Maladaptive cognitive processes during exposure in people with OCD (checking subtype)

Cognitive Behaviour Therapy (CBT) is regarded as one of the most efficacious psychological treatments of Obsessive Compulsive Disorder (OCD) and is recommended in the recent National Institute for Clinical Excellence guidelines (NICE, 2006). Despite this, comparative studies have consistently shown CBT to be no more effective than Exposure and Response Prevention (ERP; McLean et al., 2001). Recently, cognitive theories of OCD have identified specific cognitive mechanisms involved in symptom-based subtypes of OCD (OCCWG, 1997,2005). It is possible that specifically targeting these mechanisms may increase the efficacy of the cognitive component of treatment (McKay et al., 2004). This study aims to expand on recent research that suggests that repeated checking behaviours are maladaptive coping strategies that serve to maintain the difficulty (Rachman, 2002). Because previous research suggests that individuals with checking rituals are more likely to have an intolerance of uncertainty (Tolin et al., 2003), it is possible that they will also use specific cognitive safety behaviours to try to manage their anxiety during exposure. The current study hypothesized that the use of a memory search and a reasoning task during exposure would lead to a decrease in memory detail and confidence,and an increase in urge to check and anxiety. Data were collected from five participants currently on the waiting list for clinical psychology services. A single case experimental design with counterbalancing was used to test each hypothesis. The results of the study were mixed and showed little change in all four experimental conditions. Furthermore, mean change scores were inconsistent with the research hypotheses. That is, the use of a memory search and a reasoning task did not appear to have a maladaptive effect. The clinical and research implications of the results are discussed along with several limitations of the study. On the basis of the findings, it was concluded that OCD is a heterogeneousd isorder and that further research is needed to examine the suitability of subtyping in OCD and the implications this has for treatment.