Thought–action fusion in individuals with OCD symptoms

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Abstract

Rachman (Rachman, S. (1993). Obsessions, responsibility, and guilt. Behaviour Research and Therapy, 31, 149–154) suggested that patients with OCD may interpret thoughts as having special importance, thus experiencing thought–action fusion (TAF). Shafran, Thordarson and Rachman (Shafran, R., Thordarson, D. S. & Rachman, S. (1996). Thought–action fusion in obsessive compulsive disorder. Journal of Anxiety Disorders, 710, 379–391) developed a questionnaire (TAF) and found that obsessives scored higher than non-obsessives on the measure. In the current study, we modified the TAF to include a scale that assessed the “likelihood of events happening to others” as well as ratings of the responsibility and cost for having these thoughts. Replicating previous findings, we found that individuals with OC symptoms gave higher ratings to the likelihood of negative events happening as a result of their negative thoughts. Individuals with OC symptoms also rated the likelihood that they would prevent harm by their positive thoughts higher than did individuals without OC symptoms. These results suggest that the role of thought–action fusion in OCs may extend to exaggerated beliefs about thoughts regarding the reduction of harm.

Introduction

Rachman (1993) suggested that patients with OCD may fuse actions and thoughts. That is, these individuals may be more likely than non-anxious individuals to consider a thought about a negative event as synonymous with the occurrence of the actual negative event. This concept may aid in explaining the maintenance, and possibly the etiology of, OCD for at least two reasons. First, if individuals with OCD believe that thinking about an unacceptable or disturbing event makes the event more likely to occur in reality, they may engage in rituals to prevent the negative consequence. Second, such individuals may believe that obsessional thoughts and negative acts are morally equivalent, thus feeling distress for having the negative thought. Research with clinical populations, as well as non-clinical populations with elevated scores on measures of OCD, supports the utility of the thought–action fusion construct (Rachman, Thordarson, Shafran & Woody, 1995).

This research has used the Thought–Action Fusion Scale (TAFS), a psychometrically valid measure of the construct. The TAFS comprises three subscales: TAF-Moral (TAFM; 12 items) (e.g., “If I wish harm on someone, it is almost as bad as doing harm”), TAF-Likelihood-Self (TAFLS; three items), (e.g., “If I think of myself being injured in a fall, this increases the risk that I will have a fall and be injured”), and TAF-Likelihood-Other (TAFLO; four items), (e.g., “If I think of a friend or relative having a car accident, this increases the risk that he/she will have a car accident”).

In two experiments, Shafran, Thordarson and Rachman (1996) found that obsessionals, i.e., individuals with scores of 11 or higher on the Maudsley Obsessional Compulsive inventory (MOCI; Hodgson & Rachman, 1977), had higher scores on the TAF-Likelihood than a sample of students and community volunteers. Furthermore, results of correlation analysis revealed that the TAF-Likelihood scores were positively correlated with severity of OC symptoms, as measured by the MOCI. Thus, there are both theoretical and empirical reasons to believe that the fusion of thoughts and actions, as measured by the TAFS, is an important construct in OCD. In addition, there is evidence that thought–action fusion may be experimentally induced (Rassin, Merckelbach, Muris & Spaan, 1999).

There are, however, a number of alternative explanations that must be ruled out in order to strengthen the notion of an association between TAF and OC symptoms. First, is the fusion of thoughts and actions in OCD confined to disastrous consequences of thoughts about negative events? Or do individuals with OC symptoms believe that their thoughts about positive events are capable of producing positive outcomes, possibly preventing harm? Shafran et al. (1996) had OCs evaluate positive events (e.g., “If I think of winning the lottery, that will increase the chance that I will win the lottery”), but suggested that these items were of little relevance to OCD and therefore eliminated them from a revised version of the TAFS. However, individuals with OC symptoms are more concerned about the positive outcomes of their harm prevention efforts rather than actual gains of a positive outcome from their thoughts.

Second, do individuals with OC symptoms rate negative events as more costly? If individuals with OCD rate negative events as more costly, then this exaggerated sensitivity to negative cost may explain their tendency to equate thoughts about negative events with the actual negative event. Alternatively, their tendency to equate thoughts and actions may explain their tendency to assign higher negative cost to negative thoughts than do non-anxious individuals. Because the TAFS does not inquire about the cost, or negative value, assigned to the negative events, it is not possible to examine these two alternative explanations.

Finally, do individuals with OC symptoms believe that having negative thoughts has consequences for their self-view? Perhaps they feel more responsible for having thoughts of negative events than do non-anxious individuals, thinking that these thoughts indicate that they are “a bad person”. Because of the prominent role of responsibility in current models of OCD (e.g., Salkovskis, 1989), it is likely that individuals with OCD take responsibility for having these negative thoughts and hence assign more importance to having them. This increased importance may explain the exaggerated tendency to fuse thoughts and actions.

The purpose of the current study was to modify the TAF questionnaire to address the questions raised above. Specifically, we expanded the “likelihood of events happening to others” subscale to include thoughts about positive events and thoughts involving prevention of harm (harm avoidance). We also added rating scales for the cost of the negative and positive events and the implication of having the thought for self-view. This last modification was designed to assess the extent of responsibility the individual felt for the thought. We report on the psychometric properties of the revised TAF and examine the internal consistency of the measure by recruiting a large number of undergraduate students. To examine the discriminate validity of the measure, we compared the scores of individuals with and without OCD symptoms in two experiments.

Section snippets

Participants

A total of 424 undergraduates students at the University of Georgia comprised the sample.

Internal consistency

All subscales had adequate coefficient alphas. These data, as well as the items for each subscale are presented in Table 1

Correlational analysis

We correlated subscales of the new TAF questionnaire with measures of psychopathology (e.g., depression, anxiety and OC symptoms). Consistent with previous research, the TAF subscales were correlated with measures of OC symptoms, depression, and anxiety. These data are summarized in Table 2.

Discriminate validity

To examine the discriminate validity of the TAF-R, we compared scores of individuals

Participants

Participants in the first study were a total of 126 undergraduate students at the University of Georgia who received partial course credit for their participation.

Group comparisons

In order to conduct group comparisons in individuals with and without OCD symptoms, we used the Obsessive Compulsory Inventory (OCI: Foa, Kozak, Salkovskis, Coles & Amir, 1998) to classify subjects based on their scores. We used a frequency-weighted distress cut-off criteria recommended by the authors of the scale. To do so, we first

Study 2: thought–action fusion in individuals with OC symptoms — a replication

The purpose of the second experiment was to replicate the findings from the first study.

General discussion

Previous research has established the utility of the thought–action fusion construct in individuals with OC symptoms. In the current study, we addressed three specific questions that may clarify the role of TAF in OCD. First, is the fusion of thoughts and actions in OCD confined to disastrous consequences of thoughts about negative events, or do individuals with OC symptoms believe that their thoughts about positive events are capable of producing positive outcomes, possibly preventing harm? We

Acknowledgements

The preparation of this manuscript was supported by faculty development grants from the University of Georgia Institute for Behavioral Research (IBR) and University of Georgia Research Foundations Inc. awarded to the first author.

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