The relationship of cognitive confidence to OCD symptoms

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Abstract

The role of meta-memory and meta-cognition in obsessive–compulsive disorder (OCD) symptoms and checking was examined in a student sample, using the memory and cognitive confidence scale (MACCS; Nedeljkovic, M., & Kyrios, M. (2007). Confidence in memory and other cognitive processes in obsessive-compulsive disorder. Behaviour Research and Therapy, 45, 2899–2914). Confirmatory factor analysis supported the MACCS's previously reported structure, and hierarchical regression supported its relationship to OCD symptom severity over-and-above depression and other OCD-related beliefs. Specifically, general confidence in memory was found to be a unique predictor of overall OCD severity. Implications for theory and research are discussed.

Introduction

Obsessive–compulsive disorder (OCD) is a highly disabling anxiety disorder characterized by persistent and recurrent obsessive thoughts, images, or impulses, and by compulsive and ritualized behaviors (APA, 2000). High levels of doubt, uncertainty and repetitiveness that characterize OCD have led to suggestions that cognitive deficits are involved in the disorder. Neuropsychological theories have proposed that the repetitive and perseverative nature of the symptoms, as well as the constant doubts, reflect the individuals’ inability to remember or monitor previously conducted actions (Otto, 1992). To this end, a number of studies has examined neuropsychological functioning in a range of domains such as verbal and non-verbal memory, and executive function (e.g., Purcell, Maruff, Kyrios, & Pantelis, 1998; Savage et al., 2000). However, findings from many such studies have been inconsistent (Geisberg & McKay, 2003), leading researchers to investigate the role of perceptions and beliefs about one's memory and thinking processes (i.e., meta-memory) in OCD, rather than memory per se.

Meta-cognitive factors – individual's beliefs about, and perceptions of their cognitive and thinking processes – have been placed as a central element in a number of cognitive theories of OCD (Purdon and Clark, 1994, Purdon and Clark, 1999; Wells & Purdon, 1999). One such factor, meta-memory has received increasing attention in OCD research (Muller & Roberts, 2005), in particular in its relevance to checking compulsions (e.g., Rachman, 2002). Recent theory and research have implicated meta-memory factors in OCD and checking (Rachman, 2002, Radomsky et al., 2006; van den Hout & Kindt, 2003b). Deficits in meta-memory (e.g., lowered memory confidence) have been consistently noted among OCD patients (Tuna, Tekcan, & Topcuoglu, 2003), OCD-checkers (McNally & Kohlbeck, 1992) and sub-clinical checkers (Rubenstein, Peynircioglu, Chambless, & Pigott, 1993). Rachman (2002) described meta-memory as a necessary component in the maintenance of checking symptoms, with several subsequent studies offering experimental evidence for a vicious cycle between repetitive checking and lowered memory confidence (Coles, Radomsky, & Horng, 2006; Radomsky et al., 2006, van den Hout and Kindt, 2003b).

While lowered memory confidence is widely recognized as being associated with OCD, particularly with respect to checking compulsions, it has recently been proposed that judgments of lowered confidence reflect a more general belief of inferior cognitive functioning among individuals with OCD. For instance, the revised memory and cognitive confidence scale (MACCS; Kyrios, 1998, Nedeljkovic and Kyrios, 2007), which assesses general beliefs about memory and related processes, was found to be associated with OCD symptoms in a student sample, predicting symptoms over-and-above mood and anxiety. This scale also differentiated individuals with OCD from community controls, with such differences remaining when controlling for depression and anxiety, but not when OCD-symptoms were controlled.

Nedeljkovic and Kyrios (2007) found meta-memory to be multifaceted. Four specific domains were identified, relating to confidence in general memory, decision-making, concentration, and beliefs that one must have perfect cognitive functioning. While there has been some support for the relevance of some of these beliefs in OCD in previous research by Cartwright-Hutton and Wells (1997), they have been conceptualized as representing a unidimensional construct. Such findings indicate that while intercorrelated, the four belief domains may represent specific dimensions of meta-cognition that show distinct patterns of association with OCD symptoms and OCD-related beliefs. Therefore, in this study we aimed to provide (1) further evidence for the validity of the four-factor structure of the proposed meta-memory model using confirmatory factor analysis (CFA); and (2) to further examine the relationship of the MACCS to OCD symptoms and other OCD-relevant beliefs. CFA takes a hypothesis-testing rather than exploratory approach to the analysis of data (Byrne, 2001). In the current study, the proposed multidimensional construct of meta-memory was tested against the alternative unidimensional model. It was expected that the multidimensional meta-memory model would provide a better fit than a unifactorial model, confirming the multifaceted nature of meta-memory.

It was further anticipated that the MACCS scale and subscales would correlate significantly with scores on measures of OCD symptoms, mood and anxiety and OCD-relevant beliefs. It was hypothesized that MACCS subscales would significantly predict OCD symptoms over and above depressive and anxiety symptoms and other OCD-related beliefs.

Section snippets

Participants

There were 250 student participants (206 females) in this study (M age = 21 years, S.D. = 7.24, range 16–62 years). All participants reported no current psychiatric diagnosis, with the majority of the sample scoring in the mild to moderate range on the symptom measures. A small proportion of participants scored within the severe range for OCD symptoms (i.e., 3% had YBOCS scores >15) and low mood (i.e., 4% with Beck Depression Inventory-II (BDI-II) scores >28), demonstrating a range of symptom

Results

Analysis was performed using SPSS version 14.0 and AMOS 6. Some MACCS items had large Skewness and Kurtosis ratios (>3) and transformation did not improve normality. However, studies have found that parameter estimates remain valid in SEM even when the data are not normal (see, McDonald & Ho, 2002), and therefore the CFA was undertaken using raw variables. All cases had Cook's distance values of less than 1 and hence were retained for the analyses. A small number of missing values (<1%) were

Discussion

This study aimed to support the multifaceted nature of a measure of meta-memory proposed in Nedeljkovic and Kyrios (2007), and to further examine the relationship between confidence in memory and OCD severity. Results supported the hypothesized multidimensional model of meta-memory, incorporating dimensions of confidence in general memory, decision-making and concentration abilities, and perfectionistic standards about cognitive performance, with all scales showing satisfactory internal

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