Inflated Responsibility Beliefs Research Articles

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.

The role of inflated responsibility beliefs in predicting symptoms of generalised anxiety disorder and depression

ABSTRACT Objective: Inflated responsibility beliefs encompass responsibility attitudes, the general tendency to accept responsibility, and responsibility interpretations, the appraisals of specific intrusive thoughts as indicating personal responsibility for harm. While inflated responsibility beliefs are central to obsessive-compulsive disorder, it is unclear whether they are also related to other disorder symptomology. Consequently, the current study investigated whether inflated responsibility beliefs predicted unique variance in symptoms of depression and generalised anxiety disorder in a non-clinical sample, after controlling for negative affect. Method: Participants were undergraduate psychology students and community members (N = 182, 43 males, 136 females, 3 non-binary), aged 18-70 years (M = 27.71, SD = 11.86) recruited through convenience and snowball sampling. A cross-sectional, correlational design was employed, whereby participants completed an online questionnaire. Data were analysed using two separate hierarchical multiple regression analyses, one with generalised anxiety disorder symptoms as the criterion and one with depression symptoms as the criterion. Results: After controlling for negative affect and age, an increase in responsibility attitudes uniquely predicted a significant small increase in generalised anxiety disorder symptoms, sr 2 = .03, 95% CI [.02, .08], p < .001, but not depression symptoms. Responsibility interpretations did not predict significant unique variance in depression or generalised anxiety disorder symptoms. Conclusions: Results suggest responsibility attitudes relate to symptoms of some disorders (i.e., generalised anxiety disorder), but not all psychopathology (i.e., depression). Responsibility attitudes should potentially be considered in aetiological models of generalised anxiety disorder. Results suggest responsibility interpretations are not transdiagnostic, although measurement difficulties render this unclear. KEY POINTS What is already known about this topic: Inflated responsibility beliefs were first discussed in relation to obsessive-compulsive disorder (OCD) and have since been established as central to OCD symptomology. However, it remains unclear whether inflated responsibility beliefs are specific to OCD or represent a general cognitive bias, due to inconsistent study methodology and findings. While reasonably strong evidence exists to suggest that inflated responsibility beliefs may be associated with symptoms of generalised anxiety disorder, these studies have used problematic measures. Limited research has examined the association between inflated responsibility beliefs and depression symptoms, and available research has produced conflicting findings. What this topic adds: The current study is the first to examine responsibility beliefs in relation to symptoms of depression and generalised anxiety disorder using the Responsibility Attitudes Scale/Responsibility Interpretations Questionnaire. Increased responsibility attitudes predicted increased generalised anxiety disorder symptoms but did not predict variance in depression symptoms in the current non-clinical sample. Responsibility interpretations did not predict variance in generalised anxiety disorder symptoms or depression symptoms in the current sample. Findings suggest responsibility attitudes may be somewhat transdiagnostic, evident in some disorders (e.g., generalised anxiety disorder) but not all disorders (e.g., depression). Findings are broadly consistent with the idea that responsibility interpretations might be specific to OCD (although this was not assessed directly in the current study).

Inflated Responsibility Beliefs in Paediatric OCD: Exploring the Role of Parental Rearing and Child Age.

Cognitive-behavioural models of obsessive-compulsive disorder (OCD) propose that inflated responsibility beliefs are central to the maintenance of the disorder and are proposed to originate during early childhood via experiences of harsh and/or controlling parenting. The current study aimed to examine the associations between perceived parental rearing behaviours, inflated responsibility/threat beliefs, and OCD severity and impairment in children (aged 7-12years) and adolescents (aged 13-17years) with OCD (n = 136). Results indicated that for younger children, greater child perceptions of overprotection and anxious rearing were each associated with increased inflated responsibility beliefs. For older children, these positive associations remained, and furthermore, inflated responsibility beliefs mediated the association between perceived maternal anxious rearing and OCD impairment. Results highlight the role of the family in the development of inflated responsibility bias and OCD-related impairment.

The Impact of Enhanced Responsibility and Threat Beliefs on Self-Report and Behavioural Indices During a Sorting Task for Young People with OCD

We aimed to experimentally assess the role of cognitive processes in provoking anxiety and compulsive behaviours in young people with OCD, and to determine whether specific cognitive appraisal subtypes (e.g., threat) best explain OCD symptoms. 29 young people with a principal diagnosis of OCD, 30 young people with an anxiety disorder other than OCD, and 25 young people meeting no diagnostic criteria completed a sorting task designed to increase or decrease responsibility/threat biases. We expected that OCD participants in the high responsibility/threat group would demonstrate higher scores on subjective (belief and anxiety ratings) and behavioural variables (e.g., urge to check, time taken to sort) compared to anxious and nonclinical control groups. Young people with OCD in the inflated responsibility/threat condition were more anxious and showed enhanced delay behaviours (e.g., slower on the task, more time checking) compared to control groups, who were not affected by the manipulation. Regression analyses revealed that threat appraisals played a more prominent role than responsibility beliefs in state anxiety ratings, overall time taken and time spent checking. The present study supports cognitive models of OCD showing a clear relationship between inflated responsibility beliefs, threat beliefs and perfectionism levels and OCD-related behaviours.

