Caterina Novara

Psychometric validation of the Obsessive Beliefs Questionnaire and the Interpretation of Intrusions Inventory: Part I

This article reports on the validation of the Obsessive Beliefs Questionnaire (OBQ) and Interpretations of Intrusions Inventory (III) developed by the Obsessive Compulsive Cognitions Working Group (OCCWG) to assess the primary beliefs and appraisals considered critical to the pathogenesis of obsessions. A battery of questionnaires that assessed symptoms of anxiety, depression, obsessive-compulsive symptoms and worry was administered to 248 outpatients with a DSM-IV diagnosis of Obsessive-Compulsive Disorder (OCD), 105 non-obsessional anxious patients, 87 non-clinical adults from the community, and 291 undergraduate students. Tests of internal consistency and test-retest reliability indicated that the OBQ and III assessed stable aspects of OC-related thinking. Between-group differences and correlations with existing measures of OC symptoms indicated that the OBQ and III assess core cognitive features of obsessionality. However, the various subscales of the OBQ and III are highly correlated, and both measures evidenced low discriminant validity. The findings are discussed in terms of the relevance and specificity of cognitive constructs like responsibility, control and importance of thoughts, overestimated threat, tolerance of uncertainty and perfectionism for OCD.

Religiousness and obsessive-compulsive cognitions and symptoms in an Italian population

Fifty-four individuals with a high degree of religiosity, 47 with a medium degree of religiosity and 64 with low religiosity completed anonymously the Italian versions of well-established measures of obsessive-compulsive (OC) cognitions and symptoms, depression and anxiety. After controlling for anxiety and depression, religious groups scored higher than individuals with a low degree of religiosity on measures of obsessionality, overimportance of thoughts, control of thoughts, perfectionism and responsibility. Moreover, measures of control of thoughts and overimportance of thoughts were associated with OC symptoms only in religious subjects. It is concluded that religion might play a role in obsessive-compulsive disorder phenomenology. Additional research is warranted because it is plausible that only a few aspects of religious teachings (e.g., inflexibility and prohibition) are linked to OC phenomena.

Coping strategies: Evidence for cross-cultural differences? A preliminary study with the Italian version of coping orientations to problems experienced (COPE)

Abstract The internal structure of the COPE inventory (Carver, Scheier & Weintraub, 1989), a questionnaire which measures 15 different coping strategies, was studied. The Italian version of COPE was administered to 521 undergraduate students. Alpha and test-retest reliabilities were very similar to those obtained in the above American study. A rotated factor analysis resulted in 13 factors, which came out in a different order with respect to those obtained in the original study. A second-order factor analysis yielded five factors similar to those obtained by Carver etal., except for ‘Turning to religion’, which was present in the Italian study only. It is concluded that the Italian version of COPE has good construct validity and that the traditional taxonomy of coping strategies should also be studied in the light of transcultural differences.

Predicting Burnout Among HIV/AIDS and Oncology Health Care Workers

Psychological stress and coping strategies in staff working with AIDS and with cancer patients were assessed using self-report methods. The Maslach Burnout Inventory (MBI), Coping Orientations to Problems Experiences (COPE), State-Trait Anxiety Inventory (STAI) and Depression Questionnaire (DQ) were completed by staff from 20 hospitals of North-Center Italy, including 268 doctors and nurses working with people with AIDS and 260 doctors and nurses working in oncology. Few significant differences were found between two units on the MBI, COPE subscale and depression/anxiety. When a Bonferroni corrected p level of p < 0.0025 was used, the difference on Emotional Exhaustion (EE) subscale of MBI still remained statistically significant, indicating greater exhaustion in the oncology staff. The regression analysis suggested that the negative aspects of burnout were predicted primary by professional status (being a doctor), type of unit (oncology), depression and the use of the humor as a coping strategy. In contrast personal accomplishment was better predicted by positive coping strategies (i.e. planning, restraint coping, non-denial) and low level of anxiety.

A study of the psychometric properties of the Obsessive Beliefs Inventory and Interpretations of Intrusions Inventory on clinical Italian individuals.

Forty-three individuals with obsessive-compulsive disorder (OCD), 17 with generalized anxiety disorder (GAD) and 50 non-clinical controls (SC), completed the Italian versions of the Obsessive Beliefs Questionnaire (OBQ) and the Interpretations of Intrusions Inventory (III), along with measures of obsessive-compulsive (OC) symptoms, depression, anxiety and worry. OBQ and III showed an excellent reliability and temporal stability. The six OBQ subscales were reasonably distinct from each other, whereas the three subscales of the III were highly interrelated. The OBQ, and in less measure the III, discriminated between OCD, GAD, and normal controls. In the OCD cohort, the two instruments correlated moderately with a measure of obsessive-compulsive symptoms but also with a measure of worry. However, a linear regression analysis evidenced a specific relationship between the OBQ and obsessive-compulsive symptoms over and above worry. Overall, at least three cognitive domains (intolerance of uncertainty, excessive concern about the importance of controlling ones thoughts and perfectionism) seemed specific to OCD, whereas overimportance of thoughts and inflated responsibility barely discriminate clinically anxious individuals from non-clinical ones. It is concluded that OBQ and III are useful measures in Italian individuals and that more research is warranted to possibly refine these two instruments.

