Cognitive Models Of Obsessive-compulsive Disorder Research Articles

The Role of Magical Thinking, Sensitivity, and Thought Content in Thought-Action Fusion

Introduction: Cognitive models of obsessive-compulsive disorder (OCD) posit that maladaptive beliefs about intrusive thinking contribute to the disorder's development and maintenance. However, the findings concerning one notable belief, thought-action fusion (TAF), have been inconsistent. Current conceptualizations of TAF may conflate constructs such as magical thinking, sensitivity, and thought content that are already the subject of informative, interdisciplinary literatures. Methods: To tease apart these constructs, adult participants (N = 249) reported their trait levels of sensitivity and magical thinking, and were randomly assigned to engage with an intrusive thought in one of three content areas. We hypothesized that morality-related content would lead to heightened maladaptive outcomes, but only in combination with higher trait levels of sensitivity and magical thinking. Results: Results indicated that morality-related content, along with sensitivity to morality, played more of a prominent role in maladaptive outcomes, with magical thinking being implicated in general outcomes like worry. Discussion: These findings suggest that the link between TAF and maladaptive outcomes may depend on which TAF elements are present for an individual. Sensitivity, in tandem with other TAF elements (e.g., morality-related content, magical thinking) is predictive of divergent outcomes (e.g., worrying, urges to neutralize) and thus may be an important target of future interventions aimed at reducing TAF, worrying, and/or OC symptoms.

Predicting negative emotions in response to in vivo triggers of thought-action fusion

Thought-action fusion (TAF) refers to the tendency to view thoughts as equivalent to behaviors. Cognitive models of obsessive-compulsive disorder suggest that patients are distressed by intrusive thoughts when they assign them personal significance, such as when they fear a thought reveals a latent desire, not merely because of having it. The aim of this study was to examine the role of intentionality and other factors in predicting reactions to an in vivo moral TAF induction, and to reflect on methodological considerations related to such paradigms. Participants completed measures of symptoms, obsessional cognitions, and religiosity. One week later, they engaged in an induction that either included desire or only the presence of a thought. Participants gave ratings of distress and moral emotions, after which they had the opportunity to neutralize. There was no effect of the manipulation. Across the sample, inflated responsibility beliefs predicted both distress and moral emotions. Beliefs about the importance and control of thoughts predicted moral emotions and subsequent neutralizing. Likelihood TAF also predicted moral emotions. Results highlight the roles of specific obsessional cognitions in reactions to unpleasant thoughts and images. In addition, we discuss conceptual and methodological issues in measuring moral TAF and emotional reactions to intrusions.

Cognitive Beliefs Across the Symptom Dimensions of Pediatric Obsessive-Compulsive Disorder: Type of Symptom Matters

The cognitive model of obsessive-compulsive disorder (OCD) posits that dysfunctional cognitive beliefs are crucial to the onset and maintenance of OCD; however, the relationship between these cognitive beliefs and the heterogeneity of OCD symptoms in children and adolescents remains unknown. We examined how the major belief domains of the cognitive model (inflated responsibility/threat estimation, perfectionism/intolerance of uncertainty, importance/control of thoughts) and dysfunctional metacognitions were related to OCD symptoms across the following dimensions: doubting/checking, obsessing, hoarding, washing, ordering, and neutralization. Self-report ratings from 137 treatment-seeking youth with OCD were analyzed. When cognitive beliefs and symptom dimensions were analyzed in tandem, inflated responsibility/threat estimation and dysfunctional metacognitions were uniquely related to doubting/checking, obsessing, and hoarding and perfectionism/intolerance of uncertainty to ordering. Cognitive beliefs explained a large proportion of variation in doubting/checking (61%) and obsessing (46%), but much less so in ordering (15%), hoarding (14%), neutralization (8%), and washing (3%). Similar relations between cognitive beliefs and symptom dimensions were present in children and adolescents. Cognitive beliefs appear to be relevant for pediatric OCD related to harm, responsibility, and checking, but they do not map clearly onto contamination and symmetry-related symptoms. Implications for OCD etiology and treatment are discussed.

The relationship between obsessions and the self: Feared and actual self-descriptions in a clinical obsessive-compulsive disorder sample.

