Appraisals of obsessional thoughts in normal samples

Cognitive theories of obsessive-compulsive disorder (OCD) posit that appraisals about the significance of thoughts are critical in the development and persistence of obsessions. Rachman [(1997). A cognitive theory of obsessions. Behaviour Research and Therapy, 35, 793-802.] proposes that appraisals of unwanted thoughts distinguish clinical obsessions from normal intrusive thoughts; thoughts appraised as important and personally significant are expected to be upsetting and recur. Appraisals are also expected to be related to symptoms of OCD. To explore the features of normal appraisals of obsession-like thoughts, nonclinical participants in two studies rated the personal significance of intrusive thoughts portrayed in vignettes containing prototypical themes associated with primary obsessions: aggressive, sexual, and blasphemous thoughts. Unwanted intrusive thoughts that were described as occurring more frequently were appraised as more personally significant, but participants appraised these socially unacceptable thoughts similarly whether they imagined having personally experienced them or a friend confiding about having experienced them. Appraisals in both studies were related to subclinical OC symptoms and OC beliefs.     

Thought control strategies as mediators of trauma symptoms in young women with histories of child sexual abuse

The current retrospective study examined thought control strategies, or cognitive techniques individuals use to deal with unpleasant thoughts following stressful events, as potential mediators of adjustment in young women with histories of child sexual abuse (CSA). In a sample of 76 undergraduate women who self-reported on abuse experiences, thought control strategies, and current trauma symptoms, several key findings emerged: (i) Greater severity of the CSA event was associated with greater reported use of worry and punishment strategies and less use of social control strategies; (ii) Increased use of worry and punishment strategies following the CSA event was associated with greater levels of trauma symptoms, while increased use of social control strategies following the CSA event was associated with lower levels of trauma symptoms; and (iii) Worry, punishment, and social control strategies served as mediators between CSA severity and trauma symptoms. The results suggest that thought control strategies, specifically increased worry and punishment, and decreased social control, play a vital role in understanding adjustment after CSA. Future research should examine the roles of these cognitive control strategies as possible avenues of intervention following CSA.     

A comparison of thought suppression to an acceptance-based technique in the management of personal intrusive thoughts: a controlled evaluation

Research suggests that suppressing unwanted thoughts is not possible, leads to a subsequent increase in frequency of the suppressed thoughts, and results in higher levels of distress. Because thought suppression may have negative effects, an alternative, acceptance-based approach has been proposed. The current paper reports the outcomes of two studies. Study I examined the relationships between two naturally occurring strategies of thought management (thought suppression and acceptance), symptoms of psychopathology, and experiences with personally relevant intrusive thoughts. Results showed that those who naturally suppress personally relevant intrusive thoughts have more, are more distressed by, and have a greater "urge to do something" about the thoughts, while those who are naturally more accepting of their intrusive thoughts are less obsessional, have lower levels of depression, and are less anxious. Study II compared three groups (thought suppression, acceptance, and monitor-only groups) on the frequency and distress associated with experiencing personally relevant intrusive thoughts. Results revealed that those instructed to suppress their personal intrusive thoughts were unable to do so and experienced an increased level of distress after suppression, whereas those instructed to use an acceptance-based strategy experienced a decrease in discomfort level (but not thought frequency) after having used such a strategy. These data offer initial evidence that acceptance may be a useful alternative to the suppression of personally relevant intrusive thoughts.     

The use of safety behaviours to manage intrusive memories in depression

Cognitive models of clinical disorders conceptualise cognitive and behavioural safety-seeking behaviours as central to symptom persistence because they prevent disconfirmation of key maintaining beliefs. Despite growing evidence of the role of negative beliefs about intrusive memories in depression, it remains unclear why such beliefs persist. Accordingly, we examined whether safety behaviours in response to unhelpful beliefs about intrusive memories might play a role in their maintenance. Eighteen high dysphoric (i.e., BDI-II12) individuals who reported an intrusive negative autobiographical memory in the past week completed a battery of measures about their memory, associated negative beliefs and safety behaviours adopted in response to their beliefs. The most commonly endorsed beliefs reflected themes of wanting to control memories (e.g., ‘I should be able to rid my mind of this memory’) and self-deprecation about experiencing them (e.g., ‘Because I can’t control this memory, I am a weak person’). The beliefs prompted a range of safety behaviours, with cognitive distraction being the most common. The findings demonstrate that safety behaviours are common in response to maladaptive beliefs about intrusive memories. Treatment developments in this area are needed, and should incorporate strategies to challenge beliefs about memories, reduce the use of safety behaviours, and promote processing of intrusive memories.     

