Interventions and Implications

Abstract

This chapter provides a framework for developing interventions that specifi cally target intrusive events. It describes the challenges in defi ning intrusive thoughts and the diffi culty in distinguishing normal processes of cognition and emotion from indicators of dysfunction, defi ned from practical, neurobiological, or cultural points of view. Throughout, the term intrusive events is used to encompass both thoughts and images that become intrusive. Examples are explored as they occur in diff erent psychiatric disorders to demonstrate their variance in form, frequency, and controllability. Treatment modalities that have been used to alleviate intrusive events in diff erent psychiatric disorders are reviewed, including behavioral, pharmacological, and emerging electromagnetic brain interventions. Two clinical vignettes illustrate the nature and severity of intrusive events in patient populations as well as the complex, multidimensional nature of the clinical reality. Ways of measuring intrusive events are examined and deconstructed into components (e.g., sensory, motor, and cognitive features). By examining intrusive events across diagnostic categories, common basic biobehavioral processes may be revealed which, in turn, could facilitate the study of neural processes underlying the behaviors. A model of cognitive and emotional decision making is presented to provide a basis for understanding and studying intrusive events. Examples of how the model might account for the “failure modes” in intrusive events are used to formulate testable hypotheses, and future interventions that combine multiple treatment modalities are considered. The chapter concludes with a discussion of the broader cultural context of intrusive events. Group photos (top left to bottom right) Judson Brewer, Harriet de Wit, Aurelio Cortese, Martin Paulus, Emily Holmes, Judson Brewer, Damiaan Denys, Colleen Hanlon, Peter Tse, Jens Schwarzbach, Martin Paulus, Colleen Hanlon, Aurelio Cortese, Harriet de Wit, Judson Brewer, Peter Tse, Damiaan Denys, Martin Paulus, Harriet de Wit, Jens Schwarzbach, Emily Holmes From “Intrusive Thinking: From Molecules to Free Will,” edited by Peter W. Kalivas and Martin P. Paulus. Strüngmann Forum Reports, vol. 30, Julia R. Lupp, series editor. Cambridge, MA: MIT Press. ISBN 978-0-262-54237-1 348 J. Brewer et al.