Obsessions, compulsions, motivation, and responsibility for harm
Salkovskis P., Freeston MH.
In a recent critique of current cognitive approaches to obsessional problems, O'Kearney (1998) suggests that there are significant problems with the theory and seeks to propose an alternative conceptualisation. Cognitive theories of obsessive-compulsive disorder (OCD) are criticised because he believes them (a) to be silent on motivational components specific to the disorder, (b) to not adequately explain why people are upset by their negative evaluation of intrusive thoughts, (c) to not provide an adequate account of the compulsive and repetitive quality of obsessional symptoms, and (d) to disregard the emotional concerns of the sufferer as influential factors in the etiology and maintenance of the disorder. We argue in this paper that O'Kearney's critique is mistaken as all of these issues are adequately addressed by current cognitive theorising. Specifically, we point out that (a) motivation is a central and crucial aspect of cognitive theories of anxiety disorders, (b) the link between responsibility beliefs concerning subjectively crucial negative events and distress is understandable, (c) compulsiveness and repetitiveness are readily accounted for by the cognitive theory, and (d) the cognitive theory regards the emotional concerns of the sufferer as central issues in both the etiology and maintenance of obsessional problems. Careful examination of O'Kearney's alternative theory suggests that it is inconsistent with both research evidence and the phenomenology of OCD. Further, as a heuristic for the treatment of OCD his account is, at best, of no value in bringing about change in the way in which patients react to their problems, and at worst may lead the therapists in directions that may prove to be counterproductive for their patients.