Cognitive models of obsessive-compulsive disorder (OCD) posit the relevance of the self in OCD, although the nature of this association is still unclear. We aimed to explore actual and feared selves and its association with obsessions and intrusions in a group of OCD patients. A group of 58 patients with OCD identified their most upsetting obsession and intrusion (non-clinical obsession) experienced in the past 3months. These cognitions were classified as either moral-based or autogenous (obsessions n = 32; intrusions n = 26) or non-moral-based or reactive, depending on their content. Next, patients described their actual self and their feared self, that is, the person they feared being or becoming, and whether they believed these descriptions were associated with their obsessions/intrusions. Results indicate that individuals with OCD described themselves as insecure, anxious and fearful, but also as good and nice. They particularly feared a selfish, aggressive, bad, liar, coward, insecure and arrogant self. Two-thirds of the patients believed that their obsessions said something about their actual self (65.52%) and that their obsessions brought them closer to the person they do not want to be (62.06%). A third of patients believed their intrusions said something about their actual self (actual self: 30.35%; feared self: 25%), which was a significantly lower percentage than for obsessions. These associations existed independent from the content of the obsession and/or intrusion, although patients with obsessions with moral-based contents more often tended to believe that their obsessions brought them closer to the person they do not want to be. Results suggest the relevance of the real and feared selves in the maintenance of obsessions.

Reconciliation of Two Cognitive Models in Obsessive-Compulsive Disorder: An fMRI Study.

Objective Although cognitive models of obsessive-compulsive disorder (OCD) fall into two categories: cognitive deficit models and dysfunctional belief models, these approaches have their own ways and have hardly been reconciled. Therefore, this study aimed to investigate the potential relationships between cognitive deficit (using the Wisconsin Card Sorting Task, WCST) and dysfunctional belief (measured by scales of dysfunctional beliefs) mediated by neural activity in OCD patients. Methods Thirty OCD patients and 30 healthy participants performed the WCST condition and a baseline MATCH condition during the 3T-functional magnetic resonance imaging (fMRI) acquisition. Results Engagement of additional frontoparietal networks with poorer performance of WCST was found during the fMRI scan in OCD patients. Selected regions of interest from activated regions have positive relationships with dysfunctional beliefs and with the unacceptable thoughts symptom dimension in the OCD group. Conclusion Findings suggest that alteration in frontoparietal networks related to cognitive deficits can be associated with dysfunctional beliefs while performing conventional neurocognitive tasks and this association with dysfunctional beliefs may be pronounced in the unacceptable thoughts domain-dominant OCD patients.

Is context a crucial factor in distinguishing between intrusions and obsessions in patients with obsessive-compulsive disorder?

Some cognitive models of obsessive-compulsive disorder (OCD) posit that intrusions exist on a continuum with obsessions; others consider that they may be unrelated phenomena that differ in the context where they occur. We aimed to examine and compare, at two different moments, the context of the occurrence of intrusions and obsessions. Sixty-eight patients with OCD completed an interview appraising their most upsetting obsession and intrusion. At their onset, the obsessions/intrusions were associated with experiencing negative emotional states and life events, and they were more likely to appear in "inappropriate" contexts. The context of the obsessions/intrusions differed the last time they were experienced. Autogenous obsessions/intrusions occurred more frequently in contexts with an indirect link. The context distinguishes between intrusions and obsessions, not when they emerge, but when the obsession is already established. The results support that there is a continuum or progression from intrusions to obsessions.

Experimental manipulation of beliefs about the importance of thoughts and the effect on an aggressive impulse.

Cognitive models of obsessive-compulsive disorder attribute a causal role to maladaptive beliefs. To test this hypothesis, we manipulated Overimportance of Thoughts (OT) beliefs and experimentally evaluated their effect on the response to an induced aggressive impulse. Eighty-five participants completed a battery of self-report instruments assessing obsession symptoms, thought control, affectivity and obsessive beliefs, and were then randomly assigned to two conditions. In the experimental condition participants read a scientific abstract on the importance of thought control whilst those in the control condition read a neutral abstract. All participants identified a loved person and imagined feeling the impulse to stab this person, then completed again OT beliefs measures (Overimportance of Thought, Moral-Thought Action Fusion and Thought Action Fusion Likelihood). The Moral component of the Thought Action Fusion was reduced by reading a brief text about the possibility and desirability of thought control. However, experimentally induced changes in beliefs did not yield differences in the intrusiveness of the aggressive impulse. Some beliefs can be modified through a single session in which information similar to what could be obtained in quotidian life is provided.

