The mediating effects of misinterpretation of intrusive thoughts on obsessive-compulsive symptoms

Perfectionism and inflated responsibility have both been identified as risk factors for the development and maintenance of obsessive-compulsive (OC) symptoms. The aim of the present study was to test whether the relationships between these two variables and OC symptoms are mediated by the misinterpretation of intrusive thoughts (MIT). Three hundred and three university students completed the Frost Multidimensional Perfectionism Scale, the Maudsley Obsessional Compulsive Inventory, the Responsibility Attitude Scale, and the Responsibility Interpretations Questionnaire. MIT was found to partially mediate the relationship between responsibility attitudes and OC symptoms. MIT also partially mediated the relationship between concern over mistakes and OC symptoms, even after controlling for responsibility attitudes. Both concern over mistakes and responsibility attitudes were significant predictors of MIT and OC symptoms, but responsibility was the stronger predictor when all of the variables were included in the model. Clinical implications for the treatment of OCD are discussed.     

Are responsibility attitudes related to obsessive-compulsive symptoms in schoolchildren?

In spite of a growth in cognitive conceptualizations of obsessive-compulsive symptoms, relatively little has been done to extend such concepts to childhood. This study investigated the relationship between responsibility attitudes and obsessive-compulsive symptoms in normal children. A measure of responsibility attitudes in children was constructed on the basis of Salkovskis' Responsibility Attitudes Scale. This measure (Responsibility Attitudes Scale for Children) was administered together with the Leyton Obsessive Inventory Child Version and the Children's Depression Inventory to a sample of two hundred and two 10-14-year-old schoolchildren in Iceland. The responsibility measure correlated moderately and similarly with the Leyton Obsessive Inventory Child Version and the Children's Depression Inventory. In a hierarchical regression analysis predicting Leyton Obsessive Inventory Child Version scores, age and gender were entered in the equation first, followed by Children's Depression Inventory scores and, finally, Responsibility Attitudes Scale for Children scores. It was shown that Responsibility Attitudes Scale for Children scores added significantly to the prediction of Leyton Obsessive Inventory Child Version over and above the other variables. It is concluded that the study of the role of responsibility attitudes in children's obsessive-compulsive symptoms is at least promising.     

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.     

Assessing the Development of Inflated Responsibility Beliefs: The Pathways to Inflated Responsibility Beliefs Scale

Inflated responsibility beliefs are hypothesized to be a central feature of obsessive-compulsive disorder (OCD; Rachman, 1998, 2002; Salkovskis, 1985), but the etiology of these beliefs remains untested. Salkovskis and colleagues (1999) proposed 5 primary pathways to the development of inflated responsibility beliefs (e.g., heightened responsibility as a child, exposure to rigid and extreme codes of conduct as a child). The current paper presents 2 studies developing a self-report measure—the Pathways to Inflated Responsibility Beliefs Scale (PIRBS)—of these hypothesized pathways. In the first study, an initial version of the scale is developed and the number of items are reduced. In the second study, the revised scale is shown to provide a reasonable match to the proposed structure and to have good internal consistency, retest reliability, and convergent and divergent validity. These initial data suggest that the PIRBS may be useful for studying the etiology of inflated responsibility beliefs that are hypothesized to be central to the development of OCD. Limitations and future directions are discussed.     

The role of cognitive factors in the pathogenesis of obsessive-compulsive symptoms: a prospective study

Cognitive models of obsessive-compulsive disorder (OCD) posit that specific kinds of dysfunctional beliefs (e.g., pertaining to responsibility and the significance of intrusive thoughts) underlie the development of this disorder. The present study was designed to prospectively evaluate whether dysfunctional beliefs thought to underlie OCD act as a specific vulnerability factor in the pathogenesis of obsessive-compulsive symptomatology. Eighty-five individuals were prospectively followed over a period of time thought to be associated with an increased onset of OCD symptoms -- childbirth and the postpartum. The majority of these new mothers and fathers experienced intrusive infant-related thoughts and performed neutralizing behaviors similar to, but less severe than, those observed in OCD. Scores on a measure of dysfunctional beliefs thought to underlie OCD predicted the development of obsessive-compulsive symptoms after controlling for pre-existing OCD symptoms, anxiety, and depression. Dysfunctional beliefs also predicted the severity of checking, washing, and obsessional OCD symptom dimensions, but not neutralizing, ordering, or hoarding symptom dimensions. These data provide evidence for specific dysfunctional beliefs as risk factors in the development of some types of OCD symptoms.     

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.     

The role of early maladaptive schemas in predicting exposure and response prevention outcome for obsessive-compulsive disorder

This is the first study that explores whether early maladaptive schemas are related to treatment outcome for patients with obsessive-compulsive disorder (OCD). The sample consisted of 88 outpatients with a diagnosis of OCD who completed exposure and response prevention treatment. The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), the Beck Depression Inventory and Young Schema Questionnaire – Short Form were administered before and after treatment. Regression analyses using post-treatment Y-BOCS as the dependent variable indicated that higher scores on the abandonment schema at pre-treatment were related to poor outcome and explained 7% of the variance in symptoms at post-treatment. Higher scores on the self-sacrifice schema at pre-treatment were related to good outcome and explained 6% of the variance in obsessive-compulsive symptoms at post-treatment. During treatment, only changes in the failure schema were significantly related to good outcome and explained 18% of the variance in symptoms at post-treatment.     

