'Things that shouldn't be': a qualitative investigation of violation-related appraisals in individuals with OCD and/or trauma histories.

BACKGROUND: Cognitive models of mental contamination (i.e. feelings of internal dirtiness without contact with a contaminant) propose that these feelings arise when individuals misappraise a violation. However, an operational definition of 'violation' and identification of specific violation misappraisals is limited. AIMS: This study's aim was to elaborate on cognitive models using qualitative data from those with lived experience to fill these gaps. METHOD: Twenty participants with a diagnosis of obsessive-compulsive disorder and/or a trauma history took part in a semi-structured interview about violation. Grounded theory was used to analyse interview transcripts. DISCUSSION: Three categories emerged, each with several themes - qualities of violation, violation-related appraisals, and violation-related behaviours. Different violation-related appraisals were associated with different emotions and urges. Specific self-focused appraisal sub-themes (i.e. permanence of consequences; self-worth; responsibility, self-blame and regret) were most closely related to emotions tied to mental contamination. These findings support and expand upon existing cognitive models of mental contamination, identifying key violation-related appraisals and differentiating between mental contamination-related appraisals and those related to other emotional sequelae. Future quantitative and experimental research can evaluate the potential of these appraisals as intervention targets.

The Covert and Overt Reassurance Seeking Inventory (CORSI): Development, validation and psychometric analyses.

BACKGROUND: Reassurance seeking (RS) is motivated by perceived general and social/relational threats across disorders, yet is often under-recognized because it occurs in covert (i.e. subtle) and overt forms. Covert safety-seeking behaviour may maintain disorders by preventing corrective learning and is therefore important to identify effectively. AIMS: This study presents the validation and psychometric analyses of a novel measure of covert and overt, general and social/relational threat-related interpersonal RS. METHOD: An initial 30-item measure was administered to an undergraduate sample (N = 1626), as well as to samples of individuals diagnosed with obsessive compulsive disorder (OCD; n = 50), anxiety disorders (n = 60) and depression (n = 30). The data were subjected to exploratory and confirmatory factor analyses, and validation analyses. RESULTS: An exploratory factor analysis using principal axis factoring with oblique rotation yielded five interpretable factors, after removing four complex items. The resulting 26-item measure, the Covert and Overt Reassurance Seeking Inventory (CORSI), evidenced good convergent and divergent validity and accounted for 54.99% of the total variance after extraction. Factor correlations ranged from r = .268 to .736, suggesting that they may be tapping into unique facets of RS behaviour. In comparison with undergraduate participants, all clinical groups had significantly higher total scores [t (51.80-840) = 3.92-5.84, p < .001]. The CFA confirmed the five-factor model with good fit following the addition of four covariance terms (goodness of fit index = .897, comparative fit index = .918, Tucker-Lewis index = .907, root mean square error approximation = .061). CONCLUSION: The CORSI is a brief, yet comprehensive and psychometrically strong measure of problematic RS. With further validation, the CORSI has potential for use within clinical and research contexts.

Development and validation of the multidimensional version of the fear of self questionnaire: Corrupted, culpable and malformed feared possible selves in obsessive-compulsive and body-dysmorphic symptoms.

In recent years, cognitive-behavioural models of OCD have increasingly recognized the potential role of feared possible selves in the development and maintenance of OCD, while simultaneously re-examining factors that have historically been linked to self-perceptions in OCD. The current article describes the development and validation of a multidimensional version of the Fear of Self Questionnaire (FSQ-EV) in a non-clinical (N = 626) and clinical OCD sample (N = 79). Principal component analyses in the non-clinical sample revealed three conceptually and factorially distinct components revolving around a feared corrupted possible self, a feared culpable possible self and a feared malformed possible self. The questionnaire showed a strong internal inconsistency, and good divergent and convergent validity, including strong relationships to obsessional symptoms. In particular, the corrupted feared self predicted OCD symptoms independently from depression and other related self-constructs and obsessive beliefs, while also strongly interacting with importance and control of thoughts in the prediction of almost all specific symptoms of OCD. Results are consistent with the notion that self-constructs can be conceptually and empirically distinguished from obsessive beliefs and appraisals with significant potential to improve our understanding of OCD and related disorders.

The development and validation of the Beliefs About Losing Control Inventory (BALCI).

