Compulsive Buying PDF

Clinical Psychology and Psychotherapy Clin. Psychol. Psychother.
16, 8399 (2009) Published online 19 February 2009 in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/cpp.585
Compulsive Buying: A CognitiveBehavioural Model

Stephen Kellett1,2* and Jessica V. Bolton3
1 2
Barnsley Primary Care National Health Service Trust, UK University of Shefeld, UK 3 South Warwickshire Primary Care National Health Service Trust, UK Compulsive buying (CB) has only relatively recently become a topic of interest for researchers and clinicians alike. This hiatus means that (unlike other impulse control disorders) there is currently little theoretical guidance for clinicians attempting to intervene with CB clients and no established model for researchers to evaluate, distil and rene. The current paper summarizes and organizes the main extant identied factors in the CB literature into four distinct phases: (1) antecedents; (2) internal/external triggers; (3) the act of buying; and nally, (4) post-purchase. The relationships and interactions between the identied phases are then hypothesized, within the proposed cognitivebehavioural model. The model distinguishes the key cognitive, affective and behavioural factors within each phase and identies how CB can become self-reinforcing over time. The over-arching treatment implication is that CB can be re-conceptualized as chronic and repetitive failure in self-regulation efforts, and that psychological interventions can accommodate this in attempting to facilitate change. A successful case example is provided of a co-dependent compulsive buyer using the model, with psychometric evaluation of key aspects of CB and mental health at assessment, termination and 6-month follow-up. The research and clinical implications of the proposed model are discussed, alongside identied short-comings and the need for psychological services to respond appropriately to CB clients seeking help. Copyright 2009 John Wiley & Sons, Ltd.
INTRODUCTION
Compulsive buying (CB) is essentially characterized by extreme and maladaptive retail behaviour. Whereas for most, buying and shopping is generally a routine aspect of everyday modern life (OGuinn & Faber, 1989); the act of shopping in CB is experienced as an irresistibleuncontrollable urge, resulting in excessive, expensive and timeconsuming retail activity; typically prompted by negative affectivity and resulting in gross social, personal and/or nancial difculties (Dittmar, Long, & Bond, 2007; Faber & OGuinn, 1989, 1992; Kyrios, Frost, & Steketee, 2004; McElroy, Keck,
* Correspondence to: Dr Stephen Kellett (BSc, MSc, D Clin Psy), Department of Clinical Psychology, Keresforth Centre, Barnsley S70 6RS, UK. E-mail: S.Kellett@shefeld.ac.uk
Pope, Smith, & Strakowski, 1994; OGuinn & Faber, 1989). CB, it appears, is all consuming for the individual, until the awareness and experience of post-purchase guilt and remorse (Christenson et al., 1994). The orthodoxy that characterized CB as typically a female disorder (dAstrous, 1990; Eccles, 2002; Faber, Christenson, de Zwann, & Mitchell, 1995; Koran, Bullock, Hartson, Elliott, & DAndrea, 2002; McElroy et al., 1994), has been usefully challenged by recent evidence (Koran, Faber, Aboujaoude, Large, & Serpe, 2006), indicating the relatively equal prevalence of CB across the genders. Although the available literature tends to use the terms CB and compulsive acquisition interchangeably, the presented model focusses entirely on CB and does not account for compulsive acquisition symptoms, such as the acquisition of free items and/or the rubbish discarded by other people (Frost et al., 1998).
Copyright 2009 John Wiley & Sons, Ltd.
84 In terms of prevalence, few studies have been conducted regarding population estimates for CB, according to the relative economic prosperity of the host country. Dittmar (2004a) therefore called for more epidemiological studies to be conducted across countries, that prole the prevalence of CB in populations, via controlled sampling. In an early study in the USA, for example, it was estimated that 1.8 to 8.1% of the population may have CB difculties, with CB difculties typically emerging between 18 and 30 years and becoming clinically signicant around the ages of 3139 years (Black, 1996). The estimated prevalence of CB in the USA across the genders was revised upwards to 5.8% in a large (n = 2513) general population study (Koran et al., 2006). There is evidence (from albeit smaller studies) that in younger samples, the rate can rise and may range from 12 (Hassay & Smith, 1996) to 16% (Magee, 1994). In the UK, Dittmar (2005a) indentied a CB rate of 13.5% in a community sample residentially matched (by town and street) to a CB self-help group sample, in which there was a CB rate of 46%. Data from Germany suggests that the prevalence of CB has increased generally over the last 10 years (Reisch, Neuner, & Raab, 2004) and in the old East Germany, recent exposure to consumer culture has resulted in a six-fold increase in CB (Neuner, Raab, & Reisch, 2005). Such data would suggest that socio-cultural factors have some role to play in CB (Dittmar, 2004a), in that the greater the maturity of a consumer society in the host country, the greater the likelihood of increased rates of CB. The impact of consumer culture in the host country on individuals is also indexed by the Diagnostic Screener for CB (Faber & OGuinn, 1989), factoring to produce a unidimensional scale in US samples (Roberts & Jones, 2001), whereas it factors to produce a bidimensional scale in South Korean (Kwak, Zinkhan, & Crask, 2003) and Mexican (Roberts & Sepulveda, 1999) samples. Desire to participate in consumer culture appears strong in non-consumer societies (Droge & Mackoy, 1995). Typical CB demographics indicate a preponderance of low- to mid-range income occupations, saddled with a considerable degree of personal debt (Schlosser, Black, Repertinger, & Freet, 1994). Salzman (1981) hypothesized that CB clients were often in denial as to the personal consequences of their constant nancial mire.
S. Kellett and J. V. Bolton at one end and compulsive buyers at the other extreme. dAstous (1990) supported the continuum concept, by arguing that CB is not qualitatively different from normal consumption, but that it crucially differs in terms of frequency, intensity and the scale of the negative long-term consequences. Continua theories tend to assume that compulsive buyers are a harmonious group that share causal and maintaining factors, yet there is evidence that challenges the CB homogeneity hypothesis. For example, DeSarbo and Edwards (1996) stated that there may well be a number of cognitive pathways to CB and similarly a range of CB manifestations ranging from typically compulsive to that of being purely impulsive. In their study comparing 104 compulsive buyers and 101 controls, regression analysis identied the presence of two distinct CB clusters, made up of participants from either sample. In the rst cluster (containing more CB participants), CB appeared to be driven by psychological factors such as impulsiveness, low self-esteem, dependence and anxiety; whereas in the second cluster the CB appeared driven by more personal circumstance variables, such as isolation and coping. Eccles (2002) used qualitative methods to analyse the in-depth interview transcripts of 46 women, all selected using the clinical screener for CB designed by Faber and OGuinn (1992), to identify four main clusters that were variously labelled existential, (termed image spenders by Boundy, 2000) revenge, mood repair and serial buyers (termed compulsive shoppers by Boundy, 2000). Nataraajan and Goff (1991) have suggested two distinct CB clusters; individuals who attempt to build selfesteem through acquisition and are likely to be more compulsive, in comparison with individuals who attempt to avoid unpleasant affect via acquisition and are therefore more likely to be impulsive. CB, unlike other impulse control disorders (Diagnostic and Statistical Manual of Mental Disorders-IV; American Psychiatric Association, 1994) such as pathological gambling or trichotillomania, has been hypothesized to be tolerated and somewhat indulged by society (Catalano & Sonenberg, 1993); as opposed to being seriously considered as the genesis of potential chronic and signicant individual, social and familial distress (Hollander & Allen, 2006). Elliott, Eccles, & Gournay (1996) noted that unlike other psychological disorders, CB can be easily masked, as shopping is socially acceptable, and there are no physical indicative signs of any problem behaviour, and CB behaviours in isolation are not apparently or immediately bizarre or obvious to others.
Clin. Psychol. Psychother. 16, 8399 (2009) DOI: 10.1002/cpp
Heterogeneity Among Compulsive Buyers