A Preliminary Investigation of Pathways to Inflated Responsibility Beliefs in Children with Obsessive Compulsive Disorder.

Cognitive theorists posit that inflated responsibility beliefs contribute to the development of obsessive compulsive disorder (OCD). Salkovskis et al. (1999) proposed that experiencing heightened responsibility, overprotective parents and rigid rules, and thinking one influenced or caused a negative life event act as 'pathways' to the development of inflated responsibility beliefs, thereby increasing risk for OCD. Studies in adults with OCD and non-clinical adolescents support the link between these experiences and responsibility beliefs (Coles et al., 2015; Halvaiepour and Nosratabadi, 2015), but the theory has never been tested in youth with current OCD. We provided an initial test of the theory by Salkovskis et al. (1999) in youth with OCD. We predicted that childhood experiences proposed by Salkovskis et al. (1999) would correlate positively with responsibility and harm beliefs and OCD symptom severity. Twenty youth with OCD (age 9‒16 years) completed a new child-report measure of the experiences hypothesized by Salkovskis et al. (1999), the Pathways to Inflated Responsibility Beliefs Scale-Child Version (PIRBS-CV). Youth also completed the Obsessive Beliefs Questionnaire-Child Version (Coles et al., 2010) and the Obsessive Compulsive Inventory-Child Version (Foa et al., 2010). Consistent with hypotheses, the PIRBS-CV was significantly related to responsibility and harm beliefs and OCD symptom severity. Results provide initial support for the theory proposed by Salkovskis et al. (1999) as applied to youth with OCD. Future studies are needed to further assess the model in early-onset OCD.

Development and initial validation of the Fear of Guilt Scale for obsessive-compulsive disorder (OCD)

Although people with obsessive-compulsive disorder (OCD) often report devastating feelings of guilt, to date, a clear link between guilt and OCD symptoms has not been established. Researchers are currently exploring the extent to which individuals with OCD fear the feeling of guilt (e.g., for harm they might have caused, averted, or minimised) and behave compulsively in consequence. However, no self-report measures of the fear of guilt construct exist, which limits our ability to examine its role in OCD. We therefore developed a 17-item Fear of Guilt Scale (FOGS), culled from a larger, 49-item pool following exploratory and confirmatory factor analyses, to measure fear of guilt in OCD. Psychometric analyses were conducted across three large, nonclinical undergraduate samples and suggest the FOGS consists of two factors: Punishment (drive to punish oneself for feelings of guilt) and Harm Prevention (drive to proactively prevent guilt). The FOGS demonstrated strong internal consistency and convergent and divergent validity. It also significantly predicted OCD symptom severity over measures of neuroticism, depression, trait guilt, and inflated responsibility beliefs. Thus, fear of guilt, as measured by the FOGS, is an important and distinct construct in understanding OCD. Implications for future use of the scale are discussed.

External Criticism by Parents and Obsessive Beliefs in Adolescents: Mediating Role of Beliefs associated with Inflated Responsibility.

Background and Objectives:Obsessive-compulsive disorder (OCD) is considered as a rare disorder in children. According to cognitive theories, criticism triggers responsibility behavior and thus causes obsessive behaviors. The purpose of the present study was to investigate the mediating role of beliefs associated with responsibility in the relationship between external criticism of parents and obsessive beliefs in adolescents.Materials and Methods:In this study, 547 high school students aged from 15 to18 years were selected using multi-stage cluster random sampling from four regions of the education office in Shiraz. Obsessive Beliefs Questionnaire-child version (OBQ-CV), Pathway to Inflated Responsibility beliefs Scale (PIRBS), and perceived criticism questionnaire were used to collect data. Pearson’s correlation was used to investigate the relationship between the study variables. For analysis of mediation model, multiple mediators analysis using Macro Software was used.Results:External criticism only indirectly and through beliefs associated with inflated responsibility accounts for 6% of the variance of responsibility, 14% of the variance of threat estimation and 10% of the variance of perfectionism of obsessive beliefs (P<0.05). However, external criticism, both directly and indirectly and through beliefs associated with inflated responsibility accounts for 7% of the variance of the importance of obsessive beliefs.Conclusion:This study showed that the beliefs associated with inflated responsibility can mediate the relationship between external criticism and obsessive beliefs. According to the cognitive model of Salkovskis, criticism by parents, as a violation to and an influence on children, by affecting the subscales of inflated responsibility, can increase the symptoms of obsessive-compulsive disorder. In order to identify potential affecting mechanisms of criticism on obsessive-compulsive disorder, further experimental research is required.

