Search

Individuals with social anxiety disorder (SAD) often report a fear that they will lose control of their emotions or report intense, unpleasant thoughts or images of uncontrollably humiliating themselves in social situations. These fears and associated beliefs that one is likely to lose control may underlie the anxiety and/or cognitive biases (e.g., self-focused attention and negative post-event processing) experienced during and following social situations. The present experiment examined whether manipulating beliefs about losing control would cause changes in symptoms of SAD.One hundred and twenty-six undergraduate psychology students were given false feedback that they were either at high or low risk of losing control, and then completed a social interaction task with an actor. Participants rated their anxiety before and during the interaction and completed a post-event processing questionnaire 24-hours later.Participants in the high beliefs about losing control (HLC) condition reported significantly greater subjective anxiety than those in the low beliefs about losing control (LLC) condition leading up to the social interaction task, and significantly more negative post-event processing.Results suggest beliefs about losing control may play a causal role in the development and maintenance of SAD. These beliefs may represent a novel domain to be targeted in CBT.The online version contains supplementary material available at 10.1007/s10608-022-10325-w.

Social anxiety is associated with increased and decreased alcohol use. Alcohol expectancies may help explain these inconsistencies. For example, a fear of losing control in front of others could motivate avoidance of alcohol. Similarly, cognitive models propose that individuals with elevated social anxiety believe they are at risk of behaving inappropriately and embarrassing themselves, indicating that beliefs about losing control over one’s behaviour may be involved in social anxiety. This experiment aimed to manipulate negative alcohol expectancies about losing control to assess their impact on symptoms and processes associated with social anxiety. Ninety-three undergraduate participants (i.e., non-clinical sample) were randomly assigned to an alcohol, placebo, or control condition and were ‘informed’ that alcohol makes people lose control over their actions/speech. They then completed a ‘getting to know you’ task. Participants in the placebo and alcohol (versus control) conditions experienced greater anxiety before and during the task and engaged in more post-event processing 24 h later. However, the physiological effects of alcohol influenced results: participants in the alcohol (versus placebo) condition experienced lower anticipatory anxiety, perceived themselves as making a better first impression, and demonstrated a lower reliance on safety behaviour. Although this experiment used a non-clinical sample, beliefs about losing control may be important to consider when conceptualizing social anxiety and treating associated symptoms from a cognitive-behavioural framework.

Background:Reassurance seeking (RS) is motivated by perceived general and social/relational threats across disorders, yet is often under-recognized because it occurs in covert (i.e. subtle) and overt forms. Covert safety-seeking behaviour may maintain disorders by preventing corrective learning and is therefore important to identify effectively.Aims:This study presents the validation and psychometric analyses of a novel measure of covert and overt, general and social/relational threat-related interpersonal RS.Method:An initial 30-item measure was administered to an undergraduate sample (N = 1626), as well as to samples of individuals diagnosed with obsessive compulsive disorder (OCD; n = 50), anxiety disorders (n = 60) and depression (n = 30). The data were subjected to exploratory and confirmatory factor analyses, and validation analyses.Results:An exploratory factor analysis using principal axis factoring with oblique rotation yielded five interpretable factors, after removing four complex items. The resulting 26-item measure, the Covert and Overt Reassurance Seeking Inventory (CORSI), evidenced good convergent and divergent validity and accounted for 54.99% of the total variance after extraction. Factor correlations ranged from r = .268 to .736, suggesting that they may be tapping into unique facets of RS behaviour. In comparison with undergraduate participants, all clinical groups had significantly higher total scores [t (51.80–840) = 3.92–5.84, p < .001]. The CFA confirmed the five-factor model with good fit following the addition of four covariance terms (goodness of fit index = .897, comparative fit index = .918, Tucker–Lewis index = .907, root mean square error approximation = .061).Conclusion:The CORSI is a brief, yet comprehensive and psychometrically strong measure of problematic RS. With further validation, the CORSI has potential for use within clinical and research contexts.

Social anxiety disorder (SAD) is often conceptualized as arising from maladaptive cognitions. One cognitive domain that has received relatively little attention, despite endorsement from people struggling with social anxiety, is the belief that they may lose control over their speech/behaviour and/or their physical symptoms of anxiety. The present study aimed to evaluate the causal role of these beliefs on social anxiety symptoms in an analogue sample. Beliefs were manipulated using false feedback in undergraduate psychology students (N = 130) to induce either high or low levels of beliefs about losing control. Participants then engaged in a social interaction task with a confederate. The high beliefs about losing control (HLC) condition reported greater anxiety just before meeting the confederate than the low loss of control (LLC) condition. Further, HLC participants reported worse social performance and greater perceived failures of control than did those in the LLC condition during their interaction with a confederate. Results suggest beliefs about losing control are producing cognitive and behavioural changes which may in part explain differences in performance in social interactions. Beliefs about losing control appear to be relevant to the cognitive model of social anxiety. Future studies should consider whether these beliefs are malleable among individuals with SAD.

Obsessive-Compulsive Disorder (OCD) is a leading cause of disability world-wide (World Health Organization, 2008). Treatment of OCD is a specialized field whose aim is recovery from illness for as many patients as possible. The evidence-based psychotherapeutic treatment for OCD is specialized cognitive behavior therapy (CBT, NICE, 2005, Koran and Simpson, 2013). However, these treatments are not accessible to many sufferers around the world. Currently available guidelines for care are deemed to be essential but insufficient because of highly variable clinician knowledge and competencies specific to OCD. The phase two mandate of the 14 nation International OCD Accreditation Task Force (ATF) created by the Canadian Institute for Obsessive Compulsive Disorders is development of knowledge and competency standards for specialized treatments for OCD through the lifespan deemed by experts to be foundational to transformative change in this field. This paper presents knowledge and competency standards for specialized CBT for adult OCD developed to inform, advance, and offer a model for clinical practice and training for OCD. During upcoming ATF phases three and four criteria and processes for training in specialized treatments for OCD through the lifespan for certification (individuals) and accreditation (sites) will be developed based on the ATF standards.