Evaluation of adherence to antiretroviral therapy in Italian HIV patients.

We studied factors associated with treatment adherence in 88 male and 21 female adults (age range, 24-65 years) with HIV infection undergoing therapy with HIV-1 protease inhibitors (PIs) in Italy. Data on sociodemographic variables, clinical and psychological symptoms, treatment compliance, physician/patient relationship, and psychosocial characteristics were obtained by means of semistructured interviews. Every subject also compiled two self-report questionnaires: Coping Orientations to Problem Experiences (COPE) and Medical Outcomes Study-HIV (MOS-HIV) in order to evaluate the use of coping strategies and quality of life. We found a high rate of adherence to HIV therapies (almost 90% of patients had taken at least 80% of medication in the previous 7 days). No significant differences were found between adherence and nonadherence groups as measured by self-report. Few significant differences were found when data laboratory were used. When a Bonferroni corrected p level of <0.001 was used, only a comparison on Mental Disengagement subscale of COPE was statistically significant.

Culture and psychopathology: superstition and obsessive-compulsive cognitions and symptoms in a non-clinical Italian sample

Two-hundred and fifty-eight high and low superstitious students completed the Italian versions of well-established measures of obsessive-compulsive cognitions and symptoms, depression, anxiety and worry. After controlling for anxiety and depression, high superstitious subjects scored higher than low-superstitious on measures of overestimation of threat, impaired mental control, contamination and worry. A logistic regression analysis showed that overestimation of threat and perfectionism discriminated high from low superstitious subjects over and above anxiety and depression measures. However, perfectionism was negatively correlated with superstitiousness. One hypothesis for this result was that perfectionism is more closely linked with checking behaviors (which, in fact, did not characterize our group of superstitious individuals) under the assumption that specific cognitive domains may account for specific obsessive-compulsive behavior in a meaningful way. It was concluded that superstitiousness may be a predisposing factor for general instead of specific psychopathology, but that cultural factors may moderate the relation between superstitiousness and psychopathology.

Assessment of cognitive functions in individuals with post-traumatic symptoms after work-related accidents.

The investigation of cognitive functions in individuals who developed post-traumatic symptoms after occupational accidents has been overlooked in the relevant literature. The present study was aimed at assessing attention, memory and executive functions in individuals with post-traumatic symptoms after a workplace accident. Moreover, possible presence of emotional interference from trauma-related cues on attentional performance was evaluated. Results showed that injured workers exhibited deficits in perceptual-psychomotor skills, executive functions, attention and concentration abilities, and memory as compared with healthy controls. With regards to emotional interference on attention, injured workers were found to perform significantly worse than controls specifically when exposed to trauma-related pictures. Overall, these findings suggest that post-traumatic symptoms following a workplace accident are associated with several cognitive and emotional dysfunctions, that should be carefully evaluated to help reduce the frequency and the adverse consequences of occupational accidents.

Longitudinal aspects of obsessive compulsive cognitions in a non-clinical sample: A five-year follow-up study

The cognitive behavioural models of Obsessive Compulsive Disorder (OCD) have stressed the role of cognitions, not only in aetiology but also in maintenance of the disorder. Little is known about the temporal relations between obsessive-compulsive cognitions and OCD symptoms. The aim of this study was to carry out a prospective assessment of OCD related beliefs and symptoms in a non-clinical sample. A total of 99 university students completed the Obsessive Beliefs Questionnaire (OBQ), Padua Inventory (PI), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI) and Worry Domain Questionnaire (WDQ) one, three and five years after baseline administration. Structural modelling predicting scores at later time periods and growth curve modelling were used to analyze the data. The results showed that obsessive-compulsive cognitions varied significantly over time. It was also found that the OBQ predicted symptom scales (Impaired Mental Control, Contamination and Checking) only at baseline. However symptom scores remained stable at each time point, as shown by the subscales of Impaired Mental Control, Contamination and Checking of the PI and the BAI, BDI and WDQ. Implications for future research and the cognitive model of OCD are discussed.

Compulsive checking and selective processing of threatening information.

Threatening stimuli are processed differently from neutral ones by anxious and obsessive-compulsive subjects. In the present research, processing of threatening words was compared with that of neutral words for two groups of Italian students, one with high mean and one with low mean score on Checking, a subscale of the Padua Inventory. Two tests were given, a computerized version of the emotional Stroop task and a later recognition test under incidental learning conditions. The expected interference effect on the Stroop task for those scoring high on Checking was confirmed. These results suggest an association between compulsive checking and bias in the first automatic stages of processing of threatening stimuli.