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.

Treatment utilization and barriers to treatment among individuals with olfactory reference syndrome (ORS).

OBJECTIVE: Olfactory reference syndrome (ORS) is characterized by a preoccupation that one is emitting a foul or offensive odor. Despite the profound psychosocial impact of ORS, many patients do not receive appropriate treatment, and there is no empirical research on treatment-seeking behavior in ORS. This study investigated treatment utilization patterns and barriers to treatment in individuals with ORS. METHOD: 253 subjects completed an online survey between January-March 2010. Data were obtained from the Yale-Brown Obsessive Compulsive Scale Modified for ORS (ORS-YBOCS), Depression Anxiety Stress Scales (DASS), Work and Social Adjustment Scale (WSAS), and questionnaires specific to treatment utilization and barriers. RESULTS: The sample was ethnically diverse, predominately male (67%), with an average age of 33.7years, and moderately severe ORS symptoms. Most participants first sought care from a medical specialist (44%), and mental health services were underutilized (14%). Higher functional impairment was significantly correlated with seeking care from a mental health provider, compared to a medical specialist. Nearly all participants endorsed multiple barriers to treatment, including (a) logistical/financial, (b) stigma/discrimination, and (c) treatment perception barriers. ORS symptom severity was significantly, positively correlated with number of logistical/financial and stigma/discrimination barriers. Treatment barriers were significantly influenced by ethnic group, ORS symptom severity, and source of odor. CONCLUSION: Results highlight the importance of increasing awareness and enhancing access to care for individuals with ORS.

Effect of Patient and Therapist Factors on Suicide Risk Assessment.

The present study examined how patient risk factors and clinician demographics predict the assessment of suicide risk. Clinicians (N = 333) read two vignettes, one of which manipulated patient risk factors, then rated the patient's likelihood of suicide and need for hospitalization. Clinicians' assessments were heterogeneous. Results indicated that certain patient risk factors (access to excess medication) and clinician demographics (relationship status, religiosity) predicted perceived suicide risk; and, moreover, clinicians' suicide risk assessment did not always align with the decision to hospitalize the patient. The authors discuss methods for standardizing clinicians' judgment of risk and minimizing error through debiasing strategies (cognitive forcing strategy).

Examining Attentional Bias in Scrupulosity: Null Findings From the Dot Probe Paradigm.

Research consistently demonstrates that individuals with anxiety symptoms exhibit attentional biases toward threatening stimuli using various computer-based tasks. However, the presence of attentional biases across obsessive-compulsive symptom presentations has been mixed and requires clarification. This study was the first to use the dot probe paradigm to investigate the association between scrupulosity symptoms (obsessions and compulsions having to do with religion and morality) and selective attention to scrupulosity-relevant lexical stimuli. Contrary to hypotheses, individuals with higher levels of scrupulosity did not selectively attend (i.e., have faster reaction times) to scrupulosity-specific threat words (e.g., hell) more so than to general threat or neutral words. Various potential explanations for these null findings, as well as directions for future research, are discussed.

Mechanisms of change in cognitive therapy for obsessive compulsive disorder: role of maladaptive beliefs and schemas.

The present study aimed to identify mechanisms of change in individuals with moderately severe obsessive-compulsive disorder (OCD) receiving cognitive therapy (CT). Thirty-six adults with OCD received CT over 24 weeks. At weeks 0, 4/6, 12, 16/18, and 24, independent evaluators assessed OCD severity, along with obsessive beliefs and maladaptive schemas. To examine mechanisms of change, we utilized a time-varying lagged regression model with a random intercept and slope. Results indicated that perfectionism and certainty obsessive beliefs and maladaptive schemas related to dependency and incompetence significantly mediated (improved) treatment response. In conclusion, cognitive changes in perfectionism/certainty beliefs and maladaptive schemas related to dependency/incompetence precede behavioral symptom reduction for OCD patients. Targeting these mechanisms in future OCD treatment trials will emphasize the most relevant processes and facilitate maximum improvement.

Prayer in Response to Negative Intrusive Thoughts: Closer Examination of a Religious Neutralizing Strategy.