The overprediction and underprediction of fear, pain, and other constructs have been linked with etiology and maintenance of anxiety disorders. We aimed to extend this research to depression by investigating the overprediction of effort and the underprediction of reward and enjoyment associated with a simple task. Participants with depression (n = 20) and a control group (n = 40) predicted how much effort and reward/enjoyment would be experienced during a short walk around the university. Post-walk, participants reported the actual effort required and the actual experienced reward and enjoyment. Compared to the control group, who demonstrated accurate predictions, depressed individuals significantly overpredicted the required effort associated with the walk even though there were no between-group differences in actual effort required. There was no evidence to suggest that the depressed group underestimated or were inaccurate in their predictions of walk-related reward and enjoyment relative to the control group. Implications for cognitive and behavioral approaches to depression are discussed.

Cognitive-behavioural models of obsessive-compulsive disorder (OCD) stemmed from knowledge acquired from cognitive science. Researchers continue to apply basic cognitive-affective science methods to understanding OCD, with the overarching goal of improving and refining evidence-based treatments. However, the degree to which such research has contributed to this goal is unclear. We reviewed OCD research in the general areas that comprise basic cognitive science, and evaluated the degree to which it has contributed to our understanding of the development, maintenance, and treatment of OCD. We focused on studies that either compared people with and without OCD and/or used experimental psychopathology methods with human participants, and attempted to resolve some of the conflicting theories related to the importance of cognitive deficits vs. cognitive biases. Overall, we observed equivocal findings for deficits in perception, attention, memory, and executive functioning. Moreover, many so-called deficits were moderated and/or explained by OCD-relevant beliefs, highlighting the role of confidence in cognitive processes as integral to our understanding of OCD. We discussed these findings in terms of cognitive measurement, cognitive-behavioural models, and clinical applicability, and made recommendations for future research that may offer innovation and insight helpful to clinicians working to improve the symptoms and lives of people with OCD.

Interventions for reassurance seeking (RS) in obsessive–compulsive disorder typically include reducing accommodation by asking partners to not provide reassurance, which may decrease RS but increase distress and be perceived as unhelpful. Alternatively, having partners provide support to encourage coping may be effective and associated with greater perceived helpfulness and lower negative affect. This experiment tested hypotheses that compared with no reassurance, supportive feedback would be associated with higher ratings of intervention helpfulness, fewer requests for reassurance, and lower ratings of RS urges and negative affect. Participants completed a threat-inducing kitchen task while observed by a partner, and afterwards sought reassurance to make a decision about safety. Partners’ feedback was manipulated such that half (n = 51) provided typical accommodation reduction-focused feedback and half (n = 51) provided support-focused feedback. Results suggest that individuals who received support-focused feedback versus accommodation reduction-focused feedback rated their partner’s feedback as significantly more helpful (d = 1.22). There was also a small-to-moderate effect size and trend suggesting that support was associated with less RS (d = 0.33). Overall, support provision may be associated with less RS behaviour and greater perceived helpfulness, and holds promise as an alternative intervention technique to strict accommodation reduction for problematic RS.

Excessive reassurance seeking (RS) in obsessive-compulsive disorder (OCD) has been conceptualized as compulsive checking by proxy. Manipulations of responsibility augment a range of OCD symptoms; however, their impact on RS behaviour has not been examined. We hypothesized that under conditions of high responsibility (HR), participants would report greater urges to seek reassurance and more actual reassurance seeking (RS) compared to low responsibility (LR) participants. Participants (N = 72) were randomized to HR or LR conditions, completed a dishwashing task with a confederate, and were given an opportunity to seek reassurance. HR participants reported feeling more responsible for the task, t(64.105) = 5.091, p

The general population has experienced a significant elevation in fear and anxiety during COVID-19 both as a direct result of the virus but also due to measures taken to prevent it spreading, such as the need to stay inside and increase hand-washing. Lockdown has been used in many/most countries to prevent widespread infection. The advice and imposed actions are necessary to prevent the virus from spreading, but they might exacerbate the problems experienced by people with a preexisting anxiety-related disorder. The treatment of anxiety-related disorders can be provided while in quarantine. Staying at home in self-isolation does not preclude obtaining psychological treatment for anxiety-related disorders. Dealing with cognitive biases, over-estimations of threat, intolerance of uncertainty, inflated responsibility and excessive safety behavior, are useful clinical directions.

In recent years, cognitive-behavioural models of OCD have increasingly recognized the potential role of feared possible selves in the development and maintenance of OCD, while simultaneously re-examining factors that have historically been linked to self-perceptions in OCD. The current article describes the development and validation of a multidimensional version of the Fear of Self Questionnaire (FSQ-EV) in a non-clinical (N = 626) and clinical OCD sample (N = 79). Principal component analyses in the non-clinical sample revealed three conceptually and factorially distinct components revolving around a feared corrupted possible self, a feared culpable possible self and a feared malformed possible self. The questionnaire showed a strong internal inconsistency, and good divergent and convergent validity, including strong relationships to obsessional symptoms. In particular, the corrupted feared self predicted OCD symptoms independently from depression and other related self-constructs and obsessive beliefs, while also strongly interacting with importance and control of thoughts in the prediction of almost all specific symptoms of OCD. Results are consistent with the notion that self-constructs can be conceptually and empirically distinguished from obsessive beliefs and appraisals with significant potential to improve our understanding of OCD and related disorders.

The cognitive model of compulsive checking (Rachman, 2002) proposes that perceptions of responsibility, seriousness of harm and probability of harm interact to promote checking behaviour. We examined these factors in an ecologically valid experimental paradigm. Two groups of participants (participants with OCD who compulsively check and undergraduate controls) were assigned to a high or low responsibility condition, and then checked objects representing: (a) high seriousness of harm (stove burners), (b) low seriousness of harm (light bulbs), (c) high probability of harm (functional burners and bulbs), and (d) low probability of harm (non-functional burners and bulbs). In general, a diagnosis of OCD, as well as conditions of increased severity/likelihood of harm, and to a lesser degree, increased responsibility, led to a greater period of time spent checking. Implications for the cognitive-behavioural model of and treatment for compulsive checking are discussed.