Woodruffe (1996) suggested a simple continuum concept in relation to CB, with apathetic shoppers
85 It has been suggested that the childhood environments of compulsive buyers are the ones wherein diligence and effort tend to be typically ignored by parents, with a hypothesized lack of emotional nurturance (Kreuger, 1988). Compared with control consumers, compulsive buyers report childhoods with a greater frequency of parents who used money and gifts as a means of positive reinforcement for desired behaviours, were less frequently encouraged as children to save and generally discouraged from expressing their opinions (Faber & OGuinn, 1988). Scherhorn (1990) echoed that rather than psychologically rewarding appropriate behaviour, parents of compulsive buyers tend to use money and/or gifts as the primary means of reinforcement. Kreuger (1988) speculated that developmental trauma leads to two causal processes for CB: (1) an over-emphasis regarding personal desirability; and (2) distorted body image, indicating the mediating role of selfesteem. Guidano and Liotti (1983) suggest that perfectionistic traits act as compensatory strategies as proof of self-worth and esteem, with CB sufferers having been found to be perfectionistic (DeSarbo & Edwards, 1996; Faber, 2000; Kyrios et al., 2004; OGuinn & Faber, 1989) and having consistently lower self-esteem than control consumers (Hanley & Wilhelm, 1992; OGuinn & Faber, 1989; Scherhorn, Reisch, & Raab, 1990), with only one study (Valence et al., 1988) failing to nd a signicant difference between compulsive buyers and control consumers on levels of self-esteem.
COGNITIVEBEHAVIOURAL MODEL OF CB
In terms of clinical practice with CB, despite an increase of research attention in recent years, well-delineated clinical models of CB according to psychotherapeutic modality are absent from the literature, despite some initial hypothesizing of key cognitive factors (Kyrios et al., 2004). This present paper attempts to synthesize the available evidence concerning CB into a cogent cognitive behavioural model, in order to stimulate hypothesis testing and to guide clinicians in delivering cognitivebehavioural interventions. Despite the evidence for cognitivebehavioural interventions dwarng any other psychotherapeutic modality in term of treating CB, the quantity and quality of the cognitivebehavioural evidence base remains in its empirical infancy (Steketee & Frost, 2003). Therefore this paper details a case example of CB using the proposed model, evaluated longitudinally over the course of the intervention, via validated measures of CB functioning. To aid in the construction of the cognitivebehavioural model, the CB literature is reviewed and organized around four proposed key stages, identied as: (1) antecedents; (2) internal/external triggers; (3) act of buying; and (4) post-purchase. The evidence for the components of each phase in the model will now be described in detail.
Phase I: Antecedent Factors Early Developmental Experiences and Family Environment

