The Expanded Version of the Inferential Confusion Questionnaire: Further Development and Validation in Clinical and Non-Clinical Samples

The current study represents the further development and validation of an expanded version of the Inferential Confusion Questionnaire (ICQ-EV) in non-clinical and clinical samples. Inferential confusion seems to be particularly relevant to Obsessive-Compulsive Disorder (OCD) and is defined as a failure to recognize the unrealistic nature of obsessions due to a subjective form of reasoning. Factor analysis of the item-set of the ICQ-EV indicated a one-dimensional solution in non-clinical and clinical samples. It was hypothesized that inferential confusion as measured by the ICQ-EV would be particularly relevant to participants with OCD. Results confirmed convergent validity with strong relationships between the ICQ-EV and obsessive-compulsive symptoms in all samples independent of other cognitive domains and general distress. In addition, those with OCD scored higher on the ICQ-EV than non-clinical controls and a mixed anxiety disorder group so confirming group-criterion validity. Finally, the ICQ-EV also showed clinical validity with change in ICQ-EV scores during treatment significantly related to successful treatment outcome.     

Inferential confusion and obsessive beliefs in obsessive-compulsive disorder

The goal of the present study was to investigate whether inferential confusion could account for the relationships between obsessional beliefs and obsessive-compulsive disorder (OCD). The Inferential Confusion Questionnaire and the Obsessive Beliefs Questionnaire were administered to a sample of 85 participants diagnosed with OCD. Results showed that the relationship between obsessive beliefs and obsessive-compulsive symptoms decreased considerably when controlling for inferential confusion. Conversely, the relationship between inferential confusion and obsessive-compulsive symptoms was not substantially affected when controlling for obsessive beliefs. Since inferential confusion has an overlap with overestimation of threat, a competing hypothesis for the results was investigated. Results indicated that inferential confusion was factorially distinct from overestimation of threat, and that the independent construct of inferential confusion remains significantly related to obsessive-compulsive symptoms when controlling for anxious mood. These results are consistent with the claim that inferential confusion may be a more critical factor in accounting for OCD symptoms than are obsessive beliefs and appraisals.     

Fusion or confusion in obsessive compulsive disorder

Inferential confusion occurs when a person mistakes an imagined possibility for a real probability and might account for some types of thought-action and other fusions reported in obsessive-compulsive disorder. Inferential confusion could account for the ego-dystonic nature of obsessions and their recurrent nature, since the person acts "as if" an imagined aversive inference is probable and tries unsuccessfully to modify this imaginary probability in reality. The clinical implications of the inferential confusion model focus primarily on the role of the imagination in obsessive-compulsive disorder rather than on cognitive beliefs.     

Validation of a Chinese Version of the Obsessive Beliefs Questionnaire

Cognitive models of obsessive-compulsive disorder (OCD) assign a central role to maladaptive beliefs. Evaluation of these OCD beliefs in Western countries is commonly accomplished using the Obsessive Beliefs Questionnaire (OBQ) and is important for conceptualizing and treating OCD. It remains unclear if Western models of OCD beliefs are appropriate for sufferers in some non-Western regions, such as China, which represents nearly 20 % of the world population. Thus, the aim of present study is to examine the psychometric properties of a Chinese translation of the OBQ in three samples: 1,322 undergraduates, 139 patients with OCD, and 79 patients with other anxiety disorders. Confirmatory factor analysis revealed poor fit for multiple English-based models of the OBQ. However, an exploratory factor analysis supported an OBQ model that differs slightly from the English version: (1) Perfectionism/Certainty (P/C), (2) Over-Estimation of Threat (T), (3) Importance of Thoughts/Responsibility for Harm (I/R). This Chinese version of the OBQ (C-OBQ) contains 30 items and shows adequate internal consistency, test-retest reliability, construct validity, and criterion-related validity. In China, the C-OBQ may be a useful instrument for delineating cognitive patterns associated with OCD to inform research and treatment.     