It has been proposed that the judicious use of safety behavior may enhance the acceptability of cognitive behavioral therapy (CBT). Indeed, Milosevic and Radomsky (2013a) found that descriptions of CBT incorporating safety behavior were more acceptable than those that dis- couraged safety behavior. This study aimed to replicate and extend this work. Participants were 688 undergraduates who rated the acceptability of descriptions of CBT varying in safety behavior (judicious or discouraged) and rationale (cognitive or extinction). Consistent with Milosevic and Radomsky, CBT with safety behavior was significantly more acceptable than traditional CBT. Cognitively based CBT was preferred over extinction-based CBT. The effects of prior treatment and general distress were also examined. Overall, previous treatment and greater anxiety were associated with significantly lower acceptability ratings. Results support the acceptability-enhancing role of safety behavior in CBT and are discussed in terms of cog- nitive-behavioral theory and treatment of anxiety and related disorders.Keywords: CBT; exposure; anxiety; safety behavior; treatment acceptabilityExposure therapy is one of the most effective and widely used treatments for anxiety and related disorders (Abramowitz, Deacon, & Whiteside, 2011; Deacon & Abramowitz, 2004; Olatunji, Cisler, & Deacon, 2010). It involves graded and prolonged experiences with feared stimuli to promote fear extinction and corrective learning. Although exposure is undoubtedly effective, a significant minority of treatment-seeking individuals refuse the treatment entirely or drop out prematurely (Bados, Balaguer, & Saldana, 2007; Foa et al., 2005; Hembree et al., 2003). In fact, fear of cognitive behavioral therapy (CBT) is a commonly endorsed reason for treatment refusal and/or dropout among individuals with anxiety disor- ders (Mancebo, Eisen, Sibrava, Dyck, & Rasmussen, 2011). As such, a modification of current effective treatments to enhance their acceptability is critically needed.It has been proposed that the judicious use of safety behavior (i.e., the careful and strategic implementation of safety behavior in the early and/or most challenging stages of treatment) may enhance the acceptability of exposure therapy (Parrish, Radomsky, & Dugas, 2008; Rachman, Radomsky, & Shafran, 2008). Safety behaviors are overt or covert strategies employed in feared situations to reduce anxiety and/or to minimize perceived threat (Salkovskis, 1991; Salkovskis, Clark, & Gelder, 1996). For instance, an individual with contamination fear may carry around hand sanitizer or hygienic wipes to use in the event of perceived contamination. Defined this way, the judicious use of safety behavior is functionally different from the traditional methods used to make exposure therapy more gradual (i.e., developing a hierarchy of feared situations in ascending order of difficulty) because it involves the intentional incorporation of safety behavior into a given exposure session. By contrast, traditional exposure therapy and hierarchy develop- ment are focused on the elimination of anxiety-reducing strategies (known as "response preven- tion") during exposure. According to cognitive theory, safety behavior prevents the acquisition of disconfirmatory evidence about feared situations because the individual attributes the nonoccur- rence of catastrophic outcomes to the presence of the safety behavior (Salkovskis, 1991; Salkovskis et ah, 1996). Alternatively, behavioral theory suggests that safety behavior interferes with fear ac- tivation during exposure, which is considered by some to be an important mechanism of change in exposure therapy (Foa & Kozak, 1986).Numerous studies have shown that safety behavior interferes with both fear reduction and cognitive change in exposure-based treatments for anxiety disorders (Kim, 2005; McManus, Sacadura, & Clark, 2008; Powers, Smits, & Teich, 2004; Salkovskis, Clark, Hackmann, Wells, & Gelder, 1999). …

Mental contamination is defined and the main features of the phenomenon are set out. In addition to the familiar form of abnormal mental contamination, as evident in psychological disorders, notably Obsessive-compulsive Disorder, the phenomenon of non-clinical mental contamination is common. The clinical form is distressing, uncontrollable, constant and dysfunctional. The normal phenomenon can be disturbing but it is usually dormant, evoked intermittently, transient, tolerable, manageable, not dysfunctional and psychologically fascinating. The cognitive theory of mental contamination encompasses the causes of mental contamination, its persistence, and individual vulnerability. The field would benefit greatly from additional work, such as that reported elsewhere in this Special Issue, to incorporate the unusual manifestations of visual contamination, morphing and self-contamination, and to account for the experience of mental contamination in nonclinical and other clinical manifestations.

Background and objectives Mental contamination (i.e., contamination concerns that arise in the absence of direct contact with a contaminant) is a common symptom in obsessive-compulsive disorder (OCD). Cognitive theories suggest that it results from individuals’ misinterpretations of perceived violations. Cognitive theories of OCD also highlight the importance of appraisals of inflated responsibility in the maintenance of other OCD symptoms. However, the role of responsibility in mental contamination has not yet been examined experimentally. The present study examined the role of perceived responsibility and violation in the relationship between workplace sexual harassment imagery and subsequent mental contamination. Methods One hundred and forty-nine participants listened to a workplace sexual harassment imagery task, wherein responsibility was manipulated. Participants were randomly assigned to one of three conditions (high responsibility (HR), low responsibility (LR), no responsibility (NR)). Participants completed questionnaires assessing mental contamination and completed a hand washing task. Results Those in the NR condition reported significantly lower levels of responsibility than those in the LR or HR conditions. Accordingly, those in the NR condition also reported significantly lower levels of anxiety and dirtiness than in the LR condition. There were no significant differences between the LR and HR condition on variables of interest. Limitations The nature of the victim blaming used for the responsibility induction may have elicited compensatory responses from participants. Conclusions Findings may highlight the central role of perceptions of violation in the understanding and treatment of mental contamination.

