Anxiety control and metacognitive beliefs mediate the relationship between inflated responsibility and obsessive compulsive symptoms
Introduction
One of the pillars of the cognitive model of obsessive compulsive disorder (OCD) assumes that intrusive ideas of contamination, guilt and other typically obsessive doubts are catastrophically misinterpreted as intrinsically “true” (Frost and Steketee, 1997). For individuals affected with OCD, thinking about contamination automatically means being contaminated. Given that non clinical individuals also experience mental intrusions and do not interpret them catastrophically, such misinterpretations are pivotal for the development of the OCD (Rachman and de Silva, 1978, Salkovskis, 1985). In turn, catastrophic misinterpretations often lead to an intense use of thought-control strategies that paradoxically increase the frequency of intrusions ultimately resulting in fully developed OCD symptomatology (Clark and Purdon, 1993, de Silva and Rachman, 1992, Salkovskis, 1985).
An individual׳s inflated sense of responsibility (Salkovskis, 1985), described as a person׳s tendency to believe that they may be pivotally responsible for causing or failing to prevent harm to themselves or others, has been identified as one of the key beliefs driving obsessive misinterpretations of intrusive thoughts. Indeed the inflated sense of responsibility has been linked to the development of patterns of response that include attempts to neutralise the mental and fearful intrusions of “un-responsibility” (interpreted as moral equivalents of carrying out un-responsible actions) and reduce the distress caused by them (Rachman, 1997, Shafran et al., 1996, Salkovskis et al., 2000). From a broader cognitive viewpoint, individuals with OCD hold the belief that harm is always preventable and people are morally responsible when they fail to prevent harm.
Adrian Wells (2000) has argued that a different set of beliefs from beliefs about inflated responsibility may be crucial in understanding the development of maladaptive response patterns in OCD. He argues that metacognitive beliefs about need to control thoughts (e.g. “I need to control my thoughts at all times”) give rise to an ‘inflation’ of the importance of the occurrence of intrusions which may be misinterpreted as indicating loss of self-control and lead to invoke rituals as a means of achieving, albeit temporarily, a degree of mental control.
Recent studies have shown that beliefs about the need to control thoughts do contribute to obsessional symptoms independently of beliefs about inflated responsibility, perfectionism and other types of anxious disturbance (Myers and Wells, 2005; Myers et al., 2008). Beliefs about the need to control thoughts are metacognitive due to the fact that they can be considered beliefs about intrusions. They represent a core element in the metacognitive model of OCD (Fisher and Wells, 2008).
It is noteworthy that the construct of beliefs about the need to control thoughts described in the metacognitive model of OCD has parallels with the broader construct of beliefs about perceived control over anxiety-related events and reactions, defined as ‘anxiety control’ (Rapee et al., 1996). Anxiety control distinguishes external and internal distinction stimuli to be controlled: external threat such as difficult or scary situations and internal anxiety reactions such as heart palpitations and feelings of panic. Anxiety control has been shown to be relevant across a range of anxiety disorders (Rapee et al., 1996, Ruggiero et al., 2012).
No research, to date, has explored the relative contribution of anxiety control and beliefs about the need to control thoughts in predicting obsessive compulsive symptoms. We set about investigating this by: (1) exploring whether beliefs about inflated responsibility, anxiety control and beliefs about the need to control thoughts would differ between clinical and non-clinical participants; and (2) testing a model, in the combined participant samples, in which beliefs about inflated responsibility would predict anxiety control and beliefs about the need to control thoughts, which in turn would predict obsessive compulsive symptoms.
The above model is theoretically plausible because beliefs about inflated responsibility imply (but do no account for explicitly) the need to control both mental states and external actions. Indeed, it has already been argued that beliefs about inflated responsibility may be too general a construct to be considered as a basis for understanding the specific cognitive ‘control’ factors leading to obsessive-compulsive symptoms (Myers and Wells, 2005). In other words, the effect of infalted responsibility may be transmitted to obsessive-compulsive symptoms but through more specific constructs directly related to anxiety control and beleifs about the need to control thoughts. This view is in line with the recent and growing focus on transdiagnostic conceptualisations of emotional distress in which perceived control plays a core and mediating role in predicting anxiety symptoms (Boisseau et al., 2010; Hayes, 2002; Wells, 2000).
