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Manual Association Splitting (Spanish)

Foreword (excerpt from the manual):

Dear patients, relatives, and colleagues,
Our research group has been involved in the research and treatment of obsessive-compulsive disorder (OCD) for many years. Since 2005, we have been developing and conducting research on a new treatment method termed ‘association splitting’ that aims to reduce the intensity and frequency of obsessive thoughts. The method aims at reducing one-sided negative associations that are typical of OCD by creating new cognitive associations (Jelinek et al., 2009, 2014).

In a pilot study with 30 patients with OCD, we found that association splitting resulted in an average reduction in obsessive-compulsive symptoms of 26%; the intensity of obsessive thoughts was reduced by 25%. After three weeks of treatment, up to 42% of participants showed a decline in symptoms of at least 35%. Further studies by our group and others (Moritz & Jelinek, 2011; Rodriguez-Martin et al., 2013) have confirmed these findings, and have provided initial supportive evidence for its effectiveness among other patient groups (Musiat et al., 2014). Association splitting therefore represents a promising treatment strategy for a subgroup of patients.

This method is aimed at people who suffer from specific obsessive thoughts (e.g., excessive concern with contaminating others; uncertainty about having run over a pedestrian; fear of causing a catastrophe by failing to place things in a particular order or not saying a certain prayer).

Despite its success among a large subgroup of patients, the method may not be beneficial for the following individuals:

  • Individuals who perform compulsive actions with no preceding obsessive thoughts. Compulsive actions may include excessive washing of one’s own body, checking (e.g., oven, door lock), sorting, and excessive hoarding. Mental compulsive actions, such as counting or mental rituals, may also be employed to “prevent” obsessive thoughts or their feared consequences. In most cases, obsessive thoughts precede compulsive actions (e.g., an exaggerated fear of having been contaminated [obsessive thought] is followed by a washing ritual [compulsive action]).
  • Individuals who do not at least partially acknowledge the exaggerated nature of their thoughts. Individuals, who are convinced that their thoughts, concerns, and actions are entirely justified and rational are not likely to benefit from the method.

If you experience no positive effects from association splitting, please do not give up hope. There are other effective therapy options for OCD, especially cognitive behavioral techniques. Consult a clinician who specializes in OCD or a self-help organization.


We are interested in your feedback to help us improve the association splitting technique and to make the manual as user friendly as possible. Please send your feedback to Steffen Moritz  (

Help us to help others!

Recognizing the difficult financial situation of many people suffering from obsessive-compulsive disorder (OCD), we offer this manual and other treatment programs we have developed free of charge (see, for example, our metacognitive training program for patients with schizophrenia).

However, research is expensive. We therefore rely on federal funding and donations. If you would like to support us in providing free treatment materials to people with psychological disorders, we would be very grateful. We will of course provide these materials to you at no cost whether or not you make a donation. No one should feel morally obligated to donate! Donations will be used for research purposes only. Upcoming projects include translation of our manuals into other languages, improvements of examples in manuals, and payment of staff members who conduct research studies. If needed for tax purposes, we are happy to send you a receipt (please send an email to Steffen Moritz  ( and include your postal address and full name). Donations may be made to the following account or online:

Pay to: UKE AG Neuropsychologie
Bank: Hamburger Sparkasse HASPA

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