Hierarchical Structure of Dysfunctional Beliefs in Obsessive‐Compulsive Disorder

The Obsessive Beliefs Questionnaire was developed as a comprehensive measure of dysfunctional beliefs, which cognitive models consider to be etiologically related to obsessive‐compulsive disorder. Obsessive Beliefs Questionnaire subscales tend to be highly correlated, which raises the question of whether obsessive‐compulsive‐related beliefs are hierarchically structured, consisting of lower‐order factors loading on 1 or more higher‐order factors. To investigate the nature and relative importance of these factors, a hierarchical factor analysis was conducted (n = 202 obsessive‐compulsive disorder patients), using a Schmid‐Leiman transformation. Results indicated a higher‐order (general factor) and 3 lower‐order factors: (i) responsibility and overestimation of threat, (ii) perfectionism and intolerance of uncertainty and (iii) importance and control of thoughts. The high‐order factor accounted for more variance in Obsessive Beliefs Questionnaire scores (22%) than did the lower‐order factors (6–7%), thereby underscoring the importance of the higher‐order factor. Despite the importance of the higher‐order factor, the lower‐order factors significantly predicted unique variance in measures of obsessive‐compulsive symptoms, including severity ratings of compulsions. These finding suggest that cognitive models of obsessive‐compulsive disorder should take into consideration the hierarchic structure of obsessive‐compulsive‐related beliefs.     

Are there interactions among dysfunctional beliefs in obsessive compulsive disorder?

Contemporary cognitive models of obsessive-compulsive disorder emphasize the importance of various types of dysfunctional beliefs, such as beliefs about inflated responsibility, perfectionism and the importance of controlling one's thoughts. These beliefs have been conceptualized as main effects, each influencing obsessive-compulsive symptoms independent of the contributions of other beliefs. It is not known whether beliefs interact with one another in their influence on obsessive-compulsive symptoms. To investigate this issue, data from 248 obsessive-compulsive disorder patients were analyzed. Dependent variables were the factor scores on the 4 Padua Inventory subscales. Predictor variables were the factor scores from the 3 factors (inflated responsibility, perfectionism and controlling one's thoughts) of the Obsessive Beliefs Questionnaire and their 2- and 3-way interactions. Regression analyses revealed significant main effects; in almost all analyses one or more of inflated responsibility, perfectionism, and controlling one's thoughts factors predicted scores on the Padua factors even after controlling for general distress. There was no evidence that beliefs interact in their effects on obsessive-compulsive symptoms, thereby providing a relatively unusual instance in which a simpler explanation (main effects only) is just as powerful as a more complex model.     

Behavior analysis and the primary prevention of occupational injuries

Contemporary cognitive models of obsessive‐compulsive disorder emphasize the importance of various types of dysfunctional beliefs, such as beliefs about inflated responsibility, perfectionism and the importance of controlling one's thoughts. These beliefs have been conceptualized as main effects, each influencing obsessive‐compulsive symptoms independent of the contributions of other beliefs. It is not known whether beliefs interact with one another in their influence on obsessive‐compulsive symptoms. To investigate this issue, data from 248 obsessive‐compulsive disorder patients were analyzed. Dependent variables were the factor scores on the 4 Padua Inventory subscales. Predictor variables were the factor scores from the 3 factors (inflated responsibility, perfectionism and controlling one's thoughts) of the Obsessive Beliefs Questionnaire and their 2‐ and 3‐way interactions. Regression analyses revealed significant main effects; in almost all analyses one or more of inflated responsibility, perfectionism, and controlling one's thoughts factors predicted scores on the Padua factors even after controlling for general distress. There was no evidence that beliefs interact in their effects on obsessive‐compulsive symptoms, thereby providing a relatively unusual instance in which a simpler explanation (main effects only) is just as powerful as a more complex model.     

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.     

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.     

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.     

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.     