Few studies have systematically examined the covert neutralizing strategies that serve to maintain and exacerbate the frequency and distress related to intrusive thoughts. Given the lack of research in this area, this study aimed to highlight development and maintenance factors for one such strategy, compensatory prayer, to inform assessment and treatment of related obsessional phenomena. We used a multimethod approach to examine the predictors and function of prayer when it is used in response to negative intrusive thoughts. Participants were 85 undergraduate students (ages 18-55 years) who self-identified with a branch of Christianity. In addition to self-report measures, participants were administered an in vivo negative thought induction and were subsequently asked about their use of compensatory prayer behaviors. Results indicated that religiosity, intrinsic religious motivation, and moral thought-action fusion (TAF) positively predicted the use of prayer, with moral TAF emerging as a unique predictor and a complete mediator between religiosity and the use of prayer. Regarding the function of prayer, results indicated that when prayer is used maladaptively (i.e., negative coping style), it is associated with higher scores on religious measures and moral TAF, as well as more frequent engagement in prayer, and a greater reduction in anxiety postprayer. Surprisingly, likelihood TAF was not found to be related to the use or function of prayer. Results are discussed in terms of certain religious teachings and TAF-related beliefs, neurobiological explanations for our pattern of findings, and clinical implications for religious-related intrusive thoughts. Future directions and limitations are also discussed.

Recent advances in research on cognition and emotion in OCD: a review.

The cognitive model of OCD suggests that misinterpreting intrusive thoughts as unacceptable leads to increased anxiety and attempts to suppress or ignore the thoughts through avoidance or compulsive rituals. An insidious negative feedback loop develops as one's attention focuses on these thoughts and in turn the unwanted thoughts do not respond to efforts to avoid or suppress. This article is a current review of the research on cognitive processes in obsessive-compulsive disorder (OCD). We review research that has (1) empirically validated the theoretical underpinnings of the cognitive model, (2) altered maladaptive cognitive processes through state-of-the-art experimental procedures, (3) refined our understanding of the relationship between obsessive beliefs and OC symptoms and (4) examined how underlying traits (e.g., anxiety and disgust sensitivity) relate to the development and maintenance of OCD. We discuss the clinical implications of this research.

The contribution of experiential avoidance and social cognitions in the prediction of social anxiety.

BACKGROUND: Cognitive models propose that social anxiety arises from specific dysfunctional cognitions about the likelihood and severity of embarrassment. Relational frame theory (RFT), on the other hand, posits that social anxiety arises from the unwillingness to endure unpleasant internal experiences (i.e. experiential avoidance [EA]). Although cognitive models have garnered empirical support, it may be that newer models such as RFT can improve our ability to predict and treat social anxiety. AIMS: We aimed to elucidate the relationship between dysfunctional cognitions and EA, as well as their independent and relative contributions to the prediction of social anxiety symptoms. We hypothesized that dysfunctional cognitions and EA would each be associated with social anxiety, as well as with each other. We also predicted that both EA and dysfunctional cognitions would remain independent predictors of social anxiety symptoms after controlling for each other and general distress. METHOD: Undergraduates high (n = 173) and low (n = 233) in social anxiety completed measures of social anxiety, dysfunctional cognitions, EA, and general distress. The overall sample was 66.3% female; mean age = 20.01 years (SD = 2.06). RESULTS: Correlational analyses revealed that EA, dysfunctional cognitions, and social anxiety symptoms were moderately correlated with one another. Additionally, hierarchical regression analyses revealed that dysfunctional cognitions predicted social anxiety symptoms even after controlling for EA; the reverse was not found. CONCLUSIONS: RESULTS suggest that EA and social anxiety specific cognitive distortions overlap to a moderate extent. EA does not add to the prediction of social anxiety symptoms above and beyond dysfunctional cognitions. Additional theoretical and treatment implications of the results are discussed.

Differences in obsessive-compulsive symptoms and obsessive beliefs: a comparison between African Americans, Asian Americans, Latino Americans, and European Americans.

Clinical research has increasingly considered ethnic group differences in the expression of anxiety disorders, but to date few investigations have focused specifically on the symptoms of obsessive-compulsive disorder (OCD). We examined group differences in OC symptoms, related cognitions ("obsessive beliefs"), and their associations. The sample included European American (N = 1199), African American (N = 215), Asian American (N = 116), and Latino American (N = 72) participants. African American and Asian American participants reported more contamination-related OC symptoms than did European Americans. Asian Americans also reported elevated levels of obsessive beliefs. Moreover, group membership moderated the relationship between obsessive beliefs and certain dimensions of OC symptoms. These findings suggest group differences in the experience of OC symptoms and related cognitions, and that the cognitive-behavioral model of some OC symptoms could be refined and tailored for groups underrepresented in OCD research to date.

Rigid Rules of Conduct and Duty: Prediction of Thought-Action Fusion.

