Obsessive– Compulsive Disorder 473
of the main cognitive and behavioral characteristics of obsessions and compulsions that
should be assessed in a cognitive case formulation.
Process- Oriented Assessment of Obsessions
After determining the client’s primary obsession from the diagnostic interview and
symptom assessment, the therapist obtains a detailed individualized assessment of vari-
ous features of the obsession and its appraisal that will provide direction for therapy.
For clients who have more than one main obsession, the client and therapist should col-
laboratively select one obsession that will be the initial focus of treatment. The therapist
questions the client on all the situations or cues that can trigger the obsession. A list of
situations is compiled that includes both frequent (i.e., daily) and less frequent triggers
of the obsession. The main focus will be on external situations but it could also include
internal cues like certain bodily sensations, emotions, or other thoughts that trigger the
obsession. A complete situational analysis should include the average distress associated
with each situation or cue, likelihood that the situation will trigger the obsessions, and
degree of avoidance associated with the situation. If clients have difficulty reporting on
eliciting situations, a situation self- monitoring form can be assigned as homework (for
copy of Situational Record Form, see D. A. Clark, 2004).
It is also critical to assign an obsession self- monitoring form as homework in order
to collect pretreatment baseline data on frequency, level of distress, effort to control,
and urge to engage in neutralization. This information will be useful in estimating the
probable length of treatment and for determining the success of the intervention. A copy
of a Daily Record of Primary Obsession can be found in Appendix 11.1.
The therapist also determines the type and intensity of emotion associated with the
obsession. Although anxiety is the most common emotion associated with obsessions,
other emotions like guilt, frustration, shame, and anger can also be present. The therapist
also explores with the client the perceived threat or anticipated negative consequences
associated with the obsession. For example, a client who compulsively checked that the
clothes dryer door was shut was afraid her cat might get locked inside and suffocate. In
addition to a few primary threats, clients are often concerned that the obsession will
result in overwhelming anxiety or an inability to function at work or school. All threats
or negative consequences associated with the obsession should be listed along with rat-
ings of distress associated with the expected consequence, its likelihood of occurrence,
table 11.3. summary of idiographic process-oriented assessment of obsessions and Compulsions
Characteristics of obsessions Characteristics of compulsions
••List of situations or cues that trigger the
obsession
••Daily frequency of primary obsession
••Type and intensity of emotion associated with
obsession
••Perceived threat or negative consequences due to
obsession
••Control effort and its perceived success
••Other primary appraisals of obsession
••Perceived consequences of failed control of
obsession••Hierarchy of anxious or avoided situations
related to obsessions or compulsions
••Daily frequency of primary compulsion
••Urge to engage in compulsion
••Extent and perceived success of resistance to
compulsion
••Identification of other types of neutralization
and control strategies utilized
••Level of insight into the excessive or irrational
nature of obsessions and compulsions