Cognitive theory of obsessive-compulsive disorder (OCD) proposes that maladaptive beliefs play a pivotal role in the development and maintenance of symptoms. Clinical reports as well as recent psychometric and experimental investigations suggest that control-related beliefs in OCD may benefit from expansion to include aspects of losing control. However, currently available measures either focus on other facets of control (e.g., sense of control) or do not put emphasis on beliefs about losing control (e.g., beliefs about control over thoughts). The current study aimed to develop and validate the Beliefs About Losing Control Inventory (BALCI), a self-report measure of negative beliefs about losing control, in a sample of undergraduate participants (N= 488). An exploratory factor analysis revealed that the BALCI's 21 items capture negative beliefs about losing control over one's thoughts, behaviour, and emotions (Factor 1), beliefs about the importance of staying in control (Factor 2), and beliefs about losing control over one's body/bodily functions (Factor 3). The BALCI was also found to have good convergent and divergent validity and to be associated with elevated OCD symptoms above and beyond previously identified obsessive beliefs. Theoretical implications and recommendations for the field of cognitive-behaviour therapy are discussed.

What do you really need? Self- and partner-reported intervention preferences within cognitive behavioural therapy for reassurance seeking behaviour.

BACKGROUND: Reassurance seeking (RS) in obsessive compulsive disorder (OCD) is commonly addressed in cognitive behavioural therapy (CBT) using a technique called reducing accommodation. Reducing accommodation is a behaviourally based CBT intervention that may be effective; however, there is a lack of controlled research on its use and acceptability to clients/patients, and case studies suggest that it can be associated with negative emotional/behavioural consequences. Providing support to encourage coping with distress is a cognitively based CBT intervention that may be an effective alternative, but lacks evidence regarding its acceptability. AIMS: This study aimed to determine whether support provision may be a more acceptable/endorsed CBT intervention for RS than a strict reducing accommodation approach. METHOD: Participants and familiar partners (N = 179) read vignette descriptions of accommodation reduction and support interventions, and responded to measures of perceived intervention acceptability/adhereability and endorsement, before completing a forced-choice preference task. RESULTS: Overall, findings suggested that participants and partners gave significantly higher ratings for the support than the accommodation reduction intervention (partial η2 = .049 to .321). Participants and partners also both selected the support intervention more often than the traditional reducing accommodation intervention when given the choice. CONCLUSIONS: Support provision is perceived as an acceptable CBT intervention for RS by participants and their familiar partners. These results have implications for cognitive behavioural theory and practice related to RS.

The role of feared possible selves in obsessive-compulsive and related disorders: A comparative analysis of a core cognitive self-construct in clinical samples.

Increasingly, cognitive-behavioural models have been considering the role of beliefs about the self in the development and maintenance of obsessive-compulsive disorder (OCD), including sensitive domains of self-concept and feared self-perceptions. This has led to the development of the Fear of Self Questionnaire (FSQ; Aardema et al., ), which has shown strong internal consistency, divergent and convergent validity, and found to be a major predictor of unwanted thoughts and impulses (i.e., repugnant obsessions). The current study aimed to investigate fear of self-perceptions using the FSQ in an OCD sample (n = 144) and related psychological disorders (eating disorders, n = 57; body dysmorphic disorder, n = 33) in comparison to a non-clinical (n = 141) and clinical comparison group (anxiety/depressive disorders, n = 27). Following an exploratory factor analysis of the scale in the OCD sample, the results showed that participants with OCD in general did not score significantly higher on fear of self-perceptions than did the clinical comparison participants. However, consistent with previous findings, fear of self was highly characteristic among OCD patients with unwanted repugnant thoughts and impulses. In addition, fear of self-perceptions were significantly more elevated in those with eating or body dysmorphic disorders relative to the other non-clinical and clinical groups. The construct of a "feared possible self" may be particularly relevant in disorders where negative self-perception is a dominant theme, either involving concerns about one's inner self or concerns related to perceived bodily faults.

Thinking high but feeling low: An exploratory cluster analysis investigating how implicit and explicit spider fear co-vary.

Research has demonstrated large differences in the degree to which direct and indirect measures predict each other and variables including behavioural approach and attentional bias. We investigated whether individual differences in the co-variance of "implicit" and "explicit" spider fear exist, and whether this covariation exerts an effect on spider fear-related outcomes. One hundred and thirty-two undergraduate students completed direct and indirect measures of spider fear/avoidance, self-report questionnaires of psychopathology, an attentional bias task, and a proxy Behavioural Approach Task. TwoStep cluster analysis using implicit and explicit spider fear as criterion variables resulted in three clusters: (1) low explicit/low implicit; (2) average explicit/high implicit; and (3) high explicit/low implicit. Clusters with higher explicit fear demonstrated greater disgust propensity and sensitivity and less willingness to approach a spider. No differences between clusters emerged on anticipatory approach anxiety or attentional bias. We discuss results in terms of dual-systems and cognitive-behavioural models of fear.

