Cognitive intrusions in a non-clinical population. II. Associations with depressive, anxious, and compulsive symptoms

Guilt, Disgust, and Not Just Right Experience Mediate the Effect of Demanding Parent Mode on Obsessive-Compulsive-Disorder-like Tendencies, and Punitive Parent Mode Moderates This Mediation

The main objective of the present study was to examine, in a non-clinical population, the validity of a moderated mediation model for obsessive mental functioning. The research was conducted on a sample of 205 participants. Data were collected using the Psychiatric Screening and Diagnostic Questionnaire, Young's Modes Questionnaire-form SMI-2, Padua Inventory of Obsessive-Compulsive Symptoms, Fear of Guilt Scale in OCD, Disgust Propensity and Sensitivity Scale-Revised, and Not Just Right Experiences Questionnaire-Revised. The results revealed that there is a significant positive, indirect effect of the Demanding Parent mode on OCD-like tendencies, which is completely mediated by fear of guilt, tendency and sensitivity to disgust, and Not Just Right Experiences severity. The Punitive Parent mode moderates only the indirect effect of the Demanding Parent mode mediated by fear of guilt, not the indirect effect mediated by disgust tendency and sensitivity and Not Just Right Experiences severity. Also, the indirect effect of the Demanding Parent mode on obsessive tendencies mediated by fear of guilt is significant only at medium and high values of the Punitive Parent mode, not at low values of the moderator. Our results provide a novel direction targeting the direct therapeutic intervention on demanding and punitive internal dialogue, complementing the classical CBT intervention protocol.

The association between stressful experiences and OCD symptoms in young adults at transdiagnostic risk

BACKGROUND

It is unclear whether there is a specific association between stressful experiences and obsessive-compulsive symptoms or whether this relationship is due to stressful experiences increasing risk for psychopathology generally.

AIMS

The current study examined the association between stressful experiences and obsessive-compulsive symptom dimensions, while adjusting for coexisting psychiatric symptoms and psychological distress in a young adult transdiagnostic at-risk sample.

METHODS

Forty-three participants completed self-report measures assessing obsessive-compulsive symptoms, stressful experiences, and a range of other psychiatric symptoms. Regression models examined the relationship between stressful experiences and different obsessive-compulsive symptoms dimensions (i.e., symmetry, fear of harm, contamination, and unacceptable thoughts), adjusting for the influence of coexisting psychiatric symptoms and psychological distress.

RESULTS

The results showed that there was an association between stressful experiences and obsessive-compulsive symptoms dimension of symmetry. Symptoms of borderline personality disorder were positively associated with the obsessive-compulsive symptom dimensions of symmetry and fear of harm symptoms. Symptoms of psychosis were found to be negatively associated with the obsessive-compulsive symptoms dimension of fear of harm.

CONCLUSIONS

These findings have implications for understanding the psychological mechanisms that underlie symmetry symptoms and highlight the need to study OCS dimensions separately to inform more precise, mechanism-targeted interventions.

Dr. Jack Rachman's contributions to our understanding and treatment of obsessive-compulsive disorder

BACKGROUND AND OBJECTIVES

This paper reviews the development of the cognitive-behavioural model of obsessive-compulsive disorder (OCD) through the work of Dr. Jack Rachman and the research his ideas inspired or shaped.

METHODS

A narrative review of Rachman's work and important developments in related areas was conducted.

RESULTS

Rachman was highly responsive to theoretical and empirical developments in the field, and continuously developed his model of OCD over the course of his career. Key developments in his thinking and of those in related areas are described.

LIMITATIONS

This is a narrative review that highlights important developments in the cognitive behavioural model of OCD only.

CONCLUSIONS

The CBT model of OCD has strong empirical support and CBT treatment is the most effective psychotherapy. Continued development in our understanding of attachment and in the persistence of compulsions is warranted.

Imagery Rescripting on Guilt-Inducing Memories in OCD: A Single Case Series Study

BACKGROUND AND OBJECTIVES

Criticism is thought to play an important role in obsessive-compulsive disorder (OCD), and obsessive behaviors have been considered as childhood strategies to avoid criticism. Often, patients with OCD report memories characterized by guilt-inducing reproaches. Starting from these assumptions, the aim of this study is to test whether intervening in memories of guilt-inducing reproaches can reduce current OCD symptoms. The emotional valence of painful memories may be modified through imagery rescripting (ImRs), an experiential technique that has shown promising results.

METHODS

After monitoring a baseline of symptoms, 18 OCD patients underwent three sessions of ImRs, followed by monitoring for up to 3 months. Indexes of OCD, depression, anxiety, disgust, and fear of guilt were collected.

