Cognitive behavioral treatment of obsessions without observable compulsions


KLINIK PSIKIYATRI DERGISI-TURKISH JOURNAL OF CLINICAL PSYCHIATRY, vol.24, no.2, pp.257-264, 2021 (ESCI) identifier identifier identifier


Pure obsessions consist of repeated intrusive thoughts, images or impulses that are not related to an overt compulsion, which are mostly ego-dystonic and regarded as unacceptable. Individuals with obsessions without overt compulsions use various suppression and mental control strategies, but these control strategies create a vicious circle by increasing the frequency and intensity of obsessive thoughts. Thus, efforts of different types of interventions are needed to be implemented for this special group. In this case report, the formulation and therapy process of a client who has been diagnosed with OCD and has different obsessions without observable compulsions is included. The therapy process consisted of cognitive behavioral psychotherapy practices including graded exposure and cognitive restructuring with behavioral experiments related to faulty appraisals. During the therapy process, cognitive and behavioral interventions were used to change faulty appraisals including thought-action fusion, exaggerated threat, need for control and intolerance to uncertainty. At the end of the psychotherapy process which consisted of 25 sessions, it was observed that the frequency of the client's intrusive thoughts decreased significantly, faulty appraisals regarding the importance and control of thoughts were replaced by realistic thoughts, and the attempts of the client to control and suppress thoughts and, also OCD symptoms decreased. As a result, in the treatment of obsessions without overt compulsions it is considered important to combine behavioral techniques with cognitive intervention techniques regarding faulty appraisals of intrusive thoughts and appraisals of mental control.