David Westbrook

Effects of neutralizing on intrusive thoughts: An experiment investigating the etiology of obsessive-compulsive disorder

A large sample of non-clinical subjects were screened and those who reported experiencing relatively frequent intrusive thoughts with associated neutralizing were selected. These subjects were randomly allocated to one of two conditions: both groups listened to repeated recorded presentations of one of their intrusive thoughts and were then required either to (a) neutralize it, or (b) distract themselves for a similar period. Ratings of discomfort were taken during this procedure (first phase), and during identical presentations of the same thought without neutralizing or distracting (second phase). Results showed that the group who neutralized during the first phase experienced significantly more discomfort during the second phase and significantly stronger urges to neutralize and distract. There was also evidence that engaging in neutralizing responses during the first phase made it difficult to stop neutralizing during the second phase. The results are considered in the context of the cognitive-behavioural hypothesis that obsessional disorders develop as a consequence of neutralizing normal intrusive thoughts.

The long-term outcome of cognitive behaviour therapy for adults in routine clinical practice

It is recognised that there is a comparative lack of evidence on the long-term outcome of cognitive behavioural therapy for patients seen in ordinary clinical settings, as opposed to research trials. This paper presents some data on the outcome of 36 adult patients followed up an average of nearly two years after the end of therapy in a National Health Service CBT clinic. Whilst the vagaries of data collection in clinical practice mean that the generalisability of these results is still tentative, they suggest that the outcome at the end of treatment was generally well-maintained over the follow-up period, with most patients maintaining fairly stable scores on the measures used, and the rest roughly equally divided between those who deteriorated and those who improved further. A high proportion of patients at follow-up reported that they were still using various CBT strategies which they had learnt during therapy.