Still Cognitive After All These Years? Perspectives for a Cognitive Behavioural Theory of Obsessions and Where We Are 30-Years Later

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, 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, neither 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 regarded as entirely treatable, with recovery a real possibility. This has come through the development and evolution of behavioural then cognitive behavioural approaches. In 1993, Clark and Purdon wrote an important and stimulating paper in Australian Psychologist in which they explored emerging cognitive theory. The current paper aims to examine the contribution of this paper to the field. We aim to review this in the context of both the status of the field in 1993 and subsequent developments. This evaluation considers the current status of cognitive and cognitive behavioural theories. Since 1993, there have been a number of key developments. In our view these include work focused on formulation, safety-seeking behaviours, identification of elevated evidence requirements, reassurance seeking, and mental contamination. All of which will be reviewed in turn. It is concluded that the Clark and Purdon paper, although incorrect in several aspects, made an important contribution to the development of a field which continues to evolve in a vibrant and challenging way.