Inferential confusion,cognitive change and treatment outcome in Obsessive–Compulsive Disorder

Inferential confusion has been defined as a confusion between reality and possibility, where the person with Obsessive–Compulsive Disorder (OCD) persists in his/her obsessional belief despite sense information to the contrary. The current study investigates whether inferential confusion is associated with treatment outcome in an OCD sample receiving cognitive–behavioral therapy (CBT). Results indicated that changes in inferential confusion as measured by the Inferential Confusion Questionnaire (ICQ) were significantly associated with treatment outcome. In addition, inferential confusion showed differential validity as a cognitive marker in OCD and was specifically associated with change in obsessive–compulsive symptoms during treatment, rather than confounded with change in negative mood states. Results are discussed in terms of the importance of the concept of inferential confusion for obsessive–compulsive disorder with and without schizotypal characteristics. Copyright © 2005 John Wiley & Sons, Ltd.     

Spanish version of the Inferential Confusion Questionnaire‐Expanded Version: Further support for the role of inferential confusion in obsessive–compulsive symptoms

The purposes of this research were (1) to analyse the psychometric properties of the Inferential Confusion Questionnaire‐Expanded Version (ICQ‐EV) in a Spanish population; (2) to explore the role of inferential confusion in obsessive–compulsive disorder (OCD); and (3) to compare the inferential confusion construct in nonclinical and clinical samples. A sample of 342 nonclinical participants and 66 patients with OCD completed the ICQ‐EV Spanish adaptation as well as a set of questionnaires. Results confirmed a good fit of the ICQ‐EV Spanish version to the original unifactorial structure and excellent internal consistency and test–retest reliability. Moreover, results confirmed that the ICQ‐EV predicts Obsessing, Checking, Washing, and Hoarding symptoms, independently of the contribution of dysfunctional beliefs. In addition, OCD patients scored significantly higher on the ICQ‐EV than nonclinical participants. The Spanish version of the ICQ‐EV is a reliable instrument to assess inferential confusion, and further support is provided for the relevance of the inferential confusion construct in OCD.     

Responsibility attitude,obsession and compulsion: further support in a non‐clinical sample

Responsibility is one of the most investigated constructs in obsessive‐compulsive disorder (OCD). Although there are an increasing number of studies on this topic, results seem to be questionable. Whereas several authors reported a significant link between OC behaviour and responsibility in nonclinical as well as in clinical samples, the findings of many authors failed to demonstrate the presence of such an association. In the current study, we examined the relationship between obsessive‐compulsive behaviour and responsibility. To this aim, participants filled in five inventories: the Responsibility Attitude Scale (RAS), the Responsibility Questionnaire (RQ), the Padua Inventory Revised (PI‐R), the State‐Trait Anxiety Inventory (STAI), and the Beck Depression Inventory (BDI). Results showed a relationship between obsessive‐compulsive behaviour (PI‐R scores) and responsibility, as measured by both RAS and RQ. A principal component analysis showed that RAS can be interpreted as a four‐factor scale, accounting for 63% of the variance overall. Regression analyses showed that responsibility can be considered a significant predictor of obsession and compulsion behaviour, as measured by PI‐R. Furthermore, showing a connection between specific factors of responsibility and certain kinds of obsessive‐compulsive behaviour, results seem to confirm the hypothesis that responsibility is more salient in checking than in cleaning symptoms. Copyright © 2001 John Wiley & Sons, Ltd.     

Vulnerability factors in OCD symptoms: cross‐cultural comparisons between Turkish and Canadian samples

