Unacceptable Thoughts Research Articles

Co-occurring PTSD in intensive OCD treatment: Impact on treatment trajectory vs. response.

Obsessive-compulsive disorder (OCD) and co-occurring posttraumatic stress disorder (PTSD) is associated with more severe and chronic OCD. However, findings regarding treatment effectiveness of cognitive behavioral treatment (CBT) with exposure and response prevention (ERP) with this comorbidity are mixed. Research aimed at understanding the precise barriers to OCD treatment effectiveness for individuals with co-occurring PTSD may help elucidate unique treatment needs. The current study used linear regression and latent growth curve analysis comparing treatment response and trajectory from patients with OCD (n=3083, 94.2%) and OCD+PTSD (n=191, 5.2%) who received CBT with ERP in two major intensive OCD treatment programs. Although patients with OCD+PTSD evidenced similar trajectories of overall severity change, patients at one site required nearly 11 additional treatment days to achieve comparable reduction in OCD severity. Further, at the dimensional level, those with OCD+PTSD had poorer treatment response for unacceptable thoughts and symmetry symptoms. The moderate effect for unacceptable thoughts, indicating the widest gap in treatment response, suggests these symptoms may be particularly relevant to PTSD. Findings are limited by a naturalistic treatment sample with variation in treatment provision. Findings emphasize caution in using a one-size-fits-all approach for patients with co-occurring OCD+PTSD within intensive OCD treatment programs, as broadly defined outcomes (e.g., reduction in overall severity) may not translate to reduction in the nuanced symptom dimensions likely to intersect with trauma. Unacceptable thoughts and symmetry symptoms, when co-occurring with PTSD, may require a trauma-focused treatment approach within intensive OCD treatment.

The contribution of inferential confusion and fear of self to psychological models of obsessive-compulsive symptoms: A dimensional approach

Current psychological models of obsessive-compulsive disorder account for a surprisingly small degree of variability in obsessive-compulsive (OC) symptoms in statistical models. The current study examined whether constructs from the inference-based approach to OCD (i.e., inferential confusion and fear of self) explain OC symptom dimensions above and beyond what is explained by the prevailing cognitive appraisal model. Undergraduate participants (N = 339) completed a battery of self-report questionnaires assessing OC symptoms, obsessive beliefs, inferential confusion, and fear of self. Results revealed that both psychological models together accounted for about one quarter of the variance in OC symptoms. The inference-based approach concepts most closely aligned with responsibility, symmetry, and unacceptable thoughts, and added explanatory value to appraisal models of these symptom domains. Limitations and future directions are discussed.

Standardization of the Korean Version of the Acceptance and Action Questionnaire for Obsessions and Compulsions in University Students and Patients With Obsessive-Compulsive Disorder.

The Acceptance and Action Questionnaire for Obsessions and Compulsions (AAQ-OC) is a version of the Acceptance and Action Questionnaire (AAQ) that specifically measures unwanted intrusive thoughts and responses (e.g., experiential avoidance) to them. This study aimed to investigate the reliability and validity of the Korean version of the AAQ-OC in clinical and nonclinical Korean samples. In this study, 561 university students and 121 patients with obsessive-compulsive disorder (OCD) completed the AAQ-OC and several other psychological scales. Descriptive, correlation, and exploratory and confirmatory factor analyses as well as group comparisons were conducted. The results of the exploratory and confirmatory factor analyses indicated a two-factor structure that best fits the data in the university sample: Factors 1 and 2 matched the original Valued Action and Willingness subscales, respectively. The reliability analyses revealed that the AAQ-OC and its factors had excellent internal consistencies. As regards the concurrent validity, the AAQ-OC and its factors had a positive correlation with the AAQ-II and Cognitive Fusion Questionnaire. Compared with the university students, the OCD patients had higher AAQ-OC scores, and their obsessive-compulsive symptoms, particularly the two symptom dimensions of responsibility for harm and mistakes and unacceptable thoughts, were significantly associated with the AAQ-OC and two subscales. The findings of this study confirm the reliability and validity of the Korean version of the AAQ-OC.

