Christine Purdon

Thought suppression and psychopathology.

Wegners seminal investigations of effects of thought suppression on later thought frequency have had a significant impact on recent approaches to understanding emotional disorders characterized by the occurrence of persistent, repetitive, unwanted thoughts. Thought suppression has now been implicated as a etiological and/or maintaining factor in depression, generalized anxiety disorder, specific phobia, posttraumatic stress disorder and obsessive-compulsive disorder. These developments are fairly new, and it has not been until recently that studies have investigated the effects of suppressing thoughts that are actually analogous to problematic thoughts characteristic of emotional disorder. This paper provides a review of this body of work, including the findings and their relevance for existing models of specific disorders. Directions for future research are suggested.

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.

Obsessive intrusive thoughts in nonclinical subjects. Part I. Content and relation with depressive, anxious and obsessional symptoms

The present study reports on the development and preliminary validation of a 52 item self-report instrument designed to assess intrusive thoughts, images and impulses that are similar to the aggressive, sexual and disease-related thinking characteristic of clinical obsessions. Two hundred and ninety-three students completed the Obsessive Intrusions Inventory (OII) as well as standard self-report measures of negative cognitions and obsessive, anxious and depressive symptoms. Regression analysis revealed that intrusive thinking was a significant and unique predictor of obsessional but not anxious or depressive symptoms. Furthermore, intrusive thinking showed a moderate correlation with anxious but not depressive cognitions. The results indicate that the intrusive thoughts assessed by the OII are distinct from other forms of negative thinking and may, in fact, constitute an analogue form of clinical obsessions in nonclinical populations.

Metacognition and obsessions

Recent cognitive-behavioural models of obsessive-compulsive disorder (OCD) developed by Salkovskis (1985, 1989, 1998) and Rachman (1997, 1998) have advanced our understanding of the disorder substantially. Inherent in both models is the assumption that beliefs about obsessions are critical in the development and persistence of the disorder. Given that OCD is characterized by an aversive reaction to specific mental events, this emphasis on the cognitive processes involved in OCD is warranted. Wells (Wells and Mathews, 1994; Wells, 1997) proposed that our understanding of obsessional problems would be further advanced by examining the role of ‘metacognitive’ processes and beliefs (that is, attempts to regulate thoughts and beliefs about thoughts and thought processes) in their development and persistence. In identifying metacognitive factors as unique contributors to the problem, this model offers new directions for treatment. This paper discusses the role of metacognition in obsessional problems in light of current models of OCD, and offers an elaboration of the role of metacognitive factors in the escalation and persistence of obsessional problems. Copyright

Suppression of obsession-like thoughts in nonclinical individuals : impact on thought frequency, appraisal and mood state

Wegners (1994, Psychological Review, 101, 34-52) research on the paradoxical effect of thought suppression has been incorporated into contemporary cognitive-behavioural models of obsessive-compulsive disorder. However, findings on the effects of thought suppression on thought frequency have been inconsistent and few studies have actually examined the suppression of thoughts that are obsessional in nature. In the present study 219 nonclinical participants were randomly assigned to suppress or not suppress a neutral, obsessional or positive thought during an initial monitoring interval. In a second thought monitoring interval, all participants received instructions not to suppress their target thought. No paradoxical effect of suppression on frequency was observed for any type of thought, although suppression of obsessional thoughts was associated with greater subsequent discomfort and a more negative mood state than suppression of positive or neutral target thoughts.

Non‐erotic thoughts: Content and relation to sexual functioning and sexual satisfaction

We examined the possible range of content of non‐erotic thoughts experienced during typical sexual activities with a partner. Undergraduate men (n = 47) and women (n = 50) were administered a measure of non‐erotic thought content, frequency, and anxiety, along with measures of sexual attitude, satisfaction, and functioning. Men were more likely to report performance‐related thoughts, and women were more likely to report thoughts about body image. However, men and women were equally likely to report thoughts about the external consequences of the activity (e.g., pregnancy, being caught) and the emotional consequences of the activity (e.g., morality, implications of the activity for the relationship). Women reported that their thoughts occurred more frequently and caused more anxiety. Greater thought frequency and greater anxiety over thoughts were associated with poorer sexual functioning for both men and women. For women, greater frequency of and anxiety evoked by thoughts was associated with lower sexual satisfaction. These data provide modest support for cognitive‐behavioral models of sexual dysfunction and indicate the importance of both examining a broad range of non‐erotic thought content and taking gender into account when applying these models to understanding and treating sexual difficulties.