Recent findings have suggested some potential psychological vulnerability factors for development of obsessive‐compulsive (OC) symptoms, including cognitive factors of appraisal and thought control, religiosity, self‐esteem and personality characteristics such as neuroticism. Studies demonstrating these associations usually come from Western cultures, but there may be cultural differences relevant to these vulnerability factors and OC symptoms. The present study examined the relationship between putative vulnerability factors and OC symptoms by comparing non‐clinical samples from Turkey and Canada, two countries with quite different cultural characteristics. The findings revealed some common correlates such as neuroticism and certain types of metacognition, including appraisals of responsibility/threat estimation and perfectionism/need for certainty, as well as thought–action fusion. However, culture‐specific factors were also indicated in the type of thought control participants used. For OC disorder symptoms, Turkish participants were more likely to utilize worry and thought suppression, while Canadian participants tended to use self‐punishment more frequently. The association with common factors supports the cross‐cultural validity of some factors, whereas unique factors suggest cultural features that may be operative in cognitive processes relevant to OC symptoms. Copyright © 2009 John Wiley & Sons, Ltd. Key Practitioner Message: ? Despite cross‐cultural validity in the cognitive accounts for OCD, there are some evidences implying the impact of cultural characteristics on some cognitive factors across different cultures. Thus, it is important for clinicians who work with people from different cultural backgrounds to be vigilant for possible variations in the cognitive processes during psychotherapy and psychological assessment.     

Not just thinking,but believing: Obsessive beliefs and domains of cognitive fusion in the prediction of OCD symptom dimensions

Cognitive fusion (CF) involves the tendency to “buy in” to thoughts and feelings and consists of three empirically established domains: somatic concerns, emotion regulation, and negative evaluation. CF is hypothesized to play a role in obsessive–compulsive disorder (OCD). The present study examined how well the CF domains, relative to traditional cognitive–behavioural constructs (i.e., obsessive beliefs such as inflated responsibility), predict OCD symptoms. Fifty‐two treatment‐seeking adults with OCD completed self‐report measures of CF, obsessive beliefs, OCD symptoms, and general distress. Domains of CF were differentially associated with the responsibility for harm, symmetry, and unacceptable thoughts of OCD dimensions; yet after accounting for obsessive beliefs, only the negative evaluation domain of CF significantly predicted symmetry OCD symptoms. Obsessive beliefs significantly predicted all OCD dimensions except for contamination. These findings provide additional support for existing cognitive–behavioural models of OCD across symptom dimensions, with the exception of contamination symptoms, and suggest that the believability of thoughts and feelings about negative evaluation adds to the explanation of symmetry symptoms. Conceptual and treatment implications, study limitations, and future directions are discussed.     

Dose meta‐cognition or responsibility predict obsessive–compulsive symptoms: a test of the metacognitive model

Cognitive models of Obsessive–Compulsive disorder (OCD) have emphasized inflated responsibility (Salkovskis, 1985), thought–action fusion (Rachman, 1993), and metacognitive beliefs (Wells, 1997; Wells & Matthews, 1994), as factors contributing to disorder. The metacognitive model views responsibility as a by‐product of metacognitions that make little additional contribution to OCD, and gives rise to the following hypotheses: (1) responsibility and meta‐cognitive beliefs are positively correlated with obsessive–compulsive symptoms, (2) the relationship between responsibility and obsessive–compulsive symptoms is statistically dependent on meta‐cognition, (3) meta‐cognitions positively correlate with obsessive–compulsive symptoms independently of responsibility. The results supported each of these hypotheses and exploratory analyses were conducted to find the best unique set of predictors among a range of metacognitive dimensions. Metacognitive beliefs concerning need to control thoughts, thought–action fusion, and negative beliefs about cognitive competence emerged as reliable predictors. An additional contribution was made by thought–event fusion in one equation. The results provide support for the meta‐cognitive model. Copyright © 2004 John Wiley & Sons, Ltd.     

Cognitive Predictors of Obsessive–Compulsive Symptoms in Adolescence: A Preliminary Investigation

This study examined relations among responsibility attitudes, metacognitive beliefs, and obsessive–compulsive (O–C) symptoms in youth. One hundred sixty-six nonclinical youth (ages 13 to 17 years) completed the following: Responsibility Attitude Scale (RAS; Salkovskis et al., 2000); Meta-Cognitions Questionnaire–Adolescent Version (MCQ–A; Cartwright-Hatton et al., 2004); Children's Depression Inventory–Short Form (CDI–S; Kovacs, 1985); Revised Children's Manifest Anxiety Scale (RCMAS; Reynolds & Richmond, 1978); the Leyton Obsessional Inventory–Child Version Survey Form (LOI–CVS; Berg, Whitaker, Davies, Flament, & Rapoport, 1988). Participants endorsed a range of responsibility and metacognitive beliefs, and both responsibility and metacognition were positively correlated with O–C symptoms. However, when age, sex, and depression were controlled, only metacognition was a predictor of O–C symptoms. The findings suggest metacognition and responsibility may be important correlates of O–C symptoms in youth.     

