Obsessions, compulsions, motivation, and responsibility for harm

in a recent critique of current cognitive approaches to obsessional problem s, O'Kearney (1998) suggests that there are significant problems with the t heory and seeks to propose an alternative conceptualisation. Cognitive theo ries of obsessive-compulsive disorder (OCD) are criticised because he belie ves them (a) to be silent on motivational components specific to the disord er, (b) to not adequately explain why people are upset by their negative ev aluation of intrusive thoughts, (c) to not provide an adequate account of t he compulsive and repetitive quality of obsessional symptoms, and (d) to di sregard the emotional concerns of the sufferer as influential factors in th e etiology and maintenance of the disorder. We argue in this paper that O'K earney's critique is mistaken as all of these issues are adequately address ed by current cognitive theorising. Specifically, we point out that (a) mot ivation is a central and crucial aspect of cognitive theories of anxiety di sorders, (b) the link between responsibility beliefs concerning subjectivel y crucial negative events and distress is understandable, (c) compulsivenes s and repetitiveness are readily accounted fur 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 problem s. Careful examination of O'Kearney's alternative theory suggests that it i s inconsistent with both research evidence and the phenomenology of OCD. Fu rther, 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 the ir problems, and at worst may lead the therapists in directions that may pr ove to be counterproductive for their patients.