Obsessive-compulsive behaviours in specific situations: The relative influence of appraisals of control, responsibility and threat

Beliefs about losing control and other OCD-related cognitions: An experimental investigation

BACKGROUND AND OBJECTIVES

Cognitive theories of obsessive-compulsive disorder (OCD) suggest that dysfunctional beliefs influence symptoms. However, well-established belief domains do not fully explain OCD symptomatology, suggesting other cognitive mechanisms may be involved. An additional belief domain which may play a role in OCD is beliefs about losing control. Indeed, these beliefs have been found to be associated with OCD symptoms. However, the relationships between beliefs about losing control and other OCD phenomena, including other relevant dysfunctional beliefs, is unclear. The aim of this study was to examine the relationships between beliefs about losing control and appraisals hypothesized to be relevant to OCD.

METHODS

A total of 163 participants completed the experimental protocol, wherein they received false (positive or negative) feedback regarding the likelihood they may lose control and completed a vignette task asking them to read hypothetical scenarios relevant to OCD concerns (checking, and aggressive thoughts). Vignettes were followed by questions and prompts used to measure OCD-relevant appraisals.

RESULTS

Based on MANOVAs, beliefs about losing control had a significant impact on appraisals in the checking, F (151) = 5.55, p = .001, and aggressive thoughts, F (151) = 2.898, p = .037, vignettes. However, planned comparison indicated that in the aggressive thoughts vignettes, this effect was in the opposite direction than was hypothesized.

LIMITATIONS

The losing control induction may have inadvertently influenced participants' beliefs about the utility of thought control.

CONCLUSIONS

Findings provide preliminary evidence for an association between beliefs about losing control and OCD-relevant appraisals.

What's control got to do with it? A systematic review of control beliefs in obsessive-compulsive disorder

Current conceptualizations of control-related beliefs in Obsessive-Compulsive Disorder (OCD) have largely been limited to beliefs about the need to control thoughts. Although growing evidence supports the notion of considering broader control-related constructs in this disorder, there has been limited research aimed at integrating findings across studies, making it difficult to determine how different control-related beliefs may influence OCD symptoms. The current review sought to systematically analyze findings from all studies investigating the relationship between control beliefs and OCD. The systematic search identified 157 eligible articles that assessed the relationship between control beliefs and OCD symptoms. Results suggested that certain control beliefs (e.g., importance of/need to control of thoughts, sense of control, beliefs about losing control) may be more closely associated with OCD than others (e.g., locus of control, and desire for control). In general, control beliefs were positively associated with OCD, with effect sizes ranging from small to large depending on the symptom domain. Based on limited studies, the only control belief which demonstrated specificity to OCD was ICT. Findings support the importance of integrating additional control beliefs in conceptualizations of OCD and provide evidence to support the benefits of targeting these beliefs in cognitive behavioural therapy.

Assessing beliefs about the consequences of not just right experiences: Psychometric properties of the Not Just Right Experience-Sensitivity Scale (NJRE-SS)

Although current cognitive conceptualizations of obsessive-compulsive disorder (OCD) emphasize that rituals are performed in order to avoid overtly threatening outcomes, it has also been noted that there are individuals for whom the attempt to correct "not just right experiences" (NJREs) rather than dangerous outcomes per se appear important. This article examines the idea that individuals have differing tolerances for-or sensitivity to-NJREs, in a similar manner as occurs regarding for other experience such as the distinction between disgust propensity and disgust sensitivity. In Study 1, using a nonclinical Italian sample, the NJRE-Sensitivity Scale (NJRE-SS) was created and refined. Its final version consisted of eight items loading on two subscales-an intolerance of NJREs due to their perceived interference with cognitive tasks and due to their interference with enjoyment of life. In Study 2, the factor structured was confirmed in a separate sample. The measure was found to have convergent validity with related measures including a separate measure assessing the severity and frequency of NJREs themselves. However, the NJRE-SS predicted OCD symptoms over-and-above the general NJRE measure, with particularly the interference with cognitive tasks subscale being of importance. Clinical implications are discussed.

