Obsessive-Compulsive Symptom Dimensions and Their Relationships with Obsessive Beliefs: A Structural Equation Modeling Analysis

Dysfunctional beliefs are central in the development and maintenance of obsessive-compulsive disorder (OCD) as well as its treatment. Yet, research suggests that not all dysfunctional beliefs are equally important for each of the symptom dimensions of OCD. However, results are inconsistent in that studies contradict each other regarding the associations between specific symptom dimensions and belief domains. The aim of the present study was to clarify which belief domain is specifically associated with which OCD symptom dimension. Results could help to tailor treatments more specifically to the patient's OCD symptom dimension. In- and outpatients with OCD (N = 328; 43.6% male and 56.4% female) filled out questionnaires on symptom dimensions of OCD (Obsessive-Compulsive Inventory Revised) and dysfunctional beliefs (Obsessive Beliefs Questionnaire). A structural equation model analysis was conducted to identify the associations between dysfunctional beliefs and symptom dimensions. Our results showed that perfectionism/intolerance of uncertainty was associated with hoarding and symmetry/ordering, (2) overestimation of threat/inflated responsibility was associated with checking compulsions, and (3) importance of thoughts/control of thoughts was associated with obsessing. These results were largely supported by a backward selection. Our results demonstrated associations of specific dysfunctional beliefs and specific OCD symptom dimensions. However, future studies are necessary to replicate these findings with other measures (e.g., clinician ratings).

Evaluation of Relationship Between Cyberchondria and Obsessive Beliefs in Adults

OBJECTIVE

The aim of this study was to evaluate the relationship between cyberchondria and obsessive beliefs and determine the potential risk of the former.

METHODS

This was a cross-sectional study conducted with 777 individuals. The Cyberchondria Severity Scale and the Obsessive Beliefs Questionnaire were applied to the participants. Univariate and hierarchical multiple linear regression analyses were used to analyze the data.

RESULTS

Of the study group 382 (49.2%) were male, 395 (50.8%), female. Their ages ranged from 18 to 63 years, with an average of 32.6 (± 9.6) years. Multiple linear regression analysis found that the frequency of internet use (several times a day; n = 670), using the internet as a source of health-related information (n = 320), using the internet to research a doctor before making and/or attending an appointment with same (n = 363), halting the use of prescribed medication based on information obtained on the internet (n = 177), and obsessive beliefs were factors linked to cyberchondria. Cyberchondria and obsessive beliefs were positively related and in the final model were found to be the strongest determinants of cyberchondria.

CONCLUSION

Obsessive beliefs may be a potential risk factor for cyberchondria. Since cyberchondria affects people's health related behaviors, it is important to ensure the safety of health-related information on the internet. The results of this study may guide future ones that thoroughly investigate the factors associated with cyberchondria. More comprehensive studies are needed to reveal the relationship between cyberchondria and obsessive beliefs.

Cognitive training using a mobile app as a coping tool against COVID-19 distress: A crossover randomized controlled trial

BACKGROUND

The COVID-19 pandemic has been suggested to constitute a broad base stressor with severe mental health consequences. mHealth applications are accessible self-help tools that can be used to reduce psychological distress during the pandemic. This randomized controlled trial evaluated the effects of mobile-based cognitive training exercises on COVID-19 related distress and maladaptive cognitions.

METHODS

Following initial screening (n = 924), participants scoring 1 standard deviations above the mean of the COVID-19 Distress Scale were randomized into two groups. Participants in the immediate-app group (iApp; n = 25) started using the application at baseline (T0) for 12 days (from T0 to T1). Participants in the delayed-app group (dApp; n = 22) started using the mobile application at T1 (crossover) and used it for the following 12 days (T1 to T2).

RESULTS

Intention to treat analyses indicated that the iApp group exhibited lower COVID-19 distress, lower depression, fewer intolerance of uncertainty and obsessive beliefs than the dApp group at T1. In addition, using the app for 12 consecutive days was associated with large effect-size reductions (Cohen's d ranging from 0.81 to 2.35) in COVID-19 distress and related maladaptive cognitions in the iApp group (from T0 to T1) and the dApp group (from T1 to T2). Moreover, these reductions were maintained at the follow-up.

