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The influence of control-related beliefs on OCD

Here is my synopsis of a Clinical Psychology Review article: "Anxiety Disorders and Control Related Beliefs". The summary is particularly helpful to understand the role of control-related beliefs in the development and maintenance of OCD.

Background

There is ample evidence that demonstrates a strong association between individuals’ beliefs about control and problems with anxiety and depression. This review article examines the particular contribution of control related beliefs to the development and maintenance of OCD toward the goal of expanding the cognitive model of OCD.

The authors carefully distinguish between two related constructs of control: sense of control (SC) and desire for control (DC). One’s sense of control (SC) generally refers to a belief about the degree of control available in a given circumstance. Researchers have long construed that anxiety, distressing thoughts, and avoidant behavior result from a low SC and the resultant inability to deal effectively with some potential threat.  Desire for control (DC), also referred to here as the need for control, is a motivation considered fundamental to humans: to exert control over circumstances so as to avoid negative and ensure positive outcomes. Frequently, DC is considered a personality trait marked by more active, assertive, and decisive behavior oriented to deliberately manage situations. But here's where DC can go awry: individuals with extreme levels of DC actually may be more vulnerable to anxiety due simply to the inherent limits of our ability to control situations.

Cognitive theories of OCD, propose that people misappraise the significance of normal intrusions when they hold dysfunctional beliefs (regarding responsibility, over importance of thoughts, excessive need to control one’s thoughts, overestimation of the probability and severity of threats, intolerance of uncertainty, and perfectionism; Obsessive Compulsive Cognitions Working Group). To look at symptoms of OCD, one might assume that fear of losing control over one's thoughts, behavior, and external events produces excessive attempts to control one's thoughts, external events, and feelings via compulsive rituals.  But, thus far, control related beliefs in general have not gained a central role in understanding the anxiety unique to OCD, except for the specific beliefs about the need to control ones thoughts.

Discussion

Evidence linking control related beliefs with OCD

There is substantial evidence that links a greater need to control thoughts and a lowered sense of control over intrusive thoughts with OCD than for other anxiety disorders. Thus, one might hypothesize that it is the discrepancy between a high need for control (DC) and a low sense of control (SC) in particular circumstances that would lead to both “distress, and ineffective attempts to regain control through neutralization and thought control strategies.” Aside from the desire to control thoughts, which is so characteristic of OCD, the desire to control the environment is often manifested in high levels of risk aversion and a preference for situations that signal safety and predictability over spontaneity. Other research has found high correlations of DC with with fear of strong emotional experiences. Perhaps the most direct evidence that links DS with OCD showed that the desire for control extended to even non-threatening situations. When not in control, subjects with OCD were more likely to predict some negative outcome as a result of not having control.

What seems to emerge from this body of research supports the idea that when elevated, DC over one's own thoughts, environment and emotional experiences, contributes to an escalation of the perceived threat of many situations. When that perceived threat is not matched by a corresponding sense of control, people with OCD will act to increase perceived sense of control. Those efforts will contribute to OC-like symptoms among other things.

Many people with OCD will also attest to the irrationality of their own obsessions and rituals and label them as superstitious or magical. But in response to a perceived threat, superstitions thoughts and behaviors appear to serve a function: they can increase one's sense of control (SC). Even when SC is founded on the illusion of control, that illusion of control acts to lessen anxiety in the moment, especially in situations where no other means of actual control may exist. In other words, magical thinking, can alternately decrease SC (for example, in thought-action fusion) and increase SC via neutralizing mental rituals. Clearly, this need for control (DC) and the intolerance for not feeling a sense of control (SC) ought to be addressed in treatment.

How can this help me?

Much of the cognitive focus in treatment for OC has centered on restructuring the dysfunctional beliefs and assumptions that foster unnecessary anxiety. If you can recognize that most neutralizing rituals are undertaken in order to restore (or preserve) a sense of control (over thoughts, over feelings, and over situations perceived as threatening), then you may also be able to identify where that desire for control is excessive. You will see where your efforts to restore that elusive sense are ultimately doomed to frustration. One hopes, then, that you will recognize that the real culprit is the unreasonable demand for control when control is not yours to have.

Treatment strategies can then help you to learn how to, and when NOT to, try to control a situation and when to yield control. Your therapy exercises can be targeted to practice skills that promote acceptance, tolerance, and coping instead. Frequently, those skills are very much underutilized in OC symptom areas. Do a cost-benefit analysis about the desire for control, practice delaying control behaviors in order to grow more tolerant of negative emotions and uncertainty, and do regular exposure to the idea of not having control. Helping to ratchet down the "need" for control (maybe to just a "wish" for control) might be an alternate, more functional goal that can reduce distress in OCD.

Citation

Moulding, R & Kyrios, M. (2006) Anxiety disorders and control related beliefs: the exemplar of Obsessive Compulsive Disorder (OCD). Clinical Psychology Review, 26, 573-583.

Posted by: James Dod, Ph.D.May 19th, 2016 Share