Psychometric validation of the Obsessive Beliefs Questionnaire and the Interpretation of Intrusions Inventory: Part I

This article reports on the validation of the Obsessive Beliefs Questionnaire (OBQ) and Interpretations of Intrusions Inventory (III) developed by the Obsessive Compulsive Cognitions Working Group (OCCWG) to assess the primary beliefs and appraisals considered critical to the pathogenesis of obsessions. A battery of questionnaires that assessed symptoms of anxiety, depression, obsessive-compulsive symptoms and worry was administered to 248 outpatients with a DSM-IV diagnosis of Obsessive-Compulsive Disorder (OCD), 105 non-obsessional anxious patients, 87 non-clinical adults from the community, and 291 undergraduate students. Tests of internal consistency and test-retest reliability indicated that the OBQ and III assessed stable aspects of OC-related thinking. Between-group differences and correlations with existing measures of OC symptoms indicated that the OBQ and III assess core cognitive features of obsessionality. However, the various subscales of the OBQ and III are highly correlated, and both measures evidenced low discriminant validity. The findings are discussed in terms of the relevance and specificity of cognitive constructs like responsibility, control and importance of thoughts, overestimated threat, tolerance of uncertainty and perfectionism for OCD.     

Processes of inference, schizotypal thinking, and obsessive-compulsive behaviour in a normal sample

Previous research has shown inferential confusion as measured by the Inferential Confusion Questionnaire to be related to obsessive-compulsive symptoms. A total of 108 participants (41 men and 66 women) from a normal population in The Netherlands (M age = 46 yr., SD = 15.5) completed a package of questionnaires measuring inferential confusion, schizotypal symptoms, and obsessive-compulsive behaviour. As expected, scores for both inferential confusion and schizotypal symptoms were significantly related to those for obsessive-compulsive behaviour. In addition, analysis showed that inferential confusion and schizotypal symptoms shared common variance, but both predicted an independent portion of the variance in obsessive-compulsive behaviour while controlling for neuroticism. The present results call for further inquiry into the role of inferential confusion and schizotypal thinking in obsessive-compulsive behaviour.     

Dimensionality of the Obsessive Beliefs Questionnaire (OBQ)

The Obsessive Beliefs Questionnaire (OBQ) is a self-report measure in development by the Obsessive Compulsive Cognitions Working Group (OCCWG), who studies cognitive aspects of obsessive–compulsive disorder (OCD). The aim of this paper was to evaluate the dimensionality of the OBQ in students (n = 995). Two models were tested in a confirmatory framework, corresponding to the OCCWG's (a) original six subscales (87 items), and (b) more recent three subscales (44 items). Both models fit the present data poorly; thus, an exploratory analysis was undertaken. Results revealed one large factor that is relevant, but not unique, to OCD, and three factors that are conceptually consistent with the OCCWG's recent three: (a) distorted beliefs about one's own thoughts, (b) perfectionism, and (c) inflated responsibility. Convergent and divergent validity analyses of the present OBQ factors generally supported the preceding interpretations. Readers are referred to the work of the OCCWG for revisions to the OBQ.     

An investigation of self-ambivalence in obsessive-compulsive disorder

Individuals vulnerable to obsessive-compulsive disorder (OCD) are hypothesized to have ambivalence about their self-worth, morality and lovability [Guidano, V., & Liotti, G. (1983). Cognitive processes and emotional disorders. New York: Guildford Press]. The purpose of this study was to examine whether self-ambivalence was associated with OCD phenomena and beliefs relevant to OCD. It also examined whether patients with OCD had higher levels of self-ambivalence compared to non-clinical controls and patients with other anxiety disorders. Participants were 73 OCD patients, 50 patients with another anxiety disorder, 225 non-clinical undergraduate students and 43 non-clinical community controls. They completed measures of self-ambivalence, OCD phenomena, OCD-relevant beliefs, depression, anxiety and self-esteem. Self-ambivalence was significantly associated with OCD phenomena and OCD-relevant beliefs, after controlling for self-esteem, depression and anxiety. Further, OCD participants were significantly more ambivalent than the non-clinical groups, but did not differ from anxious controls. It was argued that these results provide a basis for extending the cognitive-behavioural model of OCD to include ambivalent self-perceptions as a component of the cognitive mechanisms relevant to the disorder.     

