Still cognitive after all these years? Perspectives for a cognitive behavioural theory of obsessions and where we are 30 years later - a commentary

Paul Salkovskis, Josephine Millar

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Background: Obsessive-Compulsive Disorder (OCD) was historically regarded as untreatable. In 1965 OCD was seen as an intractable and deteriorating condition, with little hope of improvement. It was not understood, but generally regarded as a kind of “pre-psychotic” state, with sufferers permanently at risk of being tipped over that edge. Treatment was confined to long term hospitalisation and psychosurgery, although neither of these held any hope of recovery. Fifty years on, OCD is not only understood as being a result of a range of otherwise normal processes but is also regarded as entirely treatable, with complete recovery being a real possibility. This has come about through the development and evolution of first behavioural then cognitive-behavioural approaches to its understanding and treatment. Objective: In 1993, Clark and Purdon, wrote an important and stimulating paper in Australian Psychologist in which they explored emerging cognitive theory, particularly that set out by Salkovskis (1985). The current paper aims to examine the contribution of the Clark and Purdon paper to the field. We aim to review this in the context of both the status of the field when it was written and subsequent developments. Method & Results: This evaluation is used to consider the current status of cognitive and cognitive behavioural theories. Since 1993 there have been a number of key developments in the field. In our view, these include work that has focused on formulation and development of a shared alternative explanation, the use of safety seeking behaviours, identification of Elevated Evidence Requirements, reassurance seeking and mental contamination. All of which will be reviewed in turn. Conclusion: It is concluded that the Clark and Purdon paper, although incorrect in several key aspects, made an important contribution to the development of a field which continues to evolve in a vibrant and challenging way.
Original languageEnglish
Pages (from-to)14-17
JournalAustralian Psychologist
Issue number1
Publication statusPublished - Feb 2016


  • Cognitive Theory; Cognitive Behavioural Theory; Obsessive Compulsive Disorder; Theory-practice links


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