RESULTS

Patients reported a significant decrease in OCD symptoms. The mean value on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) changed from 25.94 to 14.11. At the 3-month follow-up, 14 of the 18 participants (77.7%) achieved an improvement of ≥35% on the Y-BOCS. Thirteen patients reported a reliable improvement, with ten reporting a clinically significant change (reliable change index = 9.94). Four reached the asymptomatic criterion. Clinically significant changes were not detected for depression and anxiety.

CONCLUSIONS

Our findings suggest that after ImRs intervention focusing on patients' early experiences of guilt-inducing reproaches there were clinically significant changes in OCD symptomatology. The data support the role of ImRs in reducing OCD symptoms and the previous cognitive models of OCD, highlighting the role of guilt-related early life experiences in vulnerability to OCD.

Can't get it out of my mind: A systematic review of predictors of intrusive memories of distressing events

Intrusive memories, when persistent and distressing, are theorized to underlie a range of transdiagnostic psychological symptoms and associated impairment. However, little is known about factors predicting the development and persistence of intrusive memories. The aim of this systematic review is to evaluate the literature on pre-event, event-based, and post-event predictors of intrusive memories. A systematic review was conducted, searching for studies that examined intrusive, event-based memories. One hundred and six articles were identified from PsycInfo, PubMed, and Medline databases. Experimental and prospective studies with clinical (N = 14) and nonclinical (N = 92) samples were critically reviewed, provided the inclusion of an analogue stressor with nonclinical samples, and that intrusive memories frequency and/or distress were assessed as primary dependent variables. Pre-existing psychopathology and pre-event appraisal style appear to predict intrusive memories (small to medium effects), whereas trait dissociation did not predict intrusive memories. Of studies examining event-based predictors, higher data-driven processing appears to predict intrusive memories with generally large effects. Post-event negative appraisals consistently predicted intrusive memories (medium to large effects), and preliminary evidence suggests higher post-event conceptual processing predicting fewer intrusive memories. This review synthesizes findings regarding a broad range of pre-event, event-based, and post-event factors that may influence the development of intrusive memories. Methodological issues of current paradigms and the lack of emphasis on memory retrieval processes limit our understanding of what predicts intrusive memory persistence. These limitations are particularly important given that individuals typically seek treatment for distressing intrusive memories once a memory has been fully consolidated, where retrieval processes are of utmost importance. (PsycINFO Database Record

The relationship between cognitions and symptoms in obsessive-compulsive disorder

BACKGROUND

The cognitive theory of obsessive-compulsive disorder (OCD) ascertains that catastrophic (mis)interpretations of normally occurring intrusive thoughts are related to the maintenance of OCD. Nonetheless, findings supporting the relationship between cognitive biases and OCD symptoms are largely inconsistent. In the present study we examined the relationship between OCD cognitions and symptoms among 382 OCD patients participating in the longitudinal Netherlands Obsessive Compulsive Disorder Association (NOCDA) study.

METHODS

OCD cognitions and OC, anxiety and depressive symptoms were assessed using self-report questionnaires at baseline and at two-year follow-up. Baseline multiple regression analyses assessed the specificity of OC cognitions to OCD symptoms. Cross-lagged analyses examined whether cognitions predict OCD symptoms at two-year follow up.

RESULTS

Baseline analyses demonstrated significant relationships between comorbid anxiety, depressive severity and OC cognitions, adjusted for OCD symptoms (β = .283, p < .001 and β = .246, p < .001, respectively). OCD severity adjusted for comorbid symptoms was unrelated to cognitions at baseline (β = .040, p = n.s). Unique associations were found between cognitions and two OCD symptom subtypes (Impulses: β = .215, p < .001; Rumination/doubting: β = .205, p < .001). Longitudinal analyses yielded non-significant associations between OCD cognitions and symptom severity. Prospective analyses of cognitions and OCD symptom subtypes yielded significant effects for both bidirectional and unidirectional associations (β = .11-.16, p < .05).

LIMITATIONS

Given the naturalistic design of the study, we did not assess therapeutic interventions between baseline and follow-up.

CONCLUSIONS

Results only partially concord with the predictions of the cognitive theory of OCD. Future studies should focus on mechanisms alternative to cognitions when investigating the course of OCD.

