Unwanted, ego-alien distressing intrusive thoughts, images, or impulses (i.e., obsessions) are a hallmark of obsessive compulsive disorder (OCD). Until recently the psychological processes involved in the origin, persistence, and treatment of these perplexing intrusive mental repetitions have not been well understood. Over the past decade, a new cognitive perspective on OCD has emerged that has provided new insights into the pathogenesis and treatment of obsessions. In this article we briefly consider recent findings on normal and abnormal obsessions, their relationship to mood disturbance, and the status of key cognitive processes implicated in the pathogenesis of obsessions as discussed in publications by Salkovskis, Rachman, Freeston, Clark, Purdon, and others. We conclude with a discussion of treatment implications and whether the inclusion of cognitive strategies that directly targets change in dysfunctional beliefs and appraisals will enhance standard behavioral treatment of OCD.
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Lyddon and Weill (in this issue) have concluded that constructivism is preferred over standard cognitive theory and therapy because the latter is based on postmodern assumptions about knowledge, reality and the self. They argue that the postmodern basis of constructivism enables it to address criticisms that social constructivism, feminism and multiculturalism have raised with cognitive psychotherapy. In this commentary I have argued that Lyddon and Weill’s evaluation of standard cognitive therapy (CT) is based on a misrepresentation of the basic assumptions of CT concerning knowledge, the social context and the nature of the therapeutic relationship. I conclude that the relative merits of constructivism over standard cognitive therapy cannot be settled by philosophical debate but only by a consideration of the research and treatment innovations offered by each perspective.
- Go to article: Mastery of Obsessive-Compulsive Disorder: A Cognitive-Behavioral Approach Therapist Guide
- Go to article: Perceived Limitations of Standard Cognitive Therapy: A Consideration of Efforts to Revise Beck’s Theory and Therapy
Perceived Limitations of Standard Cognitive Therapy: A Consideration of Efforts to Revise Beck’s Theory and Therapy
In this paper I discuss five basic principles that make Beck’s cognitive therapy (CT) a distinctive school of psychotherapy. In light of these principles, four major criticisms of Beck’s standard cognitive theory and practice are considered. These include: (a) standard CT has a limited view of emotion; (b) CT has an inadequate view of interpersonal factors; (c) CT ignores the therapeutic alliance; and (d) CT overemphasizes conscious controlled processing. Each of these criticisms are evaluated on whether they can be accommodated within the standard CT approach advocated by Beck thereby leading to refinement of his theory and therapy, or whether efforts at revision and/or integration with other schools of psychotherapy result in a transformation so radical as to threaten the distinctiveness of Beck’s therapy.
This article offers a brief review and comment on the three articles by Robert Leahy, Michael Tompkins, and John Riskind and Nathan Williams on case conceptualization and treatment resistance. It focuses on how each of the authors understands treatment failure as a by-product of inaccurate case conceptualization and their proposal for overcoming resistance to change through improved case formulation. I conclude with some general comments on the similarities and differences between the three articles, and propose a number of questions that remain unanswered about the nature of treatment resistance in psychotherapy.
- Go to article: Transdiagnostic Cognitive-Behavioral Treatments for Mood and Anxiety Disorders: Introduction to the Special Issue
Transdiagnostic Cognitive-Behavioral Treatments for Mood and Anxiety Disorders: Introduction to the Special Issue
Transdiagnostic cognitive-behavioral approaches attempt to develop broad theories of clinical conditions (e.g., general theories of mood and anxiety disorders) and corresponding treatment protocols that can be applied to a range of clinical conditions. These can be contrasted with diagnosis-specific theories and treatments, which focus on particular clinical conditions (e.g., theories of panic disorder and panic-specific treatments). In this introductory article we trace the history of transdiagnostic and diagnosis-specific cognitive-behavioral approaches. Both have their origins in the late 1950s and early 1960s. Over the subsequent decades there was waning interest in transdiagnostic approaches and a corresponding increase in interest in diagnosis-specific approaches to theory and treatment. Over the past several years, however, interest has been revived in transdiagnostic approaches. We summarize the reasons for this growing interest and provide an overview of the following articles in this special issue.
- Go to article: The Transdiagnostic Perspective on Cognitive-Behavioral Therapy for Anxiety and Depression: New Wine for Old Wineskins?
The Transdiagnostic Perspective on Cognitive-Behavioral Therapy for Anxiety and Depression: New Wine for Old Wineskins?
Transdiagnostic cognitive-behavioral therapy (CBT) for anxiety and depression has been of growing interest in psychotherapy research. In this article we discuss several fundamental issues raised by contributors to this special issue on transdiagnostic CBT for emotional disorders. Although researchers have tended to assume that interventions are transdiagnostic because they are labeled as such, the actual boundary between transdiagnostic and disorderspecific treatments may be far less clear than previously acknowledged. Nevertheless, there are many reasons to advocate for greater attention to a transdiagnostic perspective, not the least being the large shared variance in the emotional disorders, which is often overlooked in contemporary disorder-specific CBT protocols. Evidence of the efficacy of transdiagnostic CBT for anxiety and depression is limited, and issues facing comparative outcome and process studies are discussed. The article concludes by suggesting a programmatic framework for advancing a theory-driven, empirically based psychotherapy research agenda that could lead to the development of a truly integrated, transdiagnostic CBT for anxiety and depression.
This series of articles discusses the nature, persistence, and treatment of unwanted, distressing intrusive thoughts, images and impulses in depression, generalized anxiety disorder, obsessive compulsive disorder, primary insomnia, and posttraumatic stress disorder. Each of the contributors considers various misinterpretations of an unwanted intrusion and futile efforts to intentionally suppress these thoughts as critical processes involved in the escalation and salience of these cognitive phenomena. Specific treatment recommendations are proposed for dealing with repetitive, unwanted distressing thoughts in each of the clinical disorders.