Section snippets
Participants
Two groups of participants were recruited to the study. The clinical group comprised of 36 participants (22 females; mean age 34.08±9.92 years) meeting diagnostic criteria for OCD (Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text rev.; American Psychiatric Association, 2000). Additional criteria for inclusion in the study were a minimum age of 18 years, and adequate written language abilities. The sample was recruited from a population that was undergoing initial assessment
Data configuration and tests of difference
Examinations of skewness and kurtosis, as well as tests of normality, revealed that the distributions of the experimental variables were non-normal. As a consequence, a series of Mann Whitney U tests were conducted to identify significant differences between the clinical and non-clinical groups across the experimental variables (see Table 1). These analyses revealed that participants in the clinical group scored significantly higher than those in the non-clinical group on all variables.
Mediation multiple regression analysis
Data was
Discussion
The results support a model in which beliefs about inflated responsibility, as described by Salkovskis (1985), predict obsessive compulsive symptoms through the mediation of both anxiety control and beliefs about the need to control thoughts. These findings thus provide further support for ‘control’ models of OCD (Rapee et al., 1996, Wells, 2008) and emphasise how beliefs about control are of greater importance than the content of beliefs systems (e.g. beliefs about inflated responsibility) in
Acknowledgements
We acknowledge the support provided by the Cognitive Psychotherapy Schools “Studi Cognitivi” and “Psicoterapia e Ricerca” of Milano, Italy, by the School of Applied Sciences of the London South Bank University, by the Azienda Sanitaria di Bolzano, Bolzano, Italy, by the University of Milano-Bicocca of Milano, Italy, and by the Macquarie University of Sydney, Australia.
References (34)
- et al.
The structure of perceived emotional control: psychometric properties of a revised anxiety control questionnaire
Behavio Therapy
(2004) - et al.
Revision of the padua inventory of obsessive compulsive disorder symptoms: distinctions between worry, obsessions, and compulsions
Behaviour Research and Therapy
(1996) - et al.
Metacognitive therapy for obsessive-compulsive disorder: a case series
Journal of Behaviour Therapy and Experimental Psychiatry
(2008) - et al.
Obsessive-compulsive symptoms: the contributions of metacognitions and responsibility
Journal of Anxiety Disorders
(2005) A cognitive theory of obsessions
Behaviour Research and Therapy
(1997)- et al.
Measurement of perceived control over anxiety-related events
Behavior Therapy
(1996) - et al.
Beliefs over control and meta-worry interact with the effect of intolerance of uncertainty on worry
Personality and Individual Differences
(2012) - et al.
Responsibility attitudes and interpretations are characteristic of obsessive compulsive disorder
Behaviour Research and Therapy
(2000) Obsessional-compulsive problems: a cognitive-behavioural analysis
Behaviour Research and Therapy
(1985)Obsession and compulsion: the padua inventory
Behaviour Research and Therapy
(1988)
Thought-action fusion in obsessive compulsive disorder
Journal of Anxiety Disorders
Measuring metacognitions associated with emotional distress: factor structure and predictive validity of the Metacognitions Questionnaire 30
Personality and Individual Differences
A short form of the metacognitions questionnaire: properties of the MCQ-30
Behaviour Research and Therapy
Another look at the psychometric properties of the anxiety control questionnaire
Behaviour Research and Therapy
Multiple Regression: Testing and Interpreting Interactions
Diagnostic and Statistical Manual of Mental Disorders (DSM IV)
The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations
Journal of Personality and Social Psychology
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2016, Journal of Obsessive-Compulsive and Related DisordersCitation Excerpt :Further support for the causal role of metacognition in OCD comes from experimental manipulations of metacognitive beliefs (e.g. Fisher & Wells, 2005; Myers & Wells, 2013), and that changes in metacognitive beliefs determine if patients recover when treated with psychological approaches (Solem et al., 2009). Overall, most of the research has been conducted on non-clinical samples, which may mean that the generalizability of the results to clinical samples is limited, although the studies which have been conducted on OCD patients (Hermans et al., 2008; Moritz et al., 2010; Sassaroli et al., 2015; Solem et al., 2009) are supportive of the predictions made by the metacognitive model. An important foundation of research is the use of measurement tools that are psychometrically sound.