Thought–action fusion: Review of the literature and future directions
Introduction
Thought–action fusion (TAF) is one of a number of cognitive variables that have been extensively researched in relation to obsessive-compulsive disorder (OCD) and other anxiety disorders in recent years. The impetus for the increasing attention paid to cognitive constructs in OCD has been a dissatisfaction with the traditional concept of OCD as a condition in which compulsions develop with the main purpose of alleviating anxiety. Clinical experience and research have repeatedly indicated that underlying beliefs and appraisals are often intervening factors between obsessions and compulsions and that they often play a role in maintaining OCD. It has been suggested that understanding the role of TAF may lead to more focused or effective psychological interventions for OCD and other disorders (Rachman, 1997).
TAF refers to the belief that thoughts and actions are inextricably linked. “Moral” TAF is the belief that unacceptable thoughts are morally equivalent to overt unacceptable actions. “Likelihood” TAF refers to the belief that certain thoughts cause particular events, or at least increase the likelihood of such events occurring. Two domains of likelihood TAF have been proposed: “likelihood self,” which refers to events occurring to oneself, and “likelihood others,” which refers to events occurring to others, as a consequence of one's thoughts.
Although the term “thought–action fusion” is recent, it was preceded by related concepts of magic and magical thinking, which were used by anthropologists, classical psychoanalytic writers and authors such as Piaget. The contemporary TAF concept arose from Rachman's (1993) and Salkovskis' (1985) theories and clinical observations of patients with obsessional thinking, where it was noticed that OCD patients assume that a “thought is like an action” (Salkovskis, 1985, p. 574). Shafran, Thordarson, and Rachman (1996) first formally introduced and investigated the concept. They developed a measure of TAF that has been incorporated into most subsequent research.
This review aims to summarize the extant literature on TAF. Conceptual issues will be explored and measurement of the concept of TAF reviewed. Studies of TAF in relation to OCD, other psychopathology and special populations will be examined. The development of TAF beliefs will be reviewed, and this will be followed by the discussion of potential therapy interventions to reduce TAF-related symptoms.
Section snippets
Unity of the TAF construct
Although TAF moral and TAF likelihood appear to be relatively distinct constructs, Rachman and Shafran (1999) have outlined how they might be intertwined. For instance, individuals who believe their thoughts have increased the likelihood of a negative event occurring to someone else, will often also form conclusions about their own morality for having thought something that could be harmful to others. Shafran et al. (1996) reported that the TAF moral and TAF likelihood factors of their TAF
Assessment and measurement of TAF beliefs
Good understanding of any cognitive phenomenon or construct requires development of an adequate instrument for assessing and measuring it. Such an instrument would have to demonstrate good reliability and validity before the results derived from its use can be fully accepted and the consequent inferences about the phenomenon or construct made.
With few exceptions, the majority of TAF studies have relied upon the Thought Action Fusion scale (TAF scale). The scale was developed by Shafran et al.
TAF in obsessive-compulsive disorder
Of the range of cognitive biases that have been investigated in anxiety disorders, the TAF construct holds particular appeal when considering OCD. Distress in OCD is typically triggered by the occurrence of particular ego-dystonic thoughts. This is consistent with the importance of thoughts implied by TAF. Additionally, the mental and behavioral compulsions of OCD often appear to be a way of preventing the consequences of a thought or of reassuring oneself of the morality of one's character.
TAF in other disorders
A tendency to ascribe immense importance to thoughts is considered characteristic of OCD. However, beliefs about the importance and truth of certain thoughts also appear to be common in other disorders. TAF might therefore play a part in other types of psychopathology as well.
TAF in other cultures
The cultural context is especially important when investigating TAF beliefs, magical thinking and related constructs. What is considered magical thinking and immoral thinking may differ between cultures (Einstein & Menzies, 2004a). Cross-cultural validation of existing TAF measures, or the development of alternative culture-specific measures, is therefore important. Aside from Rassin, Merkelbach et al.'s (2001) replication of the psychometrics of the TAF scale in a Dutch sample, Yorulmaz et al.
Development of TAF beliefs
There is a dearth of research investigating factors that may contribute to the development of TAF beliefs. This is understandable given that beliefs such as TAF may develop from numerous subtle and interacting factors occurring over many years (Salkovskis et al., 1999).
It is possible that two of the factors hypothesized by Salkovskis et al. (1999) to contribute to elevated responsibility beliefs may also play a part in the development of TAF beliefs. For instance, TAF moral may arise from
Implications for therapy
Given that TAF appears to play a part in the development or maintenance of symptoms in OCD and possibly in other disorders, recent research has investigated whether TAF beliefs are sensitive to therapy. Educational and cognitive therapy approaches hold much appeal.
The study of Zucker et al. (2002) described earlier provides evidence that educational interventions may reduce anxiety and endorsement of TAF beliefs. The intervention consisted of reading a script to participants. The script
General conclusions and suggestions for future research
Investigating TAF is important for better understanding of the genesis and maintenance of particular disorders, as well as for improving treatment options.
As a construct, TAF appears to encompass separate but related moral and likelihood factors. TAF likelihood appears to be most closely related to symptoms of OCD and other anxiety disorders, whereas TAF moral appears to be most closely associated with depressive symptoms. It remains to be determined whether TAF is an appraisal style, a belief,
Acknowledgement
Emily Phillips is thanked for her editorial assistance.
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