Vitosha Hall - Marinela

Neither Hurting nor Harming: Using CBT to empower people with OCD to choose to change - Part II

Obsessive-compulsive disorder results when people misinterpret otherwise normal intrusive cognitions as indicating not only that harm may occur, but that they may be responsible for it through what they do or fail to do. The preventative action is motivated by the way in which the person interprets intrusions. Such responses have two effects. Firstly, they can increase the occurrence of intrusive cognitions and secondly, maintain or even increase the person’s beliefs about threat and their responsibility for it.

Cognitive-behavioural treatment builds on this modification of behavioural theory and Exposure and Response Prevention. The primary focus of intervention is to help the patient understand their problem as one of anxiety rather than danger in order to weaken the motivation and drive for compulsive responses as a prelude to helping the patient to choose to respond differently. Ultimately the purpose of such interventions is to allow the person affected by OCD to reclaim their life, a process which should be integral to treatment.

The importance of treatment flexibility and integrity will be emphasised; detailed supervision is the best strategy to ensure these. Although some discomfort is likely as people reclaim their lives, CBT really doesn’t have to hurt,!

The process of treatment will be illustrated through practical clinical case material, including where possible video of actual therapy. Examples of more complex and “difficult to treat” issues will be included.


Challacombe, F., Oldfield, V. & Salkovskis, P.M. (2011) Break Free from OCD  Vermillion Press (a book intended for patients as a self help guide….some less experiencedtherapists also find it useful)

Bream, V, Challacombe, F, Palmer, A & Salkovskis, P.M. (2017) Cognitive Behaviour Therapy for OCD   Oxford University Press: Oxford (A very recent Therapist Manual)