From the laboratory to the clinic (and back again): How experiments have informed cognitive–behavior therapy for obsessive–compulsive disorder

Abstract

Behavioral and cognitive models-as well as complementary theories such as the inference-based, mood-asinput, and seeking proxies for internal states approaches-have been put forward to explain the development and maintenance of obsessive-compulsive disorder (OCD). Although theory is important to inform the conceptualization and treatment of OCD, experimental research is essential to provide empirical support for these different theoretical approaches. Experiments allow an increased understanding of the mechanisms (e.g., maladaptive beliefs) associated with the etiology and maintenance of OCD symptoms and, in this way, directly contribute to the expansion and creation of cognitive-behavioral treatment strategies. This selective review demonstrates how foundational and sometimes groundbreaking experiments pertaining to core OCD symptoms (i.e., checking/reassurance seeking, obsessions, contamination, and ordering/arranging) have informed the improvement of cognitive-behavior therapy for this debilitating mental illness. The relevance of experiments with both clinical and analog samples is discussed, and recommendations for future experimental work are provided.

Always Saying the Wrong Thing: Negative Beliefs About Losing Control Cause Symptoms of Social Anxiety

“…Finally, although experimental work with analogue samples provides valuable insight into the cognitive mechanisms which underlie symptoms observed in disorders such as SAD (e.g., Abramowitz et al, 2014 ; Gagné et al, 2018 ), they are not a replacement for work with clinical samples. Further, given that beliefs about losing control and post-event processing are thought to be relevant in anxiety-related disorders more transdiagnostically (e.g., Perera et al, 2016 ), an important future direction for this research would be to examine the specificity of these beliefs in social anxiety, perhaps by comparing nature of these beliefs and their impact on symptoms across anxiety related disorders.…”

“…An analogue sample completed a bogus cognitive task and then received false feedback that they were either at high or low risk of losing control. Experimental manipulation of beliefs related to psychopathology in analogue samples can provide valuable insight into how these phenomena may function among clinical populations (e.g., Abramowitz et al, 2014 ; Gagné et al, 2018 ). This research was conducted in the context of the COVID-19 pandemic; therefore, all data collection and interactions were conducted online.…”

Modelling OCD: a test of the inflated responsibility model

“…It may be that the processes involved in the onset and maintenance of clinical OCD are not comparable to those in subclinical obsessive compulsive symptoms. However, several recent review articles have found strong support for the validity of using analogue samples in OCD research (Abramowitz et al, 2014;De Putter et al, 2017;Gagné et al, 2018a).…”

Exam-related unwanted intrusive thoughts and related neutralizing behaviors: Analogues to obsessions and compulsions

“…One limitation of this method is that the participants tend to experience the selected UITs very rarely [e.g., a few times a year; 17 , 20 , 21 ], which might compromise the transfer of results to obsessions and compulsions. In the second practice, researchers temporarily induce UITs and neutralizing behaviors in the laboratory [ 16 , 22 ]. For example, writing and then saying out loud a sentence such as “I hope [insert loved person] is in a car accident” can be an effective method of inducing UITs and neutralizing behaviors that resemble obsessions and compulsions [ 10 , 16 , 23 , 24 ].…”