Paul Salkovskis

Salkovskis proposed that almost everyone experiences intrusive thoughts, but these become obsessions when a person interprets them as indicating personal responsibility for preventing harm. The distress triggered by this sense of responsibility then drives compulsive behaviors—checking, washing, neutralizing—intended to reduce the perceived risk.

His formulation holds that health anxiety arises when normal bodily sensations are catastrophically misinterpreted as signs of serious illness, and safety behaviors such as repeated checking or medical reassurance-seeking prevent the disconfirmation of those fears. Treatment focuses on modifying the misinterpretations and reducing the avoidance and checking behaviors that maintain the anxiety.

Salkovskis has held clinical and academic positions at several UK institutions, including the University of Oxford and King's College London, and later at the University of Bath. He has also been involved in the development of NHS cognitive-behavioral therapy services, particularly for anxiety disorders.

Earlier behavioral models treated compulsions as habits maintained by anxiety reduction alone, whereas Salkovskis's cognitive account emphasizes that it is the individual's belief that they are personally responsible for preventing catastrophic harm that transforms ordinary intrusive thoughts into persistent obsessions. This insight shifted treatment toward challenging the responsibility appraisals, not just the compulsions themselves.