Are all safety behaviours created equal? A comparison of novel and routinely used safety behaviours in obsessive-compulsive disorder.

Contamination fear is one of the most common symptoms of obsessive-compulsive disorder (OCD). Exposure and response prevention (ERP) is effective for OCD, but a significant minority of treatment-seeking individuals refuse ERP entirely or drop out prematurely. Research suggests that safety behaviour (SB) may enhance the acceptability of ERP; however, questions remain about how to incorporate SB into existing treatments. Clinical participants with OCD and contamination fear (N = 57) were randomized to receive an exposure session with no SB (ERP), a routinely used SB (RU), or a never-used SB (NU). Significant reductions in contamination fear severity were observed in all conditions. Although omnibus comparisons were only marginally significant, pairwise comparisons revealed some condition differences. NU demonstrated significantly lower self-reported contamination fear severity at post-exposure, as well as marginally higher treatment acceptability ratings. Findings suggest that exposure with SB may be effective and acceptable, and are discussed in terms of cognitive-behavioural theory and treatment of anxiety and related disorders.

Factor structure and temporal stability of the Vancouver Obsessional Compulsive Inventory-Mental Contamination Scale (VOCI-MC) and psychometric properties of its Italian version.

OBJECTIVE: The Vancouver Obsessional Compulsive Inventory-Mental Contamination Scale (VOCI-MC) is a self-report instrument that assesses symptoms of mental contamination. The aim of this study was to investigate the psychometric properties of the Italian version of the VOCI-MC in non-clinical and clinical samples. METHOD: Factor structure, internal consistency, temporal stability, construct and criterion validity were investigated in 541 participants from the general population, 120 participants diagnosed with OCD and 31 participants diagnosed with other anxiety disorders (OAD). For some of these analyses, our OCD sample was subdivided into those with contamination-related symptoms and concerns (n=39) and those whose OCD excluded concerns related to contamination fear (n=81). Exploratory and confirmatory factor analyses supported the expected one-factor structure of the VOCI-MC both in non-clinical and OCD sample. RESULTS: VOCI-MC scores showed good internal consistency, temporal stability, construct validity and criterion validity. In particular, the VOCI-MC successfully discriminated between those with OCD who reported contamination-related concerns and all other groups of participants. CONCLUSION: These findings suggest that the Italian version of the VOCI-MC retains the adequate psychometric properties of the original, provide preliminary evidence of its one-factor structure and temporal stability, and suggest that it can be confidently used as an assessment tool of mental contamination symptoms in both clinical and research settings.

The Treatment Acceptability/Adherence Scale: Moving Beyond the Assessment of Treatment Effectiveness.

It is becoming more broadly recognized that beyond effectiveness, the acceptability of interventions for anxiety disorders is an important consideration for evidence-based practice. Although advances in treatments for anxious psychopathologies have demonstrated that cognitive-behavioural interventions are more desirable than other types of psychotherapy or pharmacotherapy, there continue to be problems with adherence and dropout. It has been suggested that low treatment acceptability may be partially responsible for high dropout rates. Although a number of preliminary investigations in this domain have been conducted, further progress is hampered by the absence of a single self-report measure that assesses both acceptability and anticipated adherence. Therefore, the current paper aimed to test the psychometric properties of the newly developed Treatment Acceptability/Adherence Scale (TAAS). In two studies of brief cognitive-behavioural interventions, the TAAS was administered immediately following the therapy session. In Study 1 (N = 120 non-clinical undergraduates), the therapy included two variants of an exposure-based intervention for contamination fear. In Study 2 (N = 27 individuals with obsessive-compulsive disorder), the therapy was a cognitively based intervention evaluating a novel treatment technique for checking compulsions. Measures of convergent and divergent validity were included. Results demonstrated that the TAAS exhibited sound psychometric properties across the two samples. It is hoped that this measure will help clinicians to predict and intervene when a treatment is not acceptable and/or when the client anticipates poor adherence to it. Furthermore, the TAAS may aid researchers in continuing to improve upon effective interventions for anxiety and related disorders.