An observational study of parent–child behaviours in paediatric OCD: Examining the origins of inflated responsibility

Inflated responsibility is a well-established belief domain relevant to the development of obsessive–compulsive disorder (OCD), and is proposed to develop during childhood (Salkovskis, P.M., Shafran, R., Rachman, S., & Freeston, M.H. (1999). Multiple pathways to inflated responsibility beliefs in obsessional problems: possible origins and implications for therapy and research. Behaviour Research and Therapy, 37(2), 1055–1072). However, parental enhancement of such beliefs have rarely been examined. This study explored the proposed pathways of development for responsibility biases in paediatric OCD by examining parent–child behaviours during a family discussion task. 24 children with OCD (mean age=12.96), 20 control children (mean age=13.13) and their parents participated in this study. Dyads discussed an ambiguous scenario for five minutes with the goal of finding a solution. Parent behaviours of autonomy granting and overinvolvement, as well as parent–child behaviours of warmth, withdrawal, aversiveness and confidence were independently coded along with parent and child enhancement of responsibility for solving the problem. Parents in OCD dyads were observed to be significantly more aversive than control parents. Children with OCD were significantly less warm and more withdrawn than control children. Irrespective of group membership, parents enhanced their child's responsibility more than their own when generating solutions. These findings add to the literature on parent–child variables that play a role in enhancing OCD related beliefs such as inflated responsibility.

The Specificity of Inflated Responsibility Beliefs to OCD: A Systematic Review and Meta-analysis of Published Cross-sectional Case-control Studies

Leading cognitive theories posited that inflated responsibility beliefs play as a vulnerability and maintenance cognitive factor for obsessive compulsive disorder (OCD). A great body of research tested the specificity of responsibility to OCD, comparing on responsibility outcomes patients with OCD relative to normal controls or patients with anxiety disorders (AD). However, findings appeared inconclusive, and a systematic review summarizing evidence has not been conducted, yet. The current systematic review and meta-analysis provided a quantitative synthesis of findings from published cross-sectional case-control studies investigating whether inflated responsibility beliefs are specific to OCD. It was hypothesized that patients with primary OCD endorse stronger inflated responsibility beliefs compared to (1) healthy controls, and to (2) patients with any primary anxiety disorder. Electronic databases were searched. Cross-sectional case-control studies were included if they compared patients with primary OCD to healthy controls or patients with any primary anxiety disorder, and they used validated outcome self-report measures of responsibility. Studies conducted on primary hoarding were excluded. Studies on patients with comorbid conditions were not excluded. Twenty-two studies (<i>n</i>= 8541, 48 effect sizes overall) were included in random-effect meta-analyses. A large effect size<i> </i>favouring patients with OCD relative to controls was found [<i>d</i>=1.13, SE= 0.09, 99% CI: 0.87-1.37, <i>p</i>= 0.0001]. A medium effect size on responsibility favoring OCD over AD patients was found [d=0.66, SE= 0.10, 99% CI: 0.39-0.92, <i>p</i>= 0.0001], but the results appeared to be confounded by a publication bias effect. Current findings did not seem to confirm definitively the specificity of responsibility to OCD. Responsibility could be a transdiagnostic factor for psychopathology. Implications for case-formulation and treatment are discussed. Causal inferences on the role of responsibility in OCD development cannot be made due to the cross-sectional nature of studies. Further prospective studies are needed. Further research with experimental designs should address whether changes in responsibility beliefs mediate OCD symptom changes during cognitive behaviour therapy targeting the responsibility domain.

