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.     

A cognitive behavioral workshop for subclinical obsessions and compulsions

The present study investigates the effectiveness of a 3-h cognitive behavioral workshop for individuals, ages 18-22, with subclinical obsessions and compulsions. It was hypothesized that, compared to individuals in an assessment-only waitlist group (n = 42), individuals assigned to the workshop group (n = 43) would experience a significant decrease in obsessive-compulsive (OC) symptomatology, comorbidity, and thought action fusion endorsement at 1-month and 5-month follow-up assessments. An additional outcome of interest was the number of incident cases of obsessive-compulsive disorder (OCD) over the course of the study. The results indicated that the workshop group reported a significantly fewer number of OC symptoms at 5-month follow-up and endorsed significantly less thought action fusion at both follow-up points. However, there were no differences between groups in severity of OC symptoms and number of comorbid diagnoses endorsed. Only one incident case of OCD was observed during the study, from a participant in the waitlist group. These results are discussed in reference to treatment of subclinical anxiety symptoms.     

Violent obsessions are associated with suicidality in an OCD analog sample of college students

The picture of suicide in obsessive-compulsive disorder (OCD) is unclear because previous research did not uniformly control for depressive symptoms when examining the relationship between OCD and suicidality. Specific links between OC symptom dimensions and suicidality were also not adequately studied. As such, we investigated specific associations between OC symptom dimensions and suicidality, beyond the contribution of depressive symptoms, in an OCD analog sample of college students, a group traditionally at risk for suicide. One hundred and forty-six college students (103 females; 43 males) who exceeded the clinical cut-off for OC symptoms on the Obsessive-Compulsive Inventory, Revised (OCI-R) were recruited. Participants completed an online questionnaire containing measures that assessed suicidality and OC and depressive symptom severity. Total OC symptom severity, unacceptable thoughts, and especially violent obsessions exhibited significant positive zero-order correlations with suicidality. However, analyses of part correlations indicated that only violent obsessions had a significant unique association with suicidality after controlling for depressive symptoms. Our findings support the hypothesis that violent obsessions have a specific role in suicidality beyond the influence of depressive symptoms in an OCD analog sample of college students. A strong clinical focus on suicide risk assessment and safety planning in college students reporting violent obsessions is therefore warranted. Future related research should employ longitudinal or prospective designs and control for other possible comorbid symptoms in larger and more representative samples of participants formally diagnosed with OCD in order to verify the generalizability of our findings to these groups.     

Functional classification of obsessive-compulsive phenomena

A classification of obsessive-compulsive phenomena based on the functional definition of obsessions as anxiety/discomfort producing and compulsions as anxiety/discomfort reducing is proposed. Based on the assumption of a functional equivalence between external and internal obsessive-compulsive behavior, four essential obsessive-compulsive forms are derived: (1) obssesions, (2) obsessions plus successful compulsions (anxiety/discomfort reducing), (3) obsessions plus obsessionalized compulsions (anxiety increasing), and (4) rituals consisting mainly of stereotyped, overt or covert behaviors (autonomous of anxiety/discomfort and/or obsessions). In addition, it is hypothesized that forms 1–4 represent developmental stages in the progress of obsessive-compulsive symptomatology, increasing in the order specified in complexity and severity and having varying prognostic implications. Finally, an attempt is made to suggest stage-specific behavioral treatment strategies.     

A comparison of autogenous/reactive obsessions and worry in a nonclinical population: a test of the continuum hypothesis

Employing the autogenous-reactive model of obsessions (Behaviour Research and Therapy 41 (2003) 11-29), this study sought to test a hypothesized continuum where reactive obsessions fall in between autogenous obsessions and worry with respect to several thought characteristics concerning content appraisal, perceived form, and thought triggers. Nonclinical undergraduate students (n=435) were administered an online packet of questionnaires designed to examine the three different types of thoughts. Main data analyses included only those displaying moderate levels of obsessions or worries (n=252). According to the most distressing thought, three different groups were formed and compared: autogenous obsession (n=34), reactive obsession (n=76), and worry (n=142). Results revealed that (a) relative to worry, autogenous obsessions were perceived as more bizarre, more unacceptable, more unrealistic, and less likely to occur; (b) autogenous obsessions were more likely to take the form of impulses, urges, or images, whereas worry was more likely to take the form of doubts, apprehensions, or thoughts; and (c) worry was more characterized by awareness and identifiability of thought triggers, with reactive obsessions through these comparisons falling in between. Moreover, reactive obsessions, relative to autogenous obsessions, were more strongly associated with both severity of worry and use of worrying as a thought control strategy. Our data suggest that the reactive subtype represents more worry-like obsessions compared to the autogenous subtype.     