Metacognitions in patients with hallucinations and obsessive-compulsive disorder: the superstition factor

On the basis of the analogy between intrusive thoughts and auditory hallucinations established by Morrison et al. [(1995). Intrusive thoughts and auditory hallucinations: a cognitive approach. Behavioural and Cognitive Psychotherapy, 23, 265-280], the present work compares the metacognitive beliefs and processes of five groups of patients (current hallucinators, never-hallucinated people with a diagnosis of schizophrenia, recovered hallucinators, obsessive-compulsive disorder (OCD) patients, and a clinical control group) and a non-clinical group. The results show that of the five metacognitive factors considered in this study, two were found to be different in the current hallucinators group in comparison to any other group in the design. Likewise, it is found that the metacognitive beliefs of the current hallucinators coincide with those of the OCD patients in various factors, particularly that relating to superstition, and this is interpreted as lending support to the model of Morrison et al. (1995). Furthermore, the results are discussed in the light of existing research on Thought-Action Fusion, stressing the role that may be played by superstitious beliefs and magical thinking in auditory hallucinations and OCD.     

Psychometric validation of the obsessive belief questionnaire and interpretation of intrusions inventory--Part 2: Factor analyses and testing of a brief version

The Obsessive Belief Questionnaire (OBQ) and the Interpretation of Intrusions Inventory (III) were designed to assess beliefs and appraisals considered critical to the pathogenesis of obsessions. In previous reports we have described the construction and psychometric properties of these measures. In this study a battery of questionnaires assessing anxiety, depression, and obsessive compulsive symptoms was completed by 410 outpatients diagnosed with obsessive compulsive disorder, 105 non-obsessional anxious patients, 87 non-clinical adults from the community, and 291 undergraduate students. Items from 6 theoretically derived subscales of the OBQ were submitted to factor analysis. Three factors emerged reflecting (1) Responsibility and threat estimation, (2) Perfectionism and intolerance for uncertainty, and (3) Importance and control of thoughts. A 44-item version (OBQ-44) composed of high-loading items from the 3 factors showed good internal consistency and criterion-related validity in clinical and non-clinical samples. Subscales showed less overlap than original scales. Factor analysis of the III yielded a single factor, suggesting the total score be used in lieu of the 3 rationally derived subscales. The scales performed well on tests of convergent validity. Discriminant validity was promising; hierarchical regression analyses indicated that the OBQ subscales and III generally predicted OC symptoms after controlling for general distress. A revision of the OBQ, the OBQ-44, is included in the appendix.     

Intrusive thoughts in patients with obsessive compulsive disorder and non-clinical participants: a comparison using the International Intrusive Thought Interview Schedule

The International Intrusive Thought Interview Schedule (IITIS) was used to assess and compare the unwanted intrusive thoughts (UITs) reported in a group of patients with obsessive compulsive disorder (OCD) and a non-clinical group. Although all participants reported at least one type of intrusion, OCD patients experienced more intrusive thoughts than non-clinical participants, and this difference was statistically significant. In the OCD group, intrusive thoughts were more frequent, interfered more with daily life, were considered to be more important to get out of the mind, and were more difficult to stop than in non-clinical participants. The two groups did not differ significantly in terms of five appraisals of the most distressing intrusive thought. One appraisal (importance) was used far more by the OCD group than the non-clinical group. For three appraisals (intolerance of anxiety, need to control, and intolerance of uncertainty), the difference was smaller. Only two of the strategies for controlling the most upsetting intrusive thought (ritual and avoidance) were of value in differentiating between the two groups. The IITIS (an instrument used to assess intrusions in non-clinical samples) appears to be of value for the assessment of patients with OCD.     

Implicit awareness of ambiguity: a role in the development of obsessive-compulsive disorder

The cognitive-behavioral model of obsessive-compulsive disorder proposes that obsessional symptoms are the consequence of the manner in which intrusive cognitions are interpreted [e.g., Salkovskis, P. M. (1998). Cognitive-behavioral approach to understanding obsessional thinking. British Journal of Psychiatry, 173(35S), 53-63]. The present study suggests that this may be attributable to maladaptive implicit cognitive processing, a deficit that results in the explicit awareness of ambiguity in idiographic obsessive-compulsive disorder (OCD) stimuli. The present study examines decision-making responses of low and high OCD scorers in a non-clinical undergraduate sample. Via a computer console, participants were shown sentence statements for three levels of ambiguity. They were then presented with a propositional statement for which they had to indicate agreement or disagreement for sentences of varying ambiguity. After this, the participants indicated whether they were completely confident or unconfident as regards their previous agree-disagree decisions. Results indicate that the high compared to the low OCD scoring group had less agreement and subsequent less confidence in decisions made for sentences of varying ambiguity. Response latencies partially fitted the predicted hypotheses. Consequently, an addition to Salkovskis, Forester, and Richards' [1998. Cognitive-behavioral approach to understanding obsessional thinking. The British Journal of Psychiatry, 173(35S), 53-63] model of OCD is suggested: namely that an implicit ambiguity deficit mediates the likelihood of normally occurring intrusions developing into abnormal obsessions. Methodological limitations and future research are considered.     