Initial Data on Recollections of Pathways to Inflated Responsibility Beliefs in Patients with Obsessive-Compulsive Disorder

Despite literature establishing a relationship between maladaptive beliefs and symptoms of obsessive-compulsive disorder (OCD), there are few studies addressing how these beliefs develop. Salkovskis and colleagues (1999) proposed specific domains of childhood experiences leading to heightened beliefs regarding responsibility. Prior studies in students and individuals who just completed treatment for OCD have found support for this theory. However, we are not aware of published data from individuals with current OCD. This paper presents initial data from adults currently meeting criteria for OCD as well as both anxious and non-anxious controls. Recollections of childhood experiences, current OCD-related beliefs, and OCD symptoms were assessed using self-report measures in 39 individuals seeking treatment for OCD, 36 anxious controls and 39 healthy controls. Initial data suggested that in individuals with OCD, increased reports of childhood exposure to overprotection and experiences where one's actions caused or influenced misfortune were associated with stronger OCD-related beliefs. Further, compared to community controls, individuals with OCD reported more childhood experiences where one's actions caused or influenced misfortune, though they did not differ from anxious controls in childhood responsibility experiences. These initial findings provide minimal support for the proposed model of the development of inflated responsibility beliefs, and highlight the need for research examining the etiology of OCD related beliefs with updated models, larger samples, and ultimately using prospective methods.

Alterations of Responsibility Beliefs Through Cognitive-Behavioural Group Therapy for Obsessive-Compulsive Disorder

Inflated responsibility is the main feature of cognitive-behavioural models of obsessive-compulsive disorder (OCD). However, few studies have examined the effect of cognitive-behavioural group therapy (CBGT) on inflated responsibility. The aim of this study was to examine the effect of CBGT on OCD symptoms and responsibility beliefs. Thirty-six subjects meeting Diagnostic and Statistical Manual of Mental Disorders, 4th edition, criteria for OCD were recruited to CBGT, and 28 of them completed 12 sessions. Subjects were assessed using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), the Responsibility Attitude Scale (RAS), and the Responsibility Interpretations Questionnaire (RIQ) at pre- and post-treatment. Y-BOCS, RAS and RIQ (belief) scores were significantly improved at the end of the treatment. This study indicates that CBGT improves not only obsessive-compulsive symptoms but also inflated responsibility beliefs in patients with OCD.

Pathways to Inflated Responsibility Beliefs in Adolescent Obsessive-Compulsive Disorder: A Preliminary Investigation

An inflated sense of responsibility is characteristic of obsessive-compulsive disorder (OCD). No previous studies have investigated its origins. Five potential pathways to inflated responsibility beliefs have been proposed; these are tested in this study. A novel measure, the Origins Questionnaire for Adolescents (OQA), was developed to assess experiences on these five pathways. Reliability of the OQA was investigated. The experiences on the five pathways to inflated responsibility beliefs of 16 adolescents with a history of OCD were compared to 16 adolescents with no history of OCD. Parents also reported on adolescents' experiences on the five pathways. Test-retest reliability was high. The internal consistency of the subscales was only partly satisfactory. The groups differed on one pathway; the clinical group reported a higher sense of responsibility for significant incidents with a negative outcome prior to onset of OCD. An inflated sense of responsibility, in combination with the occurrence of specific incidents, might act as a vulnerability factor for development of OCD. Future research should consider how to measure the subtle effects of experiences of responsibility over the course of development.

Pathways to Inflated Responsibility Beliefs, Responsibility Attitudes and Obsessive-Compulsive Symptoms: Factor Structure and Test of a Mediational Model

Inflated responsibility has been hypothesized as an important influence on OCD symptoms. According to Salkovskis and colleagues (1999) there are in turn five developmental pathways that lead to inflated responsibility. Coles and Schofield (2008) proposed the Pathways to Responsibility Beliefs Scale (PIRBS) as a measure of these pathways. In the present study the psychometric properties of an Icelandic translation of the PIRBS were evaluated and its factor structure was studied in a confirmatory factor analysis. Further it was tested whether responsibility mediated between pathways to responsibility beliefs and OCD symptoms. While neither a four nor a five-factor structure of the PIRBS was found to be wholly satisfactory; support for the latter was slightly better. Correlations of the PIRBS scales with measures of responsibility and obsessive-compulsive disorder symptoms were moderate as expected. Support was found for a mediating role of responsibility attitudes between pathways measured by the PIRBS and OCD symptoms in support of Salkovskis and colleagues' theory (1999). The PIRBS is a promising approach to study the developmental precursors of inflated responsibility and OCD symptoms but its factor structure may need a revision.