A preliminary investigation of the mediating roles of self-compassion and emotion dysregulation in the relationship between maladaptive perfectionism and obsessive-compulsive behaviors.

Recent research has highlighted an association between maladaptive perfectionism and obsessive-compulsive disorder (OCD).However, the mechanisms underlying this relationship are not well understood. The primary aim of this preliminary study was to investigate whether self-compassion and emotion dysregulation independently mediated this relationship. The secondary aim was to determine whether serial mediation existed between these factors. Whether these relations held for overall obsessive-compulsive (OC) symptoms, versus distinct dimensions of OCD, was also of interest. Three hundred and ninety-two university students (Mage = 21.81, SD = 8.01), predominantly female (79.18%), participated in an online questionnaire that included a dimensional measure of OCD. Scales assessing maladaptive perfectionism, self-compassion, emotion dysregulation, and negative emotion states were also included. Greater maladaptive perfectionism was related to more severe OCD. Emotion dysregulation, but not self-compassion, independently mediated this relationship. A serial mediation relationship was found, in that greater maladaptive perfectionism was associated with lower self-compassion, which was linked to greater emotion dysregulation, and in turn related to more severe OC behaviors. In addition, distinct patterns emerged for separate OC dimensions. These findings highlight emotion regulation and self-compassion as potential targets for OCD prevention, especially in individuals with symptoms in the symmetry and unacceptable thoughts dimensions.

Rethinking Unacceptable Thoughts: Validation of an Expanded Version of the Dimensional Obsessive-Compulsive Scale

The Dimensional Obsessive-Compulsive Scale (DOCS) is widely used to measure obsessive-compulsive disorder (OCD) severity across four broad symptom dimensions (i.e., contamination, responsibility for harm, unacceptable thoughts, symmetry). Despite its proven utility, there is reason to suspect that the unacceptable thoughts subscale conflates different types of unacceptable thoughts that are meaningfully distinct from one another. In the current study, we first evaluated the psychometric properties of a newly developed DOCS violent and/or aggressive thoughts subscale. We then examined the factor structure, psychometric properties, and diagnostic sensitivity of a seven-factor version of the DOCS that includes the four original DOCS subscales and three more-specific versions of the unacceptable thoughts scale (i.e., sexually intrusive thoughts, violent and/or aggressive thoughts, and scrupulous or religious thoughts). The sample included 329 residential and intensive outpatients, the majority of which had a diagnosis of OCD (75.2%). The new unacceptable thoughts subscales demonstrated convergent and discriminant validity with unique associations between the subscales and depression, suicide, and perceived threat from emotions that were not present in the broader unacceptable thoughts subscale. The seven-factor version of the DOCS demonstrated slightly lower levels of diagnostic sensitivity than the original DOCS. Thus, the four-factor version of the DOCS is recommended for screening purposes. A score of 40 or higher on the seven-factor version of the DOCS best predicted a diagnosis of OCD. Overall, the three additional unacceptable thoughts subscales appear to be distinct factors that have potential value in research and clinical settings.

Is Acceptance and Commitment Therapy Effective for Any Obsessive-Compulsive Symptom Dimensions?

Acceptance and commitment therapy (ACT) has been recently introduced for treating obsessive-compulsive disorder (OCD). Although there are data supporting the efficacy of ACT, only few studies have investigated the effectiveness of ACT against any obsessivecompulsive (OC) symptom dimension or a specific dimension alone. In total, 64 patients with OCD received an 8-session ACT group program. All measures were evaluated before and after treatment. The Dimensional Obsessive-Compulsive Scale was used to assess OCD severity across the four empirically supported symptom dimensions (i.e., contamination, responsibility for harm, unacceptable thoughts, and symmetry). ACT processes were evaluated using the Acceptance and Action Questionnaire-II (AAQ-II), Acceptance and Action Questionnaire for Obsessions and Compulsions (AAQOC), and Cognitive Fusion Questionnaire. After an 8-week program, there were significant reductions in all four OC symptom dimensions after ACT. The unacceptable thoughts and contamination domains had medium effect size. The responsibility for harm and symmetry dimensions had small effect size. The unacceptable thoughts dimension was significantly correlated with all ACT process measures. The symmetry dimension was significantly correlated with AAQ-OC and AAQ-II scores while the responsibility for harm dimension was correlated with AAQ-II alone. However, the contamination dimension was not associated with any process measures. ACT may be effective for managing all four symptom dimensions with small to moderate effect size. Moreover, depending on the symptom dimension, there may be different relationship patterns between symptom reduction and changes in ACT processes.