CB has been associated with both potentially neglectful (McElroy, Keck, & Philips, 1995) and abusive childhood environments (DeSarbo & Edwards, 1996). Indeed, perceptions of parental criticism have been found to be closely related to CB (Kyrios et al., 2004). Black, Repertinger, Gaffney, and Gabel (1998) investigated family histories in persons with CB, compared with matched controls. First-degree relatives in the CB group were more likely to suffer from depression, alcoholism and substance misuse and more psychiatric disorders in general. In a similar study, Valence, dAstous, and Fortier (1988) found that respondents with elevated buying scores reported dysfunctional family histories, containing variously alcoholism, bulimia, anxiety and depression in caregivers. Of the 18 compulsive buyers in the McElroy et al. (1995) sample, 17 had one or more rst-degree relatives with a mood disorder.
Specic CB Cognitions
Such childhood experiences appear to be risk factors for developing stronger attachments to possessions, with possessions functioning to provide opportunistic ways of feeling psychologically safe and secure (Kyrios et al., 2004; Kellett, 2007), via the development and maintenance of dysfunctional cognitive schema (Young, Klossco, & Weishaar, 2003). Across all consumers, possessions have been hypothesized to function as a means of creating and maintaining a sense of self-denition (Ross, 1971) and as a symbolic extension of the self (Belk, 2000). However, in CB, commodity fetishism entails an unhealthy over-investment of the self in possessions (Belk, 2000), implying a continuum of beliefs regarding the importance, worship and veneration of material goods. Richins (2004) empirically illustrated materialistic attitudes to be associated with buying, with acquisition being perceived as a prime indicator of social rank and also a source of personal well-being.
86 Materialistic attitudes and values have therefore been illustrated to be strongly related to CB (Dittmar, 1992, 2005a, 2005b; OGuinn & Faber, 1989) and account for 27% of the variance of CB scale scores, even when other predictor variables such as gender, age and income are controlled for (Dittmar et al., 2007). Rindeisch, Burroughs, and Denton (1997) explored the impact of family structure (intact n = 165 versus disrupted n = 96) on materialistic attitudes and CB in young adults; reporting that participants from disrupted families had higher levels of both materialism and CB. Roberts, Manolis, and Tanner (2003) re-examined the relationships specied in the Rindeisch et al. (1997) study, with a younger sample of students (n = 669). Whereas the study did nd that respondents from disrupted families (n = 174) believed that ownership of material objects created happiness, the study did not nd a relationship between family structure and CB. It has been argued that the increased societal acceptance of materialism may enable materialistic values to grow unchecked over time (Kasser & Kanner, 2004). As well as beliefs about the importance of possessions, CB appears to reect more basic decits in information processing and erroneous beliefs about possessions (Frost & Hartl, 1996; Frost, Steketee, & Williams, 2002). Beliefs important in CB include: (1) buying objects will compensate, reward or neutralize negative feelings; (2) objects provide emotional security and emotional attachment; (3) objects are unique, with a marked opportunity cost should they not be purchased; and (4) a sense of heightened personal responsibility for objects (Kyrios et al., 2004). Buying specic beliefs were been shown to predict CB behaviours, even when age, mood, obsessivecompulsive disorder (OCD), decision-making fears, perfectionistic beliefs and developmental inuences were all controlled for (Kyrios et al., 2004). Hanley and Wilhelm (1992) suggested that people with CB strongly believe that generating sufcient funds to enable acquisition represented a unitary solution to any assortment of emotional or interpersonal problems. Although the specic schemas of compulsive buyers are yet to be identied (and represent a primary research goal), it is likely that the following schemas may be present: defectiveness/shame, underdeveloped self, entitlement, insufcient self-control and recognition seeking (Young, 1999).
S. Kellett and J. V. Bolton control disorder or if CB reects more underlying obsessivecompulsive processes. In terms of the empirical support for the impulse control hypothesis, two streams of research have emerged, which have either studied CB in the context of eating disorders or substance misuse. Faber et al. (1995) compared 84 binge eaters with 113 controls to illustrate higher rates of CB in the binge-eating group. Christenson et al. (1994), McElroy et al. (1994) and Lejoyeux, Tassain, Solomon, and Ades (1997) all noted (albeit, with smaller sample sizes) that eating disorders and CB tended to co-occur; whereas Mitchell et al. (2002) found no difference between compulsive buyers and controls in terms of history or prevalence of eating disorders, nor current eating disorder pathology scale scores. Both the Mitchell et al. (2002) and Christenson et al. (1994) studies found that CB participants (in comparison with controls) were likely to have higher lifetime histories of substance misuse/dependence. Lejoyeux et al. (1997), in a sample of depressed patients, found that both benzodiazepine and alcohol abuse were signicantly more frequent among the CB group in comparison with the non-CB group. Three main factors have been identied for impulsive buying: (1) the absence of due contemplation/consideration; (2) high emotional/psychological involvement with the desired item; and (3) the disregard of nancial considerations (Dittmar & Drury, 2000; Verplanken & Herabadi, 2001). A proportion of the CB literature compares the typical cognitive and behavioural processes of CB, with similar processes and events in OCD (McElroy et al., 1994). Lejoyeux, Bailly, Moula, Loi, and Ades (2005), counted the rates of CB in patients with OCD (n = 60) versus matched controls (n = 60); 23% of patients in the OCD group met the criteria for CB, in comparison with 6% in the matched control group. In a similar study, but without a control condition, DuToit, van Kradenburg, Niehaus, and Stein (2001) illustrated a CB rate of 10.6% in 85 patients with OCD. Schlosser et al. (1994) reported a co-morbidity rate of 22% (total n = 46) between CB and obsessivecompulsive personality disorder. Compulsive buyers have been shown to have signicantly more OCD symptoms than controls (Frost et al., 2002). In a student sample (and with a focus on hoarding), Frost et al. (1998) illustrated a signicant correlation between CB and the Padua Inventory (a validated measure of OCD severity). Investigations of the frequency/continuity of the compulsion to buy have been conducted: some compulsive buyers experience the urge to buy and acquire every day, whereas others tend
Obsessional Thinking Style

An issue of debate in CB (Benson, 2000), is whether CB can be better conceptualized as either an impulse
Compulsive Buying: A CognitiveBehavioural Model to engage in stereotypical binge purchasing episodes in response to negative affect (Faber, 2000; McElroy et al., 1994; OGuinn & Faber, 1989). A criticism of the CB/OCD literature is that cognitive/obsessional components have not tended to be clearly delineated from compulsive/behavioural aspects of CB (e.g., Faber & OGuinn, 1988, 1992; OGuinn & Faber, 1989), and that the evidence of positive affect during purchasing phases is not apparent in other compulsions (Scherhorn, 1990). There is some evidence, however, suggesting a relationship between obsessive CB cognitions and associated CB behaviours. Kwak, Zinkhan, and Roushanzamir (2004) found a relationship between an obsessive cognitive style and CB behaviours. The current cognitivebehavioural model emphasizes that aspects of compulsivity and impulsivity are possible (McElroy et al., 1995; Swan, Mitchell, & Faber, 2005), with the individual formulation of CB cases needing to reect the combination or unitary nature of compulsive and impulsive elements. Theoretically such a compromise position is created by conceptualizing CB as operating on an impulsive-compulsive spectrum (Christenson et al., 1994).
87 of negative affectivity. Such awareness is likely to be experienced as intrusive (Harvey, Watkins, Mansell, & Shafron, 2004) by the individual, with high levels of associated rumination, tending to be associated with proneness to depression (Thomas & Bentall, 2002). Black et al. (1998) found that compulsive buyers were more likely than controls to have lifetime mood disorders and particularly, major depression. Similarly, Frost et al. (2002) compared a sample of 75 CB participants with 85 controls, and found the CB group to be more likely to have a history of depressive episodes, both personally and in other family members. In a group of patients prone to recurrent depressive episodes, CB tended to be absent when the depression was in remission (Lejoyeux et al., 1997). Negative self-appraisals and associated negative affectivity appear to impel people, particularly those with exceptionally high standards or expectations, to try to escape such painful self-awareness (Duval & Wicklund, 1972), via the compensatory and neutralizing behaviour of buying. Mitchell et al. (2006) noted, however, low levels of depression in CB participants prior to intervention. Across both anxiety and depression in the current model, acquisition/buying creates alternative cognitive activity, therefore enabling avoidance of painful self-awareness, as it involves focussing on the immediate, concrete, low-level and ultimately achievable task of purchase.
Phase II: Triggers Internal Cognitive Triggers

A key factor in prompting binges of acquisition or more continuous CB behaviour appears to be the experience of negative and/or self-conscious emotions, such as feelings of body dysmorphia, depression, tension, uncontrollable need or anxiety prior to shopping episodes (Black et al., 1998; Christenson et al., 1994; Lejoyeux et al., 2005; McElroy et al., 1994). A small number of studies have investigated the role of anxiety in CB. Christenson et al. (1994) compared 24 CB participants with 24 agegendermatched controls using standardized diagnostic clinical interviews, to nd that the CB group were signicantly more likely to report lifetime histories of anxiety disorders. McElroy et al. (1994) used a similar methodology to interview 20 CB participants and found that all participants reported experience of two or more lifetime axis I disorders, including that of anxiety. Such high rates, however, may have been attributable to the sample being recruited from psychiatric populations. Although Mitchell et al. (2002) found anxiety disorders to be twice as common in their CB sample, this difference was not statistically signicant. Scherhorn et al. (1990) found a strong correlation between CB and the frequency of the awareness
External Environmental Triggers

