In a new survey regarding user satisfaction of GGRO (n=75) 95.6% of participating users responded “strongly agree” or “agree” to the statement “I like using GGRO”. In addition, 83.1% of users responded “strongly agree” or “agree” with the statement “GGRO is a useful training App for dealing with relationships doubts and preoccupations” and 68.9% of users marked “strongly agree” or “agree” with the statement “GGRO helped me with my relationship fears and anxieties”.
Throw away and pull towards: A new way to challenge OCD related cognitions using the GGRO mobile application training platform.
Authors: M. Roncero, B. Pascual, S. Arnáez, M. Giraldo-O’Meara, G. García-Soriano, A. Belloch, and G. Doron.
According to cognitive models of OCD, obsessive compulsive symptoms result from catastrophic misinterpretations of commonly occurring intrusive thoughts, images and urges and the use of counterproductive strategies used to manage them. Maladaptive beliefs such as inflated responsibility/threat, importance and control of thoughts, perfectionism and intolerance for uncertainty increase the likelihood of such negative interpretations of intrusive experience. Indeed, traditional cognitive behavioral therapy (CBT) includes a variety of intervention to challenge maladaptive beliefs including behavioral experiments and cognitive reconstruction. Consistent with a growing body of literature supporting the usefulness of mobile based technologies in fostering cognitive behavior change, the present study assessed the effectiveness of a novel cognitive training exercise designed to challenge OCD related cognitive beliefs. This mobile technology (application) based training exercise consists of users having to pull statements challenging OCD-related beliefs towards themselves (downwards) and to throw away (push upwards) contra-productive self-statements Method: 36 third year BA students started the trial. Twenty completed both pre and post measures of OCD symptoms (OCI-R; Foa et al., 2002), ROCD (ROCI & PROCSI; Doron et al., 2012a, 2012b), OCD related beliefs (OBQ; Moulding et al., 2011) and mood (Antony et al., 1998). Participants were instructed to complete two minutes of daily training (3 training levels) for a period of 15 days. Results: No significant differences were found between completers and no-completers on demographic and symptom related measures at Time 1. Repeated-measures ANOVA of the 20 completers showed a significant reductions on all OCD symptoms measures and on OCD-beliefs. No significant reduction was found in depression symptoms. Discussion: This innovative mobile technology based training exercise may be useful in reducing OCD-related beliefs levels and associated symptoms. The use of this and similar mobile training platforms holds promise for low intensity psychological treatments recommended by NICE (2005), and may be effective as prevention tool for those people at risk of suffering OCD. Limitation: This is an open trial with relatively small student sample.
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What We’re Learning About Relationship Obsessive-Compulsive Disorder (ROCD)
“During the holidays my obsessions are the worst. Doctor, I must know whether I’m in the right relationship! I cannot go on like this. Every little thing triggers my relationship doubts. When I see couples buying each other holiday gifts or families going shopping with their kids, I think ‘Do I love my partner that much? Is he the one I want to have kids with?’ Even everyday experiences such as seeing other interesting-looking men in the street or someone posting an interesting post on Facebook trigger thoughts such as, ‘This person may be a better fit for me than my current partner.’ These thoughts and doubts have a real negative impact on my life. I do not know what to do! I check and recheck how I feel towards my partner, whether I’m really in love with him and whether I am passionate about him. The problem is my feelings change all the time. At times, I am not sure whether I love him and I obsess about his incompetence and slowness. I fear he will embarrass me in front of my family or friends. Other times, I miss him, want to be with him and I think I love him. Not only that… I get obsessively jealous about him. I check his Facebook page (I have his password) and his phone all the time. I interrogate him about his day, who he spoke with and why. Please tell me, should I stay with my current partner?”
Intense preoccupation with whether one is in the right relationship is the hallmark symptom of relationship obsessive compulsive disorder (relationship OCD or ROCD). Our clients describe hours a day doubting the strength or quality of their feelings towards their romantic partner and the “rightness” of the relationship and their partner’s feelings towards them. Other clients describe being obsessively preoccupied with the perceived flaws or deficiencies of their partners. They spend several hours a day thinking about flaws in their partner’s appearance (e.g., body proportion, hair, facial features etc.), character (e.g., intelligence, morality, social skills) or both. They often describe being extremely distressed by these doubts and preoccupations.
I always ask my clients, “Do you make any attempts to get rid of these thoughts or to reduce your anxiety?” More often than not, they describe a long list of strategies and behaviors they use to reduce their distress. They describe asking others for reassurance regarding their relationship, they monitor their body for feelings of love or passion and compare the qualities of their current partner with the qualities of other potential partners. They also try “not to think” about their partners’ flaws and the relationships and avoid situations where their doubts and preoccupations are triggered. In addition, many clients use self-criticism (e.g., “I’m so stupid for having such thoughts.”), self-reassurance (e.g., ”He is smart – he said something intelligent the other day.”) and many other strategies to reduce their doubts and distress.
Of course, from time to time, we all have doubts regarding our partner or our relationship. Psychological intervention is warranted in cases where such doubts and preoccupations are distressing, time-consuming, and lead to problems in functioning in areas of life such as work, school, or social interactions.
My colleagues and I started investigating ROCD in 2012. We noticed some clients diagnosed with OCD did not respond well to treatment. These clients seemed to have obsessions and compulsions in a very specific domain: romantic relationships. Most of these clients initially sought couple or family counseling, but these interventions did not seem to address their difficulties. Their relationship had problems, but mainly as a side effect of one partners’ doubts and preoccupations. The core of the problem did not seem to be the couple or family dynamics.
