Hélène Letarte

Cognitive—behavioral treatment of obsessive thoughts: A controlled study.

Twenty-nine patients with obsessive-compulsive disorder as diagnosed in accordance with the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., revised; American Psychiatric Association, 1987) who did not have overt compulsive rituals were randomly assigned to treatment and waiting-list conditions. Patients in the treatment condition received cognitive-behavioral therapy consisting of a detailed explanation of the occurrence and maintenance of obsessive thoughts, exposure to obsessive thoughts, response prevention of all neutralizing strategies, cognitive restructuring, and relapse prevention. Compared with waiting-list patients, treated patients improved significantly on measures of severity of obsessions, current functioning, self-report obsessive-compulsive symptoms, and anxiety. When waiting-list patients were subsequently treated, the combined group improved on all outcome measures. Treatment gains were maintained at 6-month follow-up. Results indicate that cognitive-behavioral therapy is effective in the treatment of patients with obsessive thoughts, a group that has often been considered resistant to treatment.

Perfectionism, responsibility and Obsessive-Compulsive symptoms

Although both perfectionism and responsibility have been associated with OCD at a theoretical level, responsibility has been the focus of a number of recent articles. This study was conducted in order to empirically test the relative importance of perfectionism and responsibility in Obsessive-Compulsive symptoms. Perfectionism and two measures of responsibility showed moderate correlations with Obsessive-Compulsive symptoms. A hierarchical regression analysis revealed that although responsibility accounted for more variance, perfectionism was still a significant predictor of Obsessive-Compulsive symptoms, once responsibility had been partialled out. These results suggest that although responsibility is related to OC symptoms, perfectionism is also independently associated. While responsibility has received much attention lately from OCD theorists and clinicians, perfectionism may also play a significant if underestimated role in some OC patients. The results are discussed in terms of their implications for current cognitive models and treatment procedures that give responsibility a central role in OCD. A new definition of perfectionism is also proposed.

Cognitive treatment of pathological gamblers

This study evaluates the efficacy of a cognitive treatment for pathological gambling. Five pathological gamblers were treated in a multiple baseline across subjects design. Cognitive correction targeted the erroneous perceptions towards the notion of randomness. Four subjects reported a clinically significant decrease in the urge to gamble, an increase in their perception of control, and no longer met the DSM-IV criteria for pathological gambling. Therapeutic gains were maintained at the 6 month follow-up. Results suggest that cognitive therapy targeting the misconception of the notion of randomness is a promising treatment for pathological gambling, a refractory disorder to most therapeutic interventions.

Self-report of obsessions and worry

The relationships between self-reported worry and obsessional-compulsive symptoms were examined among 145 hospital outpatients. Subjects completed the Penn State Worry Questionnaire and the Padua Inventory. Despite moderately strong correlations, the scales measured distinct constructs. Eliminating five items from the Padua Inventory may improve its discriminant validity. Correlations with the Padua Inventory subscales showed that obsessional loss of mental control was moderately correlated to both worry and checking, whereas worry and checking were only weakly correlated. The results are discussed in terms of possible relationships between worry and obsessions.

Inflated responsibility in obsessive compulsive disorder: Validation of an operational definition

An excessive sense of responsibility has been identified in obsessive-compulsive disorder (OCD) where patients evaluate their thoughts in terms of the harm they could cause to themselves or others. In a new definition, responsibility was defined as the belief that one possesses pivotal power to provoke or prevent subjective crucial negative outcomes. In order to empirically test the validity of this definition, two studies used a semi-idiographic design to evaluate responsibility across ambiguous situations related to major OCD themes like contamination, verification, somatic concerns, loss of control, making errors, sexuality and magical thinking. In the first study, 397 volunteer adults participated in the experiment. For each situation, subjects briefly described a possible negative outcome and then rated this outcome on four dimensions: (1) probability; (2) severity; (3) influence; and (4) pivotal influence, using a 9-point Likert scale. Finally Ss rated perceived responsibility and personal relevance. Highly relevant situations were retained for the final analysis. Regression analysis suggested that influence and pivotal influence were better predictors of responsibility ratings than probability and severity. The second study examined the effect of the order of the questions on the responsibility ratings. A first group of Ss (n = 85) answered the Responsibility Questionnaire (RQ) in the original order, while a second group (n = 53) rated responsibility before the other ratings. Regression analysis showed that although proportion of variance explained diminished when the order was reversed, pivotal influence was still the best predictor of responsibility. Results are discussed in terms of current models of OCD and implications for future research and cognitive treatment are identified.