A short form of the metacognitions questionnaire: properties of the MCQ-30

The metacognitions questionnaire (MCQ) measures individual differences in a selection of metacognitive beliefs, judgments and monitoring tendencies considered important in the metacognitive model of psychological disorders. The development and properties of a shortened 30-item version of the MCQ, the MCQ-30, are reported. Construct validity was evaluated by confirmatory and exploratory factor analysis. Overall, the fit indices suggested an acceptable fit to a five-factor model consistent with the original MCQ. Exploratory factor analysis supported a five-factor structure, which was almost identical to the original solution obtained in previous studies with the full MCQ. The five factors are cognitive confidence, positive beliefs about worry, cognitive self-consciousness, negative beliefs about uncontrollability of thoughts and danger, and beliefs about need to control thoughts. The MCQ-30 showed good internal consistency and convergent validity, and acceptable to good test-retest reliability. Positive relationships between metacognitions and measures of worry and obsessive-compulsive symptoms provided further support for the validity of the measure and the metacognitive theory of intrusive thoughts. The psychometric properties of MCQ-30 suggest that the instrument is a valuable addition to the assessment of metacognitions that has the advantage of being more economical to use compared with the original MCQ.     

Thought control strategies in obsessive-compulsive disorder: a replication and extension

Previous research suggests that individuals with OCD use maladaptive strategies to control their unpleasant thoughts (Behav Res Ther (1977) 35, 775). These include worry and self-punishment strategies. In the present study we replicated and extended the previous findings by comparing thought control strategies used by patients with OCD to strategies used by anxious and non-anxious control participants. We also examined changes in thought control strategies for OCD patients who underwent cognitive-behavioral therapy. Compared to controls, OCD patients reported more frequent use of worry and punishment strategies, and less frequent use of distraction. Following successful treatment, OCD patients evidenced increased use of distraction and decreased use of punishment. Findings are discussed in terms of the cognitive model of 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.     

Thought control strategies in acute stress disorder

Intrusive trauma-related thoughts and the means to manage them are a central dynamic in posttraumatic stress. Thought control strategies were investigated in survivors of motor vehicle accidents with either acute stress disorder (ASD; n=20) or no ASD (n=20). Participants completed the Acute Stress Disorder Interview, the Beck Depression Inventory, the Beck Anxiety Inventory, the Impact of Event Scale, and the Thought Control Questionnaire (TCQ) within four weeks of their accident. Although distraction, social control, and reappraisal were the most common strategies in both groups, ASD participants engaged in punishment and worry more than non-ASD participants. Worry and punishment were also strongly associated with severity of intrusive, avoidance, arousal, and depressive symptoms. Findings are discussed in terms of the role of cognitive strategies in resolving posttraumatic stress.     

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.     

Cognitions, metacognitions, and chronic pain

Purpose: Although the content of thoughts has received a considerable amount of attention in pain research, the importance of thought processes (metacognitions) has received less attention. Method: One hundred twenty-nine individuals with muscular dystrophy and chronic pain completed measures assessing metacognitions and frequency of both catastrophizing and pain control beliefs. Results: Greater use of reappraisal and distraction metacognitions were associated with more perceived control over pain, whereas greater use of worry and punishment metacognitions were associated with more catastrophizing. Conclusions/Implications: The current findings indicate that metacognitions are associated with both pain control beliefs and catastrophizing and therefore may play an important role in the development or maintenance of pain-related cognitive content thought to influence patient functioning. Research is needed to determine whether treatments that encourage changes in both metacognitions and cognitive content are more effective than treatments that focus on cognitive content alone. (PsycINFO Database Record (c) 2012 APA, all rights reserved).     

Cognitive control of obsessional thoughts

A defining characteristic of obsessive-compulsive disorder (OCD) is unsuccessful suppression of unwanted thoughts. Recent evidence of individual differences in ability to control intrusive thoughts may inform our understanding of failures of cognitive control associated with OCD symptomatology. The current study investigated characteristics of cognitive style that are potentially associated with OCD symptoms and may influence response to unwanted thoughts, including perceived ability to control thoughts and tendency to ruminate. Undergraduate students (N = 166) completed self-report measures of OCD symptoms, perceived thought control, and ruminative thinking. They were then presented with a distressing target thought and completed a standard thought suppression paradigm. Correlational results indicated that, controlling for anxiety and depression, OCD symptoms were positively associated with rumination and inversely associated with perceived thought control ability. In addition, OCD symptoms were associated with higher levels of distress and greater spontaneous efforts to suppress the target thought during a baseline period, while perceived thought control ability predicted frequency of target thoughts during suppression. Finally, results of the experimental manipulation confirmed that participants instructed to suppress experienced more intrusions during the recovery period. Clinical implications and future directions are discussed.     

