460 TREATMENT OF SPECIFIC ANXIETY DISORDERS
O’Connor, 2005; O’Connor, Aardema, & Pélissier, 2005, for further discussion). This
faulty inductive reasoning intensifies a state of doubt and confusion which in turn can
elevate the threatening nature of the obsessional concern.
Heightened Arousal and Distress
Increased autonomic arousal may play a more prominent role in certain types of OCD
such as compulsive cleaning where the obsession has strong phobic elements. Other
forms of OCD, such as compulsive checking, may involve different negative emotions
like guilt (Rachman & Hodgson, 1980). Thus the extent of physiological hyperarousal
associated with schematic fear activation in OCD can vary across individual cases,
although autonomic arousal such as elevated heart rate has been well documented when
obsessions are provoked (see Rachman & Hodgson, 1980, for review). When height-
ened physiological arousal is present, the person with OCD is likely to be a motivated
to find relief from this negative state like any other individual with an anxiety disorder.
Moreover, the most obvious immediate defensive response in OCD is some form of
cognitive or behavioral escape/avoidance. Compulsive rituals are a more complex neu-
tralization response that requires considerable elaborative processing and so it is located
within the secondary phase of the model. Finally, any automatic thoughts or images
that occur during the immediate fear response probably reflect the actual obsessional
concerns of the individual.
Secondary Elaborative Processes (Phase II)
Two processes are considered critical to the persistence of OCD at the elaborative phase
of anxiety: (1) the appraisal of the obsession and one’s ability to cope and (2) the per-
formance of a neutralization response or compulsive ritual in order to reduce anxiety
or prevent some anticipated dreaded outcome. The faulty appraisals presented in Figure
11.2 illustrate the evaluations of the obsession that occurs at the secondary phase.
Primary Appraisals of Obsessions
Metacognitive processes, or “thinking about thinking” (Flavell, 1979), are particularly
germane to OCD because the appraisal of obsessional thoughts, images, and impulses
as well as our ability to control them are key cognitive processes responsible for the per-
sistence of the obsession. Wells and Mathews (1994) presented a metacognitive model
of OCD in which beliefs about the significance of intrusive thoughts and a behavioral
response to them provide a framework for the etiology and persistence of OCD (see also
Wells, 1997, 2000). A number of key metacognitive appraisals have been implicated in
the elaboration and persistence of obsessional thinking (see also Table 11.2).
••Inflated responsibility—the significance of a thought is evaluated in terms of a
perceived personal influence that is pivotal to instigating or preventing a subjec-
tively crucial negative outcome to self or others (Salkovskis, 1999; e.g., “If I think
I might have contracted cancer germs, I need to wash myself thoroughly so I don’t
spread the cancer to others”).
••Thought– action fusion (TAF)—interpreting the very occurrence of an intrusive