Differences in clinical intrusive thoughts between obsessive-compulsive disorder, generalized anxiety disorder, and hypochondria

Differences and similarities between intrusive thoughts typical of obsessive-compulsive disorder, generalized anxiety disorder, and hypochondriasis are relevant for their differential diagnosis, formulation, and psychological treatment. Previous research in non-clinical samples pointed out the relevance of some process variables, such as responsibility, guilt, or neutralization strategies. This research is aimed to investigate the differences and similarities between clinical obsessions, worries, and illness intrusions in some of these process variables. A second aim is to identify models based on these variables that could reliably differentiate between them. Three groups of patients with obsessive-compulsive disorder (n = 35; 60% women, mean age 38.57), generalized anxiety disorder (n = 36; 61.1% women, mean age 41.50), and hypochondriasis (n = 34; 70.6% women, mean age 31.59) were evaluated using the Cognitive Intrusions Questionnaire-Transdiagnostic Version (Romero-Sanchiz, Nogueira-Arjona, Godoy-Ávila, Gavino-Lázaro, & Freeston, ). The results showed that some appraisals (e.g., responsibility or egodystonicity), emotions (e.g., guilt or insecurity), neutralization strategies, and other variables (e.g., verbal content or trigger from body sensation) are relevant for the discrimination between obsessions, worries, and illness intrusions. The results also showed 3 stable models based on these variables for the discrimination between these thoughts. The implication of these results in the diagnosis, formulation, and psychological treatment of obsessive-compulsive disorder, generalized anxiety disorder, and hypochondriasis is discussed.

Examining the impact of thought substitution on intentional forgetting in induced and naturally occurring dysphoria

Two experiments were conducted to determine if natural and induced dysphoria is associated with impaired forgetting and, whether a thought-substitution strategy would ameliorate any observed deficits. Study 1: 36 dysphoric & 36 non-dysphoric participants learnt a series of emotional word pairs. Participants were subsequently presented with some of the cues and were asked to recall the targets or prevent the targets from coming to mind. Half of the participants were provided with substitute words to recall instead of the original targets (aided suppression). At final memory testing, participants were asked to recall the targets to all cues. Dysphoric participants exhibited impaired forgetting, even when using a thought substitution strategy. Non-dysphoric participants, however, were able to use substitutes to suppress words. Study 2: 50 healthy participants initially completed the aided condition of the forgetting task. Participants were then given a positive or negative mood-induction, followed by another version of the forgetting task. Although all participants showed a forgetting effect prior to the mood-induction, only the positive group was successful at forgetting after the mood induction. Taken together, these findings do not support the utility of thought-substitution as an aid to forgetting in individuals in a naturally or induced dysphoric mood.

Perceived Parental Rearing Behaviours, Responsibility Attitudes and Life Events as Predictors of Obsessive Compulsive Symptomatology: Test of a Cognitive Model

Background: It is important to investigate the role of cognitive, developmental and environmental factors in the development and maintenance of Obsessive Compulsive Symptomatology (OCS). Aims: The main objective of this study was to examine the vulnerability factors of OCS in a non-clinical sample. On the basis of Salkovskis’ cognitive model of OCD, the study aimed to investigate the role of perceived parental rearing behaviours, responsibility attitudes, and life events in predicting OCS. Furthermore, the mediator role of responsibility attitudes in the relationship between perceived parental rearing behaviours and OCS was examined. Finally, the specificity of these variables to OCS was evaluated by examining the relationship of the same variables with depression and trait anxiety. Method: A total of 300 university students (M = 19.55±1.79) were administered the Padua Inventory-Washington State University Revision, Responsibility Attitudes Scale, s-EMBU (My memories of upbringing), Life Events Inventory for University Students, Beck Depression Inventory, and State-Trait Anxiety Inventory-Trait Form. Results: Regression analysis revealed that perceived mother overprotection, responsibility attitudes and life events significantly predicted OCS. Furthermore, responsibility attitudes mediated the relationship between perceived mother overprotection and OCS. The predictive role of perceived mother overprotection and the mediator role responsibility attitudes were OCS specific. Conclusions: The findings of the present study supported that perceived mother over-protection as a developmental vulnerability factor significantly contributed to the explanation of a cognitive vulnerability factor (namely responsibility attitudes), and perceived maternal overprotection had its predictive role for OCS through responsibility attitudes.