Validation of the Interpretation of Intrusions Inventory for the Mexican Population: Cross-Cultural Discrepancies.

To facilitate research on the cognitive model of obsessive-compulsive disorder (OCD), leaders in the field of OCD (Obsessive-Compulsive Cognitions Working Group [OCCWG]) developed and validated the Interpretation of Intrusions Inventory-31 (III-31). The current sought to adapt and validate this important measure for the Mexican population using a large sample of emerging adults (N = 457). Specifically, we evaluated the factor structure and convergent validity of the III-31 for the Mexican population. Based on a series of confirmatory factor analyses, previously established one-, two-, and three-factor models were found to be a poor fit with current data. However, an exploratory factor analysis yielded a two-factor solution, with one factor assessing the harmfulness and danger of intrusive thoughts (Harmfulness/Danger), and the other assessing exaggerated responsibility and efforts to control intrusions (Responsibility/Control). Satisfactory convergent validity was found with the severity of dysfunctional beliefs and OCD symptoms. Implications and limitations of study results are discussed.

Prior Beliefs About the Importance and Control of Thoughts are Predictive But Not Specific to Subsequent Intrusive Unwanted Thoughts and Neutralizing Behaviors

Dysfunctional beliefs are the central element in cognitive-behavioral conceptualizations of obsessive–compulsive disorder (OCD). The purpose of this study was to further elucidate the etiological role of preexisting dysfunctional beliefs in the occurrence of unwanted intrusive thoughts and neutralizing behaviors after a critical event by examining their predictive value and specificity in a prospective study with undergraduate students. The dysfunctional belief domains importance/control of thoughts (ICT), responsibility/threat (RT), and perfectionism/certainty (PC) were assessed at baseline 8 weeks prior to the critical event “exam situation” in N = 169 students. Exam-related unwanted intrusive thoughts and neutralizing behaviors, anxiety, and depression were assessed during the week immediately before the exam. Complete data for both baseline and follow-up were available for 79 participants (46%). After controlling for baseline obsessive–compulsive symptoms, anxiety, and depression, ICT but not RT or PC prospectively predicted exam-related intrusive thoughts and neutralizing behaviors, ICT also prospectively predicted depressive symptoms but not anxiety, and RT and PC both prospectively predicted anxiety but not depressive symptoms. Findings are partially consistent with cognitive models of OCD. They support the idea that ICT is a cognitive vulnerability factor for unwanted intrusive thoughts and neutralizing behaviors during a stressful event. Its predictive power was small and not specific to unwanted intrusive thoughts and neutralizing behaviors.

Distinct Response Inhibition Patterns in Obsessive Compulsive Disorder Patients and Pathological Gamblers.

Background: Obsessive-compulsive disorder (OCD) and pathological gambling (PG) are common disorders. The cognitive models of OCD and PG focus on abnormalities in response inhibition. Although, these functions have been studied in different PG and OCD samples, no study has compared the response inhibition in both.Methods: Medication-naïve OCD (n = 61) and PG subjects (n = 109) and healthy controls (n = 131) performed CPT and Go/NoGo tasks.Results: Compared to healthy controls (HC), PG and OCD groups underperformed on speed and exhibited larger time variability on the CPT and Go/NoGo task. Only in OCD patients, a positive correlation between omission errors and response time (RT) was observed in the CPT. At the Go/NoGo task, a negative correlation between false alarms and RT (a fast-errors trade-off) was significant only in the PG group. The HC group had greater sensitivity values (d') than the OCD and PG groups in the Go/NoGo task. The PG group displayed lower d' values and more conservative response criterion in the CPT. In addition, only the OCD group expressed a high switching cost compared to both the PG and HC groups in terms of the RT and d' values.Conclusions: Both the PG and OCD groups demonstrated impaired response inhibition compared to the HC group. On several measures, the OCD and PG groups showed comparable impairments, and in others these were distinct. Thus, it appears that distinct neurocognitive patterns are involved in performance of the CPT and the Go/NoGo tasks among OCD and PG subjects whose cognitive status is currently under intensive investigation.

