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Kieron Oconnor Frederick Aar BEYOND REASONABLE DOUBT Reasoning Processes in Obsessive-Compulsive Disorder and Related Disorders Beyond Reasonable Doubt: Reasoning Processes in Obsessive-Compulsive Disorder and Related Disorders. Kieron O’Connor, Frederick Aardema and Marie-Claude Pelissier´ Copyright 2005 John Wiley & Sons, Ltd. ISBN: 0-470-86877-5 BEYOND REASONABLE DOUBT Reasoning Processes in Obsessive-Compulsive Disorder and Related Disorders Kieron O’Connor Frederick Aardema and Marie-Claude Pe´lissier Fernand-Seguin Research Center, Louis-H. Lafontaine Hospital, University of Montreal, Canada Copyright u 2005 John Wiley & Sons Ltd, The Atrium, Southern Gate, Chichester, West Sussex PO19 8SQ, England Telephone (+44) 1243 779777 Email (for orders and customer service enquiries): [email protected] Visit our Home Page on www.wileyeurope.com or www.wiley.com All Rights Reserved. No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, scanning or otherwise, except under the terms of the Copyright, Designs and Patents Act 1988 or under the terms of a licence issued by the Copyright Licensing Agency Ltd, 90 Tottenham Court Road, London W1T 4LP, UK, without the permission in writing of the Publisher. Requests to the Publisher should be addressed to the Permissions Department, John Wiley & Sons Ltd, The Atrium, Southern Gate, Chichester, West Sussex PO19 8SQ, England, or emailed to [email protected], or faxed to (+44) 1243 770620. Designations used by companies to distinguish their products are often claimed as trademarks. All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. The Publisher is not associated with any product or vendor mentioned in this book. This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is sold on the understanding that the Publisher is not engaged in rendering professional services. If professional advice or other expert assistance is required, the services of a competent professional should be sought. Other Wiley Editorial Offices John Wiley & Sons Inc., 111 River Street, Hoboken, NJ 07030, USA Jossey-Bass, 989 Market Street, San Francisco, CA 94103-1741, USA Wiley-VCH Verlag GmbH, Boschstr. 12, D-69469 Weinheim, Germany John Wiley & Sons Australia Ltd, 33 Park Road, Milton, Queensland 4064, Australia John Wiley & Sons (Asia) Pte Ltd, 2 Clementi Loop #02-01, Jin Xing Distripark, Singapore 129809 John Wiley & Sons Canada Ltd, 22 Worcester Road, Etobicoke, Ontario, Canada M9W 1L1 Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books. Library of Congress Cataloging-in-Publication Data O’Connor, Kieron Philip. Beyond reasonable doubt : reasoning processes in obsessive-compulsive disorder and related disorders / Kieron O’Connor, Frederick Aardema, and Marie-Claude Pe´lissier. p. cm. Includes bibliographical references and index. ISBN 0-470-86876-7 (cloth : alk. paper) – ISBN 0-470-86877-5 (pbk. : alk. paper) 1. Obsessive-compulsive disorder–Treatment. 2. Reasoning (Psychology) 3. Reasoning. I. Aardema, Frederick. II. Pe´lissier, Marie-Claude. III. Title. RC533.O34 2005 616.85’22706–dc22 2004011339 British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library ISBN 0-470-86876-7 (hbk) ISBN 0-470-86877-5 (pbk) Typeset in 10/12pt Palatino by Dobbie Typesetting Ltd, Tavistock, Devon Printed and bound in Great Britain by Antony Rowe Ltd, Chippenham, Wiltshire This book is printed on acid-free paper responsibly manufactured from sustainable forestry in which at least two trees are planted for each one used for paper production. CONTENTS About the Authors . vii Preface . ix Foreword by Paul M.G. Emmelkamp . xiii Acknowledgments . xv 1 Cognitive Approaches to Obsessive-Compulsive Disorder: An Overview....................................... 1 Obsessive-Compulsive Disorder . 1 Cognitive Approaches to OCD . 4 Intrusions and Inferences in OCD . 10 Phobic and Non-Phobic Models of Development in OCD . 12 Treatment Considerations . 13 Conclusion . 16 2 Reasoning in Everyday Life ............................. 17 Formal Logic and Informal Thinking. 17 Making Sense of the Senses. 32 3 Reasoning and Narrative ............................... 53 Conversation and Conviction . 53 Inference and Imagination. 67 Conclusion . 80 4 Reasoning and Psychopathology ......................... 81 Reasoning in Clinical Populations . 81 Reasoning Therapy . 96 General Conclusion . 110 5 An Inference-Based Approach to Obsessive-Compulsive Disorder .......................................... 113 Clinical and Phenomenological Investigations into Inferential Confusion . 113 vi CONTENTS Critical Concepts in an Inference-Based Model . 