Factor Structure and Further Validation of the 20-Item Short Form of the Obsessive Beliefs Questionnaire

A 44-item version of the Obsessive Beliefs Questionnaire (OBQ-44) put forward by the Obsessive Compulsive Cognitions Working Group remains the most widely used version of the OBQ, despite research casting doubt on its factorial validity and the existence of a short form (i.e., OBQ-20). In a large sample of undergraduate students ( n = 1,210), a bifactor model of the OBQ-20, consisting of a general factor and four specific factors (threat, responsibility, importance/control of thoughts, perfectionism/certainty), was supported as the best-fitting model. None of the examined OBQ-44 models provided adequate fit. The bifactor model of the OBQ-20 was retained in two independent samples ( n = 1,342 community adults, n = 319 undergraduate students). The incremental validity of the specific factors of the OBQ-20 beyond the general factor was evidenced across multiple criterion indices, including obsessive–compulsive symptom measures and reactions to a thought-induction task. Results further support use of the OBQ-20.

Role of the Perigenual Anterior Cingulate and Orbitofrontal Cortex in Contingency Learning in the Marmoset

Two learning mechanisms contribute to decision-making: goal-directed actions and the "habit" system, by which action-outcome and stimulus-response associations are formed, respectively. Rodent lesion studies and human neuroimaging have implicated both the medial prefrontal cortex (mPFC) and the orbitofrontal cortex (OFC) in the neural basis of contingency learning, a critical component of goal-directed actions, though some published findings are conflicting. We sought to reconcile the existing literature by comparing the effects of excitotoxic lesions of the perigenual anterior cingulate cortex (pgACC), a region of the mPFC, and OFC on contingency learning in the marmoset monkey using a touchscreen-based paradigm, in which the contingent relationship between one of a pair of actions and its outcome was degraded selectively. Both the pgACC and OFC lesion groups were insensitive to the contingency degradation, whereas the control group demonstrated selectively higher performance of the nondegraded action when compared with the degraded action. These findings suggest the pgACC and OFC are both necessary for normal contingency learning and therefore goal-directed behavior.

Obsessive-compulsive disorder patients have a reduced sense of control on the illusion of control task

There is disagreement regarding the role of perceived control in obsessive–compulsive disorder (OCD). The present study used a traditional illusion of control paradigm (Alloy and Abramson, 1979) to empirically test control estimation in OCD. Twenty-six OCD patients and 26 matched comparison subjects completed an illusion of control task wherein their goal was to attempt to exert control over a light bulb. The density of reinforcement (high, low) and the valence of trials (gain, loss) were experimentally manipulated within subjects. Unbeknownst to participants, the illumination of the light bulb was predetermined and irrespective of their behavior. OCD patients exhibited lower estimates of control compared with healthy comparison subjects. There were no interactions between group and outcome density or group and valence. We found that OCD patients endorse lower estimates of control than comparison subjects. This finding highlights a potential role for contingency learning in the disorder.

Locus of Control in Obsessive-Compulsive (OC) and Depression Symptoms: The Moderating Effect of Externality on Obsessive-Related Control Beliefs in OC Symptoms

Although the role of excessive efforts to exert mental control over one's unwanted intrusive thoughts has been successfully explained and documented in the cognitive-behavioural models of obsessive–compulsive disorder (OCD), individual's beliefs regarding the controllability of events, that is, locus of control (LOC), have been largely ignored in recent cognitive formulations of OCD. The present study aimed to examine the relationship between these two control-related cognitions by comparing their roles in obsessive–compulsive (OC) and depression symptoms. Measures of LOC, obsessive-related beliefs, depression, anxiety and OCD symptoms were administered to a sample of 530 Turkish university students. Results showed that while external LOC was positively associated with depression symptoms, the relation was different for OC symptoms. The interaction of LOC with a high desire for thought control was significantly associated with general OC symptoms, particularly with checking symptoms. The findings suggest that beliefs regarding the controllability of events are critical factors in OC symptomatology, but only when there is also a high desire of thought control.

The Mediating Roles of Disgust Sensitivity and Danger Expectancy in Relation to Hand Washing Behaviour

Background: Recent interest in the role of vulnerability factors in obsessional washing has suggested that disgust sensitivity, danger expectancy and health anxiety may be of interest. Aims: This study explores the differential impact of these factors on both behavioural and cognitive measures of washing behaviour and is based on a replication of the Jones and Menzies (1997) experiment, during which participants immersed their hands in a noxious compound while rating themselves on a range of measures: the time they subsequently took to wash their hands was measured and danger expectancies were found to be the best predictor of this. Method: The present study added measures of disgust sensitivity and health anxiety to this experimental methodology while removing factors they found to be of little import to compulsive washing. Thirty non-clinical participants took part. Results: Results confirmed that disgust sensitivity was related to the behavioural measure of washing time, but that this relationship was almost entirely mediated by the danger expectancy concerning judgements of severity of consequent disease. However, a different pattern emerged when the outcome measure was questionnaire based: danger expectancy was not at all related to this. Disgust sensitivity mediated the relationship between health anxiety and scores on a questionnaire measure of washing compulsions. Interestingly, these scores were not related to the behavioural measure of washing time. Conclusions: The implications of these relationships to the further development of subtypes of Obsessive Compulsive Disorder (OCD) are discussed.