Overcoming the forbidden: Identification and stigma of unacceptable thoughts in obsessive–compulsive disorder.

Overcoming the forbidden: Identification and stigma of unacceptable thoughts in obsessive–compulsive disorder.

Supplemental Material for Overcoming the Forbidden: Identification and Stigma of Unacceptable Thoughts in Obsessive–Compulsive Disorder

Supplemental Material for Overcoming the Forbidden: Identification and Stigma of Unacceptable Thoughts in Obsessive–Compulsive Disorder

Cross-sectional direct and indirect relationships between the corrupted feared self and obsessive-compulsive symptoms in a clinical sample: The role of mental contamination.

There is a significant relationship between a general feared self and contact contamination concerns in obsessive-compulsive disorder (OCD), especially when the influence of mental contamination is considered a part of this relationship. However, these associations have not been explored in a clinical OCD sample when using each dimension of the multidimensional conceptualization of the feared self as the predictor (i.e., the corrupted, culpable, and malformed feared selves). We tested these associations using a cross-sectional design. Specifically, a sample of patients diagnosed with OCD (N = 417) completed a series of self-report measures of OCD symptoms and its related constructs. We also explored these associations with unacceptable thoughts as the outcome, rather than contamination concerns, due to unacceptable thoughts having evidenced strong associations with the feared self and mental contamination. After controlling for relevant cognitive (i.e., obsessive beliefs) and affective (i.e., depressive symptoms) constructs and comorbidity, the corrupted feared self was found to have a direct link, along with an indirect link through mental contamination, with symptoms of contact contamination and unacceptable thoughts. The fear of being corrupted may be associated with feelings of contamination in the absence of direct contact with a contaminant, which may then predict OCD symptoms of repugnant obsessional thoughts and contact contamination concerns. The corrupted feared self and mental contamination should therefore be targeted in treatments for repugnant obsessions and contamination-related OCD.

The effects of brief emotional acceptance instructions on emotional distress and compulsive urges of various obsessive-compulsive symptoms dimensions

Background and Objectives: Emotion regulation (ER) deficits are increasingly implicated in obsessive-compulsive symptoms (OCS). The ER difficulty of ‘non-acceptance of emotions’ has been most consistently found to correlate with OCS – albeit not uniformly with all OCS dimensions. This study examined the causal relationships between the acceptance of emotions and four OCS dimensions: contamination, responsibility of harm, unacceptable thoughts and symmetry. Methods: Participants in this online study rated their baseline emotional distress and compulsive urges to OC scenarios corresponding to each OCS dimension. After completing questionnaires on ER, OCS, anxiety and depressive symptoms, participants were randomly assigned to two conditions and instructed to observe and accept their emotions (acceptance condition; n = 180) or observe their emotions (control condition; n = 185) as they re-read the scenarios. Participants then rated their post-manipulation emotional distress and compulsive urges to each scenario. Results: The instructions to accept emotions resulted in lower compulsive urges to the responsibility of harm scenario, for participants with lower baseline compulsive urges. There were no other group differences on post-manipulation measures. Conclusions: The current findings suggest that even brief instructions to accept one’s emotions reduced compulsive urges, pointing to the potential clinical utility of enhancing the acceptance of emotions.