Cognitive biases, such as thought-action fusion (TAF), play a crucial role in the cognitive-behavioral model of obsessional symptoms and have been shown to prospectively increase the risk of developing such symptoms. Much less research, however, has examined factors that might lead to the development of the cognitive biases themselves. This study aimed to replicate and extend existing work on correlates of moral (thinking about something is the moral equivalent of the corresponding action) and likelihood (thinking about a particular event increases the probability that this event will occur) TAF. A large sample of unscreened participants (N = 407) completed a measure of TAF, as well as measures of religiosity, motivation for religion, parental psychological control, and parental guilt induction. Results indicated that religion-related variables predicted the moral TAF, whereas parenting strategies were associated with likelihood TAF. Intrinsic motivation for religion also mediated the relationship between religiosity and moral TAF. Findings are discussed in terms of developmental psychopathology and limitations are addressed.

The "Arnold Schwarzenegger Effect": is strength of the "victim" related to misinterpretations of harm intrusions?

The present study used an in vivo paradigm to examine whether the victim's vulnerability in a harm-related intrusion affects beliefs about the importance of thoughts (i.e., Thought Action Fusion; TAF). Sixty-six undergraduate students at a large university were randomly assigned to imagine either a vulnerable (e.g., elderly man) or able-bodied individual (e.g., strong youthful male) they know getting into a car accident and provided in vivo ratings of anxiety, guilt, likelihood, moral wrongness, and urges to neutralize. Results indicated that thinking of car accident involving a vulnerable, compared to an able-bodied person, provoked more distress (anxiety and guilt), stronger feelings of moral wrongness, greater urges to cancel the effects of thinking such thoughts, and higher estimates of the likelihood that the collision would occur. The findings of our study broadly support Rachman's (1998) assertion that more significance and importance is attached to negative thoughts about vulnerable or helpless people. Current findings are discussed in terms of the cognitive-behavioral model of obsessions and clinical implications are addressed.

Dimensions of anxiety sensitivity in the anxiety disorders: evaluation of the ASI-3.

Anxiety sensitivity (AS), the fear of sensations of anxious arousal based on beliefs about their harmful consequences, is increasingly recognized as a multidimensional construct. The recently developed Anxiety Sensitivity Index-3 [ASI-3; Taylor, S., Zvolensky, M., Cox, B., Deacon, B., Heimberg, R., Ledley, D. R., et al. (2007). Robust dimensions of anxiety sensitivity: Development and initial validation of the Anxiety Sensitivity Index-3 (ASI-3). Psychological Assessment, 19, 176-188] measures three dimensions of AS: physical concerns, social concerns, and cognitive concerns. The ASI-3 shows promise, although further evaluation of its psychometric properties and validity in independent samples is needed. We evaluated the ASI-3 in a mixed sample of anxiety disorder patients (N=506) and undergraduate student controls (N=315). The measure demonstrated a stable 3-factor structure and sound psychometric properties, with the three factors showing theoretically consistent patterns of associations with anxiety symptoms and diagnoses. ASI-3 total scores were less discriminative. Implications for conceptual models of anxiety are discussed.

The relationship between anxiety sensitivity and obsessive-compulsive symptom dimensions.

BACKGROUND AND OBJECTIVES: Anxiety sensitivity (AS), the tendency to fear arousal-related body sensations based on beliefs that they are dangerous, is a cognitive vulnerability factor for certain anxiety symptoms such as panic and posttraumatic stress symptoms. Very little research, however, has examined the relationship between AS and obsessive-compulsive (OC) symptoms, which was the objective of the current research. METHODS: We administered dimensional measures of AS and OC symptoms to a large sample of undergraduate students (N = 636). We also included measures of general distress and cognitive distortions related to OCD (i.e., obsessive beliefs) as control variables. RESULTS: Regression analyses indicated that AS was predictive of OC symptoms even after controlling for general distress and obsessive beliefs. In addition, the three domains of AS (physical, social, and cognitive concerns) were differentially associated with the four dimensions of OC symptoms (contamination, responsibility for harm, symmetry, and unacceptable thoughts). LIMITATIONS: Our findings are based on a non-clinical student sample and their generalization to OCD requires replication with a sample of OCD patients. CONCLUSIONS: These results provide preliminary evidence that AS plays a role in OC symptoms. Implications for clinical practice and for future research are discussed.

The effects of familiarity on thought--action fusion.