Cognitive theories of obsessive-compulsive disorder (OCD) posit that maladaptive beliefs lead to the development of symptoms. However, psychometric studies have provided mixed evidence regarding whether beliefs about control over thoughts predict OCD symptoms above and beyond other obsessive beliefs. Clinical reports have documented concerns among those diagnosed with OCD regarding a potential loss of control over their thoughts and behaviour, indicating that broadening the scope of beliefs about control by integrating aspects of losing control may better explain their role in OCD. In this study, 133 undergraduate participants underwent a bogus EEG session and received (positive or negative) false feedback about the possibility that they may lose control over their thoughts and behaviour, and completed a task asking them to control the pace of pictures. As hypothesized, participants in the high (versus low) beliefs about losing control condition checked significantly more often which keys they should use to control the pictures, t(106.95) = 2.28, p = .02, d = .44, demonstrating that manipulating beliefs about control can impact checking behaviour when a potential loss of control is emphasized. Also, checking behaviour predicted a lower desire for control, such that compulsions may be seen as opportunities to re-establish disrupted control cognitions.

Increasingly, cognitive-behavioural models have been considering the role of beliefs about the self in the development and maintenance of obsessive-compulsive disorder (OCD), including sensitive domains of self-concept and feared self-perceptions. This has led to the development of the Fear of Self Questionnaire (FSQ; Aardema et al., ), which has shown strong internal consistency, divergent and convergent validity, and found to be a major predictor of unwanted thoughts and impulses (i.e., repugnant obsessions). The current study aimed to investigate fear of self-perceptions using the FSQ in an OCD sample (n = 144) and related psychological disorders (eating disorders, n = 57; body dysmorphic disorder, n = 33) in comparison to a non-clinical (n = 141) and clinical comparison group (anxiety/depressive disorders, n = 27). Following an exploratory factor analysis of the scale in the OCD sample, the results showed that participants with OCD in general did not score significantly higher on fear of self-perceptions than did the clinical comparison participants. However, consistent with previous findings, fear of self was highly characteristic among OCD patients with unwanted repugnant thoughts and impulses. In addition, fear of self-perceptions were significantly more elevated in those with eating or body dysmorphic disorders relative to the other non-clinical and clinical groups. The construct of a "feared possible self" may be particularly relevant in disorders where negative self-perception is a dominant theme, either involving concerns about one's inner self or concerns related to perceived bodily faults.

Background:Reassurance seeking (RS) in obsessive compulsive disorder (OCD) is commonly addressed in cognitive behavioural therapy (CBT) using a technique called reducing accommodation. Reducing accommodation is a behaviourally based CBT intervention that may be effective; however, there is a lack of controlled research on its use and acceptability to clients/patients, and case studies suggest that it can be associated with negative emotional/behavioural consequences. Providing support to encourage coping with distress is a cognitively based CBT intervention that may be an effective alternative, but lacks evidence regarding its acceptability.Aims:This study aimed to determine whether support provision may be a more acceptable/endorsed CBT intervention for RS than a strict reducing accommodation approach.Method:Participants and familiar partners (N = 179) read vignette descriptions of accommodation reduction and support interventions, and responded to measures of perceived intervention acceptability/adhereability and endorsement, before completing a forced-choice preference task.Results:Overall, findings suggested that participants and partners gave significantly higher ratings for the support than the accommodation reduction intervention (partial η2 = .049 to .321). Participants and partners also both selected the support intervention more often than the traditional reducing accommodation intervention when given the choice.Conclusions:Support provision is perceived as an acceptable CBT intervention for RS by participants and their familiar partners. These results have implications for cognitive behavioural theory and practice related to RS.

We evaluated a novel, empirically-based cognitive therapy for compulsive checking - a common form of obsessive-compulsive disorder. Twelve adults completed 12 sessions of the therapy. Significant reductions in checking-related symptoms were found pre- to post-treatment, and pre-treatment to 6-month follow-up (moderate to large effect sizes). Participants reported high treatment acceptability after the third session, which was maintained at post-treatment. This pilot trial provides preliminary support for treating compulsive checking using this novel cognitive approach.

Fear of acting on unwanted impulses (e.g., stabbing a loved one) and avoidance of threatening stimuli (e.g., knives) are common phenomena in obsessive-compulsive disorder (OCD). Cognitive models of OCD suggest that maladaptive beliefs underlie the development and maintenance of symptoms. The goal of this experiment was to determine whether beliefs about losing control over one's behaviour lead to experiencing anxiety and intrusive thoughts while approaching stimuli that are commonly feared in OCD, and to behaving more cautiously while interacting with the stimuli. Undergraduate participants (N = 128) were provided with false feedback about the meaning of their intrusive thoughts: “having intrusive thoughts means that you are likely to lose control over your behaviour” versus “intrusive thoughts are normal”. Participants were then asked to approach sharp knives in a stepwise manner (i.e., behavioural approach test; BAT). Afterwards, they sorted the stimuli in a knife block as quickly as possible. Participants with higher (versus lower) beliefs about losing control experienced significantly increasing anxiety throughout the BAT. They also remembered experiencing more intrusive thoughts throughout the protocol and perceived themselves as less cautious while sorting the knives. Interestingly, objective measures of intrusive thoughts and caution were not significantly different between conditions.

Cognitive theory of obsessive-compulsive disorder (OCD) proposes that maladaptive beliefs play a pivotal role in the development and maintenance of symptoms. Clinical reports as well as recent psychometric and experimental investigations suggest that control-related beliefs in OCD may benefit from expansion to include aspects of losing control. However, currently available measures either focus on other facets of control (e.g., sense of control) or do not put emphasis on beliefs about losing control (e.g., beliefs about control over thoughts). The current study aimed to develop and validate the Beliefs About Losing Control Inventory (BALCI), a self-report measure of negative beliefs about losing control, in a sample of undergraduate participants (N= 488). An exploratory factor analysis revealed that the BALCI's 21 items capture negative beliefs about losing control over one's thoughts, behaviour, and emotions (Factor 1), beliefs about the importance of staying in control (Factor 2), and beliefs about losing control over one's body/bodily functions (Factor 3). The BALCI was also found to have good convergent and divergent validity and to be associated with elevated OCD symptoms above and beyond previously identified obsessive beliefs. Theoretical implications and recommendations for the field of cognitive-behaviour therapy are discussed.