Inflated responsibility in obsessive-compulsive disorder: Psychometric studies of a semiidiographic measure

An excessive sense of responsibility has been attributed a key role in recent models of obsessive-compulsive disorder (OCD). This study presents the development and initial validation of the Responsibility Questionnaire. Three hundred ninety-seven volunteer adults participated in the study. The Responsibility Questionnaire demonstrated adequate stability over a 6-week interval. Correlation analysis showed that responsibility was significantly related to obsessive-compulsive symptoms, thought suppression, irrational beliefs, and obsessional thoughts. Results are discussed in terms of current models of OCD and the implications for future research.

Health-related intrusive thoughts☆

Two studies address the prevalence, concomitants, and appraisal of health-related intrusive thoughts. Eighty-three percent of adults (N = 658) in waiting rooms of two general hospitals reported at least one intrusive thought during the preceding month and 75.0% of patients and 55.5% of people accompanying them reported a health-related intrusive thought in the same period. The intrusions were associated with anxious and depressive symptoms. Health related intrusive thoughts were reported by 61% of a sample of university students (N = 608) and were the most frequent intrusive thought among 19.9% of the students. First, triggering stimuli reported by the subjects were significant predictors of thought frequency, worry, removal difficulty, and effort used in removing the thought. Second, appraisals of high probability were significant predictors of high frequency, worry, and especially difficulty in removing the thought. Finally, perceived responsibility and disapproval of the thought were also significant predictors of thought frequency, worry, removal difficulty, effort used in removing the thought, and guilt. These data support the position that cognitive appraisal of intrusive thoughts is closely linked to the subjective experience of the thought: more extreme appraisals were associated with more troublesome thoughts. The clinical implications of these studies are discussed in terms of current models of hypochondriasis and health anxiety.

Physical symptoms associated with worry in a nonclinical population

This study examines physical symptoms related to worry in a nonclinical sample (N = 583). According to the Generalized Anxiety Disorder Questionnaire, physical symptoms for DSM-III-R GAD criteria were frequently experienced by nonclinical subjects who met cognitive criteria for GAD. Factor analysis, item endorsement rates, and concurrent validity of individual items identified eight symptoms that were frequently endorsed, had good concurrent validity, and were factorially separate from a panic-like factor. Seven of these items are retained for DSM-IV. Furthermore, these items form a brief scale that does not overlap with other well-established scales for measuring anxious symptoms. The reliability and convergent/divergent validity of the scale were satisfactory. In conclusion, this study indicates that nonclinical populations experience physical symptoms that are similar to those associated with GAD and that DSM-IV retains items that are frequently endorsed, distinguish worriers from nonworriers, and are factorially separate from a panic-like factor.

Images and Doubts in Intrusive Cognitive Activity

Intrusive thoughts are variously reported as images, thoughts, doubts, impulses etc. Recent accounts of emotional processing make important distinctions between cognitive activity in verbal form and images. The comparison of verbal intrusions and images was made on archival data about intrusive cognitions from 628 university students. Images and doubts (a verbal form) occurring together were perceived as more difficult to dismiss than either images or doubts alone. In addition, images and doubts together were more frequent, more probable, and required more effort to counter than images alone. Likewise, images and doubts together and doubts alone were more worrisome and more frequently triggered by various stimuli than images alone. These results suggest that cognitive intrusions identified as a mixture of doubts and images are qualitatively different and more troublesome than those identified as either doubts or images. These findings are discussed in terms of current accounts of emotional processing.

Incentive to Suppress a Neutral Thought

A suppression-mention task was used to evaluate the influence of increasing the incentive to suppress on subsequent enhancement and/ or rebound effects. The experimental group suppressed neutral thoughts with a financial incentive for performance. A bogus pipeline was used to control for honesty. Two control groups, one with the bogus pipeline and one without, were asked to suppress the thought without the possibility of financial reward contingent on performance. Results showed that the group with a possible financial reward, although more successful in suppressing the thought, were still unable to suppress the thought. No enhancement or rebound effects were observed.