Persistence of Obsessive Compulsive Symptoms: Similarities and Contrasts with Symptoms of Depression in a Turkish Sample

Contemporary cognitive theories of obsessive-compulsive disorder (OCD) propose that certain types of dysfunctional beliefs and assumptions play a salient role in the genesis and persistence of OCD (e.g., Clark, 2004; Rachman, 1993, 1997; Salkovskis, 1985). The present study aimed to examine whether the three proposed dysfunctional beliefs — inflated sense of responsibility, thought suppression, and thought-action fusion — play a significant role particularly on the persistence of obsessive–compulsive (OC) symptoms, as compared to other emotional disorders, such as symptoms of depression. The participants of the present study were 109 undergraduate university students, who completed a set of questionnaires, including The Responsibility Attitude Scale (RAS), The Thought Action Fusion Scale (TAF), The White Bear Suppression Inventory (WBSI), The Maudsley Obsessive–Compulsive Inventory (MOCI), and The Beck Depression Inventory (BDI). After a 4-week interval, participants were again asked to complete the MOCI and BDI. Two separate hierarchical regression equations were formulated to examine the factors significantly accounting for the residual changes from Time 1 to Time 2 assessments of OC and depressive symptomatologies. Results of these analyses indicated that while thought suppression (WBSI scores) played a significant role on the persistence of both OC and depressive symptoms across time, the role of inflated sense of responsibility (RAS scores) was specific to the persistence of OC symptoms.

Differences and similarities between obsessive and ruminative thoughts in obsessive-compulsive and depressed patients: a comparative study

Repetitive, intrusive cognitive phenomena are central both to obsessive-compulsive patients - typically as obsessive thoughts - and to depressed patients - typically as ruminative thoughts. The objective of the present study is to compare obsessive and ruminative thoughts in non-depressed obsessive-compulsive and depressed patients. Thirty-four patients diagnosed with obsessive-compulsive disorder and 34 patients diagnosed with major depression disorder were asked to identify both a personally relevant obsessive and a personally relevant ruminative thought and to subsequently evaluate these thoughts on a modified version of the Cognitive Intrusions Questionnaire (CIQ) developed by Freeston, Ladouceur, Thibodeau, and Gagnon (1991). The CIQ assesses general descriptors, emotional reactions, appraisal and coping strategies on a nine-point Likert scale. A mixed-model ANOVA demonstrated that obsessive and ruminative thoughts are distinct cognitive processes, clearly distinguishable in form, appraisal and temporal orientation across disorders. In obsessive-compulsive patients, ruminative thoughts were more common and more emotionally distressing than predicted. In depressed patients, obsessive thoughts occurred infrequently and were not associated with high negative emotions. Clarifying similarities and differences between ruminative and obsessive thoughts and understanding their interaction might ultimately help to expand on the role of cognitive vulnerability factors in obsessive-compulsive and major depression disorder.

Dysfunctional beliefs in group and individual cognitive behavioral therapy for obsessive compulsive disorder

The primary aim of the study was to investigate dysfunctional beliefs in the form of inflated responsibility (IR) and thought action fusion (TAF) as predictive and mediating variables in individual (n=33) and group (n=37) cognitive behavioral therapy (CBT) for obsessive compulsive disorder (OCD). IR and TAF declined significantly during CBT, and the decline was positively associated with change in OCD symptoms. However, when controlling for change in depressive symptoms, only change in IR remained significantly associated with OCD symptom change. The moral subtype of TAF predicted poorer treatment outcome, but only in group CBT. Both treatments produced a similar amount of change in the dysfunctional beliefs. The results provide some, preliminary evidence that IR, but not TAF, may be specifically involved in the change mechanisms of both individual and group CBT for OCD, although the design of the study with pre- and post-therapy measurements only does not allow for a causal mediator analysis.

How does thought-action fusion relate to responsibility attitudes and thought suppression to aggravate the obsessive-compulsive symptoms?

BACKGROUND

Comprehensive cognitive theories of obsessive compulsive disorder (OCD) propose that clinical obsessions and compulsions arise from specific sorts of dysfunctional beliefs and appraisals, such as inflated sense of responsibility, thought-action fusion (TAF), and thought suppression.

AIMS

The present study aimed to examine the mediator roles of responsibility and thought suppression between TAF and obsessive-compulsive symptoms. Specifically, it aimed to explore the relative effects of TAF factors (i.e. morality and likelihood) on inflated sense of responsibility and on thought suppression to increase the obsessive qualities of intrusions.

METHOD

Two hundred and eighty-three Turkish undergraduate students completed a battery of measures on responsibility, thought suppression, TAF, OC symptoms, and depression.

RESULTS

A series of hierarchical regression analyses, where depressive symptoms were controlled for, indicated that TAF-morality and TAF-likelihood follow different paths toward OC symptoms. Although TAF-morality associated with inflated sense of responsibility, TAF-likelihood associated with thought suppression efforts, and in turn these factors increased OC symptoms.