Previous research has highlighted the potential role of dysfunctional reasoning (i.e. “inferential confusion”) and feared self-perceptions in the development and maintenance of Obsessive-Compulsive Disorder (OCD). However, these investigations have primarily relied on self-report measures, and investigations into inferential confusion in relation to feared self-perceptions remain scarce. Also, previous investigations only pertain to a limited number of reasoning processes in inferential confusion (i.e. inverse reasoning) and fail to cover the entire spectrum of processes proposed to be relevant to OCD. In the present study, a new task-based measure, the Dysfunctional Reasoning Processes Task (DRPT), covering a wider range of dysfunctional processes, was used to investigate the relationship of inferential confusion with feared self-perceptions and symptoms of OCD. 172 undergraduate students completed computerized versions of the DRPT and self-report measures. Results showed that feared self-perceptions and OC-related beliefs sequentially mediated the relationship between inferential confusion and OC symptoms. Hence, without a feared self, the effect of inferential confusion on OC symptoms may be attenuated. These findings provide further evidence of the interrelationship between dysfunctional reasoning and feared self-perceptions and their potential role in the development and maintenance of OCD, emphasizing the need to address both in cognitive-behavioral treatment.

Although people with obsessive-compulsive disorder (OCD) often report devastating feelings of guilt, to date, a clear link between guilt and OCD symptoms has not been established. Researchers are currently exploring the extent to which individuals with OCD fear the feeling of guilt (e.g., for harm they might have caused, averted, or minimised) and behave compulsively in consequence. However, no self-report measures of the fear of guilt construct exist, which limits our ability to examine its role in OCD. We therefore developed a 17-item Fear of Guilt Scale (FOGS), culled from a larger, 49-item pool following exploratory and confirmatory factor analyses, to measure fear of guilt in OCD. Psychometric analyses were conducted across three large, nonclinical undergraduate samples and suggest the FOGS consists of two factors: Punishment (drive to punish oneself for feelings of guilt) and Harm Prevention (drive to proactively prevent guilt). The FOGS demonstrated strong internal consistency and convergent and divergent validity. It also significantly predicted OCD symptom severity over measures of neuroticism, depression, trait guilt, and inflated responsibility beliefs. Thus, fear of guilt, as measured by the FOGS, is an important and distinct construct in understanding OCD. Implications for future use of the scale are discussed.

Research has demonstrated large differences in the degree to which direct and indirect measures predict each other and variables including behavioural approach and attentional bias. We investigated whether individual differences in the co-variance of "implicit" and "explicit" spider fear exist, and whether this covariation exerts an effect on spider fear-related outcomes. One hundred and thirty-two undergraduate students completed direct and indirect measures of spider fear/avoidance, self-report questionnaires of psychopathology, an attentional bias task, and a proxy Behavioural Approach Task. TwoStep cluster analysis using implicit and explicit spider fear as criterion variables resulted in three clusters: (1) low explicit/low implicit; (2) average explicit/high implicit; and (3) high explicit/low implicit. Clusters with higher explicit fear demonstrated greater disgust propensity and sensitivity and less willingness to approach a spider. No differences between clusters emerged on anticipatory approach anxiety or attentional bias. We discuss results in terms of dual-systems and cognitive-behavioural models of fear.

Contamination fear is one of the most common symptoms of obsessive-compulsive disorder (OCD). Exposure and response prevention (ERP) is effective for OCD, but a significant minority of treatment-seeking individuals refuse ERP entirely or drop out prematurely. Research suggests that safety behaviour (SB) may enhance the acceptability of ERP; however, questions remain about how to incorporate SB into existing treatments. Clinical participants with OCD and contamination fear (N = 57) were randomized to receive an exposure session with no SB (ERP), a routinely used SB (RU), or a never-used SB (NU). Significant reductions in contamination fear severity were observed in all conditions. Although omnibus comparisons were only marginally significant, pairwise comparisons revealed some condition differences. NU demonstrated significantly lower self-reported contamination fear severity at post-exposure, as well as marginally higher treatment acceptability ratings. Findings suggest that exposure with SB may be effective and acceptable, and are discussed in terms of cognitive-behavioural theory and treatment of anxiety and related disorders.

The judicious use of safety behavior may enhance the acceptability of exposure. However, practical questions concerning safety behavior fading remain. The current study compared the efficacy and acceptability of participant- and experimenter-initiated fading of safety behavior during exposure. Undergraduate students (N=100) with subclinical contamination fear were assigned to complete an exposure session under one of three fading conditions: (1) participant-initiated (PI); (2) experimenter-initiated time (ET), in which the timing of safety behavior fading was yoked to the timing observed in PI; or (3) experimenter-initiated distress (ED), in which fading was based on subjective distress ratings. Compared to ET, PI demonstrated greater reductions in obsessive beliefs and peak fear, comparable changes in anticipatory fear and behavioral approach, and marginally higher expectancy ratings. PI and ED did not differ in outcome or acceptability. Results are discussed in terms of self-efficacy theory and the potential utility of safety behavior in exposure.

The Obsessive-Compulsive Inventory-Revised (OCI-R) assesses distress associated with the symptoms of obsessive-compulsive disorder (OCD). This study reports on the psychometric properties of the Turkish version of the OCI-R as a widely known measure. The sample consisted of 319 Turkish university students (67.1% women; M age = 21.5, SD = 2.0). The questionnaire battery included measures of OCD symptoms, specific cognitions, thought control, and personality characteristics. A target rotation analysis supported the factorial validity of the Turkish OCI-R as indicated by its replicability with the original factor structure (i.e., checking, washing, obsessing, hoarding, ordering, and mental neutralizing). High-scoring OCD symptom groups also significantly differed on the Turkish OCI-R and thus presented preliminary evidence for its criterion validity. Correlational analysis supported convergent and divergent validity of the measure, with significant correlations between the Turkish OCI-R and OCD symptoms, OCD-specific beliefs, two thought control strategies (e.g., worry and punishment), and neuroticism, but not with psychoticism or extraversion. The current findings provide initial evidence of sound psychometric properties for the Turkish OCI-R in a nonclinical sample.