The present study examined whether beliefs about the importance of thoughts (i.e., thought--action fusion; TAF) are related to the target subject of the negative thought. One hundred and seven undergraduate students were randomly assigned to imagine either a beloved relative or a stranger being diagnosed with cancer and provided in vivo ratings of anxiety, likelihood, moral wrongness, urge to neutralize, and how upsetting the event would be if it occurred. Results indicated that thinking of a relative being diagnosed with cancer provoked more distress, urges to neutralize, and higher estimates of likelihood, as well greater use of mental neutralizing behaviors, compared to thinking of a stranger. Contrary to our prediction, the groups did not differ in their ratings of the moral wrongness. These findings broadly support the assertion that the more personally significant a negative intrusive thought, the more it will provoke distress and urges to neutralize. Results are discussed in terms of the cognitive model of obsessions and clinical implications are addressed.

The relationship between obsessive beliefs and symptom dimensions in obsessive-compulsive disorder.

Research findings on the specific relationships between beliefs and OCD symptoms have been inconsistent, yet the existing studies vary in their approach to measuring the highly heterogeneous symptoms of this disorder. The Dimensional Obsessive-Compulsive Scale (DOCS) is a new measure that allows for the assessment of OCD symptom dimensions, rather than types of obsessions and compulsions per se. The present study examined the relationship between OCD symptom dimensions and dysfunctional (obsessive) beliefs believed to underlie these symptom dimensions using a large clinical sample of treatment-seeking adults with OCD. Results revealed that certain obsessive beliefs predicted certain OCD symptom dimensions in a manner consistent with cognitive-behavioral conceptual models. Specifically, contamination symptoms were predicted by responsibility/threat estimation beliefs, symmetry symptoms were predicted by perfectionism/certainty beliefs, unacceptable thoughts were predicted by importance/control of thoughts beliefs and symptoms related to being responsible for harm were predicted by responsibility/threat estimation beliefs. Implications for cognitive conceptualizations of OCD symptom dimensions are discussed.

The relationship between religion and thought-action fusion: use of an in vivo paradigm.

Research has demonstrated that higher levels of religiosity are positively correlated with thought-action fusion (TAF), a set of cognitive biases found to be associated with obsessive-compulsive symptoms. However, previous studies have exclusively relied on a nomothetic approach to measuring TAF using a single self-report instrument, the thought-action fusion scale. The current study examined the relationship between religiosity and TAF using an in vivo behaviorally-based assessment in which participants thought about and wrote down thoughts of negative events involving loved ones. Forty-three highly religious Protestant Christians were compared to 30 Atheists/Agnostics on their in vivo ratings of anxiety, estimates of likelihood, and moral wrongness related to the negative thoughts. Results indicated that compared to the non-religious participants, those who were highly religious believed that writing and thinking about the negative events was more morally wrong and increased the likelihood of the event. Results are discussed in terms of the potential relationship between certain religious teachings and TAF-related beliefs about the importance, significance, and influence of thoughts.

Assessment of obsessive-compulsive symptom dimensions: development and evaluation of the Dimensional Obsessive-Compulsive Scale.

Although several measures of obsessive-compulsive (OC) symptoms exist, most are limited in that they are not consistent with the most recent empirical findings on the nature and dimensional structure of obsessions and compulsions. In the present research, the authors developed and evaluated a measure called the Dimensional Obsessive-Compulsive Scale (DOCS) to address limitations of existing OC symptom measures. The DOCS is a 20-item measure that assesses the four dimensions of OC symptoms most reliably replicated in previous structural research. Factorial validity of the DOCS was supported by exploratory and confirmatory factor analyses of 3 samples, including individuals with OC disorder, those with other anxiety disorders, and nonclinical individuals. Scores on the DOCS displayed good performance on indices of reliability and validity, as well as sensitivity to treatment and diagnostic sensitivity, and hold promise as a measure of OC symptoms in clinical and research settings.

Predicting anxiety: the role of experiential avoidance and anxiety sensitivity.

Anxiety sensitivity (AS), the tendency to fear arousal-related body sensations based on beliefs that they are harmful, is a strong psychological risk factor for development of anxiety psychopathology; however, in most studies AS explains only a portion of the variability in anxiety symptoms. Recent theoretical and research work has suggested that experiential avoidance (EA), unwillingness to endure unpleasant internal experiences (e.g., thoughts, emotions, memories), is related to anxiety disorders. The current study examined independent contributions of EA and AS in the prediction of anxiety symptoms in a sample of 42 adults with DSM-IV anxiety disorders. Participants completed measures of AS, EA, anxiety, and depression. Correlational analyses indicated associations between AS, EA, and anxiety, yet more conservative regression analyses indicated that the Physical Concerns dimension of AS predicted anxiety symptom severity independently of EA. Theoretical and treatment implications of the results are discussed.