CONCLUSIONS

These findings provide support for the critical role of sense of responsibility and thought suppression between the relationship of TAF and OC symptoms. Findings were discussed in line with the literature.

Fear of cancer recurrence: specific profiles and nature of intrusive thoughts

INTRODUCTION

Although the fear of cancer recurrence (FCR) is to varying degrees almost universal in cancer survivors, few studies have been carried out specifically on this issue partly because of the complexity and the heterogeneity of the phenomenon.

PURPOSE

To explore the presence of specific profiles of FCR and to describe the nature of intrusive thoughts associated with FCR.

METHODS

A medical database was used to randomly select a large pool of French-Canadian patients who had been treated for breast, prostate, lung, or colorectal cancer within the past ten years. A sample of 1 984 participants completed, by mail, the Fear of Cancer Recurrence Inventory (FCRI) and the Cognition Intrusive Questionnaire (CIQ).

RESULTS

Cluster analysis revealed four distinct groups of FCR patients: Mild FCR-Low Copers, Mild FCR-High Copers, Moderate FCR-High Copers and High FCR-High Copers. Percentages of endorsement obtained on CIQ items suggested that intrusive thoughts associated with FCR share many characteristics with worries (i.e., egosyntonic, verbal content). However, intrusive thoughts associated with High FCR presented more characteristics of obsessions.

CONCLUSION

There are different profiles of FCR, which vary according to its severity and the type of coping strategies used. Characteristics of intrusive thoughts associated with FCR suggested different targets for FCR specific intervention.

The relationship between adverse childhood experience and obsessive-compulsive symptoms and beliefs: the role of anxiety, depression, and experiential avoidance

Current cognitive-behavioral models of the etiology of obsessive-compulsive disorder (OCD) suggest that maladaptive appraisal of otherwise normal intrusive thoughts have their origins in early learning experiences. The present study investigated the relationship between adverse childhood experience and OCD symptoms and related dysfunctional beliefs in a general population using a structural equation modeling approach. The role of experiential avoidance and anxiety and depression were also explored in the model. Results indicated that adverse childhood experience was strongly associated with OCD symptoms and beliefs, but after controlling for anxiety and depression the relationship with OCD symptoms became non-significant and only a weak relationship with OCD beliefs remained. Experiential avoidance was significantly associated with OCD symptoms and beliefs and remained significant after controlling for anxiety and depression. Implications of these results in the context of a complete model of the development of OCD are discussed.

Perceived Control and Appraisal of Obsessional Intrusive Thoughts: A Replication and Extension

The present study had two purposes: 1) to examine the relationship between tendency to experience obsessional intrusive thoughts and tendency to worry; 2) to replicate and extend earlier findings (Purdon and Clark, 1993, 1994) on appraisal and thought suppression strategies in the persistence and control of obsessional intrusive thoughts. A sample of 160 college students were administered the Revised Obsessional Intrusions Inventory (ROII), the Penn State Worry Questionnaire (PSWQ), the Beck Depression Inventory (BDI), and the White Bear Suppression Inventory (WBSI). The ROII total score had minimal association with worry, trait thought suppression, or depressive symptoms, thereby supporting the distinctiveness of obsessional intrusive thoughts. Hierarchical multiple regression analyses revealed that cognitive appraisal, especially worries that the intrusion might come true in real life, accounted for a significant amount of variance in thought frequency and controllability. Thought suppression strategies accounted for substantially less variance in both frequency and control of intrusive thoughts. The results are discussed in terms of their support for Rachman's (1993) and Salkovskis' (1985, 1989) theories regarding the role of personal responsibility in the persistence of obsession-like intrusive thoughts.

Psychopathological Correlates and Psychometric Properties of the White Bear Suppression Inventory in a Turkish Sample

This study examined the psychometric properties of the White Bear Suppression Inventory (WBSI) in a sample of 273 Turkish undergraduate students. The WBSI assesses people’s tendency toward thought suppression. The reliability and validity analyses of the Turkish version of the scale indicated that the WBSI had adequate psychometric properties in a Turkish sample. Internal consistency, and split-half and test-retest reliability coefficients were satisfactory. Consistent with the original WBSI, factor analysis of the scale identified a single component that accounted for 43.3% of the total variance. Concurrent validity of the Turkish version indicated that the scale exhibited significantly positive correlations with obsessive-compulsive, depression, and trait anxiety symptoms, as well as with responsibility attitudes, and thought-action fusion biases. All these findings supported the cross-cultural validity of WBSI.

How does locus of control and inflated sense of responsibility relate to obsessive-compulsive symptoms in Turkish adolescents?

