Effects of suppressing neutral and obsession-like thoughts in normal subjects: beyond frequency

Recent cognitive-behavioral theories on obsessive-compulsive disorder (OCD) show that deliberate attempts to suppress intrusive and undesirable thoughts lie at the genesis of clinical obsessions. In this paper the results of an experimental study on the suppression of neutral and obsession-like thoughts in normal subjects are presented. Eighty-seven university students performed in three experimental periods: (1) base-line monitoring, (2) experimental instruction, and (3) monitoring. For each of these periods, the frequency of the occurrence of a "white bear" thought or a personally relevant intrusive thought was registered. Half of the subjects received instructions to suppress the target-thought in period 2, and the other half were instructed to only monitor the target-thought in each of the experimental periods. Several measures were also obtained before and after the experiment: annoyance caused by the intrusion, suppression effort, subjective success, and evaluative appraisals of the target-thought. The results showed neither immediate nor delayed frequency increases of the target thought. However, evidence was found that deliberate thought suppression efforts, regardless of their content, had greater negative consequences than did non suppression. These results are discussed in relation to the recent cognitive proposals about OCD.     

Effects of suppression and appraisals on thought frequency and distress

Cognitive theories of obsessions highlight appraisals of personal significance and thought suppression in the development and maintenance of intrusive thoughts. The current study examined the role of personal significance within the context of a thought suppression paradigm. The primary aim was to examine whether suppression would have differential effects for target thoughts appraised as personally meaningful versus relatively unimportant. A blasphemous thought served as the target thought, and highly religious and nonreligious participants were recruited. Participants completed a two-interval thought suppression task; during interval 1 they were randomly assigned to suppress or not suppress the target thought and during interval 2, all participants were given “do not suppress” instructions. Suppression resulted in sustained frequency of thoughts in contrast to the decline in thought frequency observed for non-suppression. Differential effects of suppression were found across the two groups. Moreover, suppression was associated with increased negative mood and anxiety. Results suggest that suppression of personally meaningful thoughts is a counterproductive strategy.     

An examination of the cognitive processes involved in childhood obsessive-compulsive disorder

The cognitive theory of obsessive-compulsive disorder (OCD) is the most widely accepted account of the aetiology and maintenance of this disorder in adults. This paper investigated whether cognitive processes were evident in a sample of children with a primary diagnosis of OCD. Using an idiographic approach, as proposed by the Obsessive-Compulsive Cognitions Working Group, this paper assessed cognitive appraisals of responsibility, probability, severity, thought-action fusion, self-doubt and cognitive control. Ratings of these cognitive appraisals were obtained across a sample of children with OCD, and were compared with ratings from a clinical control group of anxious children and a non-clinic control group. It was hypothesised that consistent with the cognitive theory of OCD, children in the OCD group would display higher estimations of these cognitive processes in comparison to anxious and non-clinic children. Results of this investigation provide preliminary support for a cognitive conceptualisation of OCD during childhood. OCD children reported significantly higher ratings of responsibility, severity, thought action fusion and less cognitive control in comparison to non-clinic children. OCD children could also be clearly differentiated from anxious children on ratings of cognitive control. Implications of this investigation are discussed and directions for future research are highlighted.     

Does magical thinking produce neutralising behaviour? An experimental investigation

Magical thinking is of relevance to obsessive compulsive disorder (OCD), and has been most widely investigated in relation to the cognitive bias known as thought-action fusion (TAF). This is seen as playing a role in the formation of fears about responsibility for harm. We suggest that magical thinking may also characterise some types of neutralising behaviour, which arise in response to those fears, and are a hallmark of the disorder. In an experimental study of 51 undergraduate students, we assessed whether the use of neutralising behaviours in response to an induction of fears of increasing likelihood for harm is related to a propensity for magical thinking. The 75.5% of participants demonstrated at least one form of neutralising behaviour in response to a TAF-induction task. Neutralising was associated with stronger and more persistent responses to the task, and with questionnaire measures of magical ideation. Those who neutralised did not report higher levels of OCD symptoms. It appears that neutralising is a common response in circumstances that provoke a sense of responsibility for harm. Its occurrence may be linked to magical thinking, however, the results from this experimental investigation suggested that this process may not be specific to OCD.     

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.     

Thought action fusion: can it be corrected?

The goal of this study was to investigate whether or not a brief educational intervention delivered prior to engaging in an anxiety-provoking task (writing a sentence about hoping that a friend/relative was in a car accident) would be effective in offsetting anxiety in college students with a strong propensity to endorse statements of thought action fusion (TAF). As hypothesized, individuals receiving the educational intervention were less anxious than a placebo intervention control group at post task; they were also less likely to endorse statements of TAF after receiving the educational intervention. Also, those who chose to neutralize after writing the sentence (regardless of experimental group) were more likely to report feeling guiltier, more immoral and a greater sense of responsibility about writing the sentence prior to neutralizing than those who did not subsequently neutralize. These results are discussed in relation to the cognitive theory of obsessive-compulsive disorder and implications for prevention programs.     