The Meta-Cognitive Beliefs Questionnaire: development of a measure of obsessional beliefs

A 67 item self-report questionnaire called the Meta-Cognitive Beliefs Questionnaire (MCBQ) was developed to assess endorsement of beliefs about the importance of control and negative consequences associated with unwanted, ego-dystonic intrusive thoughts, images and impulses. The MCBQ and a battery of questionnaires that assessed symptoms and cognitions of worry, obsessive-compulsive disorder, anxiety, and depression were administered to large samples of undergraduate students. Beliefs about control of intrusive thoughts and perceived negative consequences due to uncontrolled mental intrusions had a unique significant relationship with obsessions, and to a lesser extent, worry. These findings are consistent with current cognitive behavioral theories that suggest an important role for meta-cognitive beliefs in the pathogenesis of obsessions.     

Obsessional Beliefs and Symptoms of Obsessive–Compulsive Disorder in a Clinical Sample

The aim of the present study was to investigate the relationships among a broad range of obsessive–compulsive disorder (OCD) symptoms and obsessional beliefs in a clinical sample of OCD patients. Ninety-nine treatment-seeking adult OCD patients completed the Obsessive Beliefs Questionnaire and the Obsessive–Compulsive Inventory-Revised. Hierarchical regression analyses, controlling for comorbid symptoms, suggested that washing was predicted by responsibility/threat estimation beliefs. Checking/doubting was not predicted by any obsessional beliefs. Hoarding was predicted by perfectionism/certainty beliefs. Neutralizing was predicted by responsibility/threat estimation beliefs. Obsessing was predicted by importance/control of thoughts and perfectionism/certainty beliefs. Ordering was predicted by perfectionism/certainty beliefs. A principal components analysis of OCD symptom dimensions and accompanying beliefs yielded two components, accounting for 53% of the variance: one, which was labeled “Fear/Threat,” consisted of importance/control of thoughts, obsessing, responsibility/threat estimation, and washing. The second, which was labeled “Incompleteness/Not Just Right,” consisted of neutralizing, perfectionism/certainty, checking/doubting, and hoarding.     

Irrational and Metacognitive Beliefs Mediate the Relationship Between Content Beliefs and GAD Symptoms: A Study on a Normal Population

Cognitive Behavioral Therapy (CBT), Rational Emotive Behavior Therapy (REBT) and Metacognitive Therapy (MCT) models show both similarities and differences in conceptualizing anxiety. This work assumes that REBT’s irrational and MCT’s metacognitive beliefs play a mediation role while CBT’s disorder specific content beliefs act as triggers. This hypothesis is tested using a regression model in which metacognitive and irrational beliefs play a mediation role while content disorder beliefs are independent variables. This paper applied this model to generalized anxiety disorder (GAD), a psychiatric diagnosis in which anxiety is the major feature. In GAD, the specific content beliefs are negative problem orientation and intolerance of uncertainty. Therefore, 149 non clinical subjects completed 4 self-report questionnaires: the Negative Orientation to the Problems Questionnaire and the Intolerance of Uncertainty Scale as measures for content cognitive beliefs, the Attitudes and Beliefs Scale for irrational beliefs, and the Metacognitive Questionnaire 30 Items Version for metacognitive beliefs. The generalized anxiety disorder questionnaire was chosen in order to measure anxiety as dependent variable. Regression analyses confirmed that irrational and metacognitive beliefs mediate the relation between cognitive content beliefs and GAD. We clinically interpret mediation as a second level regulation.     