PSYCHOMETRIC PROPERTIES OF THE OBSESSIVE-COMPULSIVE INVENTORY-REVISED IN A TURKISH ANALOGUE SAMPLE.

The Obsessive-Compulsive Inventory-Revised (OCI-R) assesses distress associated with the symptoms of obsessive-compulsive disorder (OCD). This study reports on the psychometric properties of the Turkish version of the OCI-R as a widely known measure. The sample consisted of 319 Turkish university students (67.1% women; M age = 21.5, SD = 2.0). The questionnaire battery included measures of OCD symptoms, specific cognitions, thought control, and personality characteristics. A target rotation analysis supported the factorial validity of the Turkish OCI-R as indicated by its replicability with the original factor structure (i.e., checking, washing, obsessing, hoarding, ordering, and mental neutralizing). High-scoring OCD symptom groups also significantly differed on the Turkish OCI-R and thus presented preliminary evidence for its criterion validity. Correlational analysis supported convergent and divergent validity of the measure, with significant correlations between the Turkish OCI-R and OCD symptoms, OCD-specific beliefs, two thought control strategies (e.g., worry and punishment), and neuroticism, but not with psychoticism or extraversion. The current findings provide initial evidence of sound psychometric properties for the Turkish OCI-R in a nonclinical sample.

Safety behaviour enhances the acceptability of exposure.

Compulsive washing and contamination fears are among the most common symptoms of obsessive-compulsive disorder (OCD). Research suggests that exposure and response prevention (ERP) is effective for OCD. However, ERP is prone to dropouts and refusals, and a substantial proportion of clients therefore do not receive the care they need. A proposed solution involves the judicious use of safety behaviour to enhance the acceptability of exposure-based interventions. The current study aimed to test this proposed solution. Participants were 70 undergraduate students who completed two exposure exercises for contamination fear, one with safety behaviour and one without. Participants then rated the acceptability of the two exercises. Exposure with safety behaviour (ESB) was rated as significantly more acceptable than ERP. Furthermore, subjective fear ratings were lower and behavioural approach to a series of contaminants was greater in the ESB condition. Results demonstrated the acceptability-enhancing potential of safety behaviour in exposure, and are discussed in terms of both theoretical and practical aspects of safety behaviour, exposure, and evidence-based interventions for anxiety disorders.

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.

At the mercy of myself: A thematic analysis of beliefs about losing control.

PURPOSE: Concerns about the likelihood, consequences, and meaning of losing control are commonplace across anxiety-related disorders. However, several experimental studies have suggested that individuals without a diagnosis of a mental disorder also believe that they can and will lose control under the right circumstances. Understanding the range of beliefs about the nature and consequences of losing control can help us to better understand the continuum of negative beliefs about losing control. METHODS: The present study used thematic analysis to identify common beliefs about losing control in an unselected sample. Twenty-one participants, half of whom met criteria for at least one anxiety-related disorder, were interviewed about their beliefs about losing control. RESULTS: All 21 participants reported that losing control was possible. Losses of control were defined as multifaceted cognitive-behavioural processes and were seen as negative considering the perceived consequences of the losses. Commonly described consequences were harm to oneself or others, powerlessness, and unpleasant emotions during (e.g., sadness, frustration, and anxiety) and following (e.g., regret, shame, and humiliation) a loss of control. CONCLUSIONS: These results suggest that perceived losses of control are common and that negative beliefs about losing may only become problematic when the losses are personally significant. Further, they offer important insight into what is common among clinical and non-clinical beliefs about losing control and inform how these beliefs might be worth targeting in cognitive and behavioural interventions.

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.

Putting things right: An experimental investigation of memory biases related to symmetry, ordering and arranging behaviour.

BACKGROUND AND OBJECTIVES: Research indicates the presence of both explicit and implicit memory biases for threat. However, empirical support for the presence of memory biases related to symmetry, ordering and arranging is lacking, despite the fact that many individuals report anxiety associated with their personal belongings being out of place. The aim of this experiment was to examine memory biases for disorderliness and their associations with symmetry, ordering and arranging symptoms. METHODS: Eighty undergraduate participants were assigned to one of four conditions, consisting of rooms in which objects were arranged according to different levels of disorderliness (orderly, slightly disorderly, slightly orderly, and disorderly). Participants next completed a memory task in which their memory for disordered vs. ordered objects was assessed. Measures of OCD symptoms, preference for symmetry, OCD belief domains, anxiety and depression were completed. RESULTS: Analyses indicated that participants in the slightly disorderly condition showed significantly better recall and recognition for the disordered items than for the ordered items, and that those in the slightly orderly condition showed the same pattern in recall, but not recognition. No associations were found between a preference for symmetry and memory biases. LIMITATIONS: The sample scored particularly low on our measure of symptoms of preference for symmetry, compromising the generalizability of our results. CONCLUSIONS: Findings provide evidence for a general memory bias for disorderliness, although this bias does not appear to be associated with symmetry, ordering and arranging symptoms. Results are discussed from a cognitive-behavioural perspective with the consideration of feelings of incompleteness.

