Aversive intrusive thoughts as contributors to inflated responsibility,

intolerance of uncertainty, and thought-action fusion

Graham C L Davey, Frances Meeten, Georgina Barnes & Suzanne R Dash

University of Sussex, UK

What are Clinical Constructs?

• “Inferred states or processes derived most often from the clinical experiences of researchers or clinicians in their interactions with patients” (Davey, 2003)

• Clinical Constructs have various functions:o To help understand psychopathology symptomso To provide a basis for developing interventionso To link thoughts, beliefs and cognitive processes to

subsequent symptoms (often in an implied causal manner)

Examples of Clinical Constructs in OCD

Research• Inflated Responsibility (Salkovskis, 1985)• Intolerance of Uncertainty (Dugas et al., 1998)• Thought-Action Fusion (Shafran & Rachman,

2002)

Inflated Responsibility

• “The belief that one has the power to bring about or prevent subjectively crucial negative outcomes” (Rachman, 1998; Salkovskis, 1985)

Intolerance of Uncertainty (IU)

• A “dispositional characteristic that arises from a set of negative beliefs about uncertainty and its connotations and consequences” (Birrell et al., 2011, p1200) and is underpinned by beliefs such as ‘uncertainty is dangerous/intolerable’ (Koerner & Dugas, 2006)

Thought-Action Fusion (TAF)

• A set of cognitive distortions involving erroneous and maladaptive beliefs about the relationship between mental events and overt behavior, and specifically that thinking unacceptable thoughts (e.g. having sex with a parent; thinking about one’s house burning down) are either moral equivalents of performing unacceptable behaviour or will increase the probability of that event happening (Berle & Starcevic, 2005; Shafran et al., 1996)

The Present Studies

• Previous research has demonstrated a causal effect of Constructs such as RESP, IU and TAF on OCD symptoms

• Present studies reversed this experimental procedure

• Investigated the effect of “symptoms” (thinking forced aversive thoughts) on measures of Constructs such as IR, IU and TAF

Experiment 1• Exposure to Obsessive Aversive Thoughts (28

obsessive statements vs 4 obsessive/24 neutral statements)in a nonclinical population

• Effects on measures of:o Inflated Responsibility (Responsibility Attitude Scale)o Intolerance of Uncertainty (Intolerance of Uncertainty Scale)o Thought-Action Fusion (Thought Fusion Instrument, TFI)

• Constructs measured (1) on composite VAS scales, and (2) on full validated questionnaires

Statements• Aversive Statements

o “I will harm someone I love”o “I will push someone under a train or bus”

• Neutral Statementso “I will have my usual breakfast”o “I will meet someone I know”

• Rachman & DeSilva (1978); Berry & Laskey (2012)

Results – Experiment 1

Mean composite ratings of RESP (p<.05), IU (ns) and TAF (p<.05) by high and low obsessive thought groups

Results – Experiment 1

Mean full questionnaire scores for RAS (p<.05), IUS (ns) and TFI (p<.05) for high and low obsessions groups

Experiment 2

• Exposure to Obsessive Aversive Thoughts (28 obsessive statements vs 4 obsessive/24 neutral statements)in a nonclinical population

• Self-relevant vs Non-self-relevant• Effects on measures of:

o Inflated Responsibility (Responsibility Attitude Scale)o Intolerance of Uncertainty (Intolerance of Uncertainty Scale)o Thought-Action Fusion (Thought Fusion Instrument, TFI)

• Constructs measured (1) on composite VAS scales, and (2) on full validated questionnaires

Results – Experiment 2

Mean composite ratings of RESP (ns), IU (sig effect of Obsessions + interaction) and TAF (sig effect of Obsessions) by high and low obsessive thought groups

Results – Experiment 2

Mean full questionnaire scores for RAS (sig interaction, p<.05), IUS (sig Main effect of obsessions, p<.05) and TFI (sig interaction, p=.05) for high and low obsessions groups

High Obsessions/Self-Referent Groups

• RAS scores were comparable to obsessional and anxious clinical samples

• TFI scores were higher than control norms but not as high as clinical population norms

• Scores on the IUS were higher that student population norms, but not as high as clinical norms

Mediating Factors

• No clear mediation models were observed• In some cases negative mood (sadness and

anxiety) significantly mediated Responsibility measures (e.g. Experiment 1)

• In other cases, construct measures (e.g. TAF and IU) mediated the relationship between obsession group and sadness/anxiety

Conclusions• Experiencing aversive uncontrollable thoughts may

facilitate appraisal processes directly implicated in OCD• Appraisals such as RESP, IU and TAF would not

necessarily have to be etiological precursors of OCD symptoms

• Bidirectionality would be expected if symptoms, constructs and negative moods are all part of a functional ‘threat management’ network

• The development of clinical constructs may need more care to prevent adaptive processes being confused with dysfunctional symptoms in the construct’s definition