Obsessive beliefs, experiential avoidance, and cognitive fusion as predictors of obsessive-compulsive disorder symptom dimensions

Cognitive models of obsessive-compulsive disorder (OCD), although widely-supported, do not fully explain obsessive-compulsive (OC) symptoms. Mid-level constructs from acceptance and commitment therapy (ACT; e.g., experiential avoidance, cognitive fusion) may advance our understanding of OCD symptoms by adding explanatory power to existing conceptual models. The current study examined the extent to which mid-level ACT constructs account for unique variability in OCD symptom dimensions within a large treatment-seeking sample of individuals with OCD. In line with previous research in analogue samples, regression analyses revealed that although experiential avoidance and cognitive fusion showed associations with OCD symptoms, these constructs did not generally add to the prediction of OCD symptoms once general distress and obsessive beliefs were accounted for. An exception was that cognitive fusion was a unique predictor of unacceptable obsessional thoughts along with beliefs about importance of and need to control thoughts. These findings provide further support for the cognitive model of OCD as well as the notion that mid-level ACT constructs best relates to the unacceptable thoughts dimension of OCD. Conceptual and treatment implications, study limitations, and future directions are discussed.

Thoughts and Thoughts about Thoughts: the Relative Contribution of Obsessive Beliefs and Metacognitive Beliefs in Predicting Obsessive-Compulsive Symptom Dimensions

The cognitive model of obsessive-compulsive disorder emphasizes the importance of “obsessive beliefs” (e.g., about threat/responsibility, certainty/perfection, and the importance of/need to control thoughts) in the maintenance of obsessive-compulsive (OC) symptoms. Metacognitive theory, in contrast, posits that OC symptoms develop as a result of maladaptive beliefs about thoughts themselves (i.e., thoughts are meaningful and powerful). Although both have empirical support, no study has yet investigated the relative contributions of these models in the prediction of OC symptom dimensions using a common sample. The present study tested the hypothesis that both obsessive and metacognitive beliefs uniquely predict OC symptom dimensions even after controlling for general distress. A nonclinical sample (N = 110) completed self-report questionnaires measuring general distress, obsessive beliefs, metacognitive beliefs, and OC symptoms. Linear regression analyses separately predicting OC symptom dimensions showed that (a) neither obsessive nor metacognitive beliefs uniquely predicted contamination symptoms, (b) both obsessive and metacognitive beliefs uniquely predicted responsibility for harm, (c) only metacognitive beliefs uniquely predicted unacceptable obsessional thoughts, and (d) only metacognitive beliefs uniquely predicted symmetry concerns. Potential implications for understanding, assessing, and treating OC symptoms are discussed.

Modifying Obsessive-Compulsive Beliefs about Controlling One’s Thoughts

Cognitive models of obsessive-compulsive disorder propose that beliefs about the importance of and need to control thoughts (ICT) are central to the maintenance of the disorder. Cognitive Bias Modification for Interpretation (CBM-I) can be used to experimentally test this theory and may also have clinical utility as an adjunct therapeutic tool. The current study extended previous research to investigate whether two CBM-I sessions (one within and one outside the laboratory) would augment effects on obsessive-compulsive beliefs and behavior. We randomly allocated undergraduate participants high in ICT beliefs to a Positive (n = 30) or Control (n = 36) CBM-I condition and conducted multi-modal assessments immediately following the first training and at one-week follow-up. As predicted, participants in the Positive condition reported a reduction in obsessive-compulsive beliefs from baseline to follow-up (partial η2 = .42), whereas those in the Control condition did not. Participants responded more adaptively to the ICT relevant stressor task at follow-up compared to post-intervention, but there was no significant difference between conditions. Likewise, participants reported a reduction in obsessive symptoms over time that did not differ between conditions. The findings are considered in light of cognitive models of OCD, and clinical implications are discussed.

Change in obsessive beliefs as predictor and mediator of symptom change during treatment of obsessive-compulsive disorder - a process-outcome study.

