Table 1 Domains of dysfunctional
Belief domain
Excessive responsibility
Overimportance of thoughts
Need to control thoughts
Overestimation of threat
Perfectionism
Intoierance for uncertainty
beliefs associated with OCD
Description
Belief that one has the special power to
cause, and (or) the duty to prevent,
negative outcomes
Belief that the mere presence of a
thought indicates that the thought is
significant (for example, the belief that
the thought has ethical or moral
ramifications or that thinking the thought
increases the probability of the
corresponding behaviour or event)
Belief that complete control over one's
thoughts is both necessary and possible
Belief that negative events are
especially likely and would be especially
awful
Belief that mistakes and imperfection are
intolerable
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