD are as follows: Where patients overestimate personal
respons