White bears and other elusive intrusions : Assessing the relevance of thought suppression for obsessional phenomena

According to recent research, deliberate suppression of unwanted thoughts may result in a paradoxical increase in their frequency. Recent cognitive-behavioral theories of obsessivecompulsive disorder now consider active thought suppression to be a crucial factor in the pathogenesis of obsessions. However, there are considerable inconsistencies in the results of studies investigating the thought suppression paradox that make it difficult to apply findings to obsessional problems. Furthermore, many studies have low ecological validity for obsessional problems. This article reviews the thought suppression research, discusses methodological issues relevant to application of the thought suppression paradox to obsessional problems, and offers recommendations for future research.

Appraisal of obsessional thought recurrences: Impact on anxiety and mood state*

Recent cognitive-behavioral models of obsessive-compulsive disorder (OCD) emphasize the role of thwarted control efforts in the escalation of thought frequency, negative thought appraisal, and subsequent negative mood state in the development and persistence of the disorder. To date, no studies have investigated the relationship between in vivo appraisal of thought recurrences and distress over obsessional thoughts and subsequent mood state. In the present study, 84 nonclinical individuals completed a measure of general thought appraisal and then were randomly assigned to suppress or not suppress their most upsetting obsessional thought during an initial thought-monitoring interval. In a second interval, all participants received the “do not suppress” instructions. Suppression was not associated with an increase in thought frequency either immediately or subsequently. However, results indicated that appraisal of thought recurrences as signifying the presence of undesirable personality characteristics and as portending future negative events was a significant predictor of immediate and subsequent anxiety, as well as more negative mood state. Natural active resistance to the thought was predicted by in vivo appraisal of the importance of regaining thought control. Results are discussed in terms of their theoretical and clinical implications.

Consistency between self-report and clinician-administered versions of the Yale-Brown Obsessive-Compulsive Scale.

BACKGROUND Preliminary efforts to demonstrate the utility of a self-rated version of the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) have been promising; however, earlier reports are based on small clinical samples. The objective of the present study was to evaluate the level of agreement between the clinician-administered Y-BOCS and a self-report version. METHODS Participants included 86 individuals with a principal diagnosis of obsessive-compulsive disorder (OCD). All participants were given the self-report version of the Y-BOCS to complete offsite and instructed to return it at a second assessment session (within a 2-week time frame), at which time a trained and experienced clinician administered the Y-BOCS interview. RESULTS The two versions were moderately correlated with the highest correlation observed for the Compulsions subscale. Comparison of scores for individual items revealed several inconsistencies between the two measures: level of agreement was low for resistance items, and the interview version generated higher compulsion severity ratings. CONCLUSIONS The study provided moderate support for the convergence of the self-report and clinician-administered version of the Y-BOCS, however, important difference were detected between the two assessment methods.

The Meta-Cognitive Beliefs Questionnaire: development of a measure of obsessional beliefs.

A 67 item self-report questionnaire called the Meta-Cognitive Beliefs Questionnaire (MCBQ) was developed to assess endorsement of beliefs about the importance of control and negative consequences associated with unwanted, ego-dystonic intrusive thoughts, images and impulses. The MCBQ and a battery of questionnaires that assessed symptoms and cognitions of worry, obsessive-compulsive disorder, anxiety, and depression were administered to large samples of undergraduate students. Beliefs about control of intrusive thoughts and perceived negative consequences due to uncontrolled mental intrusions had a unique significant relationship with obsessions, and to a lesser extent, worry. These findings are consistent with current cognitive behavioral theories that suggest an important role for meta-cognitive beliefs in the pathogenesis of obsessions.