An experimental manipulation of responsibility in children: A test of the inflated responsibility model of obsessive-compulsive disorder

The objective of this study was to investigate whether Salkovskis (1985) inflated responsibility model of obsessive-compulsive disorder (OCD) applied to children. In an experimental design, 81 children aged 9–12 years were randomly allocated to three conditions: an inflated responsibility group, a moderate responsibility group, and a reduced responsibility group. In all groups children were asked to sort sweets according to whether or not they contained nuts. At baseline the groups did not differ on children's self reported anxiety, depression, obsessive-compulsive symptoms or on inflated responsibility beliefs. The experimental manipulation successfully changed children's perceptions of responsibility. During the sorting task time taken to complete the task, checking behaviours, hesitations, and anxiety were recorded. There was a significant effect of responsibility level on the behavioural variables of time taken, hesitations and check; as perceived responsibility increased children took longer to complete the task and checked and hesitated more often. There was no between-group difference in children's self reported state anxiety. The results offer preliminary support for the link between inflated responsibility and increased checking behaviours in children and add to the small but growing literature suggesting that cognitive models of OCD may apply to children.

Thought–action fusion and inflated responsibility beliefs in obsessive–compulsive disorder

In obsessive–compulsive disorder (OCD), inflated responsibility (IR) beliefs and thought–action fusion (TAF) are two cognitive schema argued to contribute to obsessions and compulsions. We investigated whether IR and TAF are OCD-specific or whether they occur in other anxiety disorders. Adults diagnosed with OCD (n = 20) or other anxiety disorders (n = 21), and non-clinical controls (n = 22) completed measures of OCD symptomatology and severity, TAF, appraisals and interpretations of responsibility, and depression. IR was more prominent in those with OCD as compared with those with other anxiety disorders, with correlational analyses confirming that a high sense of personal responsibility was associated with high levels of obsessionality even after controlling for depression. No group differences, however, emerged between the clinical groups on measures of TAF, both groups showing elevated TAF compared with controls. Indeed, TAF and obsessional symptoms were correlated only in the presence of negative affect. These results suggest that although IR may be higher in those with OCD compared with other anxiety disorders, TAF is not specific to OCD. Results are discussed in the context of cognitive appraisal models of OCD.

Assessing the Development of Inflated Responsibility Beliefs: The Pathways to Inflated Responsibility Beliefs Scale

Inflated responsibility beliefs are hypothesized to be a central feature of obsessive-compulsive disorder (OCD; Rachman, 1998, 2002; Salkovskis, 1985), but the etiology of these beliefs remains untested. Salkovskis and colleagues (1999) proposed 5 primary pathways to the development of inflated responsibility beliefs (e.g., heightened responsibility as a child, exposure to rigid and extreme codes of conduct as a child). The current paper presents 2 studies developing a self-report measure—the Pathways to Inflated Responsibility Beliefs Scale (PIRBS)—of these hypothesized pathways. In the first study, an initial version of the scale is developed and the number of items are reduced. In the second study, the revised scale is shown to provide a reasonable match to the proposed structure and to have good internal consistency, retest reliability, and convergent and divergent validity. These initial data suggest that the PIRBS may be useful for studying the etiology of inflated responsibility beliefs that are hypothesized to be central to the development of OCD. Limitations and future directions are discussed.

An exploration of the relationship between mental pollution and OCD symptoms

Rachman [(1994). Pollution of the mind. Behaviour Research and Therapy, 32, 311–314] theorized that a subtype of compulsive washing exists which has its compulsions triggered by feelings of internal dirtiness, or ‘mental pollution’. Since this construct was proposed, few empirical studies have examined it in relation to obsessive–compulsive contamination fear. This study represents a validation of the Mental Pollution Questionnaire (MPQ), which was developed for the measurement of mental pollution. Psychometric data were obtained from two studies using non-clinical samples. The final version of the MPQ consisted of eight items and two subscales related to washing and ideation. Higher mental pollution scores were associated with greater obsessions, contamination, and washing symptoms. In addition, MPQ scores were positively associated with inflated responsibility beliefs and thought–action fusion. Lastly, a third study found that both MPQ subscales predicted OC symptoms after controlling for general distress, trait guilt, and disgust sensitivity. Potential uses of the MPQ as a clinical and research instrument are discussed.

Multiple pathways to inflated responsibility beliefs in obsessional problems: possible origins and implications for therapy and research

The purpose of this paper is to consider the possible origins of an inflated sense of responsibility which occupies an important place in the cognitive theory of obsessive compulsive disorder (Rachman, S. (1993). Obsessions, responsibility, and guilt. Behaviour Research and Therapy, 31, 149–154. Salkovskis, P. M. (1985). Obsessional-compulsive Problems: A cognitive-behavioural analysis. Behaviour Research and Therapy, 23 (5), 571–583). Clinical experience and consideration of current cognitive conceptualisations of obsessions and obsessive compulsive disorder suggest a number of possibilities, each of which is described after a brief introduction to the concept itself. While there are reasons to believe that some general patterns can be identified, the origins of obsessional problems are best understood in terms of complex interactions specific to each individual.