This study aimed to examine the effects of responsibility attitudes, locus of control and their interactions on the general obsessive-compulsive (OC) symptomatology and the dimensions of OC symptoms in a sample of Turkish adolescents (n=385), their ages varied from 16 to 20 with a mean of 17.23 (S.D.=.68). The results of the present study revealed a significantly positive relationship between responsibility attitudes and general OC symptomatology. However, locus of control did not appear as a significant predictor of general OC symptomatology. Furthermore, results revealed that there was a significant interaction effect of responsibility attitudes with locus of control on OC symptomatology. That is, an inflated sense of responsibility and the presence of an external locus of control produced the highest level of OC symptoms. Related to the dimensions of OC symptoms, responsibility was a weak predictor of obsessive thinking symptoms, and a moderate predictor of cleanliness and checking symptoms. Locus of control and its interaction with responsibility attitudes only significantly predicted obsessional thinking symptoms.

Intrusive thoughts, obsessions, and appraisals in obsessive–compulsive disorder: A critical review

This article reviews empirical findings on two key premises of the appraisal model of obsessive-compulsive disorder (OCD): (a) non-clinical populations experience intrusive thoughts (ITs) that are similar in form and in content to obsessions; and (b) ITs develop into obsessions because they are appraised according to dysfunctional beliefs. There is support for the universality of ITs. However, the samples used are not representative of the general population. IT measures do not relate systematically or exclusively to OCD symptom measures, and are not specific enough to exclude other types of intrusive thoughts such as negative automatic thoughts or worries, nor are they representative of all types of obsessions. When general distress is controlled, there is so far no evidence that participants with OCD endorse obsessive belief domains more strongly than anxious participants, and inconclusive evidence that OCD and non-clinical samples differ on the belief domains. Some OCD symptom subtypes are associated with belief domains. Currently, there is no coherent model to offer strong predictions about the specificity of the empirically derived belief domains in OCD symptom subtypes. Cognitive therapy based on the appraisal model is an effective treatment for OCD, although it does not add to the treatment efficacy of behaviour therapy. It is unclear how appraisals turn ITs into obsessions. Implications for future research are discussed.

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.

Clinical obsessions in obsessive-compulsive patients and obsession-relevant intrusive thoughts in non-clinical, depressed and anxious subjects: where are the differences?

Contemporary cognitive models of obsessive-compulsive disorder (OCD) assume that clinical obsessions evolve from some modalities of intrusive thoughts (ITs) that are experienced by the vast majority of the population. These approaches also consider that the differences between "abnormal" obsessions and "normal" ITs rely on quantitative parameters rather than qualitative. The present paper examines the frequency, contents, emotional impact, consequences, cognitive appraisals and control strategies associated with clinical obsessions in a group of 31 OCD patients compared with the obsession-relevant ITs in three control groups: 22 depressed patients, 31 non-obsessive anxious patients, and 30 non-clinical community subjects. Between-group differences indicated that the ITs frequency, the unpleasantness and uncontrollability of having the IT, and the avoidance of thought triggers obtained the highest effect sizes, and they were specific to OCD patients. Moreover, two dysfunctional appraisals (worry that the thought will come true, and the importance of controlling thoughts) were specific to OCD patients. The OCD and depressed patients shared some dysfunctional appraisals about their most disturbing obsession or IT (guilt, unacceptability, likelihood thought would come true, danger, and responsibility for having the IT), whereas the non-obsessive anxious were nearer to the non-clinical participants than to the other two groups of patients. The OCD patients showed an increased use of thought control strategies, with overt neutralizing, thought suppression, and searching for reassurance being highly specific to this group.

Cognitive-behavioural theory and therapy for obsessive-compulsive disorder in children and adolescents: current status and future directions

Obsessive-compulsive disorder is recognised to be much more common than once thought, and increased awareness of prevalence has been associated with an increase in clinical and research attention. However, while the cognitive behavioural model of OCD has received considerable empirical support from adult studies, there has been relatively little investigation of this model in childhood populations. Although this literature is beginning to emerge, initial evaluations suggest there may be important differences between childhood and adult OCD with regard to the cognitive, behavioural, and family factors implicated in the etiology and maintenance of the disorder. Despite this, cognitive-behavioural interventions have been largely modelled on their adult counterparts, and there has been little evaluation of the effectiveness of various treatment components. This paper therefore seeks to critically review the current status of CBT for children and adolescents with OCD, addressing both cognitive behavioural theory and therapy. Current issues in clinical practice will be identified, gaps in the knowledge base will be highlighted, and the paper will conclude by making specific recommendations regarding the integration of research and practice.