LIMITATIONS

This study was a crossover trial with a relatively limited sample size and mainly female participants.

CONCLUSION

Our findings underscore the usefulness of brief, low-intensity, portable interventions in alleviating the negative effects of the pandemic on mental health.

Obsessive beliefs prospectively predict adherence to safety behaviours related to COVID-19 through obsessive-compulsive symptoms and COVID-19 distress: A serial multiple mediator analysis

Obsessive–compulsive tendencies may render individuals vulnerable to elevated distress and over‐adherence to safety behaviours during illness outbreaks. The present study investigated obsessive beliefs as a predictor of obsessive–compulsive symptoms, COVID‐19 distress and the exercise of safety behaviours related to COVID‐19 in a community sample. Four hundred seventy‐nine participants responded to a questionnaire battery in March 2020 and 218 individuals participated in a follow‐up assessment in September 2020. Results indicated that baseline obsessive beliefs predicted the exercise of baseline safety behaviours through obsessive–compulsive symptoms and COVID‐19 distress. In addition, the relationship between baseline obsessive beliefs and safety behaviour adoption 6 months later was mediated by later obsessive–compulsive symptoms and COVID‐19 distress. Findings extended prior research on the association between obsessive–compulsive phenomena and psychological changes related to illness outbreaks. The implications for prevention and treatment strategies are discussed.

Facets of adult attachment style in patients with obsessive-compulsive disorder

Literature data did not show univocal evidence in discriminating which form of attachment insecurity is involved in obsessive-compulsive disorder (OCD): both anxiety and avoidance was related to OCD symptomatology. No study used the Attachment Style Questionnaire (ASQ) that allows for investigation of differentiated facets of attachment anxiety and of avoidance. We investigated: (1) whether individuals with OCD differed from controls in the facets of attachment security (anxiety and avoidance), (2) which attachment facets predicted a diagnosis of OCD, controlling for socio-demographics and obsessive beliefs, (3) which attachment facets predicted specific OCD symptoms, controlling for socio-demographics and obsessive beliefs. Two hundred seventy participants (135 OCD patients and 135 matched controls) completed the Obsessive-Compulsive Inventory-Revised, Obsessive Beliefs Questionnaire-46 and ASQ. OCD patients reported respectively lower and higher levels on confidence and attachment anxiety than controls. Higher need of approval was the most important predictor of OCD diagnosis beyond the other attachment facets, and even of the obsessive beliefs. Using multivariate generalised linear models, the two facets of attachment anxiety, the need for approval (that predicted higher levels of obsessing and ordering symptoms), and preoccupation with relationships (that predicted higher hoarding symptoms) seemed to explain variance over and above OCD-related beliefs and socio-demographics. Discomfort with closeness contributed to the predictions of ordering symptoms. In conclusion, the interpersonal dynamics related to attachment in OCD patients should be carefully considered during assessment and treatment of OCD patients in clinical practice.

Adherence to exposure and response prevention as a predictor of improvement in obsessive-compulsive symptom dimensions

Exposure and response prevention (ERP) is an effective treatment for obsessive compulsive disorder (OCD); yet, improvement rates vary and it is therefore important to examine potential predictors of outcome. The present study examined adherence with ERP homework as a predictor of (a) treatment response across OCD symptom dimensions and (b) reductions in psychological factors implicated in the maintenance of OCD. Fifty adults with OCD received manualized twice-weekly ERP as part of a treatment trial. Results indicated that treatment was effective for all OCD symptom dimensions and that greater adherence with ERP homework predicted post-treatment (but not follow-up) improvements in OCD symptoms pertaining to responsibility for harm, unacceptable obsessional thoughts, and symmetry. Adherence did not predict outcomes for contamination symptoms, however. Adherence also predicted improvement in psychological maintenance factors such as obsessive beliefs and experiential avoidance. Implications of the findings include the importance of emphasizing adherence to homework instructions, as well as the importance of considering OCD symptoms dimensionally as opposed to globally in examining predictors of treatment response.

