Evaluation of an Inference‐Based Approach to Treating Obsessive‐Compulsive Disorder

O’Connor, Kieron; Aardema, Frederick; Bouthillier, Donald; Fournier, Stéphanie; Guay, Stéphane; Robillard, Sophie; Pélissier, Maud; Landry, Pierre; Todorov, Christo; Tremblay, Martin; Pitre, Denise

doi:10.1080/16506070510041211

Cited by 82 publications

(60 citation statements)

References 34 publications

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“…Beliefs may be transmitted; however, where an idiosyncratic belief is arrived at punctually, it may draw on shared or at least accepted subcultural beliefs-but in a confusing manner. O'Connor et al 45 have referred to this process as inferential confusion and the inferential process is best revealed when examining the narrative rather than resting just with isolated statements out of context. Inferential confusion is characteristic of obsessional and delusional disorder, as compared with other anxiety disorders and nonpsychiatric controls, and that its presence correlates highly with symptomatology.…”

Section: Cognitive Styles In Psychosismentioning

confidence: 99%

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Cognitive and Meta-cognitive Dimensions of Psychoses

O’Connor

2009

Can J Psychiatry

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T he cognitive approach distinguishes between the normality of psychotic experiences and the later appraisal and (sub)cultural context making sense of the experience and emotional reaction to the thoughts. A key claim here is that the symptoms of a psychotic experience, for example, voice hearing, delusions, persecutory ideas, and dissociations, are all phenomena that have been experienced at one time by most people without psychosis. What makes the symptoms more persistent in the case of psychosis is a peculiar combination of emotional stress, feelings of vulnerability, threat appraisals, cognitive styles, and cultural and personal beliefs that together create distress and dysfunction about anomalous experiences.Thus cognitive models represent a sharp shift away from a medical model focusing on symptoms toward viewing the psychotic experiences as a product of an interaction of several psychological process dimensions. Further, most of these process dimensions, which include external attribution, threat appraisal, resistance to thoughts coupled with low self-esteem, and fluctuations in affective state, if taken separately, constitute also processes present in different degrees in nonclinical populations. This paper outlines cognitive approaches to understanding and treating positive psychotic symptoms, such as hallucinations, delusions, and dissociations. Recent cognitive accounts of psychosis are reviewed along with the claim that it is not the symptoms themselves but cognitive and meta-cognitive appraisals (attributions and beliefs) about the significance of the symptoms that cause distress and dysfunction. Psychotic symptoms do lie on a continuum with normal experience. Cognitive appraisal dimensions may interact with reasoning styles such as inferential confusion, cognitive slippage, fantasy proneness, and perceptual immersion (styles also normally distributed in the population) and together persuade the person with psychosis to live in fictional narratives as if they were real. Recent clinical studies suggest that addressing beliefs about symptoms modifying inferential styles and normalizing experiences may help symptom management.Can J Psychiatry. 2009;54(3):152-159. Highlights· Psychoeducation techniques normalizing anomalous experiences in psychosis could help relieve symptom distress. · Cognitive therapy may usefully target beliefs and meta-worries in response to anomalous experiences rather than the experiences themselves. · Hallucinations and delusions may not result from perceptual distortion but rather from cognitive styles, which encourage cognitive, affective, and sensory immersion in fictional narratives.that the thought has been injected into them by an evildoer, instead of treating the sensation as a maturational event.Someone who understands that stress narrows attention may well let go that they forgot an important errand when stressed. For someone who does not or cannot accept such forgetfulness, even under stress, some other unusual cause must be sought and the memory lapse means they are m...

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Section: Cognitive Styles In Psychosismentioning

confidence: 99%

“…Inferential confusion (confusing fictional and nonfictional narratives) can be modified through narrative re-storying. 45 Psychoeducation is needed also in how appraisals, metacognitions, and attributions maintain distress. A series of cognitive strategies are recommended for eliminating cognitive biases.…”

Section: Treatment Implicationsmentioning

confidence: 99%

Cognitive and Meta-cognitive Dimensions of Psychoses

O’Connor

2009

Can J Psychiatry

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“…Furthermore, it is apparent that CR alone can have a significant treatment effect even in the absence of systematic, intensive ERP (Cottraux et al, 2001;Whittal et al, 2005;Wilson & Chambless, 2005). Although some studies have found CBT equivalent to ERP (Cottraux et al, 2001;Whittal et al, 2005), others reported that intensive ERP alone is more effective than CBT (McLean et al, 2001) or that adding CR to ERP did not significantly improve treatment outcome (O'Connor et al, 2005). Moreover, Whittal, Woody, McLean, Rachman, and Robichaud (2010) found that CBT and stress management were equally effective in treating individuals who experienced obsessions without overt compulsions.…”