Once compulsive buyers enter retail environments, they are placing themselves in contexts that have been deliberately designed to be appealing to all the senses (Pooler, 2003). As the raison dtre of retail is the maximization of prot, much time and effort goes into the design of retail environments and the style of retail interactions (OGuinn & Faber, 1989), in order to psychologically enhance motivations to purchase (Gilboa & Rafaeli, 2003). Eightynine percent of the Mitchell et al. (2006) treatment sample (n = 39), noted that their CB episodes tended to occur in stores. Such retail environments represent the external trigger mechanisms for CB in the suggested modelindeed one treatment approach to CB (Rodriguez-Villarino, Otero-Lopez, & Rodriguez-Casto, 2001) teaches media literacy to compulsive buyers, so that they may be more cognizant of buying cues. Feinberg (1986) found in a student sample that participants exposed to credit card logos at purchase points were more likely to purchase, made purchase decisions more rapidly and actually spent more, than the matched controls not exposed to the advertising. Younger generaClin. Psychol. Psychother. 16, 8399 (2009) DOI: 10.1002/cpp
88 tions are spending more time shopping (Herbig, Koehler, & Day, 1993) and watching television (Bennett, 1994) than previous generations and therefore have increased exposure to the inuence of advertising. Schlosser et al. (1994) reported that when in retail environments, compulsive buyers tend to particularly notice and be enticed by a range of retail stimuli, such as colour tones, texture, sound and smell of a shop and/or of the purchase itself. Boundy (2000) suggests that shopping channels on television expand the possibilities and boundaries of CB. There is some preliminary evidence to suggest that CB can occur in different buying environments and that the expansion of the internet provides an additional context in which CB can be displayed, via purchasing online (Browne, Durrett, & Wetherbe, 2004; LaRose & Eastin, 2002). Just as stores are designed to encourage acquisition, then web sites are designed to serve the same commercial purposes. The ready availability of credit in Westernstyle economies may contribute to lapses or collapses in self-regulation efforts, due to mediating the relationship between negative affects and CB behaviours (Roberts & Jones, 2001). A culture of indebtedness (Lea, Webley, & Walker, 1995) appears to be a societal-wide risk factor for CB (Lunt & Livingstone, 1992), with access to credit cards triggering bouts of acquisition for compulsive buyers (McElroy et al., 1994). Subsequently, compulsive buyers tend to chronically carry larger credit card balances (Ritzer, 1995). The greater the severity of presenting CB, the greater the proportion of available income spent (Black, Monahan, Schlosser, & Repertinger, 2001).
S. Kellett and J. V. Bolton Frost & Hartl, 1996). As such, the consideration of such simplicities of do I really need this, or have I enough money to afford this are all the more difcult to achieve, whilst highly absorbed during the act of buying. Pooler (2003) suggested that compulsive buyers are oblivious to the world around themselves during shopping due to such dissociative processes, a factor also emphasized in the very earliest accounts of CB (Bleuler, 1924; Kraepelin, 1915). Eccles (2002) qualitative study suggested that the group of participants labelled as existential compulsive buyers, were particularly prone to high levels of absorption while shopping. Heatherton and Baumeister (1991), McElroy et al. (1995) and Frost et al. (2002) all emphasize that mental absorption disqualies any executive/reective cognitive processing, which facilitates effective selfregulation efforts (i.e., Im aware of myself and my true motivations for purchasing this product while Im considering buying this). Evidence suggests that people are more emotionally responsive when in a dissociated/absorbed state of mind (Talbot, Talbot, & Tu, 2004), again lowering inhibitory information processing and allowing the mood-altering effects of purchase to form a positive feedback loop for buying behaviours.
Affect and Mood Alteration

Although there is evidence of mood change in about one in four general consumers during acquisition, in CB the experience of mood alteration appears ubiquitous (Faber & Christenson, 1996; Faber & Vohs, 2004) and typically is mood change towards positive affect and into either high arousal states (McElroy et al., 1994) or relief/gratication (Christenson et al., 1994). Faber and Christenson (1996), in a matched sample of 24 compulsive buyers and 24 controls, found that 95.8% of the CB sample retrospectively reported mood change as a result of buying, in comparison with 29.2% in the control sample. Several studies illustrate that compulsive buyers retrospectively report a greater mood change from before to immediately following a purchase than controls (Dittmar, 2001, 2005a). Faber, OGuinn, and Krych (1987) used a sentence completion methodology, to show that purchases tended to occur in the context of negative mood states for compulsive buyersa nding that also emerged from a qualitative study of excessive consumers (Dittmar & Drury, 2000). What appears consistent across accounts of CB is that acquisition serves a psychological purpose,
Phase III: The Act of Buying Attention