The role of disgust propensity and sensitivity on sexual excitations and inhibition in obsessive-compulsive disorder

Sexuality is understudied in Obsessive-Compulsive Disorder (OCD). According to the Dual Control Model, low sexual excitation (SE) and high sexual inhibition (SI) are indicative of a higher probability of experiencing a sexual dysfunction. The present study investigated SE and SI in OCD patients compared with controls. It was hypothesized that OCD patients report lower SE and higher SI than controls. Given their potential role as inhibitors of sexual response, it was hypothesized that in the OCD group higher disgust propensity/sensitivity, contamination/washing symptoms, unacceptable thoughts, and obsessive beliefs predicted lower SE, higher SI due to Threat of Performance Failure, and higher SI due to Threat of Performance Consequences. Seventy-two OCD patients and 72 controls matched on gender/age completed the Disgust Propensity and Sensitivity Scale-Revised, Obsessive Beliefs Questionnaire-46, Obsessive Compulsive Inventory- Revised, and Sexual Inhibition/Sexual Excitation Scales. OCD patients had higher SE, SI due to Threat of Performance Failure, and SI due to Threat of Performance Consequences than controls. In the OCD group, higher disgust sensitivity, SI due to Threat of Performance Consequences, and perfectionism predicted higher SI due to Threat of Performance Failure. Higher SI due to Threat of Performance Failure and contamination/washing symptoms predicted higher SI due to Threat of Performance Consequences. These findings highlight the presence of sexual difficulties in OCD patients, particularly a higher SE and SI. The latter is especially relevant in those patients with higher disgust sensitivity, contamination/washing symptoms and perfectionism. Psychotherapists should assess and target sexuality during clinicalpractice with OCD patients.

Mediating Mechanisms in Cognitive Behavioral Therapy for Childhood OCD: The Role of Dysfunctional Beliefs

Reframing cognitions is assumed to play an important role in treatment for obsessive-compulsive disorder (OCD). However, there hardly is any empirical support for this assumption, especially for children. The aim of this study was to examine if changing dysfunctional beliefs is a mediating mechanism of cognitive behavioral therapy (CBT) for childhood OCD. Fifty-eight children (8-18 years) with OCD received CBT. Dysfunctional beliefs (OBQ-CV) and OCD severity (CY-BOCS) were measured pre-treatment, mid-treatment, post-treatment, and at 16-week follow-up. Results showed that OCD severity and dysfunctional beliefs decreased during CBT. Changes in severity predicted changes in beliefs within the same time interval. Our results did not support the hypothesis that changing dysfunctional beliefs mediates treatment effect. Future studies are needed to replicate these findings and shed more light on the role of explicit and implicit cognitions in treatment for childhood OCD.

Development and Preliminary Psychometric Properties of an Instrument for the Measurement of Obsessional Dissociative Experiences: The Van Obsessional Dissociation Questionnaire (VOD-Q)

A growing body of research evidence documents the substantial associations between obsessive-compulsive disorder (OCD) and dissociation. This article describes the development and preliminary psychometric properties of the Van Obsessional Dissociation Questionnaire (VOD-Q). Obsessional dissociation is defined as a tendency to dissociate in reaction to distressing, unwanted and intrusive thoughts, images and impulses. The screening tool is conceptualized to tap obsessional dissociation across three dimensions: obsessional absorption, obsessional depersonalization/ derealization and obsessional amnesia. The VOD-Q, the Padua Inventory-Revised (PI-R), the Dissociative Experiences Scale (DES), and the Obsessive Belief Questionnaire (OBQ-44) were administered in this study. The results showed that the VOD-Q had excellent test-retest reliability (ranging from 0.73 to 0.90) and internal consistency (ranging from 0.90 to 0.97). The VOD-Q total and subscale scores were significantly associated with measures of obsessive-compulsive symptoms and dissociative experiences. OCD patients scored significantly higher on the VOD-Q than community participants. Based on the present findings, the VOD-Q appears to be a reliable and valid instrument for the measurement of obsessional dissociative experiences.