Cognitive-behavioural theories of obsessive-compulsive disorder (OCD) have recently focused on the potential causal role of vulnerable self-themes, suggesting that the idea or fear of who one could be or become may specifically cause OCD symptoms, such as the occurrence of obsessions, obsessional distress, and repeated attempts to prevent one from becoming their feared self (i.e., compulsions). The current study tested the proposed causal relation between feared self-perceptions and OCD symptoms by manipulating them using a novel virtual reality-based paradigm. Undergraduate participants (N = 130) were randomly assigned to receive an experimental induction of feared self-perceptions or to a control condition. The fear-of-self condition, relative to the control condition, reported significantly higher levels of feared self-perceptions, and demonstrated a greater number of intrusions related to harm and a greater urge to suppress these on a behavioural measure of OCD symptoms. Exploratory analyses indicated that younger adults, who were expected to have more vulnerable self-concepts, experienced greater feared self-perceptions following the fear-of-self manipulation relative to control. Results provide preliminary evidence for the working model proposed in the Editorial of the current Special Issue in the Journal of Obsessive-Compulsive and Related Disorders and tentatively support targeting these in cognitive-behavioural treatments.

It is well-established that intrusions are universal phenomena that differ from obsessions in frequency, intensity, and distress, but otherwise are very similar in content. This understanding has guided research in obsessive-compulsive disorder (OCD) to focus on the misappraisals of intrusions, rather than the intrusions themselves. However, recent evidence suggests that other factors might distinguish intrusions from obsessions, namely the context in which they arise. Indeed, intrusions that occur without direct evidence are related to increased OCD symptoms, obsessive beliefs, and the tendency to confuse reality with the imagination, especially confusing a feared possible self with the person's actual self. However, experimental evidence supporting these findings is lacking, a gap the current study aimed to fill. Five hundred and fifty-seven undergraduate students completed a battery of questionnaires online, which included an experimental task made up of scenarios designed to gauge endorsement in specific intrusions that are either supported or not supported by direct evidence. Results showed that intrusions without direct evidence supporting them uniquely predicted OCD symptoms, whereas intrusions with evidence did not predict OCD symptoms; and that inferential confusion and feared self-perceptions predicted characteristics of the intrusions without direct evidence. Implications for cognitive-behavioural formulations of OCD are discussed.

Contamination concerns are among the most common symptoms of obsessive-compulsive disorder (OCD). Research has recently focused on mental contamination, defined as feelings of dirtiness and/or washing behaviour arising in the absence of direct contact with a contaminant. Mental contamination is highly prevalent; a substantial amount of washing behaviour related to contact contamination may actually be a manifestation of mental contamination. As such, washing may reflect an attempt to cleanse oneself of a feared corrupted self, rather than of any physical contaminant. Indeed, a recent treatment study found that reductions in feared self-perceptions also predicted reductions in contamination symptomatology; we propose that this link may be explained by mental contamination. We examined whether mental contamination, relative to established OCD belief domains, mediated the relationship between feared self-perceptions and contact contamination. In our sample of 626 undergraduate participants, feared self-perceptions significantly predicted contact contamination symptoms, with mental contamination and two OCD belief domains (perfectionism/intolerance of uncertainty, importance of/control over thoughts) as significant mediators. Importantly, mental contamination was the strongest mediator. These findings provide further evidence for the predictive power of vulnerable self-themes in OCD and highlight the important role of mental contamination in this relationship with regard to contamination symptoms.

Background and objectives The cognitive theory of compulsive checking in OCD proposes that checking behaviour is maintained by maladaptive beliefs, including those related to inflated responsibility and those related to reduced memory confidence. This study examined whether and when specific interventions (as part of a new cognitive therapy for compulsive checking) addressing these cognitive targets changed feelings of responsibility and memory confidence. Methods Participants were nine adults with a primary or secondary diagnosis of OCD who reported significant checking symptoms (at least one hour per day) on the Yale-Brown Obsessive-Compulsive Scale. A single-case multiple baseline design was used, after which participants received 12 sessions of cognitive therapy. From the start of the baseline period through to the 1 month post-treatment follow-up assessment session, participants completed daily monitoring of feelings of responsibility, memory confidence, and their time spent engaging in compulsive checking. Results Results revealed that feelings of responsibility significantly reduced and memory confidence significantly increased from baseline to immediately post-treatment, with very high effect sizes. Multilevel modelling revealed significant linear changes in feelings of responsibility (i.e., reductions over time) and memory confidence (i.e., increases over time) occurred following the sessions when these were addressed. Finally, we found that improvements in these over the course of the treatment significantly predicted reduced time spent checking. Limitations The small sample size limits our ability to generalize our results. Conclusions Results are discussed in terms of a focus on the timing of change in cognitive therapy.

Both contact contamination (CC) and mental contamination (MC) fears-which combined represent the most common manifestation of obsessive-compulsive disorder (OCD)-have been widely associated with disgust propensity. However, extant research explored this relationship using measures assessing only pathogen-related disgust, not taking into account the potential role played by sexual and moral disgust, despite literature about MC suggesting that this might be particularly relevant. In Study 1, the psychometric properties of the Italian version of the Three Domains of Disgust Scale (TDDS) were assessed in a large Italian community sample. Exploratory and confirmatory factor analyses confirmed the three-factor structure of the TDDS. The scale also showed good internal consistency and construct validity. In Study 2, the differential patterns of relationships between CC and MC and the three disgust domains were explored in an Italian clinical OCD sample using a path analytic approach. The TDDS-Pathogen subscale was a unique predictor of CC while the TDDS-Sexual subscale was a unique predictor of MC, after controlling for anxiety and depression. Surprisingly, the TDDS-Moral subscale was not a predictor of either domain of contamination fear. Limitations and clinical implications are discussed.

