Classical behavioral theories posit a two-stage process by which OCD develops and is maintained. In the first stage (fear acquisition), a natural event becomes associated with fear by being immediately paired with an aversive stimulus that evokes anxiety. For example, a knife may acquire the ability to elicit anxiety by being paired with a traumatic experience. In the second stage (maintenance), avoidance and compulsive rituals are negatively reinforced because they result in a reduction in anxiety. For example, if checking that the drawers are locked relieves distress evoked by thoughts of knives, this kind of checking is likely to be repeated whenever thoughts of knives occur. Although there is evidence that obsessional thoughts increase anxiety, and compulsive rituals reduce it, the classical behavioral model of OCD does not adequately explain the development of OCD symptoms.
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