Whilst in the act of searching for, or buying possessions, compulsive buyers experience narrowing of attentional processes (Faber & Vohs, 2004), which are believed to be indicative of highly mentally absorbed states of mind (Pooler, 2003). In the comparison with control consumers, compulsive buyers have been shown to score signicantly higher on the trait of absorption (Faber, Peterson, & Christenson, 1994). Absorption is indicative of an altered and dissociated state of mind, during which effective processing of information is typically compromised (de-Ruiter, Phaf, Elzinga, & van-Dyck, 2004), which supports the informationprocessing decit approach to CB (Frost et al., 2002;
Compulsive Buying: A CognitiveBehavioural Model which is distinct and differentiated from the desire to actually own objects. Negative mood state is rapidly transformed once acquisition is under way (Faber & Christenson, 1996) and compulsive buyers appear to surrender to buying schema. Miltenberger et al. (2003) asked 19 female CB participants to recall their moods prior to, during and following purchase, and noted that CB tended to be driven by negative affectivity, but was maintained by the positive emotions experienced at the point of purchase. Buying crucially appears to provide a temporary improvement in mood and self-esteem (Faber, 2000; Faber & Christenson, 1996; OGuinn & Faber, 1989) and is the primary motivation for CB, rather than the ownership of objects, per se (Pooler, 2003). The mood repair (Elliott, 1994) that appears to take place during CB has been termed the self-medication hypothesis (Dittmar et al., 2007) of an assumed emotional void (Lawrence, 1990). Dittmar (2004a) indentied mood alteration as an emotional-social motivator of CB, with CB presumed to act as an action symptom in terms of altering mood (Krueger, 2000). Kreuger (2000), Scherhorn et al. (1990), Belk (2000) and Pooler (2003) all emphasize that the act of purchasing enables compulsive buyers to align their self-perception with that of a desired ingroup (e.g., funky, fashionable, of-the-moment, lots of friends), in which the envy or admiration they feel towards others, is imagined to be felt by others towards the self. In terms of the type of product that is acquired, there is evidence that CB is not concerned with the global acquisition of undifferentiated products (as in the case it appears of compulsive acquisition), but rather tends to be directed particularly at certain types of product. McElroy et al. (1994), Christenson et al. (1994), Kreuger (1988), Faber et al. (1987), Schlosser et al. (1994) and Mitchell et al. (2006) all indicated that CB tends to be limited to the purchase of clothes, shoes, cosmetics and jewellery; products potentially capable of temporarily changing appearance and associated perceptions of self-attractiveness (Belk, 1991). Such ndings may be due to, however, the extensive female sample bias that has accrued across CB studies. The Koran et al. (2006) data on the apparent equal distribution of CB across the genders means that the typical purchases of male CB sufferers is a potential new research arena. Pooler (2003) suggests that the acquisition of such products enables compulsive buyers to feel that they are effectively competing with envied others, with retailers tending to consistently emphasize the social rivalry aspects of ownership in advertising
89 products (Droge & Mackoy, 1995). Dittmar (2005a, 2005b) empirically illustrated that perceived identity gains were directly related to CB and bound up in the desire to achieve an ideal self. Yurchisin and Johnson (2004) also noted that perceived social status predicted CB behaviours (but in a sample limited to n = 305 undergraduates). Therefore, compulsive buyers appear particularly vulnerable to pursuing the vagaries and ux of fashion (Park & Burns, 2005) that, by its very nature, encourages and emphasizes the rapid purchase and replacement of on-trend items. Such products are suggested to be craved as necessities as opposed to luxuries in CB (Boundy, 2000), thus creating a treadmill of consumption (Bell, 1998). Pooler (2003) describes CB as a doomed attempt at self-denition, via the accomplishment task of purchase, which would be understood as schema compensation activity (Young et al., 2003). It is important to note that such aligning selfperceptions appear fantasy-based (Belk, 1991; Elliott, 1994; Jacobs, 1986; OGuinn & Faber, 1989), wholly transient, and have been termed a desperate search for self (Benson, 2000). Fantasies may serve a reinforcing function in CB, via the mental rehearsal of a range of imagined positive outcomes (OGuinn & Faber, 1989)presumably the demonstration of social power/competitiveness, via displays of material wealth (Bell, 1998). Dittmar (2004b) noted that identity-driven buying was active during internet shopping as well as during conventional store-shopping and in a later paper (Dittmar et al., 2007) conrmed that emotional enhancement and identity gains were common factors in internet-based CB. In terms of learning theory, the positively reinforcing effect of mood alteration during buying episodes appears omnipresent on each occasion of purchase (Falk, 1981), regardless of whether the purchase is made in a shop or online. Furthermore, the biphasic reinforcement effect characteristic of impulse control disorders (Marlatt, Baer, Donovan, & Kivlahan, 1988), means that the short-term effects of the CB are likely to exert a far greater inuence on decision making, than do considerations of the long-term negative consequences (Feinberg, 1986). Indeed, some CB clients state that the singular instance, during which they are free of anxious and/or negative affectivity, is during the act of buying (Elliott, 1994; Friese & Koenig, 1993). Interactions with retail staff are largely positive, due to the very nature of the sales environment, with such interactions also possibly providing temporary boosts to fragile images of self (OGuinn & Faber, 1989).
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S. Kellett and J. V. Bolton CB as variously nancial, temporal, emotional and functional.
Behaviour
Compulsive buyers tend to prefer to shop in a solitary fashion, rather than in the company of others (Elliott, 1994; Schlosser et al., 1994)again, a factor that needs to be considered with regards to the availability of shopping channels and the internet. In a eld experiment, Buckler (1996) illustrated that compulsive buyers tended to nd the presence of others whilst shopping as an irritant and annoyance. Presumably, interaction with others derails absorption and is therefore avoided, with an assumption that compulsive buyers may be actually seeking to achieve an absorbed state of mind (Faber & Vohs, 2004), in order to distract from more uncomfortable affects or self-images (DeSarbo & Edwards, 1996). The behavioural act of acquisition appears akin to ascent behaviours in bipolar disorder (Mansell & Lam, 2003), whereby uncomfortable self-awareness tends to promote a higher need for stimulation and associated disorganized behaviour. Learning that buying can serve potent psychological purposes promotes the risk of a complete breakdown of self-regulation efforts regarding consumption (Faber & Vohs, 2004). The act of acquisition can subsequently expand in scope and frequency due to positive feedback mechanisms, to become behaviourally over-learnt and automatic (Faber, 2000; OGuinn & Faber, 1989). Buying provides a sense of gratication that is immediate, focal and wholly positive during the moment of purchase (Faber & Vohs, 2004). Baumeister, Heatherton, and Tice (1994) refer to this process as behavioural snow-balling, wherein there is a complete breakdown in self-regulation efforts, with chronic patterns of apparently self-defeating behaviours being apparent, as is the case in CB.
Cognitions
Once purchases are acquired, then the person is likely to leave the retail environment and as such is nally aware of the reality of the breakdown in self-regulation efforts and becomes cognisant of the manner in which CB impacts negatively on social, familial and occupational functioning (Black, 2001; Lejoyeux et al., 1997). Accounts are available that once some compulsive buyers exit the desired higharousal/relief state, they can be confronted with evidence of multiple identical purchases (OGuinn & Faber, 1989), again implicating dissociative processes being present during the acquisition episode. As the person is no longer in a reinforcing retail environment and associated high arousal or relief state, then they come face-to-face with prepurchasing episode negative affects and selfimages. Therefore the dysfunctional schema driving the buying (e.g., Im unattractive and unwanted) are perpetuated through the process of the associated negative personal impact (Young et al., 2003).
Emotions
At this point, evidence suggests that compulsive buyers experience feelings of guilt, shame, regret, despair and self-recrimination (Faber & Vohs, 2004; McElroy et al., 1994), which are superimposed upon pre-existing negative affectivity and poor self-images, putting neatly in place the conditions to seek temporary psychological respite once again, via CB.
Behaviours
Benson (2000) and McElroy et al. (1994, 1995) suggest that such post-buying difculties also tend to promote secrecy and concealment, with fears of being perceived or exposed as vacuous or materialistic by others. The actual usage of possessions purchased appears a side issue in CB (Belk, 2000), with possessions rarely utilized (McElroy et al., 1994), but often hoarded or hidden (Frost et al., 1998, 2002; Mueller et al., 2007). Indeed, control consumers have been shown to have a higher desire to actually own objects than do compulsive buyers (OGuinn & Faber, 1989).
Phase IV: Post-purchase