Parenting style and obsessive‐compulsive symptoms and personality traits in a student sample

There is widespread acceptance of the idea that aspects of parenting such as overprotectiveness and perfectionism contribute to the pathogenesis of obsessive‐compulsive disorder (OCD). Less resolved is whether the important dimensions of parenting are overprotectiveness, lack of acceptance, authoritarian style, discouragement of risk‐taking, and/or induction of guilt. It is also unclear whether different parenting characteristics are associated with the development of symptoms of OCD, compared to the traits of obsessive‐compulsive personality disorder (OCPD). OCD symptoms and OC personality traits were measured in a non‐clinical, student sample and correlated with students' report of parents' acceptance, disciplinary firmness, and psychological control (a construct which included psychological manipulation and guilt‐induction). Following the literature on both clinical and subclinical OCD and OCPD, we predicted that all three scales would correlate with OCD symptoms and OCPD traits. Stepwise regression analysis revealed that psychological control was the unique predictor, controlling for depressive symptoms. Unexpectedly, a controlling parenting style was not selectively associated with classical OC symptoms or OC personality traits. Rather, psychological control was associated with a broad‐spectrum of anxiety and depressive symptoms which cut across diagnostic boundaries. Findings are generally compatible with a single underlying vulnerability to both OCD and OCPD, as well as generalized/social anxiety and depressive symptoms, which can be shaped by cultural and familial factors to a specific clinical presentation. Copyright © 2002 John Wiley & Sons, Ltd.     

The effect of childhood maltreatment on suicidal ideation through cognitive emotion regulation strategies and specific obsessive–compulsive symptoms in obsessive–compulsive disorder

Childhood maltreatment is thought to be associated with suicidality in patients with obsessive–compulsive disorder (OCD). Although the underlying mechanism of this relationship is not clear, cognitive emotion regulation strategies (CERSs) and the specific OC symptoms including unacceptable obsessional thoughts (UOTs) and responsibility for harm (RFH) may underlie this link. Accordingly, the study aimed to assess the effect of childhood maltreatment on suicidal ideation through UOTs, RFH and adaptive and maladaptive CERSs in OCD patients. Three hundred patients meeting a DSM-5 diagnosis of OCD were selected and completed the scales measuring childhood maltreatment, OCD, suicidality and depressive symptoms. After controlling for depressive symptoms and OCD severity, childhood maltreatment was shown to affect suicidal ideation directly. Also, the indirect effect of childhood maltreatment on suicidal ideation was mediated by adaptive CERSs, UOTs and RFH. The findings show that OCD patients with a history of childhood maltreatment, less use of adaptive CERSs and the experiences of UOTs and RFH should be carefully considered regarding suicidal risk.     

The associations of obsessive–compulsive symptom dimensions and general severity with suicidal ideation in patients with obsessive–compulsive disorder: The role of specific stress responses to COVID-19

Suicidal ideation is prevalent in patients with obsessive–compulsive disorder (OCD); but, during COVID-19, it may be increased. The present study aimed to examine the effects of obsessive–compulsive (OC) symptom dimensions and OCD severity on suicidal ideation by considering the role of stress responses in reaction to COVID-19 in a clinical sample of patients with OCD. In a cross-sectional study, 304 patients with OCD completed measures of OC symptom dimensions, OCD severity, general mental health (depression and anxiety), and COVID-19-related stress. Results showed that after controlling for depression, anxiety, comorbidity, and lifetime suicide attempts, the OC symptom dimensions of responsibility for harm and unacceptable obsessional thoughts as well as general severity had indirect effects on suicidal ideation through the specific stress responses to COVID-19, including traumatic stress and compulsive checking. The study shows that OCD patients with specific OC symptom dimensions and severe OCD are more likely to have suicidal ideation during the pandemic. Further, the specific stress responses to COVID-19 may be an underlying mechanism. Clinicians should carefully assess suicidal ideation in patients with OCD who experience responsibility for harm and unacceptable thoughts, particularly during the pandemic.     