Comparisons between rumination and worry in a non-clinical population

Major depression is characterised by ruminative thinking whilst worry is considered central in generalised anxiety disorder (GAD). However, not only do these two forms of repetitive negative thinking regularly co-occur in the same individual but similarities between worry and rumination are apparent. Adapting a methodology developed by Langlois et al. (Behav. Res. Therapy 38 (2000) 157-173), this study directly compared worry and rumination in a non-clinical population across a series of variables drawn from current models (appraisal, general descriptors and emotional reactions). Each of 149 female volunteers, with a wide range of age and backgrounds, identified a ruminative thought and a different worry and subsequently evaluated them using the Cognitive Intrusion Questionnaire. Significant within-subject differences were revealed on seven variables: chronicity, unpleasantness, reality of problem, future orientation, past orientation, feelings of worry and insecurity. There were no differences found between worry and rumination on appraisals and strategies, consistent with accounts that propose that worry and rumination share the same processes but involve different content (Cognitive Ther. Res. 24 (2000) 671-688).

Why are some obsessions more upsetting than others?

Little is known about why certain obsessional thoughts are more upsetting than others for people with obsessive compulsive disorder (OCD). Obsessional thought content often seems arbitrary to sufferers. The current study examined three possible reasons why particular thoughts would be especially upsetting for individuals, based on suggestions put forth by cognitive theories of obsessional thoughts. Twenty-eight individuals with a principal diagnosis of OCD completed questionnaires and interviews at two different periods of time on (1) their most upsetting current obsession and (2) their least upsetting current obsession. Results suggested that more upsetting obsessions were evaluated as more meaningful or significant than less upsetting obsessions, and more upsetting obsessions contradicted valued aspects of the self to a greater degree. All examples of current obsessions, both most and least upsetting, arose in the context of life concerns or issues. Results support cognitive theories in that the strength and nature of appraisal appears to be linked with the distress associated with a thought, and more upsetting thoughts are those that have implications for a person's sense of self.

Working memory capacity and suppression of intrusive thoughts

We sought to show that individual differences in working memory capacity are related to the ability to intentionally suppress personally relevant intrusive thoughts, and that this effect cannot be explained by differences in negative mood. Sixty participants identified their most frequent intrusive thought and then completed a thought suppression task. Better performance on a measure of working memory capacity (OSPAN) was related to having fewer intrusions in the suppression condition but was unrelated to number of intrusions in the expression condition, suggesting a specific association with attempts to inhibit unwanted thoughts. In contrast, a more negative mood was related to having more intrusions in both conditions, suggestive of a more general influence on the accessibility of unwanted thoughts. Working memory capacity was not associated with negative mood or with the frequency of intrusive thoughts reported in everyday life. The findings extend previous results to the domain of personally relevant intrusive thoughts and support the idea that individual differences in the cognitive abilities supporting inhibitory mechanisms are relevant to clinical conditions such as obsessive-compulsive disorder and posttraumatic stress disorder.

Feared identity and obsessive-compulsive disorder

We tested predictions from cognitive-behavioural theory that people with obsessive-compulsive disorder (OCD) regard their intrusions as revealing unacceptable aspects of their character. We compared an OCD sample with anxious controls (AC) and non-anxious controls (NAC) on a measure of the extent to which intrusions led to negative inferences about the self, assessed the discrepancy between their actual and feared self, and recorded the traits making up the feared self. The OCD sample did not differ from AC on self-discrepancies, but did differ from both control groups on the measure of negative inferences about the self. In addition, the feared self of the OCD sample was significantly more likely to consist of bad and immoral traits.

Characteristics of illness intrusions in a non-clinical sample

This study examines whether illness intrusions can be distinguished from obsessional intrusions and worries. It also assesses the relationship between strategies, thought characteristics, and appraisal of illness intrusions. Two hundred and forty-three non-clinical participants identified an obsessive intrusive thought, a worry, and an illness intrusion. They evaluated each thought using items from the Cognitive Intrusions Questionnaire. The comparisons of intrusions showed that illness intrusions share characteristics of worries and obsessional intrusions, but also have their own characteristics. Illness intrusions seem to be particularly egosyntonic. The relationships between the strategies used to counter illness intrusions and their appraisal were also tested. Results support the idea that there are specific links between the evaluation of cognitive intrusions and the way they are processed. It demonstrated that escape/avoidance strategies are associated with the egodystonic nature of the thought and that problem-focused strategies are associated with the thought's basis in reality. Illness intrusions may be conceptualised as either obsessions or worries. This study demonstrated that the category of an intrusive thought might not be as important as the way it is processed. It seems more important to consider appraisal of the disturbing thought and the way in which the person subsequently reacts and behaves.