强迫症诊断研究的新变化

临床实践与相关研究表明,强迫症的诊断标准已不能满足复杂的临床工作需要。首先,有关患者的自知力以及主观痛苦程度等诊断指标需要进一步修订。其次,就强迫症的核心症状而产生的争议,研究者提出应重新考虑强迫症、焦虑障碍、强迫谱系障碍和囤积障碍这四个概念之间的从属关系和诊断标准。未来研究应考虑从认知神经科学的视角探索强迫症的核心症状和病理机制,为强迫症的诊断标准提供新的依据。     

Obsessive-compulsive behaviours in specific situations: the relative influence of appraisals of control, responsibility and threat

Obsessive-compulsive disorder (OCD) is characterized by repeated and persistent attempts by the individual to control their thoughts and by taking action through rituals in order to prevent feared or personally distressing outcomes. While cognitive theories of OCD have generated supportive research findings and effective treatments, they have not considered broader control beliefs that may motivate aspects of OC-phenomenology. We have previously proposed that broader control beliefs, specifically desire for control and sense of control, may play a role in OC-symptoms (Moulding & Kyrios, 2006). In the present study, non-clinical participants (N=219) were presented with four hypothetical scenarios relevant to an OCD-checking concern, and using a manipulation paradigm, the relationship between control constructs and appraisals hypothesized to be relevant to OCD (threat, responsibility) was examined. Desire for control was moderately affected to responsibility and threat appraisals, while sense of control did not relate to these constructs. The relationship between aspects of OC-phenomenology and appraisals of control, responsibility and threat were also investigated. Higher desire for control predicted both affect and action, while a lower sense of control predicted higher distress and action, over-and-above appraisals of threat and responsibility. Control appraisals were particularly relevant to use of action, and to affect in the low responsibility situations. A possible interactive model of desire for control, threat and responsibility is discussed.     

Relations between a ruminative thinking style and obsessive–compulsive symptoms in non-clinical samples

Abstract

There is tremendous interest in understanding the cognitive processes behind obsessive–compulsive disorder (OCD). Whereas previous research on cognitive OCD models has focused on the dysfunctional content of obsessional thinking, processes and styles of thinking have not yet been investigated. The present study investigated the relationship between a ruminative response style and obsessive–compulsive (OC) symptomatology in two non-clinical samples. In Sample 1, 261 students completed the Ruminative Response Scale, the Padua-Inventory, Revised, and the Beck Depression Inventory. Tendency to ruminate was positively correlated with the severity of OC symptoms and particularly with obsessive rumination, even after controlling for depression. Results were replicated in Sample 2 (211 students). Data indicate that a ruminative response style and obsessive rumination share common processual features. Understanding the interaction between rumination and obsessional thinking might help to further elucidate the role of cognitive vulnerability factors in OCD and to expand cognitive and metacognitive models of OCD.     

The status of hoarding as a symptom of obsessive-compulsive disorder

Hoarding is considered by many to be a symptom of obsessive-compulsive disorder (OCD). Yet although it is observed in people with OCD, hoarding symptoms also appear in a number of other psychological and psychiatric conditions. The present studies were conducted using samples of OCD patients, patients with other anxiety disorders, and a non-clinical sample to further elucidate the relationship between hoarding and OCD. Across two investigations, we found that (a) whereas OCD patients had higher scores than the other groups on non-hoarding symptoms, this was not the case for hoarding symptoms; (b) hoarding tended to correlate more weakly with other OCD symptoms (e.g., washing, checking) than these other symptoms intercorrelated; (c) items measuring hoarding had the weakest factor loadings when a measure of OCD symptoms was submitted to factor analysis; (d) hoarding symptoms were not correlated with global OCD or anxiety severity, whereas other OCD symptoms were; and (e) hoarding did not show consistent relationships with OCD-related cognitive variables. These results do not support a specific relationship between hoarding and OCD; and they call into question hoarding's status as a specific symptom of OCD. Results are also discussed in terms of the importance of functional assessment of hoarding and OCD symptoms.     