The post-purchase phase in CB appears to share similarities with decent behaviours in bipolar disorder (Mansell & Lam, 2003), whereby postacquisition the individual engages in, for example, social withdrawal/isolation, rumination or selfcritical thinking, likely to re-establish persistent negative affectivity. The nancial consequences of CB are well established (Christenson et al., 1994; Glatt & Cook, 1987; McElroy et al., 1994; McElroy, Satlin, Pope, Keck, & Hudson, 1991; Mitchell et al., 2006; Ritzer, 1995; Rook 1987) and in the current cognitivebehavioural model provide additional impetus for the CB cycle to begin anew. Dittmar (2004a, 2004b) identied the negative impacts of
Summary of the Model

The cognitivebehavioural model of CB presented (Figure 1) conceptualizes CB as containing four key stages: (1) antecedent factors, including
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Phase I Antecedents
Early experiences
Schemas Entitlement, recognition-seeking Specific cognitions

Materialistic attitudes Commodity fetishism Buying beliefs Impulsive/ compulsive cognitive vulnerability
Phase II Triggers
Internal State Depressed, anxious; Uncomfortable sense of self
Phase IV Post purchase

Cognitions
Awareness of breakdown in selfregulation
Emotions
Guilt Shame Regret Despair
Behaviour
Hiding purchases Ignoring purchases
+
External cues Advertising Interaction with staff Credit
Phase III Buying

Attention
Poor self-regulation Dissociated Absorbed
Emotions
Equal to others Buzz Relief
Behaviour
Solitary Disorganised
Figure 1.
Cognitivebehavioural model of compulsive buying
92 early life experiences; (2) internal emotional and external triggers; (3) the act of buying; and (4) post-purchase emotional, behavioural and nancial factors. Within each stage, the CB evidence has been reviewed to support the inclusion of the factors in the model. Crucially, the model depicts CB in the form of a vicious circle, whereby the nal negative post-purchase realization stage creates the emotional and psychological triggers for the CB circuit to be repeatedly completed. The following sections review the evidence of the previous attempts to psychologically intervene in CB using cognitivebehavioural therapy and present a case using the new model in clinical practice.
S. Kellett and J. V. Bolton tive model to CB, in detailing the proposed causal relationship between thoughts, feeling and buying behaviours. In a waiting-list control study of the Burgard and Mitchell (2000) approach, Mitchell et al. (2006) illustrated that 12 sessions of group CBT for the 39 participants reduced the number of CB episodes and time spent shopping, with reductions on validated scales of CB, that were all maintained at a 6-month follow-up. Larger effect sizes were illustrated on the measures focal to CB than on the measures of general mental health. These two studies therefore focussed exclusively on changing response patterns in phases II, III and IV of the current suggested model and largely ignored any therapeutic work with regards to phase I (early experience). Steketee et al. (2000), in a hoarding context, found that CBT focal to compulsive acquisition behaviours was moderately effective in reducing acquisition and buying. Again, within this hoarding approach, the CBT approach focussed exclusively on maintenance and coping, at the expense of early experience-schema linkages.
EXISTING COGNITIVEBEHAVIOURAL THERAPY (CBT) OUTCOME EVIDENCE

Few examples of treatment of CB with CBT are available and fewer still evaluations of clinical outcomes in the short and long-term; indeed, well-controlled studies of efcacy and effectiveness, regardless of the psychotherapeutic modality, are scant (Benson & Gengler, 2004; Mitchell et al., 2006; Steketee & Frost, 2003). Black, Monahan, and Gabel (1997) argued that altering buying cognitions and impulses were at the epicentre of effective treatment of CB. Lee and Mysky (2004) criticize treatment approaches to CB for medicalizing what they view as a purely socio-cultural phenomena. Within the outcome literature concerning CB, despite the lack of difference between the genders regarding the prevalence of CB (Koran et al., 2006), there appears a gender difference in terms of help-seeking for CB, with women tending to constitute between 80 and 95% of typical study participants (Koran et al., 2002; Koran, Chuong, Bullock, & Smith, 2003; Ninan et al., 2000). Indeed, the Mitchell et al. (2006) open trial of group CBT for CB, actually actively excluded males from the intervention. Burgard and Mitchell (2000) described an adapted 14-session, 8-week form of manualized group CBT for CB, with a focus on the cognitive and behavioural factors maintaining CB and on treatment strategies for controlling CB; personal/ historical aetiological factors were not a therapeutic focus. Session content focussed on the management of compulsive/impulsive behaviours and included cash management, thought-feeling linkages/challenges, social support, assertiveness and relapse prevention. The group was unevaluated, but did provide a template for applying the cogniCopyright 2009 John Wiley & Sons, Ltd.
CASE STUDY
The case study provides the case details and treatment of a female client, (given the pseudonym here of Kath) presenting with CB using the proposed CBT model, evaluated using validated outcome measures of CB. The purpose of this section is to provide an example of the models application, with a client meeting established research and clinical criteria for CB. In terms of outcome in CB (like binge eating, for example), total abstinence from the behaviour simply cannot be a goal of treatment. Treatment for CB is focused on modifying unhelpful CB behaviours, rather than aiming for a complete abstinence approach (Benson & Gengler, 2004). The case is distinctive in that the client met the Boundy (2000) denition for identifying a codependent compulsive buyer. Such compulsive buyers are consistently driven by the desire to buy for others, in the effort to win approval, love and also to avoid possible imagined rejection (Boundy, 2000).
Presentation
The client was 36 years of age and lived with her husband and children. She presented complaining of a lifelong pre-occupation with shopping, meeting criteria for CB according to the description
Compulsive Buying: A CognitiveBehavioural Model outlined at the beginning of this paper on clinical assessment and on the CB scale (see below). Kath reported that she tended to spend all her spare time shopping, that she tended to shop on a daily basis and that shopping was her sole hobby. The vast majority of Kaths shopping was concerned with buying for her family. She stated that she simply could not stop shopping and that her previous attempts to cease had failed miserably. Kath noted that the CB had caused a high degree of marital conict and that, at times, the family had been in dire nancial circumstances.
93 and rejected. Kath reported that her parents would tend to shower her with gifts and that she would receive any present that she asked for, but her parents would not spend any quality time with her. Kath reported that such gifts and possessions became the epicentre of her life, due to her struggling to establish friendships in her peer group. At assessment, Kath detailed a profound misunderstanding and misconception of what love and affection really mean and stated that her model of self-care and the manner in which she cared for her family were solely driven by materialistic expressions and commodity acquisition (Boundy, 2000). Kath reported that her mental focus was typically focussed on the acquisition of possessions and when she was not shopping, then she tended to be ruminating on shopping or planning her next shopping trip.
Measures
At the initial assessment session, the following valid and reliable measures were completed to index both CB and additional mental health difculties: (1) Brief Symptom Inventory (BSI)a psychiatric symptom scale yielding three composite scales, namely, the Global Severity Index (GSI), Positive Symptom Distress Index (PSDI) and the Positive Symptom Total (PST), (Derogatis, 1993); (2) Beck Depression Inventory-II (BDI-II)a measure of depressed mood (Beck, Steer, & Brown, 1995); (3) Inventory of Interpersonal Problems (IIP-32)a measure of interpersonal difculties (Barkham, Hardy, & Startup, 1996); (4) CB Scale (CBS)a clinical screen for CB (Faber & OGuinn, 1992); (5) Compulsive Acquisition Scale (CAS)a measure containing two scales concerning CB and acquisition of free items (Frost et al., 1998); and nally the (6) Yale-Brown ObsessiveCompulsive ScaleShopping version (YBOCS-SV)a scale measuring severity of CB (Monahan et al., 1996). The assessment CBS score was 6.70; markedly below the cut-off of 1.34 that has been illustrated to differentiate compulsive from non-compulsive buyers (Faber & OGuinn, 1989, 1992). The YBOCSSV has been identied as a key scale for measuring change during interventions for CB (Monahan et al., 1996).
Phase II Evidence
In terms of internal triggers, Kath reported that she tended to shop in order to escape feelings of depressionher BDI score at assessment was 19, indicating the presence of moderate levels of depression (Beck et al., 1995). When low in mood, Kath reported that she would tend to ruminate on her perceived weaknesses and failing and become extremely self-critical. Kath also worked in a large supermarket, on the clothes section, which she had chosen deliberately, in order to be close to the focus of her compulsions. She had her own clothes rail in the storeroom, to secure planned purchases as they came into the store.
Phase III Evidence