Change in obsessive beliefs as predictor and mediator of symptom change during treatment of obsessive-compulsive disorder - a process-outcome study

BACKGROUND

Cognitive models of obsessive-compulsive disorder suggest that changes in obsessive beliefs are a key mechanism of treatments for obsessive-compulsive disorder. Thus, in the present process-outcome study, we tested whether changes in obsessive beliefs during a primarily cognitive behavioral inpatient treatment predicted treatment outcome and whether these changes mediated symptom changes over the course of treatment.

METHODS

Seventy-one consecutively admitted inpatients with obsessive-compulsive disorder were assessed with the Yale-Brown Obsessive-Compulsive Scale and the Obsessive Beliefs Questionnaire at treatment intake, after six weeks of treatment and at discharge, and with the Beck-Depression-Inventory-II at intake and discharge.

RESULTS

Changes in obsessive beliefs during the first six weeks of treatment predicted obsessive-compulsive symptoms at discharge when controlling for obsessive-compulsive and depressive symptoms at intake in a hierarchical regression analysis. Multilevel mediation analyses showed that reductions in obsessive beliefs partially mediated improvements in obsessive-compulsive symptoms over time.

CONCLUSIONS

Our findings indicate that decreasing obsessive beliefs in inpatient cognitive behavioral therapy for obsessive-compulsive disorder might be a promising treatment approach.

Symptom Dimensions in Obsessive-Compulsive Disorder and Obsessive Beliefs

BACKGROUND

Obsessive-compulsive disorder (OCD) is a heterogeneous condition with a few major symptom dimensions. These symptom dimensions are thought to have unique clinical and neurobiological correlates. There seems to be a specific relation between OCD symptom dimensions and obsessive beliefs, but the findings are not consistent across studies. There is also a paucity of literature from culturally diverse settings. One of the reasons for the varied findings could be due to the method employed in measuring OCD symptoms.

MATERIALS AND METHODS

In this study, we examined the relation between symptom dimensions and obsessive beliefs using the Dimensional Yale-Brown Obsessive-Compulsive Scale and the Obsessive Beliefs Questionnaire respectively in 75 patients with Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition OCD.

RESULTS

Perfectionism predicted both aggressive and symmetry dimensions whereas responsibility beliefs predicted sexual and religious dimensions.

CONCLUSIONS

The findings suggest that certain obsessive beliefs predicted certain OCD symptom dimensions, but results are not entirely consistent with the published literature suggesting the possibility of cross-cultural variations. That the symptom dimensions have unique belief domains support the argument that symptom dimensions could be targeted to reduce the heterogeneity in etiological and treatment studies of OCD. Therapeutic interventions may have to aim at modifying unique belief domains underlying certain symptom dimensions rather than having generic cognitive-behavioral strategies.

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.

An examination of obsessive-compulsive symptoms and dimensions using profile analysis via multidimensional scaling (PAMS)

Contemporary cognitive models of obsessive-compulsive disorder (OCD) emphasize the importance of various types of dysfunctional beliefs in contributing to OC symptoms, such as beliefs about excessive personal responsibility, perfectionism, and intolerance for uncertainty. The present study seeks to further our understanding of the role of these beliefs by identifying the common profiles of such beliefs, using profile analysis via multidimensional scaling (PAMS). In Study 1, a large student sample (N=4079) completed the 44-item obsessive beliefs questionnaire. One major profile, control of thoughts and perfectionism, was extracted. Study 2 examined profiles of the 87-item obsessive beliefs questionnaire in people with obsessive-compulsive disorder (OCD; n=398), other anxiety disorders (n=104), and a sample of undergraduate students (n=285). Inflated responsibility was a prominent subscale in the profiles of all three groups. Only control over thoughts was a unique subscale in the profile obtained for the OCD group, with this group having lower scores compared to the other groups. The results suggest that while inflated responsibility is a significant subscale in the profile of individuals with OCD, it is not a unique contributor; instead, control over thoughts is unique to OCD. The data, as well as recent research investigating obsessive beliefs, suggest the need to revise the contemporary cognitive model of OCD.