Dana S. Thordarson

Thought-action fusion in obsessive compulsive disorder☆

Abstract Recent psychometric results suggested that the phenomenon of thought-action fusion (TAF) is implicated in obsessive compulsive disorder (OCD). The construct of TAF has two components: (a) the belief that thinking about an unacceptable or disturbing event makes it more likely to happen and (b) the belief that having an unacceptable thought is the moral equivalent of carrying out the unacceptable or disturbing action. The construct of TAF is explored, and its relevance to responsibility and obsessive-compulsive disorder examined. A highly reliable questionnaire to measure TAF has been developed, and psychometric data obtained from two studies are presented. TAF was higher in obsessional samples than in nonobsessional samples, particularly the belief that thinking about a negative event involving other people makes the event more likely to happen. You have heard that it was said, “Do not commit adultery”. But now I tell you: Anyone who looks at a woman and wants to possess her is guilty of committing adultery with her in his heart.

Comparative efficacy, speed, and adverse effects of three PTSD treatments: Exposure therapy, EMDR, and relaxation training

The authors examined the efficacy, speed, and incidence of symptom worsening for 3 treatments of posttraumatic stress disorder (PTSD): prolonged exposure, relaxation training, or eye movement desensitization and reprocessing (EMDR; N = 60). Treaments did not differ in attrition, in the incidence of symptom worsening, or in their effects on numbing and hyperarousal symptoms. Compared with EMDR and relaxation training, exposure therapy (a) produced significantly larger reductions in avoidance and reexperiencing symptoms, (b) tended to be faster at reducing avoidance, and (c) tended to yield a greater proportion of participants who no longer met criteria for PTSD after treatment. EMDR and relaxation did not differ from one another in speed or efficacy.

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.

Perceived responsibility: Structure and significance

Given the postulated significance of inflated responsibility in obsessive compulsive disorder (OCD), there is a need for clarification of the concept itself and a means for measuring such responsibility. Two psychometric studies were conducted in order to develop a reliable self-report scale. In the first study 291 students completed the specially constructed Responsibility Appraisal Questionnaire (RAQ). Four factors emerged: responsibility for harm, responsibility in social contexts, a positive outlook towards responsibility, and thought-action fusion (TAF). In the second study, 234 students completed a revised RAQ. Four comparable factors emerged, and the TAF subscale correlated significantly with measures of obsessionality, guilt, and depression. The correlations between TAF and obsessionality and guilt remained significant even after BDI scores were controlled. It is concluded that the broad concept of inflated responsibility needs to be qualified; the connection between inflated responsibility and OCD appears to be situation-specific and idiosyncratic. There is more inflated responsibility than there is OCD. The measured concept of inflated responsibility is multifactorial (harm, social, positive, and TAF), not unitary. The TAF factor appears to be particularly significant in OCD.

The Claustrophobia Questionnaire.

The content and psychometric properties of the Claustrophobia Questionnaire (CLQ) are described. An earlier version of the CLQ was developed to test the hypothesis that claustrophobia is comprised of two distinct but related fears--the fear of suffocation and the fear of restriction [J. Anxiety Disord. 7 (1993) 281.]. The scale was used to assess patients undergoing the magnetic resonance imaging (MRI) procedure [J. Behav. Med. 21 (1998) 255.] and in participants with panic disorder [J. Abnorm. Psychol. 105 (1996) 146; Taylor, S., Rachman, S., & Radomsky, A. S. (1996). The prediction of panic: a comparison of suffocation false alarm and cognitive theories. Unpublished data.]. On the basis of these studies, we decided to revise and shorten the CLQ, collect normative data, and provide information on the scales predictive and discriminant validity as well as its internal consistency and test-retest reliability. This was done through a set of four interconnected studies that included psychometric analyses of undergraduate and community adult questionnaire responses and behavioural testing. Results indicate that the CLQ has good predictive and discriminant validity as well as good internal consistency and test-retest reliability. The CLQ appears to be a reliable and sensitive measure of claustrophobia and its component fears. We encourage the use of the CLQ in a variety of clinical and research applications. The scale is provided in this paper for public use.

Group and Individual Treatment of Obsessive-Compulsive Disorder Using Cognitive Therapy and Exposure Plus Response Prevention: A 2-Year Follow-Up of Two Randomized Trials.

Relatively little is known about the long-term durability of group treatments for obsessive-compulsive disorder (OCD) and contemporary cognitive treatments. The current study investigated the 2-year follow-up results for participants who completed randomized trials of group or individual treatment and received either cognitive therapy (CT) or exposure plus response prevention (ERP). Yale-Brown Obsessive Compulsive Scale (YBOCS) scores for individual ERP and CT were not significantly different over 2 years. However, YBOCS scores were consistently lower over time for group ERP participants than for group CT participants. With a single exception in the group treatment study, secondary cognitive and depression scores were stable, indicating that gains achieved during acute treatment were maintained over 2 years. Less than 10% of treatment completers relapsed in each of the treatment trials. Approximately 50% of the completer sample was rated as recovered at 2 years. Additionally, a tentative cross-study comparison suggests that CT was better tolerated and resulted in less dropout than did ERP. Despite the overall positive results, efficacy of OCD treatments has reached a plateau and may require a fresh perspective to move forward.

