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of danger.When a neutralizing effort brings about a temporary reduction in discomfort,
it is reinforced and will likely be repeated. Eventually the neutralizing thought or act is
used so often that it becomes, by definition, an obsession or compulsion. At the same
time, the individual becomes more and more convinced that his or her unpleasant intrusive thoughts are dangerous. As the person’s fear of such thoughts increases, the thoughts
begin to occur more frequently and they, too, become obsessions.
In support of this explanation, studies have found that people who have obsessivecompulsive disorder experience intrusive thoughts more often than other people, resort
to more elaborate neutralizing strategies, and experience reductions in anxiety after
using neutralizing techniques (Shafran, 2005; Salkovskis et al., 2003).
Although everyone sometimes has undesired thoughts, only some people develop
obsessive-compulsive disorder. Why do these individuals find such normal thoughts so
disturbing to begin with? Researchers have found that this population tends (1) to be
more depressed than other people (Hong et al., 2004), (2) to have exceptionally high
standards of conduct and morality (Rachman, 1993), (3) to believe that their intrusive
negative thoughts are equivalent to actions and capable of causing harm (Steketee et al.,
2003), and (4) generally to believe that they should have perfect control over all of their
thoughts and behaviors (Coles et al., 2005).
Cognitive therapists help clients focus on the cognitive processes involved in their
obsessive-compulsive disorder. Initially, they educate the clients, pointing out how
misinterpretations of unwanted thoughts, an excessive sense of responsibility, and neutralizing acts help produce and maintain their symptoms. The therapists then guide the
clients to identify, challenge, and change their distorted cognitions. It appears that cognitive techniques of this kind often help reduce the number and impact of obsessions
and compulsions (Rufer et al., 2005; Eddy et al., 2004).
While the behavioral approach (exposure and response prevention) and the cognitive approach have each been of help to clients with obsessive-compulsive disorder, some
research suggests that a combination of the two approaches is often more effective than
either intervention alone (McKay et al., 2010; Foa et al., 2005). In such cognitive-behavioral
treatments, clients are first taught to view their obsessive thoughts as inaccurate occurrences
rather than as valid and dangerous cognitions for which they are responsible and upon
which they must act. As they become better able to identify and recognize the thoughts
for what they are, they also become less inclined to act on them, more willing to subject
themselves to the rigors of exposure and response prevention, and more likely to make
gains in that behavioral technique. The Biological Perspective
In recent years two lines of research have uncovered evidence that biological factors play
a key role in obsessive-compulsive disorder, and promising biological treatments for the
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