Recognition rates, treatment recommendations and stigma attributions for clients presenting with taboo intrusive thoughts: A vignette‐based survey of psychotherapists

Abstract

IntroductionObsessive compulsive disorder (OCD) is a prevalent mental health disorder which is characterised by high levels of morbidity. Most individuals with OCD do not receive adequate psychotherapeutic intervention. Research suggests that taboo intrusive thoughts are less likely to be recognised as OCD in comparison to more recognisable forms. Stigma attributions are higher for individuals with taboo intrusive thoughts. The aim of this study is to examine psychotherapists' capacity to recognise different forms of OCD, their recommendations for psychotherapeutic intervention, and stigma attributions towards clients with OCD symptoms.MethodologyFive hundred fourteen psychotherapists in Ireland were randomly assigned a vignette describing a client with different OCD presentations—paedophilia, aggressive, religious, homosexuality, contamination and symmetry. Participants gave their interpretations of the presenting symptoms, their therapy recommendations and rated their confidence in their responses. Perceived dangerousness and willingness to work with the client were also investigated.ResultsThe taboo intrusive thoughts vignettes were significantly less likely to be recognised as OCD than the contamination and symmetry vignettes. Participants attributed greater levels of stigma to clients with aggressive and paedophilia intrusive thoughts. Recommendations for evidence‐based therapies were low. Participants who recognised OCD were significantly more likely to recommend an evidence‐based therapy. Confidence was a poor predictor of OCD identification and evidence‐based therapy recommendation.ConclusionsThe results suggest a lack of awareness of certain types of OCD presentation amongst psychotherapists, the meaning of the symptoms and of evidence‐based psychotherapeutic interventions for OCD. The implications of this, and possible applications of these results, are discussed.

Harnessing Large Language Models for Identification and Treatment of Obsessive-Compulsive Disorder

“…The behavior and attitude of mental health providers towards their clients can significantly affect treatment outcomes [42,43]. Nevertheless, the present study and the study by Canavan [27] provide encouraging data that show low levels of stigma among mental health professionals. This finding contrasts with several studies that have reported higher levels of stigma among mental health professionals.…”

“…With respect to client gender, there were no significant differences in recognition rates across any of the vignette subtypes. Consequently, the data for the male and female versions of each vignette type were combined for the remainder of the analysis, as reported by Canavan [27].…”

“…We then compared these LLM evaluations with results from 514 psychotherapists in Ireland, as reported by Canavan. [27]. The same vignettes were also used by Glazier et al [35,36] in their articles and underwent extensive validation.…”

“…To investigate the extent to which LLMs are sensitive to OCD, we used a series of vignettes developed by Canavan. [27]. The series included six different types of vignettes: four vignettes covering intrusive thoughts that were deemed taboo (pedophilia, homosexual, aggressive, and religious), as well as vignettes that covered contamination and symmetry.…”

“…Recognizing OCD can be challenging due to the diversity of symptom presentations [26]. OCD generally manifests in four key subtypes: contamination, symmetry/incompleteness, responsibility for harm, and taboo intrusive thoughts [27,28]. Of these, taboo intrusive thoughts such as aggressive/violent, religious, or sexual obsessions are more difficult to recognize and have fewer treatment outcomes, often leading to misdiagnosis [29].…”