Noah C. Berman

Assessment of Obsessive-Compulsive Symptom Dimensions: Development and Evaluation of the Dimensional Obsessive-Compulsive Scale

Although several measures of obsessive-compulsive (OC) symptoms exist, most are limited in that they are not consistent with the most recent empirical findings on the nature and dimensional structure of obsessions and compulsions. In the present research, the authors developed and evaluated a measure called the Dimensional Obsessive-Compulsive Scale (DOCS) to address limitations of existing OC symptom measures. The DOCS is a 20-item measure that assesses the four dimensions of OC symptoms most reliably replicated in previous structural research. Factorial validity of the DOCS was supported by exploratory and confirmatory factor analyses of 3 samples, including individuals with OC disorder, those with other anxiety disorders, and nonclinical individuals. Scores on the DOCS displayed good performance on indices of reliability and validity, as well as sensitivity to treatment and diagnostic sensitivity, and hold promise as a measure of OC symptoms in clinical and research settings.

The relationship between obsessive beliefs and symptom dimensions in obsessive-compulsive disorder

Research findings on the specific relationships between beliefs and OCD symptoms have been inconsistent, yet the existing studies vary in their approach to measuring the highly heterogeneous symptoms of this disorder. The Dimensional Obsessive-Compulsive Scale (DOCS) is a new measure that allows for the assessment of OCD symptom dimensions, rather than types of obsessions and compulsions per se. The present study examined the relationship between OCD symptom dimensions and dysfunctional (obsessive) beliefs believed to underlie these symptom dimensions using a large clinical sample of treatment-seeking adults with OCD. Results revealed that certain obsessive beliefs predicted certain OCD symptom dimensions in a manner consistent with cognitive-behavioral conceptual models. Specifically, contamination symptoms were predicted by responsibility/threat estimation beliefs, symmetry symptoms were predicted by perfectionism/certainty beliefs, unacceptable thoughts were predicted by importance/control of thoughts beliefs and symptoms related to being responsible for harm were predicted by responsibility/threat estimation beliefs. Implications for cognitive conceptualizations of OCD symptom dimensions are discussed.

Dimensions of anxiety sensitivity in the anxiety disorders: Evaluation of the ASI-3

Anxiety sensitivity (AS), the fear of sensations of anxious arousal based on beliefs about their harmful consequences, is increasingly recognized as a multidimensional construct. The recently developed Anxiety Sensitivity Index-3 [ASI-3; Taylor, S., Zvolensky, M., Cox, B., Deacon, B., Heimberg, R., Ledley, D. R., et al. (2007). Robust dimensions of anxiety sensitivity: Development and initial validation of the Anxiety Sensitivity Index-3 (ASI-3). Psychological Assessment, 19, 176-188] measures three dimensions of AS: physical concerns, social concerns, and cognitive concerns. The ASI-3 shows promise, although further evaluation of its psychometric properties and validity in independent samples is needed. We evaluated the ASI-3 in a mixed sample of anxiety disorder patients (N=506) and undergraduate student controls (N=315). The measure demonstrated a stable 3-factor structure and sound psychometric properties, with the three factors showing theoretically consistent patterns of associations with anxiety symptoms and diagnoses. ASI-3 total scores were less discriminative. Implications for conceptual models of anxiety are discussed.

Predicting anxiety: The role of experiential avoidance and anxiety sensitivity

Anxiety sensitivity (AS), the tendency to fear arousal-related body sensations based on beliefs that they are harmful, is a strong psychological risk factor for development of anxiety psychopathology; however, in most studies AS explains only a portion of the variability in anxiety symptoms. Recent theoretical and research work has suggested that experiential avoidance (EA), unwillingness to endure unpleasant internal experiences (e.g., thoughts, emotions, memories), is related to anxiety disorders. The current study examined independent contributions of EA and AS in the prediction of anxiety symptoms in a sample of 42 adults with DSM-IV anxiety disorders. Participants completed measures of AS, EA, anxiety, and depression. Correlational analyses indicated associations between AS, EA, and anxiety, yet more conservative regression analyses indicated that the Physical Concerns dimension of AS predicted anxiety symptom severity independently of EA. Theoretical and treatment implications of the results are discussed.

The relationship between religion and thought—action fusion: Use of an in vivo paradigm

Research has demonstrated that higher levels of religiosity are positively correlated with thought-action fusion (TAF), a set of cognitive biases found to be associated with obsessive-compulsive symptoms. However, previous studies have exclusively relied on a nomothetic approach to measuring TAF using a single self-report instrument, the thought-action fusion scale. The current study examined the relationship between religiosity and TAF using an in vivo behaviorally-based assessment in which participants thought about and wrote down thoughts of negative events involving loved ones. Forty-three highly religious Protestant Christians were compared to 30 Atheists/Agnostics on their in vivo ratings of anxiety, estimates of likelihood, and moral wrongness related to the negative thoughts. Results indicated that compared to the non-religious participants, those who were highly religious believed that writing and thinking about the negative events was more morally wrong and increased the likelihood of the event. Results are discussed in terms of the potential relationship between certain religious teachings and TAF-related beliefs about the importance, significance, and influence of thoughts.