BackgroundCognitive models of obsessive-compulsive disorder suggest that changes in obsessive beliefs are a key mechanism of treatments for obsessive-compulsive disorder. Thus, in the present process-outcome study, we tested whether changes in obsessive beliefs during a primarily cognitive behavioral inpatient treatment predicted treatment outcome and whether these changes mediated symptom changes over the course of treatment.MethodsSeventy-one consecutively admitted inpatients with obsessive-compulsive disorder were assessed with the Yale-Brown Obsessive-Compulsive Scale and the Obsessive Beliefs Questionnaire at treatment intake, after six weeks of treatment and at discharge, and with the Beck-Depression-Inventory-II at intake and discharge.ResultsChanges in obsessive beliefs during the first six weeks of treatment predicted obsessive-compulsive symptoms at discharge when controlling for obsessive-compulsive and depressive symptoms at intake in a hierarchical regression analysis. Multilevel mediation analyses showed that reductions in obsessive beliefs partially mediated improvements in obsessive-compulsive symptoms over time.ConclusionsOur findings indicate that decreasing obsessive beliefs in inpatient cognitive behavioral therapy for obsessive-compulsive disorder might be a promising treatment approach.

Cognitive Mediation of Symptom Change in Exposure and Response Prevention for Obsessive-Compulsive Disorder

This study examined cognitive mediators of symptom change during exposure and response prevention (EX/RP) for obsessive–compulsive disorder (OCD). Based on cognitive models of OCD, obsessive beliefs were hypothesized as a mediator of symptom change. Participants were 70 patients with primary OCD receiving EX/RP either as part of a randomized controlled trial (n=38) or in open treatment following nonresponse to risperidone or placebo in the same trial (n=32). Blinded evaluations of OCD severity and self-report assessments of three domains of obsessive beliefs (i.e., responsibility/threat of harm, importance/control of thoughts, and perfectionism/intolerance of uncertainty) were administered during acute (Weeks 0, 4 and 8) and maintenance treatment (Weeks 12 and 24). Study hypotheses were examined using cross-lagged multilevel modeling. Contrary to predictions, the obsessive beliefs domains investigated did not mediate subsequent OCD symptom reduction. In addition, OCD symptoms did not significantly mediate subsequent change in obsessive beliefs. The present study did not find evidence of cognitive mediation during EX/RP for OCD, highlighting the need to investigate other plausible mediators of symptom improvement.

Fear of Self and Unacceptable Thoughts in Obsessive-Compulsive Disorder.

Cognitive-behavioural models have linked unacceptable or repugnant thoughts in obsessive-compulsive disorder (OCD) with vulnerable self-themes and fear-of-self concerns. To investigate this notion, Aardema and coworkers recently developed and validated the Fear of Self-Questionnaire (FSQ) in non-clinical samples, finding it had strong internal inconsistency, and good divergent and convergent validity, including strong relationships to obsessional symptoms and with other processes implicated in cognitive models of OCD (e.g., obsessive beliefs and inferential confusion). The current article describes two studies that aim to replicate and extend these findings in clinical OCD and non-clinical samples. Study 1 investigated the psychometric properties of an Italian translation of the FSQ in a non-clinical sample (n = 405). Results of confirmatory factor analysis supported the unidimensionality of the scale; the FSQ also showed very good internal consistency and temporal stability. Study 2 investigated the role of fear of self in OCD symptoms, and unacceptable thoughts and repugnant obsessions in particular, using a clinical OCD sample (n = 76). As expected, fear of self was a unique, major predictor of unacceptable thoughts independent of negative mood states and obsessive beliefs. Moreover, even when considered with obsessive beliefs, anxiety and depression, the feared self was the only unique predictor of obsessionality, providing support for the notion that self-themes could explain why some intrusions convert into obsessions, whereas others do not. Implications for current cognitive-behavioural models are discussed. Copyright © 2015 John Wiley & Sons, Ltd. Unacceptable thoughts in OCD have been linked with vulnerable self-themes and a fear of self. Aardema and coworkers recently developed and validated the Fear of Self-Questionnaire (FSQ). Study 1 investigated the Psychometric properties of an Italian translation of the FSQ in a non-clinical sample. Study 2 investigated the role of fear of self in unacceptable thoughts, using a clinical OCD sample. Fear of self was a unique, major predictor of unacceptable thoughts in OCD over and beyond obsessive beliefs.