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.     

Differences in latent inhibition as a function of the autogenous-reactive OCD subtype

We examined differences in a visual search-based latent inhibition (LI) task in 48 non-treatment seeking individuals diagnosed with obsessive-compulsive disorder (OCD) and 26 non-OCD controls, using a visual search-based LI task as a function of participants’ primary obsessional presentation based on the autogenous-reactive subtype model of obsessions ( [Lee and Telch, 2005] and [Lee and Telch, 2007]). We hypothesized that LI would be significantly attenuated among OCD participants whose primary obsessions were characterized by aversive impulses, images, or thoughts with sexual, aggressive, blasphemous, and repulsive themes (autogenous obsessions) due to their weakened attentional inhibitory mechanisms and elevated schizotypal personality features, as compared with those whose primary obsessions were characterized by somewhat realistic aversive mental intrusions about contamination, mistakes, accidents, or disarray (reactive obsession) and non-OCD controls. Results showed that those primarily displaying autogenous obsessions failed to display LI, whereas those primarily displaying reactive obsessions and non-OCD controls displayed significant LI effects. Our data suggest that the magnitude of LI varies as a function of primary obsessional presentations among individuals with OCD.     

A multi-modal investigation of the roles of distress tolerance and emotional reactivity in obsessive-compulsive symptoms

Emerging evidence implicates important roles of poor distress tolerance and heightened emotional reactivity in obsessive-compulsive disorder. To date, investigations have relied mostly on self-report measures, and we sought to extend the literature by examining the relationship between OC symptoms and distress tolerance, as well as emotional reactivity, using three laboratory assessments. Nonclinical participants (N=167) viewed emotional films associated with four different negative emotions and also completed mirror tracing and handgrip persistence tasks. Greater obsessions scores were predictive of poorer emotional tolerance for a sad film and shorter persistence on the mirror tracing task. Among men only, obsessions were negatively correlated with persistence on the handgrip task. Associations between increased emotional reactivity and washing symptoms also emerged. These findings provide further evidence for the role of poor distress tolerance in obsessions and suggest heightened emotional reactivity may play a role in compulsive washing.     

Event‐based prospective memory and obsessive–compulsive disorder intrusive obsessional thoughts

Recent studies have found poorer prospective remembering among students selected for elevated obsessive–compulsive disorder (OCD) checking and washing. However, as prospective memory performance also requires retrospective remembering, it is not clear from earlier work whether deficits in prospective memory in samples with OCD symptomatology are due to problems with prospective remembering, or to retrospective memory failures that result in poorer performance on prospective memory tasks. The present study examines performance on matched prospective and retrospective memory tasks among students selected for high (n = 48) and low (n = 44) scores on the Obsessive–Compulsive Inventory‐Revised Obsession subscale. Significant differences between the groups were found in prospective memory (regardless of whether the word was neutral or harm/danger‐related), but not retrospective memory. The findings are consistent with the prediction that obsessional thoughts that occupy working memory capacity would have a deleterious effect on a resource‐demanding prospective memory task. An additional finding was that there were no group differences in self‐reported complaints of problems with prospective memory.     

Advances in the Cognitive Behavioural Treatment of Obsessive Compulsive Disorder

The aim of this paper is to highlight key advances in the cognitive-behavioural treatment of obsessive compulsive disorder over the course of Professor Lars Göran Öst's illustrious career. The paper will focus on three specific areas of interest: the treatment of obsessions, compulsive checking, and the fear of contamination. It will also highlight recent advances concerning the broader need to ensure that treatment is acceptable. An increase in acceptability could result in improvements in completion rates so that more patients benefit from the recent improvements in the science and therapy for this disabling disorder.