Applying cognitive behavioral therapy (CBT) for OCD helped many of our ROCD clients. However, they did not respond as well as we expected. Both ourselves and our clients felt there is something missing in the therapeutic process. We have decided to look for more ROCD-specific targets for CBT. We looked at the professional literature but did not find much research focusing on this presentation of OCD. Therefore, during the last few years, we have started researching ROCD to get a better understanding of ROCD symptoms, what maintains ROCD, and ultimately how to better help our clients. We interviewed clients, developed questionnaires and assessed the impact of ROCD symptoms on peoples’ lives. We found that ROCD symptoms may cause difficulties in sexual functioning and reduce relationship satisfaction. We found that ROCD symptoms are associated with other OCD symptoms but also with depression, anxiety, and symptoms of body dysmorphic disorder (BDD, being obsessed about one’s own perceived physical flaws). In some cases, a person’s ROCD symptoms may lead their partner to obsess more about the relationship as well as their own flaws. Finally, we found that ROCD symptoms may also be associated with obsessive jealousy.
Importantly, our research and clinical work further informed us about the problematic strategies people use to deal with ROCD symptoms and the maladaptive beliefs and self-vulnerabilities that may maintain ROCD symptoms. For instance, we found that people with ROCD often compulsively monitor their own feelings towards their partner. Such increased monitoring reduces their ability to truly experience emotions which further increases their doubts and preoccupations. Clients with ROCD also report extreme beliefs about romantic relationships (e.g., “Being in a wrong relationship will destroy me and I will never be able to get out.”), love (e.g., “If you have any negative feelings towards your partner, it’s not real love.”) and regret (e.g., “I will never be able to cope with feelings of regret.”). Holding such beliefs increases relationship-related anxiety and negative interpretations of daily events. For example, believing one should never have negative thoughts or feelings towards a partner may lead people to interpret everyday fluctuation in mood and naturally occurring critical thoughts as indicating something is wrong with their relationship. Our experience suggests that using CBT techniques to address extreme beliefs regarding romantic relationships and self-vulnerabilities may improve therapy outcome.
Unfortunately our understanding of ROCD is not complete and requires more research. At the relationship OCD research unit (ROCD-RU), we are doing our best to learn more about ROCD and disseminate our knowledge. On our website, we provide full access to papers/book chapters on ROCD. We have developed mobile applications to help with the treatment of ROCD (for iPhone and Android) and other OCD symptoms (for iPhone; for Android), and we are working on an ROCD treatment manual. Our goal is to enhance and disseminate knowledge of the causes and consequences of ROCD symptoms to reduce misdiagnosis and improve existing evidence-based treatments.
In a research meeting dedicated to advancing OCD treatment with Profs Paul Salkovskis, Randy Frost, Gail Steketee, David Veale, David Clark, Associate Prof. Guy Doron presented a paper about ROCD in a section
dedicated to the homogeneity and heterogeneity of obsessive-compulsive phenomena (Chaired by Prof. Randy Frost).
According to Professor Guy Doron and his colleague Gur Ilany, the application developed (named ‘GG Relationship’) was especially designed for dealing with relationship doubts and fears. The application is based on the principles of Cognitive Behavioral Therapy (CBT) – one of the most research-supported psychological therapies.
According to CBT models, negative self-talk – individuals’ ongoing interpretations of the self, others and the world – maintain psychological difficulties such as obsessive preoccupation, low mood, and maladaptive behaviors. In ROCD, for instance, individuals negative self-talk often relates to fear of being in the wrong relationships or/and missing the ‘right’ relationship. Individuals with such fears will continuously say to themselves (in their heads) phrases such as ‘Maybe my partner is not the ONE’, ‘He is not smart enough for me’ or ‘I will regret my decision to stay/leave with my partner forever‘. Such negative self-talk, of course, ultimately increases relationship doubts/fears, intensifies negative mood and often provokes relationship conflict.
Professor Guy Doron says ‘GG Relationship was developed in order to provide an accessible CBT training platform that would allow individuals with relationship fears and doubts to better deal with negative self-talk’. According to Gur Ilany, the application is designed to ‘(1) increase individuals’ awareness of negative self-talk, (2) train individuals’ to better identify and challenge negative self-talk, (3) increase individuals’ access to neutral and positive self-talk, and (4) increase the automaticity of the above processes’.
The core gameplay of the training is simple: individuals are presented with ‘blocks’ featuring self-talk statements such as “I am proactive”, “I am reliable” or “I am a loser”- and have to respond by pulling the supportive ‘blocks’ towards themselves (i.e., downwards) and throwing away from themselves the negative ‘blocks’ (i.e., rejecting them upwards). A/Prof Doron says ‘to further strengthen learning of supportive self-talk, each level the player completes is followed by a small memory game in which one has to identify a supportive statements that appeared in the previous level’. As the game progresses, the individual passes through thematically relevant issues such as self-esteem, beliefs in change, dealing with relationship doubts, facing uncertainty, overcoming perfectionism, coping with embarrassment, commitment anxiety, etc.,.
Training using this application, Gur says ‘will hopefully allow for gradual, steady learning of more positive self-talk thereby helping to break the vicious thought cycle maintaining relationship doubts and preoccupations’.
- See Opening Keynote given by A/Professor Guy Doron in Ankara, Turkey on the current state of ROCD related research.
Starts at (1:30)
See Associate Professor Guy Doron interviewed by Stuart Ralph on ROCD:
We now have the Relationship obsessive compulsive inventory (ROCI) and the partner related obsessive compulsive symptom inventory (PROCSI) translated to Turkish (see http://rocd.net/roci-procsi-translated-2/)
We are happy to have Dr. Mujgan Inozu as one of our collaborators. Dr Inozu is an academic and clinical psychologist at Department of Psychology,Hacettepe University, Ankara, Turkey.