Compulsive behaviours and levels of belief in obsessive–compulsive disorder: a case-series analysis of their interrelationships

Abstract

This study examined interrelationships of changes in compulsive behaviours and two levels of belief over treatment of obsessive-compulsive disorder (OCD). Levels were individual-specific obsessive beliefs (termed here manifest beliefs) and OCD-relevant general beliefs. If OCD-relevant general beliefs are functionally linked to manifest beliefs and compulsive behaviours, changes in compulsive behaviours and both belief types should occur mostly in tandem, even if only one or two of these three elements are explicitly targeted. Baselines consisting of time performing compulsive behaviours, strength of manifest belief and strength of OCD-relevant general beliefs were monitored daily by six participants over three phases in an A/B/B + C design. (A = no treatment, B = exposure/response prevention and C = cognitive therapy targeting only OCD-relevant general beliefs.) Changes in compulsive behaviours, manifest beliefs and OCD-relevant general beliefs moved primarily in tandem over treatment phases, suggesting functional links between these elements.

Obsessional beliefs, compulsive behaviours and symptom severity: their evolution and interrelation over stages of treatment

“…Our results can be summarized as follows: there was a signifi cant decrease in the duration of compulsive behaviour in all participants but two; all participants but two showed a decrease in conviction levels over treatment phases; and all participants showed a signifi cant decrease in Y-BOCS scores over each treatment phase. Since the sample was chosen on the basis of successful clinically signifi cant outcome, the results seem to confi rm previous fi ndings showing that effective therapy induces uniform change in cognitive and behavioural parameters regardless of the principally behavioural or cognitive orientation of the therapy (Foa, Abramowitz, Franklin, & Kozak, 1999;Lelliott, Noshirvani, Basoglu, Marks, & Monteiro, 1988;Storchheim & O'Mahoney, 2006). However, decrease in conviction levels of obsessional doubt and anticipated consequences could show desynchrony.…”

“…For the Y-BOCS, the test-retest reliabilities were known and these varied between 0.81 and 0.97. So following Storchheim and O'Mahoney (2006), the conservative estimate of 0.81 was chosen.…”

“…The longitudinal data was initially analysed by visual inspection to look for transition points and then analysed statistically following the procedure of Mueser, Yarnold and Foy (1991) and Storchheim and O'Mahoney (2006), similar to Jacobson and Truax (1991). The statistical procedure permitted testing for signifi cant changes over three phases of treatment, namely the baseline, the mid-treatment and the end of treatment.…”

“…A previous study divided cognitions into two levels (Storchheim & O'Mahoney, 2006). The fi rst level represented OCD individual-specifi c beliefs such as the belief that one might cause harm to others and that one needed to neutralize any disastrous consequences.…”

“…The second level represented more general OCD-relevant beliefs such as the tendency to overestimate danger and to have an infl ated sense of responsibility. For Storchheim & O'Mahoney (2006), individual-specifi c beliefs referred to manifest thoughts refl ecting the immediately apparent nature, by defi nition, of fi rst-level beliefs. General beliefs referred to an underlying level of OCDrelevant thoughts that may or may not be specifi c to OCD.…”