Discovering what is hidden: The role of non-ritualized covert neutralizing strategies in Obsessive-Compulsive Disorder.
OBJECTIVE
Neutralizing strategies are secondary to obsessions and an additional cause of distress and interference, but they have received little attention in theories and research, especially the non-ritualized covert strategies. This study focuses on the comparative impact of non-ritualized covert and compulsive-overt strategies in the course of OCD.


METHODS
Eighty-two OCD adult patients completed measures assessing distress, interference, appraisals and overt and covert neutralizing strategies to control obsessions. Thirty-eight patients who had completed cognitive therapy were assessed again after treatment.


RESULTS
Only overt compulsions are associated with OCD severity. Nonetheless, considering the main symptom dimension, covert strategies are also associated with severity in patients with moral-based obsessions. Patients who used covert strategies more frequently, compared to those who use them less, reported more sadness, guilt, control importance, interference, and dysfunctional appraisals. Regarding the overt strategies, patients who used them more reported more anxiety and ascribed more personal meaning to their obsessions than the patients who used them less. After treatment, recovered patients decreased their use of both covert and overt strategies, while non-recovered patients did not. There was a higher rate of non-recovered patients among those who used more non-ritualized covert strategies before treatment.


CONCLUSIONS
Emotions and appraisals were assessed with a single item. OCD symptom dimensions were only assessed by the Obsessive-Compulsive Inventory.


CONCLUSIONS
In addition to studying overt compulsions, the impact of covert neutralizing strategies on the OCD course and severity warrants more in-depth study.
Department of Personality Psychology, University of Valencia, Avda.Blasco Ibañez 21, 46010, Valencia, Spain. Electronic address: amparo.belloch@uv.es.
Amparo
A
Belloch
Mental Health Outpatient Clinic, Department 06, Agencia Valenciana de Salud, C/ Rubert i Villo, 4, 46100, Burjassot, Valencia, Spain. Electronic address: carrio_car@gva.es.
Carmen
C
Carrió
Mental Health Outpatient Clinic, Department 05, Agencia Valenciana de Salud, Avda, Ausias March s/n, 46134, Foios, Valencia, Spain. Electronic address: ekabedo@ono.com.
Elena
E
Cabedo
Department of Personality Psychology, University of Valencia, Avda.Blasco Ibañez 21, 46010, Valencia, Spain. Electronic address: Gemma.Garcia@uv.es.
Gemma
G
García-Soriano
D000328:Adult; D000704:Analysis of Variance; D003072:Cognition Disorders / Q000209:etiology* / Q000534:rehabilitation; D015928:Cognitive Behavioral Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009771:Obsessive-Compulsive Disorder / Q000150:complications* / Q000523:psychology* / Q000534:rehabilitation; D011569:Psychiatric Status Rating Scales; D055815:Young Adult
Cognitive-behavioral therapy; Compulsions; Covert neutralizing; OCD