Masculine Gender Role Stress: a potential predictor of phobic and obsessive-compulsive behaviour

Eisler and Blalock (Clin. Psychol. Rev. 11 (1991) 45) developed a cognitively mediated notion of Masculine Gender Role Stress (MGRS) which assumes that rigid commitment to masculine schemata for appraisal and coping with life's problems may both produce stress and result in dysfunctional coping patterns in men. Previous findings obtained in a non-clinical sample pointed to the ability of the MGRS General scale to predict different forms of irrational fears. Using a predominantly psychologically distressed sample, the present study replicated this finding. In addition, different subordinate concepts of MGRS (Physical inadequacy, Emotional inexpressiveness, Subordination to women, Intellectual inferiority, and Performance failure) predicted Agoraphobic fears, Blood-Injury fears, Social fears, and Obsessional checking and washing compulsions distinctively. Intellectual inferiority was the strongest predictor of Social fears. Most MGRS measures emerged as better predictors of Checking than of Washing rituals. There were no sex differences in the predictive capabilities of any of the MGRS measures on any of the criterion measures. A hypothetical explanation is given for the observation of MGRS being more strongly predictive of Checking than of Washing rituals using the concept of "inflated responsibility". Implications for assessment, treatment and further studies are briefly pinpointed.

Obsessions and compulsions and intolerance for uncertainty in a non-clinical sample

It has been hypothesized that decision-making difficulties in patients with obsessive-compulsive disorder may arise from intolerance for uncertainty. We investigated the relationship between obsessivity and intolerance for uncertainty (defined in terms of need for cognitive closure), controlling for state and trait anxiety and depression. We tested nonclinical subjects through the Need for Closure Scale (NFCS), the Padua Inventory Revised (PI-R), the Beck Depression Inventory (BDI), and the State-Trait Anxiety Inventory (Form-Y; STAI-Y). A principal component analysis showed a lack of correlation between the PI-R and the NFCS subscales. A set of multiple regression analyses performed on PI-R subscales showed that the need for cognitive closure cannot be considered as a strong predictor of obsessions and compulsions. These results speak against the hypothesis that people with high obsessivity have difficulties in taking decisions because of a cognitive need for certainty. We instead argue that difficulties in taking decisions may be related to other specific cognitive beliefs or meta-beliefs.

Two different types of obsession: autogenous obsessions and reactive obsessions

We propose that obsessions are categorized into two subtypes, i.e. autogenous obsessions and reactive obsessions, which are different in terms of identifiability of their evoking stimuli, subjective experiences, contents, and subsequent cognitive processes. Autogenous obsessions tend to come abruptly into consciousness without identifiable evoking stimuli, which are perceived as ego-dystonic and aversive enough to be repelled, and include sexual, aggressive, and immoral thoughts or impulses. On the other hand, reactive obsessions are evoked by identifiable external stimuli, which are perceived as relatively realistic and rational enough to do something toward the stimuli, and include thoughts about contamination, mistake, accident, asymmetry, loss, etc. Through three empirical studies, we confirmed the differences between the two types of obsessional intrusion in their frequency, subjective experiences, subsequent appraisal and control strategy. In particular, autogenous obsessions led to high appraisal on 'control over thought' and 'importance of thought' and frequent use of 'avoidant control strategies', while reactive obsessions linked with high appraisal on 'responsibility' and frequent use of 'confrontational control strategies'. These findings are expected to provide a basis for classifying and explaining the heterogeneous phenomena of obsessive-compulsive disorder.

Religiousness and obsessive-compulsive cognitions and symptoms in an Italian population

Fifty-four individuals with a high degree of religiosity, 47 with a medium degree of religiosity and 64 with low religiosity completed anonymously the Italian versions of well-established measures of obsessive-compulsive (OC) cognitions and symptoms, depression and anxiety. After controlling for anxiety and depression, religious groups scored higher than individuals with a low degree of religiosity on measures of obsessionality, overimportance of thoughts, control of thoughts, perfectionism and responsibility. Moreover, measures of control of thoughts and overimportance of thoughts were associated with OC symptoms only in religious subjects. It is concluded that religion might play a role in obsessive-compulsive disorder phenomenology. Additional research is warranted because it is plausible that only a few aspects of religious teachings (e.g., inflexibility and prohibition) are linked to OC phenomena.