The presence of magical thinking in obsessive compulsive disorder

Two research groups have raised the possibility that magical ideation may be a fundamental feature of obsessive-compulsive disorder. It has been proposed to underlie thought action fusion and superstitious beliefs. In this study, the Magical Ideation scale, the Lucky Behaviours and Lucky Beliefs scales, the Thought Action Fusion-Revised scale, the Padua Inventory, and the Obsessive Compulsive Inventory-Short Version were completed by 60 obsessive compulsive patients at a hospital clinic. Of all the measures, the Magical Ideation (MI) scale was found to be the most strongly related to obsessive compulsive symptoms. Large and significant relationships between MI scores and the measures of OCD were obtained even when alternative constructs (Lucky Behaviours, Lucky Beliefs, Thought Action Fusion-Revised scales) were held constant. No other variable remained significantly related to the Obsessive Compulsive Inventory-Short Version when magical ideation scores were held constant. The findings suggest that a general magical thinking tendency may underpin previous observed links between superstitiousness, thought action fusion and OCD severity.     

Change in metacognitions predicts outcome in obsessive–compulsive disorder patients undergoing treatment with exposure and response prevention

Wells' (Wells, A. (1997). Cognitive therapy of anxiety disorders: a practice manual and conceptual guide. Chichester, UK: Wiley) metacognitive model of obsessive–compulsive disorder (OCD) predicts that metacognitions must change in order for psychological treatment to be effective. The aim of this study was to explore: (1) if metacognitions change in patients undergoing exposure treatment for OCD; (2) to determine the extent to which cognitive and metacognitive change predicts symptom improvement and recovery. The sample consisted of 83 outpatients with a diagnosis of OCD who completed exposure and response prevention treatment. The Yale–Brown Obsessive–Compulsive Scale (Y-BOCS), the Metacognitions Questionnaire (MCQ-30) and the Obsessive Beliefs Questionnaire (OBQ-44) were administered before treatment, after treatment, and at 12-month follow-up. Treatment resulted in significant changes in symptoms, metacognition score, responsibility and perfectionism. Regression analysis using post-treatment Y-BOCS as the dependent variable indicated that when the overlap between predictors was controlled for, only changes in metacognition were significant. Changes in metacognitions explained 22% of the variance in symptoms at post-treatment when controlling for pre-treatment symptoms and changes in mood. A further regression revealed that two MCQ-30 subscales made individual contributions. The patients had significantly higher scores compared to community controls on the MCQ-30. Patients who achieved clinical significant change had lower scores on the MCQ-30 compared to patients who did not change. The results did not change significantly from post-treatment to follow-up assessment. These findings provide further support for the importance of metacognitions in treating OCD.     

Expanding the Nexus of Cognitive and Psychomotor Abilities

A study was conducted to expand the nexus of cognitive and psychomotor abilities. A cognitive aptitude battery and a psychomotor battery were administered to 429 military recruits. A confirmatory factor analysis yielded higher-order factors of general cognitive ability (g) and psychomotor/technical knowledge (PM/TK). PM/TK was interpreted as Vernon's (1969) practical factor (k:m). In the joint analysis of these batteries, g and PM/TK each accounted for about 31% of the common variance. No residualized lower-order factor accounted for more than 7% PM/TK influenced a broad range of lower-order psychomotor factors. The first practical implication of these findings is that psychomotor tests are expected to be at least generally interchangeable. A second implication is that the incremental validity of psychomotor tests beyond cognitive tests is expected to be small. These findings should help guide test developers and inform personnel selecting agencies regarding the expected utility of psychomotor tests.     

Do patients with OCD and pathological gambling have similar dysfunctional cognitions?

The obsessive-compulsive spectrum disorder (OCSD) theory postulates that a wide range of disorders is closely related to OCD. Current cognitive models ascertain that certain beliefs leading to misinterpretation of the significance of intrusions are important in the etiology and maintenance of OCD. This study examined whether pathological gambling, a disorder belonging to the OC spectrum, is characterized by similar dysfunctional cognitions as OCD. Dysfunctional beliefs of OCD patients were compared to those of patients with pathological gambling, panic disorder and normal controls. These beliefs were measured by the Obsessive-compulsive Beliefs Questionnaire-87 (OBQ-87), which was developed by a group of leading OCD researchers [Behav. Res. Ther. 35 (1997) 667]. It was hypothesized that according to the OCSD theory, pathological gamblers would exhibit similar cognitions to OCD patients, as well as increased levels of OCD symptoms. Analysis showed that OCD patients exhibited higher OBQ-87 scores than both panic patients and normal controls, but equal to pathological gambling patients. Pathological gamblers exhibited, however, no increase in OCD symptoms. These mixed results do not seem to support the OC spectrum theory for pathological gambling, moreover being contradictory to contemporary cognitive OCD models.     