Recent Advances in Research on Cognition and Emotion in OCD: A Review

The cognitive model of OCD suggests that misinterpreting intrusive thoughts as unacceptable leads to increased anxiety and attempts to suppress or ignore the thoughts through avoidance or compulsive rituals. An insidious negative feedback loop develops as one’s attention focuses on these thoughts and in turn the unwanted thoughts do not respond to efforts to avoid or suppress. This article is a current review of the research on cognitive processes in obsessive-compulsive disorder (OCD). We review research that has (1) empirically validated the theoretical underpinnings of the cognitive model, (2) altered maladaptive cognitive processes through state-of-the-art experimental procedures, (3) refined our understanding of the relationship between obsessive beliefs and OC symptoms and (4) examined how underlying traits (e.g., anxiety and disgust sensitivity) relate to the development and maintenance of OCD. We discuss the clinical implications of this research.

The relationship between anxiety sensitivity and obsessive-compulsive symptom dimensions.

BACKGROUND AND OBJECTIVES Anxiety sensitivity (AS), the tendency to fear arousal-related body sensations based on beliefs that they are dangerous, is a cognitive vulnerability factor for certain anxiety symptoms such as panic and posttraumatic stress symptoms. Very little research, however, has examined the relationship between AS and obsessive-compulsive (OC) symptoms, which was the objective of the current research. METHODS We administered dimensional measures of AS and OC symptoms to a large sample of undergraduate students (N = 636). We also included measures of general distress and cognitive distortions related to OCD (i.e., obsessive beliefs) as control variables. RESULTS Regression analyses indicated that AS was predictive of OC symptoms even after controlling for general distress and obsessive beliefs. In addition, the three domains of AS (physical, social, and cognitive concerns) were differentially associated with the four dimensions of OC symptoms (contamination, responsibility for harm, symmetry, and unacceptable thoughts). LIMITATIONS Our findings are based on a non-clinical student sample and their generalization to OCD requires replication with a sample of OCD patients. CONCLUSIONS These results provide preliminary evidence that AS plays a role in OC symptoms. Implications for clinical practice and for future research are discussed.

Mechanisms of change in cognitive therapy for obsessive compulsive disorder: role of maladaptive beliefs and schemas.

The present study aimed to identify mechanisms of change in individuals with moderately severe obsessive-compulsive disorder (OCD) receiving cognitive therapy (CT). Thirty-six adults with OCD received CT over 24 weeks. At weeks 0, 4/6, 12, 16/18, and 24, independent evaluators assessed OCD severity, along with obsessive beliefs and maladaptive schemas. To examine mechanisms of change, we utilized a time-varying lagged regression model with a random intercept and slope. Results indicated that perfectionism and certainty obsessive beliefs and maladaptive schemas related to dependency and incompetence significantly mediated (improved) treatment response. In conclusion, cognitive changes in perfectionism/certainty beliefs and maladaptive schemas related to dependency/incompetence precede behavioral symptom reduction for OCD patients. Targeting these mechanisms in future OCD treatment trials will emphasize the most relevant processes and facilitate maximum improvement.

Experiential Avoidance and Saving Cognitions in the Prediction of Hoarding Symptoms

The cognitive-behavioral approach to hoarding implicates dysfunctional beliefs about possessions (i.e., “saving cognitions”). Acquiring and saving possessions can be conceptualized as avoidance behaviors that prevent feeling the distress provoked by such beliefs in certain situations (e.g., discarding). Experiential avoidance (EA) involves an unwillingness to endure upsetting emotions, thoughts, memories, and other private experiences, and deliberate efforts to control or escape from them. EA has been investigated in several clinical disorders, but to date little investigation of the role of EA in hoarding has been made. The present study examined EA in the prediction of hoarding symptoms. A large sample of unscreened undergraduates completed measures of EA, saving cognitions, and hoarding symptoms. EA predicted the acquisition and clutter components of hoarding even after controlling for saving cognitions and general distress. However, EA was not uniquely associated with the difficulty discarding component of hoarding. Implications for future research are discussed.

The Contribution of Experiential Avoidance and Anxiety Sensitivity in the Prediction of Health Anxiety

Anxiety sensitivity (AS) refers to a fear of arousal-related body sensations based on beliefs that such sensations are dangerous. Experiential (emotional) avoidance (EA) involves an unwillingness to endure upsetting emotions, thoughts, memories, and other private experiences. As both of these constructs are thought to be predictive of health anxiety, the present study examined their relative contribution in the prediction of health anxiety symptoms. A large sample of nontreatment-seeking participants completed measures of AS, EA, and health anxiety. An analogue sample of participants with clinical levels of health anxiety endorsed more AS and EA relative those with less health anxiety. Within the analogue sample, both AS and EA predicted health anxiety symptoms. However, whereas AS (specifically, the physical concerns domain) uniquely predicted health anxiety, EA did not contribute significantly over and above the contributions of AS. Results are also discussed in terms of the conceptualization and treatment of health anxiety.