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.     

Special series Subtypes of obsessive-compulsive disorder: Introduction

An accumulating body of research suggests that obsessive-compulsive disorder (OCD) is a heterogeneous condition, yet there is not yet a consensus on how best to conceptualize subtypes or dimensions of the disorder. This special series considers theoretical and practical issues pertaining to OCD subtypes. New possibilities for conceptualizing differences among OCD patients are considered, and avenues for treating different presentations of obsessions and compulsions are discussed. Treatment programs continue to be refined and outcome studies continue to demonstrate that tailoring cognitive-behavioral treatment toward specific presentations of OCD (e.g., contamination fears, severe obsessions) represents the future of OCD treatment. The articles in this special series are intended to further efforts to consider ways of better understanding the heterogeneity of 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.     

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 Cruelest Cure? Ethical Issues in the Implementation of Exposure-Based Treatments

Numerous studies have provided supportive evidence for the efficacy of exposure-based treatments for many psychological disorders. However, surprisingly few therapists use exposure therapy in the clinical setting. Although the limited use of exposure-based treatments may be partially attributable to a shortage of suitably trained therapists, exposure therapy also suffers from a “public relations problem” predicated upon concerns that it is cruel and at odds with some ethical considerations (e.g., first do no harm). This article provides an overview of ethical issues and considerations relevant to the use of exposure therapy. It is argued that the degree to which ethical issues become problematic in implementing exposure-based treatments is largely dependent upon the therapist's ability to create an adequately safe and professional context. Specific strategies that may be employed for avoiding potential ethical conflicts in the use of exposure-based treatments are discussed.     

The Disgust Scale: item analysis, factor structure, and suggestions for refinement

In the 4 studies presented (N = 1,939), a converging set of analyses was conducted to evaluate the item adequacy, factor structure, reliability, and validity of the Disgust Scale (DS; J. Haidt, C. McCauley, & P. Rozin, 1994). The results suggest that 7 items (i.e., Items 2, 7, 8, 21, 23, 24, and 25) should be considered for removal from the DS. Secondary to removing the items, exploratory and confirmatory factor analyses revealed that the DS taps 3 dimensions of disgust: Core Disgust, Animal Reminder Disgust, and Contamination-Based Disgust. Women scored higher than men on the 3 disgust dimensions. Structural modeling provided support for the specificity of the 3-factor model, as Core Disgust and Contamination-Based Disgust were significantly predictive of obsessive- compulsive disorder (OCD) concerns, whereas Animal Reminder Disgust was not. Results from a clinical sample indicated that patients with OCD washing concerns scored significantly higher than patients with OCD without washing concerns on both Core Disgust and Contamination-Based Disgust, but not on Animal Reminder Disgust. These findings are discussed in the context of the refinement of the DS to promote a more psychometrically sound assessment of disgust sensitivity.     

Better Together: A Review and Recommendations to Optimize Research on Family Involvement in CBT for Anxiety and Related Disorders

Anxiety and related disorders (ARDs) occur in an interpersonal context. Individuals with ARDs respond well to individual cognitive behavioral therapy (CBT); however, there is room for improvement. As such, family members may be included to “enhance” treatment outcomes, yet findings from studies examining family involvement in CBT for ARDs are equivocal. The present paper (a) identifies methodological considerations for explaining inconsistent outcomes among CBT for ARDs with family involvement, and (b) reviews factors that affect outcomes of CBT for ARDs with family involvement including levels of involvement in treatment (e.g., number, duration, and spacing of sessions) and characteristics of who is involved in treatment (e.g., family member cognitions and cultural factors). Limitations of the literature and recommendations for future research are discussed. Researchers should focus on conducting studies that can test not whether but for whom and how family involvement can contribute to improved outcomes above and beyond individual CBT for ARDs.