Structural differentiation of disgust from trait anxiety in the prediction of specific anxiety disorder symptoms

Research has begun to implicate the role of disgust in the etiology of specific phobias and obsessive–compulsive disorder (OCD). However, it remains unclear if the association between disgust and specific anxiety disorder symptoms is an artifact of trait anxiety or a potential mechanism through which trait anxiety effects specific anxiety disorder symptoms. The present study employed structural equation modeling to differentiate disgust from trait anxiety in the prediction of four types of specific anxiety disorder symptoms in a non-clinical sample (N=352). Results indicate that disgust and trait anxiety latent factors were independently related to spider fears, blood-injection-injury (BII) fears, general OCD symptoms, and OCD washing concerns. However, when both variables were simultaneously modeled as predictors, latent disgust remained significantly associated with the anxiety disorder symptoms, whereas the association between latent trait anxiety and the anxiety disorder symptoms became non-significant or was substantially reduced. Statistical tests of intervening variable effects converged in support of disgust as a significant intervening variable between trait anxiety and spider fears, BII fears, and OCD symptoms (particularly washing concerns). The relevance of these findings for future research investigating the role of disgust in specific anxiety disorders is discussed.     

Worry and Rumination in Generalized Anxiety Disorder and Obsessive Compulsive Disorder

Ample work has already been conducted on worry and rumination as negative thought processes involved in the etiology of most of the anxiety and mood related disorders. However, minimal effort has been exerted to investigate whether one type of negative thought process can make way for another type of negative thought process, and if so, how it subsequently results in experiencing a host of symptoms reflective of one or the other type of psychological distress. Therefore, the present study was taken up to investigate whether rumination mediates the relationship between worry and generalized anxiety disorder (GAD), and between worry and obsessive compulsive disorder (OCD) in two clinical groups. Self-report questionnaires tapping worry, rumination, generalized anxiety disorder (GAD), and obsessive compulsive disorder (OCD) were administered to a clinical sample of 60 patients aged 30–40. Worry, rumination, generalized anxiety disorder (GAD), and obsessive compulsive disorder (OCD) correlated substantially with each other, however, rumination did not mediate the relationship between worry and generalized anxiety disorder (GAD) and between worry and obsessive compulsive disorder (OCD). We also analyzed differences of outcome variables within two clinical groups. These results showed that worry and rumination were significantly different between GAD and OCD groups.     

Confidence in memory and other cognitive processes in obsessive-compulsive disorder

Previous studies have implicated beliefs about one's memory (i.e., meta-memory), in maintaining the symptoms of obsessive–compulsive disorder (OCD), particularly with respect to checking rituals. However, most research has focused on task- or situation-specific perceptions about memory performance. Expanding on this research, we undertook two studies with analogue and clinical cohorts to examine the relationship between general ‘trait’ beliefs about memory and related processes and OCD symptoms. Trait meta-memory as measured in the current study was conceptualised as a multi-dimensional construct encompassing a range of beliefs about memory and related processes including confidence in one's general memory abilities, decision-making abilities, concentration and attention, as well as perfectionistic standards regarding one's memory. Meta-memory factors were associated with OCD symptoms, predicting OCD symptoms over-and-above mood and other OCD-relevant cognitions. Meta-memory factors were found to be particularly relevant to checking symptoms. Implications for theory and research are discussed.     

Connections among symptoms of obsessive-compulsive disorder and posttraumatic stress disorder: a case series

Theoretical, clinical, and empirical implications of the functional connections between symptoms of obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD) are abundant. As such, four cases are presented here of men and women who met criteria for comorbid OCD and PTSD. All had been diagnosed with treatment-resistant OCD and were seeking treatment from an OCD specialty clinic or institute, all reported a history of traumatic experiences prior to the onset of OCD, and all appeared to demonstrate negative treatment outcomes. Upon examination, it appeared that symptoms of OCD and PTSD were connected such that decreases in OCD-specific symptoms related to increases in PTSD-specific symptoms, and increases in OCD-specific symptoms related to decreases in PTSD-specific symptoms. Speculations about the function of OCD symptoms in relation to post-traumatic psychopathology are put forth; and theoretical, research, and treatment implications are discussed.