Treatment of obsessions: A randomized controlled trial

This study tested Rachman's cognitive behavioral method for treating obsessions not accompanied by prominent overt compulsions. The cognitive behavioral treatment was compared to waitlist control and an active and credible comparison of stress management training (SMT). Of the 73 adults who were randomized, 67 completed treatment, and 58 were available for one-year follow-up. The active treatments, compared to waitlist, resulted in substantially lower YBOCS scores, OCD-related cognitions and depression as well as improved social functioning. Overall, CBT and SMT showed large and similar reductions in symptoms. Pre-post effect sizes on YBOCS Obsessions for CBT and SMT completers was d = 2.34 and 1.90, respectively. Although CBT showed small advantages over SMT on some symptom measures immediately after treatment, these differences were no longer apparent in the follow-up period. CBT resulted in larger changes on most OCD-related cognitions compared to SMT. The cognitive changes were stable at 12 months follow-up, but the differences in the cognitive measures faded. The robust and enduring effects of both treatments contradict the long-standing belief that obsessions are resistant to treatment.     

The effects of familiarity on thought--action fusion

The present study examined whether beliefs about the importance of thoughts (i.e., thought–action fusion; TAF) are related to the target subject of the negative thought. One hundred and seven undergraduate students were randomly assigned to imagine either a beloved relative or a stranger being diagnosed with cancer and provided in vivo ratings of anxiety, likelihood, moral wrongness, urge to neutralize, and how upsetting the event would be if it occurred. Results indicated that thinking of a relative being diagnosed with cancer provoked more distress, urges to neutralize, and higher estimates of likelihood, as well greater use of mental neutralizing behaviors, compared to thinking of a stranger. Contrary to our prediction, the groups did not differ in their ratings of the moral wrongness. These findings broadly support the assertion that the more personally significant a negative intrusive thought, the more it will provoke distress and urges to neutralize. Results are discussed in terms of the cognitive model of obsessions and clinical implications are addressed.     

Affection and attention: On the phenomenology of becoming aware

Addressing the matter of attention from a phenomenological perspective as it bears on the problem of becoming aware, I draw on Edmund Husserl's analyses and distinctions that mark his “genetic” phenomenology. I describe several experiential levels of affective force and modes of attentiveness, ranging from what I call dispositional orientation and passive discernment to so-called higher levels of attentiveness in cognitive interest, judicative objectivation, and conceptualization. These modes of attentiveness can be understood as motivating a still more active mode of reflective attention, i.e., philosophical attentiveness, and to this extent, even it would be subject to varying influences of affection. What role, if any, does affection play in a peculiar kind of reflective attention that is phenomenological? I conclude by briefly considering phenomenological reflective attentiveness and its relation to affection.     

How to remain neutral: An experimental analysis of neutralization

Many patients with obsessive-compulsive problems engage in neutralizing activity to reduce or “cancel out” the effects of the obsession. In many cases, neutralization is covert and therefore difficult to assess or manipulate experimentally. We hypothesize that neutralization resembles overt compulsions. In particular, it was predicted that: (i) neutralization reduces the anxiety evoked by unacceptable thoughts, and (ii) if neutralization is delayed, anxiety and the urge to neutralize will decay naturally. To test the hypothesis, 63 Ss prone to a cognitive bias known to be associated with obsessional complaints (thought-action fusion) were asked to write a sentence that would evoke anxiety. Measures of anxiety (and other variables of interest such as guilt, responsibility and the likelihood of harm) were taken. Subjects were then instructed to either immediately neutralize (n = 29) or delay for 20 min (n = 34), after which time anxiety and urge to neutralize were re-assessed. The Ss who had neutralized were then instructed to delay, and the Ss who had delayed were now instructed to neutralize, after which time the final assessments were taken. The results confirmed the predictions and supported the hypothesis that neutralization resembles overt compulsions. Of note, there were no differences between anxiety reduction after a 20-min delay, and after immediate neutralization. The problems involved in designing and conducting experiments on covert phenomena are discussed, and the clinical implications of the study are considered.     

On becoming a child: Reverie in the psychotherapy of children

My aim in this paper is to examine the role of reverie in facilitating the development of the child‐subject, that is, the child's continuous motion towards subjectivity. I begin by briefly reviewing the concept of reverie and proceed with an examination of elements I believe are fundamental and common to both reverie and child psychotherapy, that is, primary thought processes and primitive impulses. I then describe and demonstrate the atmosphere created by these elements using three examples from the psychotherapy of 8 year‐old Jonathan. Next, I discuss an intersubjective parallel of Bion's reverie and a developmentally oriented version of Ogden's reverie, focusing on its relation to processes of destruction and recognition. I argue that reverie provides the recognition of the child's struggle for his own birth and growth as a subject, that is, of his child‐subject. Finally, I refer to the presence of reverie from the primary preoccupation of mother and father till the child's reverie of himself, his day‐dreaming.     