Advances in the cognitive behavioural treatment of obsessive compulsive disorder.

The aim of this paper is to highlight key advances in the cognitive-behavioural treatment of obsessive compulsive disorder over the course of Professor Lars Göran Öst's illustrious career. The paper will focus on three specific areas of interest: the treatment of obsessions, compulsive checking, and the fear of contamination. It will also highlight recent advances concerning the broader need to ensure that treatment is acceptable. An increase in acceptability could result in improvements in completion rates so that more patients benefit from the recent improvements in the science and therapy for this disabling disorder.

Can immorality be contracted? Appraisals of moral disgust and contamination fear.

While extant research underlines the role of disgust in obsessive-compulsive disorder (OCD) with contamination fear, less research attention has been devoted to moral disgust. This study endeavored to examine the types of appraisals that are elicited by moral disgust in comparison to core disgust, and to examine their associations with both contact and mental contamination symptoms. In a within-participants design, 148 undergraduate students were exposed to core disgust, moral disgust, and anxiety control elicitors via vignettes, and provided appraisal ratings of sympathetic magic, thought-action fusion and mental contamination, as well as compulsive urges. Measures of both contact and mental contamination symptoms were administered. Mixed modeling analyses indicated that core disgust and moral disgust elicitors both provoked greater appraisals of sympathetic magic and compulsive urges than anxiety control elicitors. Further, moral disgust elicitors elicited greater thought-action fusion and mental contamination appraisals than all other elicitors. Overall, these effects were greater in those with higher contamination fear. This study demonstrates how a range of contagion beliefs are evoked by the presence of 'moral contaminants', and that such beliefs are positively associated with contamination concerns. These results shed light on moral disgust as an important target in the treatment of contamination fear.

An Experimental Investigation of Moral Self-Violation and Mental Contamination.

Purpose: Cognitive models of mental contamination (feelings of dirtiness/washing behaviour that arise without direct contact with a contaminant) highlight the central role of perceptions of violation in the onset and maintenance of these feelings. Little research has been done to clarify violation-specific appraisals relevant to mental contamination. Perceptions of violation of one's moral self-concept may represent one such appraisal domain. This experiment aimed to examine the impact of these appraisals on feelings of mental contamination. Methods: One hundred and fifty participants received false feedback that they scored high on a morality subscale of a bogus personality test. They then completed a writing task wherein their degree of moral self-violation was manipulated. They received a writing prompt corresponding to one of three randomly assigned conditions (violated self (VS), bolstered self (BS), general negative (GN)). Finally, participants completed measures of mental contamination. Results: The manipulation was effective at violating participants' moral self-concept. Those in the VS condition reported significantly higher levels of feelings of mental contamination than those in the BS or GN conditions. There were no significant differences between conditions regarding urges to wash. Conclusions: Findings highlight the relevance of moral self-violation in the understanding and treatment of mental contamination.

Interrelationships between spider fear associations, attentional disengagement and self-reported fear: a preliminary test of a dual-systems model.

Recent conceptualisations of anxiety posit that equivocal findings related to the time-course of disengaging from threat-relevant stimuli may be attributable to individual differences in associative and rule-based processing. The current study was designed to test the hypothesis that strength of spider-fear associations would indirectly predict reported spider fear via impaired disengagement. One hundred and thirty-one undergraduate volunteer participants completed the Go/No-go Association Task, a visual search task, and self-report spider fear questionnaires. Stronger spider-fear associations were associated with reduced disengagement accuracy, whereas higher levels of reported spider fear were related to faster engagement with and disengagement from spiders. Bootstrapping multiple mediation analyses demonstrated that stronger-spider fear associations evidenced an indirect relationship with reported spider fear via reduced disengagement accuracy, highlighting the importance of fine-grained analyses of different aspects of cognitive bias. Results are discussed in terms of cognitive models of anxiety.