Obsessive beliefs predict cognitive behavior therapy outcome for obsessive compulsive disorder

Cognitive accounts of obsessive compulsive disorder (OCD) assert that core beliefs are crucial to the development, maintenance, and treatment of the disorder. There are a number of obsessive beliefs that are considered fundamental to OCD, including personal responsibility, threat estimation, perfectionism, need for certainty, importance of thoughts, and thought control. The present study investigated if pretreatment severity of obsessive beliefs, as well as the change in obsessive beliefs following treatment, predicted intensive, residential cognitive behavioral therapy (CBT) treatment outcome. A series of hierarchical regression analyses were carried out to investigate the relations between obsessive beliefs and treatment outcome. Results indicated that inflated pretreatment responsibility/threat estimation beliefs were significantly related to less overall obsessive compulsive (OC) symptom reduction at discharge, explaining 2% of the overall variance. Changes in obsessive beliefs broadly, and importance/control of thoughts specifically, were positively related to overall OC symptom reduction at discharge, respectively explaining 18% and 3.6% variance. Results are modestly consistent with a number of theoretical models, which argue that inflated responsibility, threat estimation, and thought control are important to the maintenance and treatment of OCD.     

Role of thought-related beliefs and coping strategies in the escalation of intrusive thoughts: an analog to obsessive-compulsive disorder

Cognitive-behavioral models of obsessive-compulsive disorder (OCD) assume that obsessions have their origin in normal intrusive thoughts. These models propose that certain beliefs, such as thought-action fusion (TAF) beliefs, combined with the use of ineffective coping strategies, such as thought suppression, lead to the development of OCD. The purpose of the current study was to examine the relationship between these variables in a non-clinical sample in addition to exploring the effects of an alternative, acceptance-based coping strategy. This study explored the relationship between TAF beliefs, thought suppression, and OC-consistent symptoms via mediational analyses. Results showed that thought suppression mediated the relationship between TAF beliefs and OC-consistent symptoms. This study also experimentally examined the effects of various coping strategies (suppression, acceptance, or monitor-only) on the frequency of a distressing intrusion and appraisal ratings (e.g., anxiety, guilt, responsibility) after a TAF induction. Spontaneous suppression in the monitor-only group made comparisons of the experimental data difficult. However, analyses provided preliminary evidence suggesting that thought suppression is related to more intrusions, higher levels of anxiety, and negative appraisals, whereas an acceptance-based approach may be a useful alternative. Additional findings, limitations of the current study, and directions for future research are discussed.     

Implicit and explicit appraisals of the importance of intrusive thoughts

To evaluate cognitive theories of obsessions, the current study experimentally manipulated appraisals of the importance of intrusive thoughts. Undergraduate students (N = 156) completed measures of obsessive-compulsive disorder (OCD) symptoms and beliefs and were primed with a list of commonly reported unwanted thoughts. Participants were then informed that unwanted thoughts are either (1) significant and indicative of their personal values, or (2) meaningless, or participants (3) received no instructions about unwanted thoughts. Participants then completed implicit and explicit measures of self-evaluation and interpretations of their unwanted thoughts. Results indicated that the manipulation shifted implicit appraisals of unwanted thoughts in the expected direction, but not self-evaluations of morality or dangerousness. Interestingly, explicit self-esteem and beliefs about the significance of unwanted thoughts were associated with measures of OCD beliefs, whereas implicit self-evaluations of dangerousness were better predicted by the interaction of pre-existing OCD beliefs with the manipulation. Results are discussed in terms of divergent predictors of implicit and explicit responses to unwanted thoughts.     

Beliefs about obsessional thoughts

Recent cognitive-behavioral formulations of obsessive-compulsive disorder postulate that intrusive or obsessional thoughts are subject to appraisal. Extreme beliefs about the occurrence and meaning of intrusive thoughts direct appraisal, thus causing marked distress and subjective responsibility which may lead to neutralizing activity. A brief self-report belief inventory was developed from a 92-item pool to assess extreme beliefs concerning intrusive thoughts and responsibility, the control of such thoughts and their possible consequences, and the appropriateness of guilt and neutralizing behavior as a response. The inventory was developed sequentially on two nonclinical samples (N=125, N=265) to distinguish between neutralizing and nonneutralizing subjects. Initial psychometric data for the final instrument were obtained for two further nonclinical samples (N=61, N=50) along with a sample of OCD patients and a matched control group. The instrument showed satisfactory reliability and evidence of criterion, convergent, discriminant, and factorial validity. Finally, data from a heterogeneous outpatient medical sample (N=299) was used to test the relationship among obsessive-compulsive symptoms, mood state, and beliefs. The implications of these results for contemporary models of obsessive-compulsive disorder are discussed.     