The Validity and Specificity of the Short-Form of the Obsessive Beliefs Questionnaire (OBQ)

Moulding et al. (Assessment 18:357–374, 2011) created a 20-item short-form of the Obsessive Beliefs Questionnaire (OBQ; Obsessive Compulsive Cognitions Working Group in Behaviour Research and Therapy 43:1527–1542, 2005) labeled the OBQ-20. To date, the psychometric properties of the OBQ-20 have yet to be examined among clinical respondents. It is also unknown whether the OBQ-20 addresses the limited specificity of prior OBQ versions to obsessive-compulsive symptoms. In Study 1, using a small clinical sample (N?=?48), each OBQ-20 scale evidenced good internal consistency and shared a nearly identical correlation in magnitude with obsessive-compulsive symptoms relative to a corresponding full-length OBQ scale. In Study 2, using a large community sample (N?=?507), the OBQ-20 scales generally correlated equivalently with obsessive-compulsive symptoms relative to both depression and generalized anxiety symptoms. The OBQ-20 demonstrated strong psychometric properties, but, like prior OBQ versions, did not emerge as specific to obsessive-compulsive symptoms. Given its brevity and potential transdiagnostic importance, the OBQ-20 will likely be a useful assessment tool in both research and clinical settings.     

DAPP-BQ: factor structure and relations to personality disorder symptoms in a non-clinical sample

We assessed the factor structure of the DAPP-BQ (Livesley & Jackson, in press), as well as the relations between DAPP-BQ higher- and lower-order personality trait scores and DSM-IV (APA, 2000) personality disorder symptoms in a sample of approximately 300 nonclinical young adults. The four-factor structure of the DAPP-BQ was replicated, and DAPP-BQ higher-order and lower-order scores were related to personality disorder symptoms in predictable ways. Finally, regression analyses revealed that specific DAPP-BQ traits accounted for variance in individual personality disorder scores above and beyond comorbid personality disorder symptoms.     

Explicating the Dispositional Basis of the OCRDs: a Hierarchical Perspective

We examined the dispositional component of the obsessive-compulsive and related disorders (OCRDs) in a large adult sample. Our battery included two hierarchical measures of personality, which allowed us to examine relations with both higher-order domains and lower-order facets of the five-factor model. In addition, our study included multiple indicators of each OCRD, which enabled us to model them as latent factors. Principal factor analyses of these indicators revealed six dimensions: Obsessive-Compulsive Disorder (OCD), Hoarding, Excoriation, Body Dissatisfaction, Trichotillomania, and Body Preoccupation. Body Dissatisfaction, OCD, and Hoarding showed the strongest links to personality, with the other symptoms displaying more moderate associations. Neuroticism was the strongest and broadest predictor of the OCRDs at the domain level, exhibiting significant positive relations with every symptom dimension except Body Preoccupation in both bivariate and multivariate analyses. Conscientiousness showed negative associations with Body Dissatisfaction and Hoarding, and was positively related to Body Preoccupation. Finally, openness was negatively linked to OCD at both the bivariate and multivariate level. In comparison to domain-level analyses, the lower-order facets jointly contributed an additional 11.8% (Excoriation) to 17.6% (OCD) of the criterion variance, with a mean increment of 14.2%. Three neuroticism facets—anger, self-consciousness, and impulsiveness—displayed robust positive associations with two or more OCRD symptom factors, but no lower-order trait contributed significantly in every analysis. Overall, our results indicate that—similar to most other forms of psychopathology—OCRD symptoms have a common component of elevated neuroticism.     