115 Psychometric Measurement of Inferential Confusion. 121 Experimental Studies of Inferential Confusion . 131 Clinical Trials of an Inference-Based Approach to Therapy (IBA) . 140 Conclusion . 146 6 Using the IBA Treatment Manual ........................ 149 Introduction to Treatment . 149 Step-by-Step Program . 149 Common Queries from Clients . 166 Troubleshooting Guide . 170 Case Studies . 178 7 Future Directions ..................................... 199 IBA and Other Cognitive Therapy. 199 Future Development in IBA . 211 A Final Comment . 213 Appendix 1 Overview of Our Treatment Program for Obsessive-Compulsive Disorder . 215 Appendix 2 Worksheets, Exercise Sheets and Training Cards . 227 Appendix 3 . 279 Appendix 4 . 281 References . 285 Index . 301 ABOUT THE AUTHORS Kieron O’Connor completed his research and clinical training in psychology at the University of Sussex and the Institute of Psychiatry and Maudsley Hospital London (UK). In 1988 he was awarded the first of a series of fellowships by the Fonds de la Recherche en Sante´ du Que´bec, and established a clinical research program at the Fernand-Seguin Research Center, Louis-H. Lafontaine Hospital, University of Montreal. The multi- disciplinary research program, which focuses on obsessive-compulsive disorder, Tourette and tic disorder, and delusional disorder, is currently funded by the Canadian Institutes of Health Research. Kieron O’Connor is also Associate Research Professor at the Psychiatry Department of the University of Montreal and is scientific advisor to the Quebec OCD Foundation. He has over 100 scientific publications. Forthcoming publica- tions include Cognitive Behavioral Treatment of Tic Disorders (Wiley, in press). Frederick Aardema studied clinical psychology at the University of Groningen and the University of Amsterdam in the Netherlands under the supervision of Prof. P.M.G. Emmelkamp in affiliation with the Fernand- Seguin Research Center located in Montreal, Canada. He currently resides in Canada and has published in international journals in the field of obsessive-compulsive disorder. In particular, his research interests include psychometric and experimental methods in the measurement of reasoning processes in OCD, as well as the application of inference and narrative based models to obsessions without overt compulsions. He is a licensed psychologist and has a private practice in Montreal, Quebec. Marie-Claude Pe´lissier studied psychology at the University of Quebec at Montreal in Canada and did most of her clinical training in London, England. She has been working for almost eight years in clinical research on obsessive-compulsive disorder and other OCD related disorders, which has resulted in publications in two international journals. As a licensed psychologist, she recently started her own private practice. She is also actively involved in local mental health community groups where she teaches and acts as scientific consultant on OCD. PREFACE In this book, we bring together three traditionally separate lines of enquiry to try to understand the clinical phenomenon of obsessional compulsive disorder, namely, reasoning research, philosophy of mind and language, and cognitive therapy. Developments in these three areas in the past 50 years seem to have led naturally to a fruitful cross-talk about the way we think. Each area in its way has grown dissatisfied with former constraints on its paradigms and has emerged with new perspectives on thinking, resulting in a potential convergence of approaches to understanding thinking disorders. Sir Frederick Bartlett in his influential work on thinking, later resumed in his 1958 book, Thinking, subtitled An experimental and social study highlighted how the complexities of thinking pervade all areas of daily life. Thinking, he proposed, was an autonomous process, best considered a skill, which, like other skills, can be learnt. Importantly, Bartlett also recognized that thinking always has ‘direction’ and ‘agency’. In other words, thinking is, above all, a human skill. Reasoning research emerged from the philosophy of logic to develop insightful applied experimental paradigms. Most early studies operationa- lized thinking in terms of deduction to enable study of the processes by which conclusions are confirmed or disconfirmed according to the content of the premise. Such research has revealed that most people do not always think or act logically and that in everyday life they are susceptible to a variety of cognitive illusions. The puzzle is, despite this, how do they manage to function adaptively? Johnson-Laird has
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