Telephone-Administered Cognitive Behavior Therapy for Obsessive-Compulsive Disorder

Exposure with response prevention and cognitive behavior therapy are widely recognized as effective treatments for obsessive-compulsive disorder. Unfortunately, many people with obsessive-compulsive disorder - particularly those living in rural areas - do not have access to therapists providing these treatments. Accordingly, we investigated the efficacy of telephone-administered cognitive behavior therapy for obsessive-compulsive disorder. Two open trials are reported, for a total of 33 people with obsessive-compulsive disorder (without major depression). The first trial consisted of 12 weeks on a waiting list followed by 12 weeks of treatment (delayed treatment). The second trial consisted of 12 weeks of immediate treatment. Obsessive-compulsive symptoms did not change during the waiting period. Symptoms declined from pre- to post-treatment, with gains maintained at 12-week follow-up. For the pooled sample our pre-to-post-treatment effect size was as large or larger than those obtained in other studies of reduced contact treatment, and similar to those of face-to-face exposure with response prevention. Our proportion of treatment dropouts tended to be lower than those of other reduced contact interventions. The results suggest that telephone-administered cognitive behavior therapy is effective and well-tolerated, at least for people with obsessive-compulsive disorder without major depression. It remains to be seen whether this treatment is safe and effective when comorbid major depression is present.

Coping styles and personality: a biometric analysis.

Abstract Previous research suggests that coping styles are modestly heritable and that this genetic influence is shared in large part with genetic influences on personality. To test this hypothesis, we estimated the heritable basis of the Coping Inventory for Stressful Situations in a sample of 91 monozygotic and 80 dizygotic twin pairs. Task-oriented, emotion-oriented, and social diversion coping styles were modestly heritable (h 2=.17 to .20), whereas the use of distraction appeared to be influenced solely by environmental factors. Multivariate analyses showed that genetic contributions to coping styles were, at best, only modestly related to genetic contributions to personality (r=−.03 to .35). Environmental contributions to personality were unrelated to environmental factors in coping style. These results suggest that coping style is not merely a manifestation of basic personality traits but does support the possibility that the genetic factors in personality influences have a modest influence on an individuals preferred coping style or strength (e.g., rigidity vs flexibility).

Development and Validation of Instruments for Measuring Intrusions and Beliefs in Obsessive Compulsive Disorder

Publisher Summary This chapter discusses the development and validation of instruments for measuring intrusions and beliefs in Obsessive Compulsive Disorder (OCD). Cognitive factors may be central to this disorder. These factors include: (1) cognitive processing (attention, memory, and information processing), and (2) cognitive appraisals or interpretations of internal and external events. The studies to examine the effects of cognitive treatments on OCD patients used Rational Emotive Therapy (RET) to alter irrational beliefs about obsessions. Perfectionism, guilt, and superstitious beliefs are considered closely associated to OCD but by no means specific to this disorder. Perfectionism is related to OCD and OCD symptoms. Guilt is the emotion most closely related to beliefs about responsibility and may be especially relevant for OCD. Although superstitious beliefs are not necessarily characteristic of individuals with OCD, they may be relevant for some individuals. The challenge of testing the measures for psychometric properties also benefited from the size and range of skill among group members. Collaborative instrument development and testing have distinct advantages over individual investigations.

Importance of Thoughts

Publisher Summary This chapter presents the importance of thoughts. The importance of thoughts domain of cognition in Obsessive Compulsive Disorder (OCD) comprises of beliefs and interpretations involving excessive importance attached to negative intrusive thoughts. These interpretations and beliefs are also described as moral “thought-action fusion;” “likelihood thought-action fusion;” and “magical thinking.” The thoughts are misinterpreted as overly important and indicate something significant about ones own self; having “negative intrusive thoughts” increases the risk of bad happenings; and “negative intrusive thoughts” must be important merely because they have occurred. The closely related concept of Thought-Action Fusion (TAF) may be seen as a subset of the more general category of importance of thoughts. TAF refers to the idea that thoughts are morally equivalent to actions, or that thoughts themselves can cause negative events. The chapter suggests that importance of thoughts or beliefs may be specifically related to obsessions about harm rather than obsessional compulsive symptoms in general. This chapter concludes that the development of the concept of importance of thoughts in OCD and the importance of thoughts subscales of the obsessional belief questionnaire may facilitate several useful lines of research, and can lead to an improved understanding of cognition in OCD and other anxiety disorders.