Distraction is often discouraged in exposure therapy for anxiety disorders, but little is known about how beliefs about distraction may impact treatment outcome (with or without distraction). One barrier to understanding the impact of these beliefs is the lack of an available measure to assess this construct. In addition to proposing a theoretical basis for beliefs about distraction, we created and validated a questionnaire assessing maladaptive beliefs about distraction, the Beliefs about Distraction Inventory. An exploratory factor analysis with an unselected student sample (N = 506, 86 % female) suggested a two-factor solution, conceptualized as “distraction is necessary”, and “distraction is effective”. A confirmatory factor analysis using a contamination-fearful sample (N = 132, 87 % female) demonstrated adequate model fit. In both samples, the measure exhibited strong reliability and validity. Preliminary findings revealed that beliefs that “distraction is necessary” were more strongly associated with anxious psychopathology than beliefs that “distraction is effective”. Results are discussed in terms of cognitive-behavioural theories and therapies for anxiety and related disorders.

It is becoming more broadly recognized that beyond effectiveness, the acceptability of interventions for anxiety disorders is an important consideration for evidence-based practice. Although advances in treatments for anxious psychopathologies have demonstrated that cognitive-behavioural interventions are more desirable than other types of psychotherapy or pharmacotherapy, there continue to be problems with adherence and dropout. It has been suggested that low treatment acceptability may be partially responsible for high dropout rates. Although a number of preliminary investigations in this domain have been conducted, further progress is hampered by the absence of a single self-report measure that assesses both acceptability and anticipated adherence. Therefore, the current paper aimed to test the psychometric properties of the newly developed Treatment Acceptability/Adherence Scale (TAAS). In two studies of brief cognitive-behavioural interventions, the TAAS was administered immediately following the therapy session. In Study 1 (N = 120 non-clinical undergraduates), the therapy included two variants of an exposure-based intervention for contamination fear. In Study 2 (N = 27 individuals with obsessive-compulsive disorder), the therapy was a cognitively based intervention evaluating a novel treatment technique for checking compulsions. Measures of convergent and divergent validity were included. Results demonstrated that the TAAS exhibited sound psychometric properties across the two samples. It is hoped that this measure will help clinicians to predict and intervene when a treatment is not acceptable and/or when the client anticipates poor adherence to it. Furthermore, the TAAS may aid researchers in continuing to improve upon effective interventions for anxiety and related disorders.

Thought–shape fusion (TSF) is a belief that entails perceptions of weight gain, moral transgression, and body dissatisfaction when thinking about food consumption. The objectives of the current study were to (1) investigate whether high TSF endorsement is associated with differences in cognitive, affective and behavioural reactions to a TSF induction in comparison to those who are low in TSF, and (2) evaluate whether TSF shows temporal stability. TSF was assessed in 32 individuals with eating disorders over a 1-month period. Participants were classified as either low (n = 16) or high (n = 16) in trait TSF. Participants attended three sessions (baseline, experimental session, and follow-up), and were exposed to a TSF induction during the experimental session. High correlations were found for trait TSF scores between baseline and follow-up appointments. Furthermore, high TSF individuals were more vulnerable to the induction, with higher negative affect and state TSF, and more food-related thoughts at follow-up in comparison to those low in TSF. These findings indicate that TSF is a stable belief holding clinical relevance.

Contamination fear is a common symptom of obsessive–compulsive disorder. Research suggests that self-efficacy, or perceived sense of mastery and confidence in a given situation, is an important determinant of anxiety and approach behavior. However, there is currently no published measure of self-efficacy for situations specifically involving perceived contamination. The current study aimed to validate a self-report measure of contamination-related self-efficacy, the Contamination Self-Efficacy Scale (CSES), which was developed from an existing measure of self-efficacy in specific phobia. Four hundred and eighteen undergraduate students completed the CSES and measures of related constructs. The CSES demonstrated excellent internal consistency and retest reliability, as well as convergent, incremental, and divergent validity. Principal axis factoring revealed a one-factor structure for the CSES. Findings support the CSES as a valid and reliable measure of contamination-related self-efficacy, and are discussed in terms of self-efficacy theory and cognitive-behavioral treatment of contamination fears.

Objective The Vancouver Obsessional Compulsive Inventory–Mental Contamination Scale (VOCI-MC) is a self-report instrument that assesses symptoms of mental contamination. The aim of this study was to investigate the psychometric properties of the Italian version of the VOCI-MC in non-clinical and clinical samples. Method Factor structure, internal consistency, temporal stability, construct and criterion validity were investigated in 541 participants from the general population, 120 participants diagnosed with OCD and 31 participants diagnosed with other anxiety disorders (OAD). For some of these analyses, our OCD sample was subdivided into those with contamination-related symptoms and concerns (n = 39) and those whose OCD excluded concerns related to contamination fear (n = 81). Exploratory and confirmatory factor analyses supported the expected one-factor structure of the VOCI-MC both in non-clinical and OCD sample. Results VOCI-MC scores showed good internal consistency, temporal stability, construct validity and criterion validity. In particular, the VOCI-MC successfully discriminated between those with OCD who reported contamination-related concerns and all other groups of participants. Conclusion These findings suggest that the Italian version of the VOCI-MC retains the adequate psychometric properties of the original, provide preliminary evidence of its one-factor structure and temporal stability, and suggest that it can be confidently used as an assessment tool of mental contamination symptoms in both clinical and research settings.