The contribution of guilt sensitivity in the prediction of obsessive-compulsive disorder symptom dimensions: Replication and extension

BackgroundObsessive-compulsive disorder (OCD) is associated with particular cognitive processes, such as beliefs about the importance of intrusive thoughts. The present study examined the explanatory power of guilt sensitivity to OCD symptom dimensions after controlling for well-established cognitive predictors. Methods164 patients with OCD completed self-reported measures of OCD and depressive symptoms, obsessive beliefs, and guilt sensitivity. Bivariate correlations were examined, and latent profile analysis (LPA) was used to generate groups based on symptom severity scores. Differences in guilt sensitivity were examined across latent profiles. ResultsGuilt sensitivity was most strongly associated with unacceptable thoughts and responsibility for harm OCD symptoms, and moderately with symmetry. After controlling for depression and obsessive beliefs, guilt sensitivity added explanatory power to the prediction of unacceptable thoughts. LPA identified 3 profiles; profile-based subgroups significantly differed from one another in terms of guilt sensitivity, depression, and obsessive beliefs. ConclusionsGuilt sensitivity is relevant to various OCD symptom dimensions. Above and beyond depression and obsessive beliefs, guilt sensitivity contributed to the explanation of repugnant obsessions. Theory, research, and treatment implications are discussed.

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

BackgroundIt 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. AimsThe 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. MethodsForty-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. ResultsThe 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. ConclusionsThese 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.

Childhood emotional maltreatment, maladaptive coping and obsessive-compulsive symptoms in patients with obsessive-compulsive disorder.

Previous studies have reported childhood emotional maltreatment (CEM) to be associated with specific obsessive-compulsive (OC) symptoms, but maladaptive coping, which may be the underlying mechanism in this relationship, has not been evaluated yet. Thus, the present study aimed to examine the effects of CEM on the OC symptoms of responsibility for harm and unacceptable thoughts, as well as obsessive-compulsive disorder (OCD) severity, through maladaptive coping, including cognitive avoidance, experiential avoidance and emotional suppression in OCD patients (n = 360). The results showed that CEM had direct effects, as well as indirect effects via cognitive and experiential avoidance and emotional suppression, on responsibility for harm and unacceptable thoughts. In addition, the indirect effect of CEM on OCD severity was significantly mediated by the roles of cognitive avoidance and experiential avoidance. The present study adds new literature to evidence indicating the role of early childhood events in developing and maintaining OCD in which adverse maladaptive coping related to unpleasant childhood abuse plays an important role in OCD. More precisely, OCD patients who experience a history of CEM may further use maladaptive coping to cope with their distress and subsequently experience responsibility for harm, unacceptable thoughts and severe OCD.

Obsessive-Compulsive Disorder During the COVID-19 Pandemic Process: A Narrative Review.

This study aimed to review all empirical contributions published between March 2020 and June 2022, addressing the impact of the COVID-19 pandemic on obsessive-compulsive disorder in adults. We searched the literature in PubMed, Google Scholar, and Web of Science. A total of 543 articles were scanned and 73 full-text articles were identified. Reviews, comments, letters to the editor, and case reports (except case series) were excluded. It was determined that 42 articles met the inclusion criteria, 6 studies involving only children and adolescents were excluded, and 36 were decided on their suitability for our study. The analysis determined that COVID-19 had an impact on obsessive-compulsive disorder. Characteristics such as liability for harm and unacceptable thoughts influenced the symptoms as well as contamination and washing. Some studies showed an increase in the severity of obsessive-compulsive symptoms, while some reported no worsening but improvement with treatment and follow-up. While some reported variations in outcomes related to sociodemographic characteristics and subtypes, some focused on the risk of suicide. There were also studies conducted on special groups such as pregnant women or healthcare workers. The results were controversial. While available data contain more information on worsening obsessive-compulsive disorder symptoms, data on the status of patients under treatment were scarce. There were not enough studies evaluating follow-up results. Influencing factors such as sociodemographic characteristics, subtypes, comorbid conditions, treatment, and support did not seem to have been adequately addressed.