Metacognitive beliefs and strategies predict worry,obsessive–compulsive symptoms and coping styles: A preliminary prospective study on an Italian non‐clinical sample

Eighty undergraduate students completed the Italian versions of the Metacognition Questionnaire and Thought Control Questionnaire along with well‐established measures of worry, obsessive–compulsive symptoms and coping styles on two occasions four months apart. A series of hierarchical regression analyses revealed that, after controlling the initial level of both worry and obsessionality, negative beliefs about worry focused on uncontrollability and danger appeared consistently associated with worry and obsessive symptoms at a four‐month distance. In addition, positive beliefs about worry predicted maladaptive coping styles whereas cognitive self‐consciousness and thought strategies aimed at distraction appeared to foster or facilitate adaptive coping styles. Results, implications and limitations are discussed according to Well's metacognitive model of emotional disorders. Copyright © 2007 John Wiley & Sons, Ltd.     

Psychometric characteristics of the Penn State Worry Questionnaire and Metacognitions Questionnaire‐30 and metacognitive predictors of worry and obsessive–compulsive symptoms in a Turkish sample

The purpose of the present study was twofold. First, to examine the psychometric properties of the Penn State Worry Questionnaire (PSWQ) and the Metacognitions Questionnaire‐30 (MCQ‐30) in a Turkish sample. Second, to investigate metacognitive predictors of pathological worry and obsessive–compulsive (o–c) symptoms in this group. The sample included 561 non‐clinical participants. Consistent with non‐English versions, the Turkish version of the PSWQ was found to have a two‐factor structure. The MCQ‐30 was shown to be composed of five factors similar to the English version. Reliability analyses indicated that both the PSWQ and MCQ‐30 possessed high internal consistency, split‐half reliability and test–retest coefficients. As expected, both scales positively correlated with measures of o–c symptoms, trait anxiety, and anxiety and depression, as well as with each other. Negative and positive metacognitive beliefs about worry were significant predictors of both pathological worry and o–c symptoms. Cognitive confidence emerged as a specific predictor of worry, while beliefs about the need to control thoughts emerged as a unique predictor of o–c symptoms. Copyright © 2008 John Wiley & Sons, Ltd.     

Self‐compassion and emotion regulation difficulties in obsessive–compulsive disorder

Lack of self‐compassion and deficits in emotion regulation are associated with various psychopathological symptoms and may play a role in the development and maintenance of obsessive–compulsive disorder (OCD). However, further empirical research is still needed to better understand these constructs in the context of this disorder. The present study investigated the relation between self‐compassion, emotion regulation difficulties, obsessive beliefs, and obsessive–compulsive symptom severity in 90 patients with OCD using self‐report questionnaires. Symptom severity and obsessive beliefs were negatively correlated to self‐compassion and positively associated with emotion regulation difficulties. Additionally, self‐compassion showed a negative relation to emotion regulation difficulties. Emotion regulation difficulties—but not self‐compassion—predicted symptom severity when controlling for obsessive beliefs and depression in a hierarchical regression analysis. Further analyses showed that emotion regulation deficits mediated the relationship between self‐compassion and OCD symptom severity. Our results provide preliminary evidence that targeting self‐compassion and putting more emphasis on emotion regulation deficits might be promising treatment approaches for patients with OCD. Future studies could investigate which specific interventions that directly address these variables improve treatment outcome.     

