A Single Belief as a Maintaining Factor in a Case of Obsessive-Compulsive Disorder

Abstract

A severe case of obsessive-compulsive disorder with 30-year chronicity was successfully treated with 7 sessions of cognitive therapy. The client, a 38-year-old male, was diagnosed as OCD by two independent clinicians. The cognitive treatment model targeted a central obsessional belief concerning the utility of the OCD. Once this single belief central to his compulsive behaviors had been dismantled, the client ceased to perceive his compulsive behaviors as useful and this led to a complete remission of symptoms at post-treatment which was maintained at 6-month and 3-year follow-up. The strategies included linking the content of the intrusion to the feared consequences and subsequent appraisals in order to specify the maintaining belief and comparing the past to the current functionality of the belief. The treatment procedure may be generalizable across other types of OCD. Keywords: obsessive-compulsive beliefs; cognitive therapy Cognitive models of obsessive-compulsive disorder (OCD) have emphasized the importance of addressing underlying assumptions and beliefs in the treatment of OCD (Salkovskis, 1999), particularly those leading to misinterpretations of significance of intrusions. However, the cognitive behavioral treatment of choice for OCD still centers around the behavioral techniques of exposure and response prevention with the addition of cognitive challenge and reality testing of anticipated consequences and appraisals. Although Ladouceur, Leger, Rheaume, and Dube (1996) reported a single case in which cognitive correction of a sense of inflated responsibility produced significant improvement of symptoms, and Freeston, Leger, and Ladouceur (2001) have also noted the plausibility of treating OCD with cognitive therapy, there are few studies reporting the successful treatment of OCD using cognitive therapy alone. The tcurrent case-study report illustrates the successful use of brief cognitive therapy in the case of OCD with a single maintaining belief. Case Report Mr. C. was a 38-year-old male who participated in a controlled study on treatment of OCD. He had been diagnosed with severe OCD and moderate generalized anxiety disorder with no other Axis I or II comorbidity. His rituals were overwhelming and affected most parts of his life. At the time of intake, he had suicidal ideations and suffered from insomnia. He reported having received no previous treatment for his OCD. As a child, his father who was an alcoholic (he described him as a "sociopath") abused him psychologically, physically, and sexually. At age 7, during an episode of physical abuse against his mother, he hid in a wardrobe and started counting and singing aloud so he would not hear his mother's screams. He stayed there until the abusive episode was over and this ritual helped him to lower his anxiety. At the beginning of his adolescence, he acquired the belief that he was at-risk of becoming like his father and this thought produced very high levels of anxiety. He recalled from that day onward how he decided to do everything to protect himself from becoming a vioknt and abusive person. Consequently, he started to perform rituals that were contrary to his father's personality. For example, he became perfectionistic and excessively organized which he perceived as contrary to his father's disorganized personality. This perfectionist behavior was reinforced by his teachers in school and maintained up to university level He also developed superstitious rituals such as stepping over sidewalk lines and always passing around posts to the right. These formed a counterpart to his obsessively organized self-control, since this was a way in which he sought control of extraneous events. These superstitions were intended to prevent a misfortune. Over time, his compulsions permeated all aspects of his life including work, family, and leisure times, although he managed to stay functional Assessment Measures and Procedures Diagnostic assessment was carried out by two independent clinicians using the Anxiety Disorders Interview Schedule-DSM-IV (ADIS-IV; Di Nardo, Brown, & Barlow, 1994) and the Yale-Brown Obsessive-Compulsive Scale (YBOCS; Goodman et al. …