Additional considerations in the cognitive-behavioral treatment of obsessional ruminations--a case study

The cognitive-behavioral treatment of a 24-year-old woman with moderately severe obsessional ruminations is described. The case demonstrates both the effectiveness and limitations of exposure with response prevention techniques for obsessive-compulsive disorder. The client's response raises questions about the clinical utility of viewing obsessions exclusively as conditioned anxiety stimuli. In addition, the case shows that cognitions related to control rather than appraisals of responsibility were instrumental in initiating neutralising activity. Further modification of the current cognitive-behavioural hypotheses regarding obsessions is recommended.