Appraisal and control of sexual and non-sexual intrusive thoughts in university students

This study examined differences in the appraisal and thought control strategies associated with the perceived control of unwanted sexual and non-sexual intrusive thoughts. Eleven appraisal dimensions, subjective physiological arousal and 10 thought control strategies were measured in 171 university students who were administered the Revised Obsessive Intrusions Inventory-Sex Version, a self-report measure of unwanted intrusive thoughts. Thought-action fusion (TAF) likelihood was a significant unique predictor of the perceived controllability of respondents' most upsetting sexual and non-sexual intrusive thought. Moreover greater subjective physiological arousal was a significant predictor of reduced control over sexual intrusions, whereas worry that one might act on an intrusive thought and greater effort to control the intrusion were significant unique predictors of the control of non-sexual intrusive thoughts. Various thought control strategies were more often used in response to non-sexual than sexual cognitions. The results are discussed in terms of the differential role of various appraisal processes in the control of unwanted sexual and non-sexual thoughts.     

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.     

Obsessional beliefs and the implicit and explicit morality of intrusive thoughts

Cognitive models of obsessive-compulsive disorder (OCD) suggest that misinterpreting intrusive thoughts exacerbates obsessional thinking. To evaluate this hypothesis, healthy participants (N=91) were prompted to recollect their unwanted thoughts, and then beliefs about the immorality of these thoughts were manipulated. Next, participants completed implicit and explicit measures of self-evaluation and appraisals of unwanted thoughts. Results from structural regression analyses indicated that explicit responses to unwanted thoughts, such as evaluations of the significance of intrusive thoughts and state self-esteem, were predicted by pre-existing obsessional beliefs, but not by the morality instruction manipulation. In contrast, implicit responses, such as appraisals of unwanted thoughts as relatively important and evaluations of the self as relatively immoral and dangerous, were predicted by the interaction between specific obsessional beliefs (e.g., intolerance of uncertainty) and the morality instructions. Findings largely support cognitive models of OCD and suggest unique predictors of implicit and explicit responses to unwanted thoughts.     

The mediating role of disgust sensitivity and thought‐action fusion between religiosity and obsessive compulsive symptoms

Psychological theories of obsessions and compulsions have long recognised that strict religious codes and moral standards might promote thought‐action fusion (TAF) appraisals. These appraisals have been implicated in the transformation of normally occurring intrusions into clinically distressing obsessions. Furthermore, increased disgust sensitivity has also been reported to be associated with obsessive compulsive (OC) symptoms. No research, however, has investigated the mediating roles of TAF and disgust sensitivity between religiosity and OC symptoms. This study was composed of 244 undergraduate students who completed measures of OC symptoms, TAF, disgust sensitivity, religiosity and negative effect. Analyses revealed that the relationship between religiosity and OC symptoms was mediated by TAF and disgust sensitivity. More importantly, the mediating role of TAF was not different across OC symptom subtypes, whereas the mediating role of disgust sensitivity showed different patterns across OC symptom subtypes. These findings indicate that the tendency for highly religious Muslims to experience greater OC symptoms is related to their heightened beliefs about disgust sensitivity and the importance of thoughts.     

Cognitive variables related to worry among adolescents: avoidance strategies and faulty beliefs about worry

Studies aiming to better understand worry have neglected children and adolescents. This constitutes an important limitation considering that excessive worry is frequent among adolescents and that patients suffering from excessive worries associate the beginning of their disorder with adolescence. This study evaluates the cognitive variables associated with worry in a sample of 777 adolescents. It attempts to determine whether cognitive avoidance and false beliefs about the usefulness of worries are present and associated with worries in adolescence. The results showed that participants with a high level of worry used more avoidance strategies and held more beliefs about worry. The results also revealed that avoidance of stimuli that trigger unpleasant thoughts and thought substitution were the major avoidance strategies related to worry among adolescents. The belief that worry helps to avoid future negative events was also related to worry. These findings may suggest that adolescents' worries are maintained by processes similar to those observed among adults.