See this paper for further details. Roncero M, Belloch A, Doron G (in press). Can brief, daily training using a mobile applications help change maladaptive beliefs? A cross-over randomized-control study evaluating the efficacy of GGRO in reducing maladaptive beliefs and obsessive-compulsive symptoms. JMIR mHealth and uHealth. DOI: 10.2196/11443
The paper is entitled: A novel approach to challenging OCD related beliefs using a mobile-app: An exploratory study .
To see a pre-printed version of the paper see this link
ROCD and other OCD symptoms are frequently related to body image distress and preoccupations such as found in BDD. A new mobile app dealing with such problems, named GGBI is now out in the apple store and Google Play: these are the links
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.
Following your requests for a mobile app dealing with common OCD symptoms like fear of harm, contamination, fear of sin and more, GGOC is now out in the apple store and Google Play: these are the links
We thank all those participating in our pilot study of GGRO! below are the results of the study.
Background: Previous research has linked relationship-related anxieties, doubts and preoccupations (i.e., relationship obsessive compulsive disorder symptoms; ROCD) with reduced functioning, decreased relational and sexual functioning and lower mood. As knowledge of ROCD is emerging, individuals with such symptoms may be frequently misdiagnosed leading to reduced accessibility to adequate treatment. A growing body of literature has supported the usefulness of mobile technology in increasing accessibility to mental health knowledge and in fostering mental health or behavior change. In the present study, we examined associations between relationship related anxieties, doubts and preoccupations (i.e., ROCD symptoms) and the pattern of use of a mobile application named GGRO. This mobile application was designed to challenge maladaptive beliefs related to relationship difficulties. GGRO encourages two minutes of daily training (3 levels a day) over a period of at least 15 days.
Method. Fifty-one users of GGRO responded to a short survey pertaining to application use, satisfaction and relationship-related anxieties and preoccupations.
Results. The number of sessions ranged from 1 to 100 with forty-five participants reporting using GGRO five times or more. Medium-size statistically significant correlations were found between reported number of sessions of GGRO users (i.e., in participants that used GGRO more than 5 times) and relationship-related anxieties and preoccupations (Spearman’s rho r=-.35) suggesting greater number of sessions was related to less such relationship difficulties reported. Similarly, the higher the level participants reported reaching on GGRO (maximum being 45), the less relationship-related anxieties and preoccupations they described (Spearman’s rho r=-.30). Finally, as expected, satisfaction from GGRO was also related to less reported relationship anxieties and preoccupations (Spearman’s rho r=-.45).
Conclusions. Daily use of mobile technology aimed at challenging underlying relationship-related maladaptive beliefs may be associated with reduced relationship-related anxieties and preoccupations.