Kath stated that she felt that she had little control over her urge to shop and that the intensity of the urge frequently led to purchasing objects that she did not require. While shopping, Kath stated that she would prefer to shop alone and that she often tended to lose track of time. She described frequently entering into dissociated states while shopping, evidenced by reported extended passages of unnoticed time and occasionally multiple purchases of the same item. Kath stated that when self-aware during shopping episodes, she tended to experience a sense of elation and an intense buzz at the point of purchase.
Description of Client Presentation Using the Model Phase I Evidence

Kath stated that her childhood had been heavily disrupted by her parents decision to relocate, in order to run a hotel when she was 6 years of age. Due to the workload involved in running the hotel, Kath described that her parents rarely had any time for her, leaving her feeling ignored, unwanted
Phase IV Post-purchase
On completing shopping trips, Kath described collapsing into guilt and shame once outside the shopping environment, as she recognized the extent and repetition of her failure in selfClin. Psychol. Psychother. 16, 8399 (2009) DOI: 10.1002/cpp
94 regulation. The daily gifts for her children (hoped and imagined to bring love and affection) tended to be quickly discarded, leaving Kath feeling alone, rejected and unwanted again. Kath reported that she would tend to hide purchased objects from her husband and also juggle money between accounts in order to fund her CB.
S. Kellett and J. V. Bolton perceiving that she had sufciently progressed with CB symptoms. The contracted intervention was for 13 intervention sessions. Kath reported attaining mastery of her shopping behaviours and an associated marked reduction of symptoms of CB. The client reported only shopping when required, she no longer dissociated while shopping and she was no longer constantly preoccupied with shopping. Kath reported that she had learnt that she could express her love and affection for her children, in a manner that did not require her to purchase gifts for them and that her children had also stopped asking for gifts, due to her behavioural shifts, increase in self-condence and assertiveness. As such, Kath appeared to individuateseparate from her previous co-dependent position. At the nal session, Kath stated that she had decided to terminate her employment in the supermarket, due to recognizing that to be in such a retail environment, was psychologically unhealthy for her. The client stated that the most important and useful aspects of the intervention were the self-monitoring and cognitive-slowing strategies, enabling her to consider purchases in retail environments, rather than impulsively acquiring them. The scores on the measures are included in Table 1, with relevant clinical and community means and standard deviations in order to provide a context for the changes observed. The most pertinent result of the intervention relates to the CBS, as this is the established clinical screener for CB. The CBS scores indicated that the client no longer met the criteria for CB at the end of treatment (CBS = 0.91) and improved on this progress over the follow-up period (CBS = 3.28). This positive outcome with regards to shopping behaviour and maintenance over the follow-up period was also mirrored in the CAS scales and the YBOCS-SV. CB measures in general indicated that the client reported functioning at community control levels in terms of shopping behaviours at termination and follow-up. In terms of mental health, the BDI-II and BSI scales showed reductions between assessment and termination, which were also maintained at the 6-month follow-up. No change was recorded on the IIP-32 measure, which did not indicate difculties with interpersonal functioning at assessment. The clinical signicance of observed changes on measures was assessed using Jacobsons Reliable Change Index (RCI; Jacobson & Truax, 1991). RCI scores determine whether recorded change in a measure, as a result of intervention, is greater than the change that would be expected due to measurement error.
Intervention
The client was seen for a total of fourteen, 50-minute sessions (three assessment sessions, 10 intervention sessions and one session of follow-up, 6-months post-intervention). The client was treated within the cognitivebehavioural model outlined, on an outpatient basis.
Assessment and Case Formulation Sessions

The three assessment sessions were used to produce an individual case formulation, subsequently employed in the 10 treatment sessions to guide both behavioural and cognitive interventions. An important aspect of the case formulation was to link the historical antecedents of the CB with the current expression of the shopping behaviours, which in turn enabled the client to see the rationale for the various intervention strategies.
Behavioural (B) and Cognitive (C) Interventions