Development and validation of the Japanese version of Responsibility Attitude Scale and Responsibility Interpretations Questionnaire

Distorted beliefs about responsibility attitude and interpretation are a central theme in Salkovskis’ cognitive model of Obsessive-Compulsive Disorder (OCD). This study aimed to develop Japanese versions of the Responsibility Attitude Scale (RAS-J) and Responsibility Interpretation Questionnaire (RIQ-J). Participants in Study 1 were 118 non-clinical Japanese students who completed the RAS-J and RIQ-J to confirm the test-retest reliability of these scales. In Study 2, 98 participants (OCD group = 37; anxiety control group = 24; healthy control group = 37) completed the RAS-J, RIQ-J and other measures to assess the validity of the RAS-J and RIQ-J. As a result of analysis, The RAS-J and RIQ-J demonstrated adequate test-retest reliability and internal consistency. In addition, both scales had adequate concurrent validity, demonstrated by significant correlations with other measures of OCD, anxiety and depression. Group comparison data using ANOVA with Bonferroni method indicated that RAS-J and RIQ-J scores fo...

An examination of obsessive-compulsive symptoms and dimensions using profile analysis via multidimensional scaling (PAMS)

Contemporary cognitive models of obsessive-compulsive disorder (OCD) emphasize the importance of various types of dysfunctional beliefs in contributing to OC symptoms, such as beliefs about excessive personal responsibility, perfectionism, and intolerance for uncertainty. The present study seeks to further our understanding of the role of these beliefs by identifying the common profiles of such beliefs, using profile analysis via multidimensional scaling (PAMS). In Study 1, a large student sample (N=4079) completed the 44-item obsessive beliefs questionnaire. One major profile, control of thoughts and perfectionism, was extracted. Study 2 examined profiles of the 87-item obsessive beliefs questionnaire in people with obsessive-compulsive disorder (OCD; n=398), other anxiety disorders (n=104), and a sample of undergraduate students (n=285). Inflated responsibility was a prominent subscale in the profiles of all three groups. Only control over thoughts was a unique subscale in the profile obtained for the OCD group, with this group having lower scores compared to the other groups. The results suggest that while inflated responsibility is a significant subscale in the profile of individuals with OCD, it is not a unique contributor; instead, control over thoughts is unique to OCD. The data, as well as recent research investigating obsessive beliefs, suggest the need to revise the contemporary cognitive model of OCD.

The experience of OCD-related intrusive thoughts in African and European Americans: Testing the generalizability of cognitive models of obsessive compulsive disorder

Cognitive theories of obsessive-compulsive disorder (OCD) emphasize the role of maladaptive appraisals and control strategies in distinguishing normal from clinically significant intrusive thoughts. Since the majority of studies testing these models utilize predominantly European American samples, the racial and ethnic generalizability of these theories is largely unknown. In the current study, African Americans (n=40) and European Americans (n=54) were interviewed about their experiences of unwanted intrusive thoughts (e.g., frequency, interference, importance, and difficulty dismissing the intrusion), as well as their appraisals and the control strategies employed to manage distress associated with their most distressing intrusive thought. Participants also completed a self-report measure of OC symptoms. Results indicated that African American and European American participants reported similar experiences of OCD-related intrusions, appraisals, and control strategies; however, the groups showed different patterns of relations between intrusion appraisals, control strategies, and self-reported OC symptoms. These findings suggest that race-associated factors may play a role in the comparative experience of OCD-related phenomena between African American and European American individuals. Theoretical and clinical implications are discussed within cognitive models of OCD.

Obsessive-Compulsive Symptoms and Beliefs in Adolescents: A Cross-Sectional Examination of Cognitive Models.

Cognitive models of obsessive-compulsive disorder (OCD) posit that particular beliefs transform normal intrusions into disturbing obsessions. A wealth of data shows that such beliefs and obsessive-compulsive (OC) symptoms are related in adults. However, there is markedly less information regarding OCD-related beliefs in youth. The purpose of this study was to assess the relation between OCD-related beliefs and OC symptoms in unselected adolescents (ages 13-18 years; N = 159). Findings from questionnaires completed on the Internet were consistent with previous findings in adults. Increased levels of OCD-related beliefs were related to increased levels of OC symptoms. Perfectionism and certainty beliefs had a specific relation with symmetry and ordering symptoms. Contrary to expectation, levels of OCD-related beliefs in this unselected sample were similar to those found in prior studies of youth diagnosed with OCD. Implications, limitations, and future directions for the study of OCD-related beliefs in youth are discussed.