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.     

Are "obsessive" beliefs specific to OCD?: a comparison across anxiety disorders

Cognitive models of obsessive-compulsive disorder (OCD) assign a central role to maladaptive beliefs about threat, uncertainty, importance and control of thoughts, responsibility, and perfection. Previous research has demonstrated that such beliefs relate to specific OCD symptoms in a theoretically meaningful way. The aim of the present study was to determine whether these beliefs are endorsed more strongly by OCD patients than by those with other anxiety disorders. Eighty-nine adult OCD patients, 72 anxious control (AC) patients, and 33 nonclinical control (NCC) participants completed a measure of obsessive beliefs as well as measures of depression and trait anxiety. Compared to NCCs and ACs, OCD patients more strongly endorsed beliefs related to threat estimation, tolerance of uncertainty, importance and control of thoughts, and perfectionism, but not inflated responsibility. Using revised, condensed subscales, OCD patients differed from ACs on beliefs about perfectionism and certainty and about importance and control of thoughts, but not on beliefs about threat estimation and inflated responsibility. When controlling for depression and trait anxiety, the OCD and AC group did not differ on most belief domains, except for a belief that it is possible and necessary to control one's thoughts. Results are discussed in light of evolving cognitive-behavioral theories that highlight appraisals of thought control and the use and effectiveness of varying thought control strategies.     

Responsibility and obsessive-compulsive disorder: an experimental test

To test the causal status of responsibility in obsessive-compulsive disorder (OCD), an experiment was executed in which responsibility was experimentally manipulated. OCD patients, non-OCD anxiety controls, and non-patients executed a classification task in either a high or a low responsibility (LoRes) condition. Subjective ratings related to danger and responsibility indicated that the manipulation was successful. Subjective OCD-like experiences and checking behaviors were higher in OCD patients in the high responsibility (HiRes) condition than in all other groups. Although the checking subscale of the Padua Inventory correlated with subjective ratings in the OCD patients in the HiRes condition, it was not associated with checking behaviors. The results confirm the hypothesis that responsibility plays a causal role in OCD.     

Dysfunctional belief-based obsessive-compulsive disorder subgroups

An attempt was made to identify obsessive-compulsive disorder (OCD) subgroups based on differences in OCD related beliefs. OCD patients (N=367) were assessed with the Obsessional-Beliefs Questionnaire prior to treatment. Individuals' scores on measures of inflated personal responsibility and the tendency to overestimate threat, perfectionism and intolerance of uncertainty, and over-importance and over-control of thoughts were subjected to cluster analysis. Support for both a simple and complex subgroup model was found (2-subgroup and 5-subgroup taxonomies). A low-beliefs subgroup was identified in both taxonomies. The low-beliefs subgroups reported scores on belief measures equivalent to scores reported for non-OCD comparison groups in earlier studies. Additional analyses were conducted to determine relations between belief-based and symptom subgroups. Significant relationships were found (e.g., Symmetry symptom subgroup membership was associated with membership in the Perfectionism/Certainty beliefs subgroup), although the shared variance was modest. Implications for understanding OCD heterogeneity and for cognitive theory are discussed.     

Responsibility and perfectionism in OCD: an experimental study

Cognitive models of obsessive-compulsive disorder (OCD) suggest a number of different variables that may play a role in the development and maintenance of obsessive compulsive symptoms [Freeston, M. H., Rhéaume, J., & Ladouceur, R. (1996) Correcting faulty appraisals of obsessional thoughts. Behaviour Research and Therapy, 34, 433-446]. This study's aim was to verify the effect of perfectionism and excessive responsibility on checking behaviors and related variables. Twenty-four moderately perfectionistic subjects (MP) and 27 highly perfectionistic subjects (HP) were submitted to a manipulation of responsibility (low and high). After each manipulation, they had to perform a classification task during which checking behaviors were observed. Results indicate that more checking behaviors (hesitations, checking) occurred in the high responsibility condition than in the low responsibility condition for subjects of both groups. After executing the task in the high responsibility condition, HP subjects reported more influence over and responsibility for negative consequences than MP subjects. These results suggest that high perfectionistic tendencies could predispose individuals to overestimate their perceived responsibility for negative events. Furthermore, perfectionism could be conceived as playing a catalytic role in the perception of responsibility. Results are discussed according to cognitive models of OCD.     