大学生完美主义、对权威的畏惧感与人格障碍倾向的相关研究

目的探究大学生的完美主义、对权威的畏惧感与人格障碍倾向的关系。考察消极完美主义能否成为诊断强迫型人格障碍的依据。方法采用訾非消极完美主义问卷(ZNPQ)、中国人人格障碍诊断量表(CPDI)及对权威的畏惧感问卷(FOA)测量108位在校大学生的消极完美主义、人格障碍倾向及对权威的畏惧感,并对这3个变量之间的关系做了统计分析。结果消极完美主义与DSM-IV-TR诊断标准中的C组人格障碍(强迫型、回避型、依赖型)有中等程度的正相关,与强迫型人格障碍倾向相关程度最高,与A组和B组人格障碍各类型相关较弱或无显著相关;对权威的畏惧感也与C组人格障碍有中等程度的正相关,与A、B组人格障碍的相关较弱或无显著相关。结论消极完美主义和对权威的畏惧感在一定程度上能预测大学生的人格障碍倾向,尤其是C组人格障碍倾向,值得在心理咨询、心理治疗和教育实践中予以重视。ZNPQ所定义的消极完美主义能够作为中国大学生强迫型人格障碍的诊断依据。     

Obsessive beliefs and their relation to obsessive–compulsive symptoms

Relationships between obsessive–compulsive symptoms and beliefs identified as relevant to obsessive–compulsive disorder (OCD) are investigated among university students and a small clinical sample. One hundred and fifty‐four participants completed measures of OCD‐related beliefs, OCD symptoms, and anxiety and depression symptoms. Results showed that belief domains were strongly interrelated and were not sufficiently separate to use individually in further analysis. The summed obsessive beliefs score was significantly correlated with all measured obsessional symptom subtypes, after controlling for anxiety and depression. Possible explanations and clinical implications of the results are discussed. Copyright © 2004 John Wiley & Sons, Ltd.     

Differences in clinical intrusive thoughts between obsessive–compulsive disorder,generalized anxiety disorder,and hypochondria

Differences and similarities between intrusive thoughts typical of obsessive–compulsive disorder, generalized anxiety disorder, and hypochondriasis are relevant for their differential diagnosis, formulation, and psychological treatment. Previous research in non‐clinical samples pointed out the relevance of some process variables, such as responsibility, guilt, or neutralization strategies. This research is aimed to investigate the differences and similarities between clinical obsessions, worries, and illness intrusions in some of these process variables. A second aim is to identify models based on these variables that could reliably differentiate between them. Three groups of patients with obsessive–compulsive disorder (n  = 35; 60% women, mean age 38.57), generalized anxiety disorder (n  = 36; 61.1% women, mean age 41.50), and hypochondriasis (n  = 34; 70.6% women, mean age 31.59) were evaluated using the Cognitive Intrusions Questionnaire—Transdiagnostic Version (Romero‐Sanchiz, Nogueira‐Arjona, Godoy‐Ávila, Gavino‐Lázaro, & Freeston, 2017 ). The results showed that some appraisals (e.g., responsibility or egodystonicity), emotions (e.g., guilt or insecurity), neutralization strategies, and other variables (e.g., verbal content or trigger from body sensation) are relevant for the discrimination between obsessions, worries, and illness intrusions. The results also showed 3 stable models based on these variables for the discrimination between these thoughts. The implication of these results in the diagnosis, formulation, and psychological treatment of obsessive–compulsive disorder, generalized anxiety disorder, and hypochondriasis is discussed.     

Obsessive–compulsive disorder beliefs,metacognitive beliefs and obsessional symptoms: relations between parent beliefs and child symptoms

Investigations of obsessive–compulsive disorder (OCD) have increasingly emphasized the role of cognition in symptom development and maintenance. In the present study, relationships between parent and adolescent child OCD symptoms and OCD cognition measures were explored to elucidate how OCD related beliefs and OCD symptoms might develop. One hundred and twenty‐six non‐clinical parent–adolescent pairs completed measures of OCD symptoms, OCD related beliefs and metacognitive beliefs (cognitive self‐consciousness [CSC], the tendency to focus attention on thought processes). A significant indirect relationship was found between parent OCD symptoms and adolescent OCD symptoms through specific adolescent OCD related beliefs. Contrary to expectations, parent and adolescent CSC were not correlated. Although findings were limited by the correlational and cross‐sectional design, implications of the observed associations for theory and treatment are discussed. Copyright © 2006 John Wiley & Sons, Ltd.     

