How do OCD patients estimate their ability to control events?

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Reuven-Magril, O., Dar, R., & Liberman, N. (2008). Illusion of control and behavioral control attempts in obsessive-compulsive disorder Journal of abnormal psychology, 117(2), 334–341.

The cognitive model suggests that OCD patients misinterpret the importance of normal intrusive thoughts, leading to excessive attempts to control them. Previous studies have found that depressed patients have more realistic (i.e. lower) sense of control compared to non-depressed individuals. As the need for control is usually a problem for OCD patients, the authors in this article wanted to further investigate the “OCD concept of control”.

In this study, participants were presented with a preprogrammed sequence of visual stimuli and encouraged to attempt to control it through keyboard presses. Results showed that participants with high OC tendencies gave higher estimations of control than those with low OC tendencies. High OC individuals were also more repetitive (used fewer patterns) than control participants.

What does this mean?

The authors discuss a potential feedback model of OCD: “we speculate that individuals with OCD are intensely occupied with attempting to achieve a sense of control in a substitute field, which becomes a test case for their ability to control events in the real world. Checking doors, washing hands, and avoiding particular words become increasingly important as indexes of general ability to control. Once anxiety reduction and a sense of control are achieved and interpreted as indicative of this general ability to control, people with OCD may experience relief and stop the substitute (ritual) activity. Unfortunately, the relief is short lived (success in the drill does not really guarantee success in the war), and when anxiety returns, the ritualized activity must be renewed.”

How is this relevant to clinicians?

We managed to get a short interview with Prof. Dar who is one of the authors:

– The message for this study, for me, is that patients develop an illusion of  control from their rules and rituals that comes at the expense of real control, and this can be talked about (and changed) in therapy.

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