Evaluation of cognitive slowing in OCD by means of creating incongruence between lexicon and prosody

Studies indicate that patients with obsessive-compulsive disorder (OCD) have slowing in cognitive processing, especially in the presence of a conflict. This study aimed to determine whether decision and motor times in OCD patients were affected by manipulating the congruence/incongruence of lexical and prosodic aspects of commands. An experimental paradigm was designed to simulate a situation that can trigger anxiety and obsessions in OCD patients. Commands with or without a conflict, that is, an incongruence between lexical and prosodic aspects, were given to the participants. Decision time, motor time and errors were the main parameters of the experiment. The control group had significantly faster decision times than the OCD group in response to both conflicting and non-conflicting commands. The OCD patients demonstrated higher trait anxiety, while Stroop interference and state anxiety were not significantly different between the groups. These results suggest that OCD patients experience slowing in their response times, regardless of whether the stimuli are conflicting or not.

The Obsessive Beliefs Questionnaire (OBQ): examination in nonclinical samples and development of a short version

The study aimed to examine the factor structure of the Obsessive Beliefs Questionnaire (OBQ), the most widely used measure of dysfunctional beliefs in obsessive-compulsive disorder (OCD). Multiple exploratory methods (exploratory factor analysis, cluster analysis by variable, multidimensional scaling) were used to examine the questionnaire. Confirmatory factor analyses were also performed in two large nonclinical samples from Australia (N = 1,234) and Israel ( N = 617). Our analyses suggested a four-factor solution with 38 items, where threat and responsibility formed separate dimensions (the "OBQ-TRIP"). This version had superior fit statistics across the two divergent confirmatory samples, when compared with four alternative models suggested by previous authors. Of the OBQ dimensions, the threat scale correlated most strongly with OCD symptom measures, even when controlling for depression. A short, 20-item version of the scale is offered for further study. Implications and limitations are discussed.

Intolerance of uncertainty mediates the relationship between responsibility beliefs and compulsive checking

Both responsibility beliefs and intolerance of uncertainty have been implicated in compulsive checking behavior. Despite this, the exact relationship of these two variables with compulsive checking behavior is yet to be determined. Using a mixed sample of individuals consisting of compulsive checkers as well as non-clinical participants, we assessed the validity of a mediation model in which the relationship between responsibility beliefs and compulsive checking was mediated by intolerance of uncertainty. Although both responsibility beliefs and intolerance of uncertainty were correlated with the frequency of compulsive checking, the relationship between responsibility and checking was fully mediated by intolerance of uncertainty. Implications for the understanding of the relationship between these constructs, as well for conceptualization of clinical checking problems are discussed.

Desire for control, sense of control and obsessive-compulsive checking: an extension to clinical samples

Research in non-clinical samples has suggested that control beliefs, specifically desire for control and sense of control, may play a role in Obsessive--Compulsive Disorder. The present study extends a previous research design to clinical participants [Moulding, R., Kyrios, M., & Doron, G. (2007). Obsessive-compulsive behaviours in specific situations: The relative influence of appraisals of control, responsibility and threat. Behaviour Research and Therapy, 45, 1693-1702]. In this study, clinical participants with OCD-checking symptoms (n=16), anxiety disorders (n=17) and community controls (n=27) were presented with four hypothetical scenarios. Using a manipulation paradigm, the relationship between control appraisals and other OCD-relevant constructs (threat, responsibility) was examined. As in the non-clinical study, desire for control was moderately affected by responsibility and threat manipulations, while sense of control was not affected by these manipulations. Individuals with OCD recorded higher desire for control and lower sense of control relative to community controls, and a higher desire for control than the anxiety group, suggesting some specificity to OCD. A possible interactive model of control, threat and responsibility is discussed.

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.