ANALYSIS OF THE MAIN CHARACTER’S MENTAL DEPRESSION IN “A GIRL LIKE HER FILM” DIRECTED BY AMY S. WEBER USING FREUD’S PSYCHOANALYTIC THEORY

Psychoanalysis is a method for treating mental illness and also a theory which explains human behavior. In psychoanalysis itself, there is defense mechanism, the psychological strategies that are unconsciously used to protect a person from anxiety arising from unacceptable thoughts or feelings. This research will focuses on the main character’s mental depression in “A Girl Like Her” film directed by Amy S. Weber in 2015. This film raises the issue of depression. The main character, Jessica Burns was a victim of bullying and it makes her commit a suicide because of depression. This research uses the theory of Defense Mechanism in Psychoanalysis by Sigmund Freud (1936) to find out the behavior of the character. Therefore, this study aims to find the defense mechanism in depression experienced by Jessica Burns. The data are taken from all utterances spoken by the characters in the film, and journals, articles related to film, also websites to support. This research uses a qualitative method, the type of method that uses words, images, and feeling except numbers. As a result, this research shows that there are six defense mechanisms related with the film, repression, denial, projection, displacement, regression, and sublimation, which show that the behavior can lead to depression.
 Keywords: Psychoanalysis, Defense Mechanism, Depression, Bullying.

Core clinical symptoms and suicidal ideation in patients with obsessive-compulsive disorder: A network analysis.

Suicidality in obsessive-compulsive disorder (OCD) is underestimated and it is important for clinicians to understand the factors that contribute to suicidal ideation. The present study aimed to estimate a network of the core clinical symptoms of OCD including obsessions, compulsions, and obsessive-compulsive (OC) symptom dimensions, depressive symptoms, and psychological traits, and to examine which symptoms contribute to suicidal ideation in patients with a primary diagnosis of obsessive-compulsive disorder. A total of 444 patients with OCD were assessed with the Yale-Brown Obsessive-Compulsive Scale, the Montgomery-Asberg Depression Rating Scale, and various other measures. Network analysis was conducted to estimate the network of obsessive-compulsive and depressive symptoms, psychological traits including alexithymia and impulsivity, and demographic covariates. Symptoms directly related to suicidal ideation in the network were examined for their relative contribution to suicidal ideation. Suicidal ideation was directly related to degree of control over compulsive behaviors, distress associated with compulsive behaviors, time spent performing compulsive behaviors, and unacceptable thoughts, along with depressive symptoms and alexithymia. In the network of OC and depressive symptoms the most central symptoms among the former were interference due to compulsive behaviors and interference due to obsessive thoughts, and among the latter were pessimistic thoughts and reported sadness. The findings suggest that along with depressive symptoms and alexithymia, compulsions and unacceptable thoughts dimension may contribute to suicidality, and thus, should be carefully monitored in patients with OCD.

Obsessive-compulsive symptoms and daily experiences of posttraumatic stress and mental contamination following sexual trauma

Although cross-sectional research highlights similarities between symptoms of obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD) among individuals exposed to sexual trauma, little is known about how these disorders relate over time. The goal of the present study was to examine whether 1) OCD symptoms prospectively predicted daily symptoms of PTSD, and 2) OCD and PTSD symptoms prospectively predicted daily experiences of sexual trauma-related mental contamination (i.e., dirtiness in the absence of a physical pollutant). Forty-one women with a sexual trauma history completed baseline measures of OCD and PTSD, as well as twice-daily assessments of PTSD symptoms and mental contamination over a two-week period. Total OCD symptoms and the unacceptable thoughts dimension significantly predicted daily PTSD symptoms after accounting for other OCD dimensions. Only total OCD symptoms significantly predicted daily mental contamination when examined together with total PTSD symptoms. No individual PTSD or OCD clusters/dimensions significantly predicted daily mental contamination when examined simultaneously. Findings from this study highlight the nuanced associations among OCD symptoms, PTSD symptoms, and experiences of mental contamination. Future research is needed to further understand the development of PTSD, OCD, and mental contamination over time to inform targets for intervention.

The association between OCD and Shame: A systematic review and meta-analysis.

