A formulation based on Salkovskis' cognitive model of OCD — mapping intrusions, responsibility appraisals, distress, and neutralising behaviours.
This formulation maps how OCD is maintained not by the intrusive thoughts themselves (which everyone has) but by the meaning you give them — particularly inflated responsibility. The appraisal triggers distress, which drives neutralising (rituals, avoidance, reassurance), which provides temporary relief but reinforces the belief that the intrusion was dangerous. Work through it with your therapist using a recent OCD episode.
Use in the early formulation phase once a working diagnosis of OCD has been established. Particularly valuable for socialising clients to the cognitive model and identifying the maintaining role of neutralising behaviours and misappraisals of intrusions.
Explain that the formulation helps map the vicious cycle keeping OCD going, drawing on Salkovskis's model. Frame it as a collaborative tool to understand why intrusions that everyone experiences become distressing and stuck for them specifically.
For clients with predominantly mental compulsions, emphasise the covert neutralising pathway. For younger adults or those with lower psychological-mindedness, consider completing section by section across sessions rather than all at once.
Avoid introducing the full formulation if the client is in acute crisis or has not yet developed sufficient trust in the therapeutic relationship. If the client presents with primarily hoarding symptoms, consider whether a hoarding-specific model may be more appropriate.
Pay close attention to the inflated responsibility appraisal — this is the key cognitive driver in Salkovskis's model and should be clearly linked to the client's specific intrusions. Ensure bidirectional arrows between appraisals, affect, and neutralising are made explicit.
Suitable for clients working with ocd, formulation, salkovskis, cognitive model, cbt, intrusions, responsibility, neutralising. This tool can be used as a standalone worksheet or as part of a structured homework plan.
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Build a graded exposure hierarchy for Exposure and Response Prevention therapy. List anxiety-provoking situations, rate them, and plan structured exposures.
Log exposure and response prevention practice sessions with SUDS ratings, urge strength, and whether you resisted the compulsion.
Track OCD episodes — intrusions, appraisals, rituals, distress, and duration — to identify patterns and measure progress.
Challenge inflated responsibility beliefs that drive OCD by examining the appraisal and generating realistic alternatives.