(B1) Planned avoidance of shopping environments and time limiting of essential shopping trips; (B2) exposure to the anxiety of not shopping; (B3) increased exposure to time spent with family and friends on activities not related to shopping; (B4) response prevention with regards to the compulsion to shop; (C1) distraction techniques for pre-occupied thoughts regarding shopping; (C2) grounding activities while shopping to reduce dissociation; (C3) self-monitoring while shopping of underlying emotional states; (C4) engaging in cognitive-slowing activities during shopping (e.g., self-questioning cognitions such as what are my motivations for buying this; do I really need this; will buying this make me more happy; how will I feel when I get home); (C5) assertiveness training in terms of externally asserting own needs with others and internally in terms of resisting impulse to purchase; (C6) challenging core specic buying-related beliefs; and nally (C7) challenging dysfunctional schema established in childhood.
Outcome
By session 10 of the intervention, a mutual decision was taken to stop the therapy, due to the client
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Table 1. Case scores on measures at assessment, termination and follow-up (with relevant community and clinical comparison norms) Assessment Termination Follow-up Clinical norms* Mean (SD) 61.4 (12.3) 24.2 (9.1) 21.1 (2.5) 22.45 (12.75) 1.32 (0.72) 2.14 (0.61) 30.80 (11.63) 1.51 (0.68) Community norms* Mean (SD) 28.5 (12.6) 15.7 (7.4) 2.9 (1.8) 12.56 (9.93) 0.44 (0.47) 1.38 (0.56) 14.46 (10.43) 0.98 (0.52)
Compulsive Buying Scale Compulsive Acquisition Scale (buying scale) Compulsive Acquisition Scale (free scale) YBOCS-Shopping Version BDI-II BSI-Global Severity Index BSI-Positive Symptom Distress Index BSI-Positive Symptom Total IIP-32
6.70 82.00 30.00 19.00 19.00 1.70 1.76 51 0.72
0.91 35.00 10.00 11.00 11.00 0.25 1.00 13 0.72
3.28 29.00 7.00 11.00 9.00 0.51 1.17 11 0.81
* Norms obtained from Beck et al., 1995 (BDI-II; US norms); Barkham et al., 1996 (IIP-32; UK norms); Francis, Rajan, and Turner, 1990 (BSI; UK population norms); Derogatis, 1993 (BSI; US outpatient norms); Frost et al., 2002 (CAS norms) and Monahan et al., 1996, Black and Gabel, 1996 (YBOCS-SV; US norms). BDI = Beck Depression Inventory. BSI = Brief Symptom Inverntory. IIP = Inventory of Interpersonal Problems; SD = standard deviation. YBOCS = Yale-Brown ObsessiveCompulsive Scale.
RCI calculations on the CBS and CAS were impossible, due to the lack of relevant psychometric information in the published literature. RCI scores need to be in excess of 1.94 to be considered clinically signicant (Jacobson & Truax, 1991). Clinically signicant change was recorded between assessment and termination on the YBOCS-SV (RCI = 3.53), BDI-II (RCI = 2.31), BSI-GSI (RCI = 4.53), BSIPSDI (RCI = 2.00) and the BSI-PST (RCI = 6.41). No single measure displayed any clinically signicant improvement (or deterioration) between termination of therapy and 6-month follow-up on the RCI calculations. The psychometric picture indicates general therapeutic benet. The case study indicates that the proposed model provides a means of effectively formulating CB and provides a framework for integrating cognitive and behavioural treatment strategies. The case also demonstrated that it is possible to work with the schemas of compulsive buyers (phase 1 of the model) to good therapeutic effect. The observation of change in a schema measure in the evaluation methodology however would have strengthened the evidence of this stance considerably.
OVERALL CONCLUSIONS TO THE PAPER

The current paper has attempted to synthesize the extant evidence regarding CB into a cognitivebehavioural model that can guide and translate both assessment and intervention strategies with clients meeting the criteria for CB. As with
other impulse control disorders (McMurran, 1994), the model has championed the scenario that there appears no single explanatory factor for CB. Despite the evidence that compulsive buyers may be a heterogeneous group, the model appears broad enough to be clinically applicable to the range of CB clients possibly seeking treatment. The case example provided an initial illustration of the clinical application of the model, with positive outcomes that were maintained at 6-month follow-up. Clearly with regard to CB, there is much empirical work to be completed regarding more thorough and exacting examinations of the model suggested and more research indexing the effectiveness of psychological interventions with this client group, particularly with male clients meeting the diagnostic threshold for CB. Two proximal developments are particularly indicated from the current work: (1) clinically, the model needs to tested via the accumulation of single case experimentally based evaluations of outcome; and (2) theoretically, by employing ecological momentary assessment procedures prior to, during and following buying episodes with CB participants (Smyth et al., 2001) as CB appears, a uid phenomena. Due to societal changes, psychological service providers may be faced with increasing numbers of clients seeking help with CB (Dittmar, 2004a; Koran et al., 2006; Roberts, 1998) and therefore such outcome research is currently at a premium (Hollander & Allen, 2006; Mueller et al., 2007). This paper has hopefully raised the clinical prole of CB as a disorder to be taken seriously by individual clinicians and service commissioners; rather than
96 it being the smiled upon compulsion (Catalano & Sonenberg, 1993), as has previously been considered to be the case.
S. Kellett and J. V. Bolton

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Clinical Psychology and Psychotherapy Clin. Psychol. Psychother.

Compulsive Buying: A CognitiveBehavioural Model

Copyright 2009 John Wiley & Sons, Ltd.

Heterogeneity Among Compulsive Buyers

Compulsive Buying: A CognitiveBehavioural Model

Phase I: Antecedent Factors Early Developmental Experiences and Family Environment

Obsessional Thinking Style

Phase II: Triggers Internal Cognitive Triggers

External Environmental Triggers

Affect and Mood Alteration

Phase III: The Act of Buying Attention

S. Kellett and J. V. Bolton CB as variously nancial, temporal, emotional and functional.

Phase IV: Post-purchase

Summary of the Model

Compulsive Buying: A CognitiveBehavioural Model

Schemas Entitlement, recognition-seeking Specific cognitions

Phase IV Post purchase

Phase III Buying

Cognitivebehavioural model of compulsive buying

Copyright 2009 John Wiley & Sons, Ltd.

Clin. Psychol. Psychother. 16, 8399 (2009) DOI: 10.1002/cpp

EXISTING COGNITIVEBEHAVIOURAL THERAPY (CBT) OUTCOME EVIDENCE

Phase III Evidence

Description of Client Presentation Using the Model Phase I Evidence

Assessment and Case Formulation Sessions

Behavioural (B) and Cognitive (C) Interventions

Compulsive Buying: A CognitiveBehavioural Model

6.70 82.00 30.00 19.00 19.00 1.70 1.76 51 0.72

0.91 35.00 10.00 11.00 11.00 0.25 1.00 13 0.72

3.28 29.00 7.00 11.00 9.00 0.51 1.17 11 0.81

OVERALL CONCLUSIONS TO THE PAPER

S. Kellett and J. V. Bolton

Copyright 2009 John Wiley & Sons, Ltd.

Clin. Psychol. Psychother. 16, 8399 (2009) DOI: 10.1002/cpp

Compulsive Buying: A CognitiveBehavioural Model

Copyright 2009 John Wiley & Sons, Ltd.

Clin. Psychol. Psychother. 16, 8399 (2009) DOI: 10.1002/cpp

S. Kellett and J. V. Bolton

Copyright 2009 John Wiley & Sons, Ltd.

Clin. Psychol. Psychother. 16, 8399 (2009) DOI: 10.1002/cpp

Compulsive Buying: A CognitiveBehavioural Model

Copyright 2009 John Wiley & Sons, Ltd.

Clin. Psychol. Psychother. 16, 8399 (2009) DOI: 10.1002/cpp

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