Cognitive and behavioural treatments of checking behaviours: An examination of individual cognitive change

Most tenants of cognitive models agree that the way OCD patients evaluate t heir intrusive thoughts leads them to use compulsions. In contrast, others have suggested that patients' cognitions would be post hoc rationalizations for their irrational neutralizing. This study examined individual cognitiv e change during successful Cognitive Therapy (CT) of compulsive checking us ing Multivariate Time Series (MTS) analysis. We also verified whether simil ar cognitive changes occurred during a standard Exposure and response preve ntion Treatment (ET). Six OCD patients suffering from compulsive checking p articipated in the study. They rated daily four variables during treatment: (1) belief about responsibility, (2) perfectionistic tendency, (3) perceiv ed severity of outcome if checking not performed and (4) Checking Interfere nce. MTS analysis was carried out on the four variables for each patient to test whether the cognitive change preceded the decrease of Checking Interf erence. Results show that for 2/3 of patients in cognitive therapy and all patients in the exposure treatment, change on at least one cognitive variab le preceded the decrease of checking interference. Moreover, for all but on e patient, some change in symptoms also preceded cognitive change at some p oint during treatment The present study suggests that at least one mechanis m involved during both CT and ET for OCD would involve the precedence of be lief change over symptoms. Results also provide some evidence for another m echanism, which would include the precedence of symptom change over cogniti ons. The question of whether one of these mechanisms occurs first then rema ins to be empirically demonstrated. Copyright (C) 2000 John Wiley & Sons, L td.