Controlling your mind without ironic consequences: Self-affirmation eliminates rebound effects after thought suppression

Thought suppression can ironically lead to a rebound of unwanted thoughts [Wegner, D. M. (1994). Ironic processes of mental control. Psychological Review, 101, 34-52.]. The present research explored whether self-affirmation may eliminate rebound effects after thought suppression. Participants either suppressed or used stereotypes in an impression formation task. Subsequently, self-affirmation was manipulated by providing participants with positive or neutral personality feedback, and stereotype accessibility was assessed. The results showed that suppression led to a rebound of stereotypic associations among neutral-feedback participants, but not among positive-feedback participants. The authors conclude that self-affirmation enhances the efficiency of mental control.     

On the forgetting of word associations: Parkin et al. reconsidered

Summary This paper represents an extension of Levinger and Clark's (1961) study, in which it was shown that associations to emotional stimuli were more readily forgotten than those to neutral stimuli, and a replication of Parkin, Lewinsohn and Folkard's (1982) study which demonstrated the reversal of this effect with delayed retention testing. The aim of the present two experiments was to replicate the results of the latter under conditions with minimal deviations from the methodology of either study. The present data indicated that more associations to emotional stimuli were forgotten regardless of the length of the interpolated retention interval. The results are seen as being inconsistent with the Parkin et al. reinterpretation of the Levinger and Clark paradigm and, therefore, as calling for further replication.     

A comparison of the effects of thought suppression, distraction and concentration

This study compared the effects of suppression, focused-distraction, and concentration on controlling unwanted distressing thoughts, and examined how anxiety levels were associated with the use of each thought-control technique. In the study, college students were told to suppress thoughts about a distressing story, to suppress the same thoughts by focusing on an alternative distraction task, to simply concentrate on that alternative task, or to think about anything without restrictions for 6 minutes. This initial period was followed by a “free-thinking” period to assess the delayed effect of thought-control techniques. The results indicated that focused-distraction and concentration led to fewer intrusions of target thoughts than suppression, and concentration in turn resulted in fewer target intrusions than focused-distraction during the initial period. Participants in the focused-distraction and concentration condition also tended to report lower anxiety during the initial period than those who were told to suppress thoughts.     

The effects of thought suppression on autobiographical memory recall

While it is well documented that autobiographical memory (ABM) recall is affected in Posttraumatic Stress Disorders (PTSD), less is known about the cognitive mechanisms that underlie this pattern. This paper presents two research studies which investigated the role of thought suppression in the recall of ABMs. Study 1 assessed the role of thought suppression as a correlate of ABM retrieval in an undergraduate student sample (n = 50). The results showed that higher levels of trait thought suppression were significantly correlated with faster recall of negative episodic memories as well as reduced recall of personal semantic memories. Thought suppression remained as a significant predictor of ABM recall, even when the participants' levels of depression and post-traumatic stress reactions were considered. Study 2 investigated the causal effects of thought suppression on ABM recall. 64 undergraduate students were shown a negative video clip and were asked either to suppress any thought of the video or simply to monitor their thoughts immediately thereafter. Results showed that suppression directly led to significantly enhanced negative episodic ABM recall, as well as a significantly reduced ability to recall personal semantic memories.     

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.     

The relation between thinking and mood in daily life: The effects of content and context of thought

The association between thought content and mood in daily life is far from established. The aim of the present investigation was to examine the role of content and context of thought in daily life mood (i) concurrent and across time, and (ii) as simple effects and as interactions between them. Participants were 50 university students (82% female), who completed experience sampling assessments for a week. Linear mixed-effects models showed that time and object aspects of thought were significantly associated with concurrent mood. In addition, interaction effects between object of thought and thought context (activity) significantly predicted concurrent, but not future, mood, sometimes showing a switch from a positive to a negative association in certain contexts. It is concluded that associations between thought content and mood in daily life (i) are depending on the activity context, and (ii) seem to be relatively short-lived in most cases.     

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.     

Personality trait inferences of Turkish immigrant and neutral targets: An experimental study

Sandal, G. M. Bye, H. H. & Pallesen, S. (2012). Personality trait inferences of Turkish immigrant and neutral targets: An experimental study. Scandinavian Journal of Psychology 53, 528–533. The study investigated whether personality traits attributed to immigrant targets differ from personality inferences made for a neutral target, and whether trait attributions differ for assimilated and integrated immigrant targets. Participants (n = 340) were randomized to one of three conditions in which they read the same story about a person, but where the person was described as either: (a) an assimilated Turkish immigrant; (b) an integrated Turkish immigrant; or (c) neutral (no nationality or religious practice indicated). Subsequently, they rated the personality of the described person on the NEO‐Five Factor Inventory (observer rating version) and completed the Balanced Inventory of Desirable Responding (Impression Management scale) with reference to themselves. Both immigrant targets were rated as significantly higher on extraversion and lower on neuroticism than the neutral target. The integrated target was rated as more open than the neutral target, and as higher than the assimilated target on neuroticism when controlling for impression management.