Section: Component Analysismentioning

confidence: 98%

Cognitive Restructuring

Clark¹

2013

The Wiley Handbook of Cognitive Behavioral Therapy

114

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Cognitive restructuring is the core therapeutic ingredient of cognitive therapy that was first introduced to the psychotherapy community by A. T. Beck and colleagues. This chapter provides a detailed breakdown and elaboration of cognitive restructuring and how it is implemented to effect symptom change. The nature of cognitive restructuring and its multifaceted therapeutic components are discussed. A critical review of the empirical research on its treatment efficacy is presented, as well as the evidence for cognitive mediation from component and mediation process research. It is concluded that cognitive restructuring is an effective treatment strategy for psychological disorders, especially anxiety and depression. However, superiority to other “less cognitive” interventions has not been demonstrated, even though the effectiveness of cognitive restructuring does occur by inducing cognitive change. Various research issues are raised that would advance a greater understanding of the mechanisms of change associated with cognitive restructuring. With greater knowledge of the change processes that characterize cognitive restructuring, clinicians will be better equipped to employ this powerful therapeutic intervention.

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“…In a recent study, IBT was shown to be as effective as behavioural or cognitive therapy as usual in treating OCD patients. Moreover, it was found to be more effective than cognitive therapy in people with OCD with high obsessional investment (O'Connor et al, 2005a). As BDD shares many similarities with OCD and as it is characterized by high levels of OVI, IBT appears a viable treatment for clients with BDD.…”

Section: Cihr Author Manuscript Cihr Author Manuscriptmentioning

confidence: 99%

Inference‐Based Therapy for Body Dysmorphic Disorder

Taillon¹,

O’Connor²,

Dupuis

et al. 2011

Clin Psychology and Psychoth

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Body dysmorphic disorder (BDD) is a debilitating disorder characterized by an excessive preoccupation with an imagined or very slight defect in one's physical appearance. Despite the overall success of cognitive behavioural therapy (CBT) in treating BDD, some people do not seem to benefit as much from this approach. Those with high overvalued ideation (OVI), for instance, have been shown to not respond well with CBT. The purpose of this study was to evaluate the efficacy of an inference-based therapy (IBT) in treating BDD. IBT is a cognitive intervention that was first developed for obsessive-compulsive disorder with high OVI, but whose focus on beliefs can also apply to a BDD population. IBT conceptualizes BDD obsessions (e.g., 'I feel like my head is deformed') as idiosyncratic inferences arrived at through inductive reasoning processes. Such primary inferences represent the starting point of obsessional doubt and the treatment focuses on addressing the faulty inferences that maintain the doubt. Thirteen BDD participants, of whom 10 completed, underwent a 20-week IBT for BDD. The participants improved significantly over the course of therapy, with large diminutions in BDD and depressive symptoms. OVI also decreased throughout therapy and was not found to be related to reduction in BDD symptoms. Although a controlled-trial comparing CBT with IBT is needed, it is proposed that IBT constitutes a promising treatment alternative for BDD especially in cases where OVI is high. KeywordsBody Dysmorphic Disorder; Inference-Based Approach; Inference-Based Therapy; Overvalued Ideation; Cognitive Therapy Body dysmorphic disorder (BDD) is characterized by an excessive pre-occupation with an imagined or very slight defect in physical appearance. Although concerns can relate to body weight or shape, they should not be better accounted for by another mental disorder such as anorexia nervosa or bulimia (American Psychiatric Association, 2000). Any body part can become the focus of concern but the most common parts are the skin, hair, nose, weight and stomach (Phillips, 2005). BDD is associated with markedly poor psychosocial functioning and low quality of life (Phillips, Menard, Fay, & Pagano, 2005) and with high levels of suicidal ideation (57.8%) and suicide attempts (2.6%) (Phillips & Menard, 2006 CIHR Author Manuscript CIHR Author Manuscript CIHR Author Manuscriptprevalence of the disorder in the general population appears to range between 0.7% and 2.4% (Faravelli, Salvatori, Galassi, & Aiazzi, 1997;Koran, Abujaoude, Large, & Serpe, 2008) but rates are much higher in certain groups such as students (2-13.1%) (Grant, Kim, & Crow, 2001;Mayville, Katz, Gipson, & Cabral, 1999) as well as in those presenting in dermatology (8.5-21.1%) and cosmetic surgery settings (2.9-16.6%) (Bellino etal., 2006;Bowe, Leyden, Crerand, Sarwer, & Margolis, 2007;Castle, Molton, Hoffman, Preston, & Phillips, 2004; Vulink et al., 2006).BDD is currently classified under somatoform disorders in DSM-IV-TR, but many experts conceptualize it as ...

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Evaluation of an Inference‐Based Approach to Treating Obsessive‐Compulsive Disorder

Cited by 82 publications

References 34 publications

Cognitive and Meta-cognitive Dimensions of Psychoses

Cognitive and Meta-cognitive Dimensions of Psychoses

Cognitive Restructuring

Inference‐Based Therapy for Body Dysmorphic Disorder

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