Due to rumination and self-criticism over unwanted obsessions and repetitive rituals, shame is a common emotion experienced by individuals with obsessive-compulsive disorder (OCD). Shame is also theorized to have relevance to unacceptable thoughts in OCD. However, empirical research looking at the relationship between OCD and shame is still emerging and findings have been mixed. Our review systematically examines the association of shame with OCD and unacceptable thoughts. The last updated search was conducted across five databases between 27 and 29 February 2022. The final selection included 20 papers, 18 of which were used in the primary meta-analysis to calculate pooled effect sizes between OCD and shame measures using a random effects model. In a separate analysis, three papers were used to calculate pooled effect sizes between shame and OCD symptom dimensions also using a random effects model. The meta-analyses identified a significant, moderate and positive correlation between total OCD and shame scores r=.352, 95% CI [0.260, 0.438]. In addition, significant, weak and positive relationships were found between shame and three OCD symptom dimensions: unacceptable thoughts r=.252, 95% CI [-0.467, 0.9708], harm obsessions r=.224, CI [-0.190, 0.638] and symmetry concerns r=.200, CI [-0.108, 0.509]. Shame measures in the reviewed studies were not specific to OCD, and between-study variance in the analyses examining unacceptable thoughts was significant. Our findings support a medium positive relationship between shame and OCD. As shame in OCD can be a barrier to seeking treatment and impair quality of life, it is imperative to address this emotion through psychoeducation, assessment and treatment.

Obsessive-compulsive symptoms among the general population during the first COVID-19 epidemic wave in Italy

This study investigated obsessive-compulsive symptoms (OCS) in the Italian general population during the initial stage of the pandemic and the impact of COVID-19 related potential risk factors. A web-based survey was spread throughout the internet between March 27th and April 9th, 2020. Twenty thousand two hundred forty-one individuals completed the questionnaire, 80.6% women. The Dimensional Obsessive-Compulsive Scale (DOCS) was included to assess the severity of the obsessive-compulsive symptom domains. Further, selected outcomes were depression, anxiety, insomnia, perceived stress, and COVID-19 related stressful life events. A panel of logistic or linear regression analyses was conducted to explore the impact of COVID-19 related risk factors, socio-demographic variables, and mental health outcomes on OCS. A total of 7879 subjects (38,9%) reported clinically relevant OCS. Specifically, more than half of the sample (52%) reported clinically relevant symptoms in the Contamination domain, 32.5% in the Responsibility domain, 29.9% in the Unacceptable thoughts domain, and 28.6 in the Symmetry/Ordering domain. Being a woman was associated with OCS, except for Symmetry/Ordering symptoms. A lower education level and younger age were associated with OCS. Moreover, depression, anxiety, perceived stress symptoms, insomnia, and different COVID-19 related stressful events were associated with OCS. We found high rates of OCS, particularly in the contamination domain, in the Italian general population exposed to the first COVID-19 epidemic wave and COVID-19 related risk factors. These findings suggest the need to investigate further the trajectories of OCS in the general population along with the long-term socio-economic impact of the pandemic.

An examination of obsessive-compulsive symptom domains, depression, and quality of life within an online survey sample.

Obsessive-compulsive disorder (OCD) is a heterogeneous and highly impairing disorder that is frequently comorbid with other conditions. Participants in this study were 212 individuals recruited through Mechanical Turk who filled out validated measures of obsessive-compulsive symptoms, quality of life (QoL), generalized anxiety, and depressive symptoms. Analyses examined the influences of each symptom variable on QoL and the mediating role of depression as an indirect link between unacceptable thoughts (UT) and QoL. Depressive symptoms had a significant negative relationship with multiple domains of functioning. Generalized anxiety was not significant. Higher endorsement of UT symptoms was related to lower physical, emotional, and social QoL. Depression partially mediated the relationship between UT symptoms and physical, emotional, and social health. Depressive symptoms are important to consider in clinical work surrounding OCD. The significant associations between UT symptoms and QoL in a nonclinical population illustrate a relevant area for future intervention, public awareness, and education.