462 TREATMENT OF SPECIFIC ANXIETY DISORDERS
obsession. Neutralization, which often involves covert mental control activities such as
reciting a certain phrase to one’s self, is mainly directed at undoing or correcting the
perceived negative effects of the obsession (Rachman & Shafran, 1998). Even though
use of overt and covert compulsive rituals distinguishes individuals with OCD from
other anxious and nonanxious comparison groups (Ladouceur, Freeston, et al., 2000),
obsession-prone individuals more often use a variety of control strategies in response
to their unwanted intrusive thoughts and obsessions including thought stopping, ratio-
nalization, distraction, thought replacement, self- punishment, self- reassurance, reassur-
ance seeking from others, or more rarely, do nothing (Freeston & Ladouceur, 1997a;
Ladouceur, Freeston, et al., 2000; Purdon & Rowa, 2002).
Given the faulty appraisals and beliefs of threat, responsibility, and control that
characterize OCD, it is natural that the person with obsessions would turn to compul-
sions and other forms of neutralization in a desperate effort to suppress or prevent the
obsession, reduce associated distress, absolve one’s perceived responsibility, and pre-
vent an anticipated negative outcome (Salkovskis, 1989; Salkovskis & Freeston, 2001).
Although neutralization efforts may be successful in achieving these aims in the short
term, they are nonetheless maladaptive coping strategies that ultimately contribute to
an increase in the frequency, salience, and attention given to the obsession (Salkovskis,
1999). The obsessional persons’ control efforts are counterproductive because of:
- Presence of disconfirmation bias—a person erroneously believes the neutral-
ization was responsible for preventing a feared outcome or for reducing anxi-
ety, thus thwarting exposure to any disconfirming evidence (Rachman, 1998,
2003). - Heightened attention—based on Wegner’s (1994) ironic process theory, any
deliberate effort to control or suppress an unwanted thought will increase auto-
matic attentional search for subsequent reoccurrences of the thought so that the
intrusion gains attentional priority. - Elevated personal responsibility—the temporary success in dealing with the
intrusion will elevate its perceived significance and the person’s responsibility in
preventing the anticipated threat (Salkovskis, 1989). - Excessive control efforts and more ambiguous “stop rules”—repeated brief suc-
cess in terminating the obsessional concern will lead to even more excessive
control efforts and increased difficulty knowing when “enough is enough” (e.g.,
knowing when I have checked enough; Salkovskis & Forrester, 2002).
empiriCal status of the Cognitive moDelThe last decade has witnessed an explosion in empirical research investigating various
facets of the CBT model of obsessions and compulsions. It is beyond the scope of this
chapter to present an extensive review of this burgeoning literature but the interested
reader is directed to several extended critical reviews that have been published in recent
years (see D. A. Clark, 2004; Frost & Steketee, 2002; Julien, O’Connor, & Aardema,
2007; Rachman et al., 2006; Shafran, 2005; Taylor et al., 2007). Below we examine
empirical support for five key hypotheses of the cognitive model.