If I do it, it must be important: Integrating basic cognitive research findings with cognitive behavior theory of obsessive-compulsive disorder

Cognitive behavior accounts of obsessive-compulsive disorder ascertain that the catastrophic interpretation of (normally occurring) intrusive thoughts as a sign of danger plays a major role in the etiology and maintenance of OCD. Various researchers have placed particular importance on metacognitive beliefs such as thought importance and control of thoughts as paramount forces driving such interpretations. Obsessive-compulsive patients and their family members have been found to show diminished capability of response inhibition relative to healthy controls. We propose that deficits in response inhibition are related to the development and maintenance of obsessive-compulsive metacognitive beliefs. We further suggest that patients observe their own behavioral tendencies and subtle reactions associated with intrusions and interpret these as indicating that the intrusions are important. Over time generalizations of this process are established in the form of metacognitive beliefs. Specific hypotheses for future research and clinical implications are suggested.