Mental health problems in adolescents with delayed sleep phase: results from a large population‐based study in Norway

The aim of the current study was to compare mental health problems, resilience and family characteristics in adolescents with and without delayed sleep phase (DSP) in a population‐based sample. Data were taken from the youth@hordaland‐survey, a large population‐based study in Hordaland County in Norway conducted in 2012. In all, 9338 adolescents aged 16–19 years (53.5% girls) provided self‐reported data on a wide range of instruments assessing mental health symptoms, including depression, anxiety, obsessive–compulsive behaviours, attention deficit hyperactive disorder (ADHD) symptoms, perfectionism, resilience and sleep. Measures of socioeconomic status were also included. Three hundred and six adolescents (prevalence 3.3%) were classified as having DSP [according to the International Classification of Sleep Disorders‐2 (ICSD‐2)] criteria. Adolescents with DSP reported higher levels of depression, anxiety and ADHD symptoms. Adolescents with DSP also exhibited significantly lower levels of resilience. The Cohen's d effect sizes ranged from small [obsessive–compulsive disorder (OCD): d = 0.15] to moderate (inattention: d = 0.71). In the fully adjusted model, the significant predictors of DSP included inattention [odds ratio (OR): 2.11], lack of personal structure (OR: 2.07), low (OR: 1.85) and high (OR: 1.91) paternal education, parents not living together (OR: 1.81), hyperactivity/inattention (OR: 1.71) and poorer family economy (OR: 1.59). In conclusion, the high symptom load across a range of mental health measures suggests that a broad and thorough clinical approach is warranted when adolescents present with DSP.     

Validation of the Serbian version of the Metacognitions Questionnaire‐30 in nonclinical and clinical samples

The Metacognitions Questionnaire (MCQ‐30) is a brief multidimensional measure used for assessment of metacognitive beliefs in psychopathology. The aim of this study was to assess the psychometric properties of MCQ‐30 in Serbian nonclinical (n = 246) and clinical (n = 171; anxiety and depressive disorders) samples. The reliability of the questionnaire and its subscales was satisfactory. An exploratory factor analysis yielded a five‐factor solution in both groups, whereas a confirmatory factor analysis showed a somewhat weaker fit of the model. The MCQ‐30 showed positive associations with measures of anxiety, pathological worry, depressive, and obsessive–compulsive symptoms in both samples, demonstrating adequate convergent validity. The instrument was sensitive to differences in metacognitive beliefs between nonclinical and clinical samples. MCQ‐30 subscales showed incremental contributions in predicting pathological worry after controlling for the variance in obsessive–compulsive symptoms and vice versa. Our results suggest that the MCQ‐30 is a reliable and valid instrument for assessing metacognitive beliefs in both nonclinical and clinical samples. Moreover, the findings support the use of the MCQ‐30 in Serbian population and extend support for the metacognitive model.     

Multidimensional assessment of OCD: integration and revision of the vancouver obsessional‐compulsive inventory and the symmetry ordering and arranging questionnaire

This article reports on the integration and revision of two self‐report measures of obsessive‐compulsive symptoms based on data from an obsessive‐compulsive disorder (OCD) sample (n=228): the Vancouver Obsessional‐Compulsive Inventory (VOCI) and the Symmetry Ordering and Arranging Questionnaire (SOAQ). The revised measure provides scores on five symptom subscales (Contamination, Checking, Hoarding, Symmetry and Ordering, Obsessions). It shows improvement upon current versions in several ways: it has a good model fit, eliminates redundancy, reduces overlap across subscales, is much shorter, and covers those OCD dimensions most frequently identified in factor‐analytic studies. Strengths of the revision compared with other measures are high distinctiveness of subscales, discriminant validity with depression and anxiety, and a more fine‐grained and comprehensive assessment of obsessional contents. © 2010 Wiley Periodicals, Inc. J Clin Psychol: 66:1–19, 2010.