Cognitive Therapy of Obsessive – compulsive Disorder: Treating Treatment Failures

Abstract

Foa (1979) has identified two groups of obsessional patients for whom behaviour therapy is ineffective; those with severe concurrent depression and those with “overvalued ideation”. She has also highlighted the need for the development of new treatment strategies for these individuals. A case history illustrating the development of overvalued ideation in a previously typical obsessional patient is described, together with an account of a successful treatment based on Beck's cognitive therapy combined with exposure. The implications of this report for views on the development of overvalued ideation in obsessionals are discussed. It is argued that cognitive–behavioural interventions such as the one described here may be useful as an adjunct to more traditional behavioural treatments for obsessional disorders as well as in the treatment of patients with overvalued ideation.