Inferential confusion in obsessive-compulsive disorder: the inferential confusion questionnaire

The current article represents the further validation of the construct of inferential confusion amongst clinical samples. Inferential confusion is proposed to be a meta-cognitive confusion particularly relevant to obsessive compulsive disorder (OCD) that leads a person to confuse an imagined possibility with an actual probability. As such, it conceptualizes OCD as a form of belief disorder similar to a delusion or overvalued idea that is a product of distorted reasoning processes. In contrast, other cognitive models of OCD emphasize a phobic model of development in OCD, and thus consider the exaggerated interpretation of intrusions as an essential element in OCD. The present study administered a revised version of the Inferential Confusion Questionnaire, and the Obsessive Belief Questionnaire (OBQ), to a total of 183 participants in three clinical groups and a non-clinical control group. Results suggest that OCD, at least in part, follows a non-phobic model of development with inferential confusion significantly related to obsessive-compulsive symptoms independently of cognitive domains as measured by the OBQ, and mood states. Further, scores on inferential confusion were particularly high in those with OCD and delusional disorder as compared to anxious and non-clinical controls.     

The Correlation of General Cognitive Ability and Psychomotor Tracking Tests

A study was conducted to investigate the nexus of cognitive and psychomotor tests as might be used for personnel selection and assessment. These two domains are frequently seen as independent. A multiple aptitude cognitive test battery and a psychomotor test battery were administered to 354 United States Air Force recruits. The average multiple correlation of the cognitive tests and each psychomotor score as a criterion was 0.34, corrected for range restriction. Confirmatory factor analyses disclosed general cognitive and general psychomotor factors, three lower-order psychomotor factors, and two lower-order cognitive factors. The general cognitive factor accounted for 39% of the variance and the general psychomotor factor accounted for 29% of the variance. Residualized, the lower-order factors accounted for between 10% and 3% of the variance. The average g saturations (loadings) of the cognitive and psychomotor tests were 0.82 and 0.34 respectively. An implication for personnel selection is that the incremental validity of psychomotor tracking tests beyond the validity of cognitive tests will be small due to the commonality of measurement. A further implication of findings is the need to study the validity of the general and specific psychomotor factors.     

Biopsychosocial etiology of obsessions and compulsions: an integrated behavioral-genetic and cognitive-behavioral analysis

Accumulating evidence suggests that particular kinds of dysfunctional beliefs contribute to obsessive-compulsive (OC) symptoms. Three domains of beliefs have been identified: (a) perfectionism and intolerance of uncertainty, (b) overimportance of thoughts and the need to control thoughts, and (c) inflated responsibility and overestimation of threat. These beliefs and OC symptoms are both heritable. Although it is widely acknowledged that OC symptoms probably have a complex biopsychosocial etiology, to our knowledge there has been no previous attempt to integrate dysfunctional beliefs and genetic factors into a unified, empirically supported model. The present study was an initial step in that direction. A community sample of monozygotic and dizygotic twins (N = 307 pairs) completed measures of dysfunctional beliefs and OC symptoms. Structural equation modeling was used to compare 3 models: (a) the belief causation model, in which genetic and environmental factors influence beliefs and OC symptoms, and beliefs also influence symptoms; (b) the symptom causation model, which is the same as (a) except that symptoms cause beliefs; and (c) the belief coeffect model, in which beliefs and OC symptoms are the product of common genetic and environmental factors, and beliefs have no causal influence on symptoms. The belief causation model was the best fitting model. Beliefs accounted for a mean of 18% of phenotypic variance in OC symptoms. Genetic and environmental factors, respectively, accounted for an additional 36% and 47% of phenotypic variance. The results suggest that further biopsychosocial investigations may be fruitful for unraveling the etiology of obsessions and compulsions.