Inflated perceptions of responsibility and obsessive-compulsive symptoms

In Salkovskis' [Salkovskis, P. (1985). Obsessional-compulsive problems: a cognitive-behavioural analysis. Behaviour Research and Therapy, 28, 571-588; Salkovskis P. (1989) Cognitive-behavioural factors and the persistence of intrusive thoughts in obsessional problems. Behaviour Research and Therapy, 27, 677-682] cognitive model for obsessive-compulsive disorder (OCD), inflated perception of responsibility is highlighted as the critical feature that maintains the disorder. In the current study, the relationship between responsibility and obsessive-compulsive (OC) symptoms was examined. Specifically, three measures of responsibility were evaluated for their psychometric properties. These measures were then used to test Salkovskis's model by examining the relationships among pervasive responsibility, automatic thoughts related to causing harm, and OC symptom severity. Findings provide partial support for the validity and reliability of the measures and for the model as a whole. Based on regression analyses, data support that pervasive responsibility significantly contributes to the prediction of OC symptoms. Furthermore, this relationship appears to be mediated by automatic thoughts related to causing harm in OCD contexts.     

Cognitive biases and obsessive-compulsive symptoms in children: examining the role of maternal cognitive bias and child age

Objective: Multiple cognitive biases associated with adult obsessive-compulsive disorder (OCD) were tested in a clinical sample of children (ages 7-11) and adolescents (12-17) and their mothers. This study examined (a) the associations between child cognitive biases and OCD severity, (b) maternal cognitive biases and child OCD severity, and (c) maternal cognitive bias and child cognitive bias. It was hypothesized that age would significantly moderate these relationships, with stronger associations with OCD severity for cognitive bias in adolescents (relative to children), and maternal cognitive bias in younger children (relative to adolescents). Method: Forty-six children and adolescents diagnosed with OCD and their mothers completed questionnaires assessing responsibility bias, thought-action fusion (TAF), thought suppression, and metacognitive beliefs. OCD symptoms were assessed using structured diagnostic interviews and semistructured symptom interviews. Results: As predicted, age significantly moderated associations between (a) child cognitive variables and OCD severity-specifically between child responsibility and child metacognition, which were associated with OCD severity for adolescents only; (b) maternal cognitive biases and child OCD severity-specifically for maternal responsibility and thought suppression, which were significantly and positively associated with child OCD severity but not adolescent OCD severity; and (c) maternal cognitive biases and child cognitive bias-such that significant associations were evident only in the younger child sample, and only between maternal TAF self and metacognition, with child suppression and child TAF moral, respectively. Conclusion: Maternal cognitive biases are more consistently linked to greater OCD severity among younger children, whereas personal cognitive biases are associated with greater OCD symptoms in adolescents. Treatments for pediatric OCD are likely to be improved by age-specific considerations for the role of maternal and child cognitive biases associated with OCD.     

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.     

Reality monitoring and metacognitive beliefs related to cognitive confidence in obsessive-compulsive disorder

The present study investigated general reality monitoring ability, and selective reality monitoring ability for anxiety relevant actions in a group of individuals with obsessive-compulsive disorder (OCD) and a group of non-anxious controls. In addition, reality monitoring confidence was assessed, as well as specific meta-cognitive beliefs related to cognitive confidence (by means of the Meta-Cognitions Questionnaire (MCQ)). No differences were found between both groups in actual reality monitoring ability. Unlike previous studies, the reality monitoring task included actions that were related to the individual concerns of the OCD patients and were ideographically selected. Nevertheless, no differential reality monitoring effect was observed for the anxiety relevant stimuli. Data from the MCQ, however, revealed that OCD patients had less overall confidence in their memory for actions and their reality monitoring ability. Analysis of the confidence ratings of the reality monitoring task showed that this reduced confidence was restricted to the neutral actions. No differences were observed for patients that reported low or high frequencies of checking behaviour. The whole of these data do not support memory deficit models of OCD, but are in line with recent emphasis on the importance of memory confidence and other meta-cognitive beliefs in OCD.     

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.     

Linguistic Analysis of Communication in Therapist-Assisted Internet-Delivered Cognitive Behavior Therapy for Generalized Anxiety Disorder

In spite of a growth in cognitive conceptualizations of obsessive‐compulsive symptoms, relatively little has been done to extend such concepts to childhood. This study investigated the relationship between responsibility attitudes and obsessive‐compulsive symptoms in normal children. A measure of responsibility attitudes in children was constructed on the basis of Salkovskis' Responsibility Attitudes Scale. This measure (Responsibility Attitudes Scale for Children) was administered together with the Leyton Obsessive Inventory Child Version and the Children's Depression Inventory to a sample of two hundred and two 10–14‐year‐old schoolchildren in Iceland. The responsibility measure correlated moderately and similarly with the Leyton Obsessive Inventory Child Version and the Children's Depression Inventory. In a hierarchical regression analysis predicting Leyton Obsessive Inventory Child Version scores, age and gender were entered in the equation first, followed by Children's Depression Inventory scores and, finally, Responsibility Attitudes Scale for Children scores. It was shown that Responsibility Attitudes Scale for Children scores added significantly to the prediction of Leyton Obsessive Inventory Child Version over and above the other variables. It is concluded that the study of the role of responsibility attitudes in children's obsessive‐compulsive symptoms is at least promising.     

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.     

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.