Obsessive-compulsive symptoms: the contribution of metacognitions and responsibility

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Abstract

Two different cognitive models of obsessive-compulsive symptoms were evaluated. One model [Salkovskis, P. M. (1985). Obsessional-compulsive problems a cognitive-behavioral analysis. Behaviour Research and Therapy, 23, 571–583.] gives a central and necessary role to beliefs and appraisals concerning responsibility. The other [Wells, A. (1997). Cognitive therapy of anxiety disorders: a practice manual and conceptual guide. Chichester, UK: Wiley.] attaches a central and necessary role to metacognitive beliefs about the meaning and danger of thoughts/feelings and the need for control. We tested the unique contributions of responsibility or metacognitions to obsessive-compulsive symptoms whilst controlling for their intercorrelations and worry. Consistent with each model, responsibility and metacognitions were positively associated with obsessive-compulsive symptoms, even when worry was controlled for. However, responsibility was not associated with obsessive-compulsive symptoms when metacognitions and worry were controlled, but the relationship between metacognitive beliefs and obsessive-compulsive symptoms was independent of responsibility and worry. Responsibility did not add anything to the variance in symptoms explained by metacognitions. The data provide further support for the metacognitive model.

Introduction

The metacognitive (Wells, 1997) and responsibility (Salkovskis, 1985) models converge on the idea that a central feature of obsessive-compulsive disorder consists of negative interpretations of intrusive thoughts. However, there are several important differences between these models such as the emphasis given to different types of beliefs. The responsibility model emphasizes the construct of inflated responsibility as the central cognitive component driving obsessional problems (Salkovskis, 1985). Responsibility is defined as: “The belief that one has power which is pivotal to bring about or prevent subjectively crucial negative outcomes. These outcomes may be actual, that is having consequences in the real world, and/or at a moral level” (Salkovskis, Richards, & Forrester, 1995, p. 285). Salkovskis et al. (2000) devised the Responsibility Attitude Scale to assess their construct. The scale consists of items such as the following: “I often feel responsible for things which go wrong” and “Everything I do can cause serious problems”. The construct of responsibility does not refer chiefly to metacognitive beliefs, that is, beliefs about thoughts. Moreover, it does not imply a distinction between different types of metacognitive beliefs.

In contrast, the metacognitive model (Wells, 1997, Wells, 2000; Wells & Matthews, 1994) emphasizes beliefs about the importance, meaning and power of thoughts, and beliefs about the need to control thoughts and perform rituals. In this model responsibility is seen as largely a consequence of metacognitive beliefs about thoughts that adds little to specifically explaining obsessional problems. Metacognitive beliefs about thoughts can be measured with instruments including the Metacognitions Questionnaire (MCQ: Cartwright-Hatton & Wells, 1997; Wells & Cartwright-Hatton, 2004), and the Thought Fusion Instrument (TFI: Wells, Gwilliam, & Cartwright-Hatton, 2001). The MCQ assesses a range of metacognitions relevant to worry and intrusive thoughts, but chiefly focuses on beliefs about worry. The TFI was devised to assess three domains of metacognitive beliefs about thoughts implicated in the metacognitive model of OCD. These have been termed Fusion beliefs, in keeping with the idea of “Thought Action Fusion” introduced by Rachman (1993): “Fusion refers to the psychological phenomenon in which the patient appears to regard the obsessional activity and the forbidden action as being morally equivalent”. The metacognitive model identifies at least three domains of fusion beliefs: (1) Thought Event Fusion (TEF) the belief that having a thought means that an event is happening, will make the event happen, or means that the event must have happened already. An example item is: “If I think about an unpleasant event it means it must have happened”. (2) Thought Action Fusion (TAF) the belief that having certain thoughts will lead to the uncontrollable commission of unwanted acts. For example, “If I have thoughts about harming myself I will end up doing it”. (3) Thought Object Fusion (TOF), which is the belief that thoughts, feelings and memories can be transferred into objects and/or caught from objects. For example, “My memories/thoughts can be passed into objects”. In addition to fusion related metacognitions, the model also posits that other metacognitive factors such as beliefs about rituals (e.g. need to control thoughts) and use of dysfunctional internal criteria for guiding cognition and behavior contribute to the development and persistence of o-c problems.

Gwilliam, Wells, and Cartwright-Hatton (2004) showed that metacognitive beliefs predicted o-c symptoms but responsibility did not when their interrelationship was controlled. This suggests that responsibility may be an emergent property of metacognitive beliefs in the context of obsessions. In the present study we aimed to further test the relative and independent contributions of metacognitive beliefs and responsibility to o-c symptoms. Gwilliam et al. (2004) used the Responsibility Appraisal Questionnaire (RAQ2: Rachman, Thordarson, Shafran, & Woody, 1995) to assess responsibility. This may not capture fully the construct of responsibility. In this study we aimed to use the Responsibility Attitude Scale (Salkovskis et al., 2000) as an alternative means of assessing the responsibility construct since this measure is based directly on the conceptualisation of responsibility in Salkovskis’ model. In testing for associations between obsessive-compulsive (o-c) symptoms and predictor variables it is necessary to control for the variance these constructs share with worry since any relationship may be spurious and due to overlap with worry rather than being specific to o-c symptoms.

The following hypotheses were tested:

  • (1)

    Metacognitive beliefs and responsibility will each be positively correlated with o-c symptoms.

  • (2)

    Metacognitive beliefs will be positively correlated with responsibility.

  • (3)

    The relationship between responsibility beliefs and o-c symptoms after worry is controlled, will be dependent on metacognition (i.e. responsibility will not add significantly to predicting o-c symptoms when worry and metacognition are controlled).

  • (4)

    The relationship between metacognitive beliefs and o-c symptoms after worry is controlled, will be independent of responsibility (i.e. metacognition will add significantly to predicting symptoms when worry and responsibility are controlled).

Section snippets

Measures

To explore the relationships between responsibility, metacognitions and obsessive-compulsive symptoms while controlling for worry, the following measures were used:

  • (1)

    The Responsibility Attitude Scale (RAS: Salkovskis et al., 2000) is a 26-item self-report scale that measures beliefs about responsibility. Subjects indicate how much they agree with each item and respond on a seven-point scale ranging from 1 (totally disagree) to 7 (totally agree). There are no subscales. The items consist of

Correlational analyses

Pearson intercorrelations between the predictor variables and between these and the dependent variables are displayed in Table 1. As in previous studies worry was significantly and positively correlated with obsessional symptoms as measured by the MOCI and PI-WSUR. Worry also correlated with responsibility and each measure of metacognitions. These relationships with worry underscore the importance of controlling for worry in exploring the cognitive predictors of o-c symptoms, an approach that

Discussion

This study aimed to investigate relationships between responsibility, metacognition, and o-c symptoms. The relative independent contributions of metacognitions and responsibility cognitions were tested. In so doing we controlled for intercorrelations between worry and obsessional symptoms, and the predictor variables.

Responsibility, as measured by the RAS, was positively associated with o-c symptoms, as found in previous studies (Salkovskis et al., 2000; Smari & Holmsteinsson, 2001). Similarly,

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