A meticulous arrangement of colored pencils, sorted by hue and perfectly aligned, visually representing ‘Just Right’ OCD, a subtype characterized by an intense need for things to feel ‘perfect’ or ‘just right’.
Key Points
Rationale
According to this prevailing model, individuals with OCD experience intrusive thoughts, images, or impulses that provoke anxiety, and engage in compulsive behaviors to reduce this anxiety and prevent feared outcomes (Abramowitz, 1997; Salkovskis, 1985).
The OCD Cycle
This understanding has informed the development of exposure and response prevention (ERP). This well-established cognitive-behavioral treatment aims to reduce anxiety through repeated exposure to feared stimuli without engaging in compulsions (Abramowitz, Deacon, & Whiteside, 2019).
Several studies have found that NJREs are common in OCD and are associated with specific symptom dimensions, such assymmetry, ordering, and arranging(Ferrao et al., 2012; Ecker & Gönner, 2008).
However, the majority of this research has been conducted in non-clinical samples, limiting our understanding of the clinical presentation and correlates of NJREs in individuals with OCD (Coles et al., 2003; Ghisi et al., 2010).
Furthermore, despite the growing recognition of NJREs as a distinct motivational process in OCD, research on the treatment of NJRE-related symptoms is limited.
To address these gaps in the literature, the current study aimed to characterize NJREs in a clinical sample of individuals with OCD and compare their experiences to anxious and non-clinical controls.
Additionally, the study sought to examine the relationship between NJREs and specific OCD symptom dimensions and the response of NJREs to cognitive-behavioral therapy.
Method
The study compared the prevalence and severity of NJREs in individuals with OCD (n= 45) to anxious (n= 34) and unselected (n= 242) control groups using the Not Just Right Experiences Questionnaire-Revised.
Associations between NJREs, OCD symptoms, and motivational factors were examined. Changes in NJREs were assessed in a subset of OCD patients (n= 19) before and after receiving CBT.
Sample
Measures
CBT Treatment
Treatment included assessment, psychoeducation, collaborative hierarchy development, and response/ritual prevention, with final sessions focusing on maintenance and relapse prevention.
Participants completed 14-17 sessions. Clinicians adapted treatment to address NJRE-motivated symptoms through targeted inquiries and exposures. Independent, trained clinicians conducted post-treatment assessments.
Statistical Analysis
ANOVAscompared NJRE scores between groups. Correlations examined associations between NJREs, OCD symptoms and motivations. Repeated measures ANOVAs assessed pre-post treatment changes.
Results
Relations between NJREs and OC symptoms
Relations between NJREs and motivations associated with OCD symptoms
Changes in NJREs from treatment
Insight
This study provides important insights into the under-recognized role of NJREs in the clinical presentation of OCD.
Not only do individuals with OCD experience more frequent and severe NJREs than controls, but these experiences are associated with overall OCD severity, especially incompleteness-related and ordering/arranging symptoms.
Crucially, the significant reductions in NJREs seen after CBT suggest that NJREs are treatable and that CBT can effectively target both classic anxiety/harm-avoidance symptoms and incompleteness-related symptoms.
The CBT protocol included specific NJRE-focused elements, so future research should examine if standard CBT produces similar NJRE improvements.
Overall, the findings highlight the utility of assessing NJREs and incompleteness motivations in OCD. An exclusive focus on anxiety and harm avoidance is insufficient.
Continued research on this topic can refine our understanding of OCD’s heterogeneous clinical presentation and potentially optimize treatment approaches. The next steps could include examining neural and behavioral correlates of NJREs and conducting controlled trials of NJRE-focused CBT.
Strengths
Limitations
Clinical Implications
The results underscore the importance of assessing for NJREs and considering incompleteness motivations in the conceptualization and treatment of OCD. An exclusive focus on harm avoidance will fail to capture important symptom dimensions for many patients.
While CBT appears effective for reducing NJREs, explicitly targeting NJREs may optimize outcomes, especially for patients with predominant incompleteness symptoms who may be less responsive to standard CBT.
For example, exposure exercises designed to provoke NJREs and practice tolerating the associated discomfort without engaging in compulsive behaviors.
However, it is important to note that the current study did not directly compare standard CBT to NJRE-focused CBT.
Randomized controlled trialscomparing these two approaches would provide valuable information about the incremental benefits of targeting NJREs and help guide treatment decision-making for individuals with incompleteness-related OCD symptoms.
References
Primary reference
Coles, M. E., & Ravid, A. (2016).Clinical presentation of not-just right experiences (NJREs) in individuals with OCD: Characteristics and response to treatment.Behaviour Research and Therapy, 87, 182-187.
Other references
Abramowitz, J. S. (1997). Effectiveness of psychological and pharmacological treatments for obsessive-compulsive disorder: A quantitative review. Journal of Consulting and Clinical Psychology, 65(1), 44-52.
Abramowitz, J. S., Deacon, B. J., & Whiteside, S. P. (2019). Exposure therapy for anxiety: Principles and practice (Second edition). Guilford Press.
Coles, M. E., Frost, R. O., Heimberg, R. G., & Rhéaume, J. (2003). “Not just right experiences”: Perfectionism, obsessive–compulsive features, and general psychopathology. Behaviour Research and Therapy, 41(6), 681-700.
Ecker, W., & Gönner, S. (2008). Incompleteness and harm avoidance in OCD symptom dimensions. Behaviour Research and Therapy, 46(8), 895-904.
Ferrao, Y. A., Shavitt, R. G., Prado, H., Fontenelle, L. F., Malavazzi, D. M., de Mathis, M. A., … & do Rosário, M. C. (2012). Sensory phenomena associated with repetitive behaviors in obsessive-compulsive disorder: An exploratory study of 1001 patients. Psychiatry Research, 197(3), 253-258.
Ghisi, M., Chiri, L. R., Marchetti, I., Sanavio, E., & Sica, C. (2010). In search of specificity: “Not just right experiences” and obsessive–compulsive symptoms in non-clinical and clinical Italian individuals. Journal of Anxiety Disorders, 24(8), 879-886.
Salkovskis, P. M. (1985). Obsessional-compulsive problems: A cognitive-behavioural analysis. Behaviour Research and Therapy, 23(5), 571-583.
Summerfeldt, L. J. (2004). Understanding and treating incompleteness in obsessive-compulsive disorder. Journal of Clinical Psychology, 60(11), 1155-1168.
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Olivia Guy-Evans, MSc
BSc (Hons) Psychology, MSc Psychology of Education
Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.
Saul McLeod, PhD
BSc (Hons) Psychology, MRes, PhD, University of Manchester
Saul McLeod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.