Background and objectives The extant literature has shown mixed results regarding the impact of distraction use on exposure outcome; however, a wide variety of distraction tasks have been utilized across studies. In order to better understand these discrepant findings, we aimed to evaluate the impact of differing levels of distraction on exposure outcome. Additionally, treatment acceptability and changes in self-efficacy were assessed to evaluate how these may differ as a function of distraction use. Methods In Experiment 1 (N = 176 participants tested), distraction tasks were experimentally validated through assessing changes in reaction time when completing concurrent tasks. Based on Experiment 1, distraction tasks were selected for use in Experiment 2, in which contamination-fearful participants were randomly assigned to one of four conditions: no, low, moderate, or high distraction during an exposure session. Participants (N = 124) completed a behavioural approach test and self-efficacy measure pre- and post-exposure and at one-week follow-up. Treatment acceptability was assessed immediately following the exposure session. Results There were no significant differences between conditions for changes in behavioural approach pre-to post-exposure or at one-week follow-up. However, increases in self-efficacy pre-to post-exposure were greatest for moderate distraction, and treatment acceptability was highest with moderate and high distraction. Limitations Participants were not assessed for clinical severity, were not treatment-seeking, and only one specific type of fear was investigated. Conclusions Distraction (at any level) did not appear to negatively impact exposure outcome (all conditions improved pre-to post-exposure and at follow-up), but utilizing moderate to high amounts of distraction increased treatment acceptability.

Memory and metamemory phenomena associated with obsessive-compulsive disorder (OCD) have received much attention in literature dedicated to a better understanding of the doubt and repetition associated with obsessions and compulsions. Following previous work on repeated checking among nonclinical participants, we asked participants to repeatedly turn on, turn off and check a real kitchen stove (n = 30 compulsive checkers diagnosed with OCD and n = 30 non-clinical undergraduates), or a real kitchen faucet (n = 30 non-clinical undergraduates) in a standardized, ritualized manner, in two connected experiments. Results indicated that following repeated relevant checking, both clinical and nonclinical participants reported significantly reduced memory confidence, vividness and detail; those who completed repeated irrelevant checking did not. The effects of repeated checking on memory accuracy were also explored. Results are discussed in terms of cognitive-behavioural formulations of OCD and in terms of the effects of repetition on memory and metamemory in association with checking behaviour.

Because of Rachman and de Silva׳s (1978) influential research on normal and abnormal obsessions, it is now a basic tenet of cognitive behavioral theories (CBT) that clinical obsessions have their origins in the normal intrusive thought phenomena that characterizes the stream of consciousness. However much of the empirical research on unwanted intrusive thoughts has utilized retrospective self-report questionnaires that have weak construct validity and the samples have been drawn primarily from Western European and North American populations. To enhance the measurement precision and investigate the universality of unwanted intrusions, a structured intrusive thoughts interview was developed and administered to 777 nonclinical individuals drawn from 13 countries. The three papers in this special issue present findings based on this large data set. Together it was found that unwanted intrusive thoughts are reported by the majority of individuals in all countries, that significant cross-cultural differences are apparent in primary intrusive thought content, that faulty appraisals and confrontational control strategies are related to the distress of intrusions, and that the frequency of dirt/contamination, doubt, and miscellaneous intrusions are specifically related to obsessive compulsive symptom distress. The authors discuss these findings in terms of their consistency with predictions derived from the CBT perspective on obsessions. The special issue concludes with a discussion paper by Professor Jack Rachman, originator of the obessional intrusions concept.

Most cognitive approaches for understanding and treating obsessive-compulsive disorder (OCD) rest on the assumption that nearly everyone experiences unwanted intrusive thoughts, images and impulses from time to time. These theories argue that the intrusions themselves are not problematic, unless they are misinterpreted and/or attempts are made to control them in maladaptive and/or unrealistic ways. Early research has shown unwanted intrusions to be present in the overwhelming majority of participants assessed, although this work was limited in that it took place largely in the US, the UK and other ‘westernised’ or ‘developed’ locations. We employed the International Intrusive Thoughts Interview Schedule (IITIS) to assess the nature and prevalence of intrusions in nonclinical populations, and used it to assess ( n =777) university students at 15 sites in 13 countries across 6 continents. Results demonstrated that nearly all participants (93.6%) reported experiencing at least one intrusion during the previous three months. Doubting intrusions were the most commonly reported category of intrusive thoughts; whereas, repugnant intrusions (e.g., sexual, blasphemous, etc.) were the least commonly reported by participants. These and other results are discussed in terms of an international perspective on understanding and treating OCD.

Cognitive models of Obsessive Compulsive Disorder (OCD) purport that obsessions are normal intrusive thoughts that are misappraised as significant, leading to negative emotional responses and maladaptive attempts to control the thoughts and related emotions. This paper utilised a large multi-national dataset of interview data regarding intrusive thoughts, to investigate three questions related to the cognitive model of OCD and to its stability across cultures. First, the paper aimed to investigate the implicit yet-hitherto-untested assumption of cognitive models that misappraisals and control strategies for intrusive thoughts relate similarly across cultures. Second, this study aimed to build upon recent studies categorising intrusive thoughts into repugnant and non-repugnant categories, by investigating whether the content of intrusive thought moderates the relationship between the thoughts and appraisals and control strategies. Finally, this study aimed to provide further evidence regarding whether general beliefs implicated in cognitive models of OCD (e.g., responsibility, importance of thoughts) influence the occurrence of intrusions via maladaptive appraisals and control strategies. Overall, it was found that while overall intrusive thought frequency, distress, ease and importance of dismissal all varied significantly by site, their relationship with appraisals and control strategies did not. Generally, appraisals and action taken to confront the thought were the more consistent predictors, with the notably caveat that the relationship between thought frequency and appraisals was not strong. Second, repugnant vs. non-repugnant thought-content differed only with respect to thought frequency, but thought-content did not moderate the relationship between intrusive thoughts and control strategies and appraisals. Finally, appraisals and control strategies generally partially mediated the relationship between general OCD-related beliefs and the occurrence of, and distress associated with, intrusive thoughts. The results are taken to add credence to cognitive models of OCD and their validity across cultures.

There has been a recent expansion of interest in the concept of mental contamination. Despite a growing number of experiments and interview-based studies of mental contamination, there is a need for questionnaire-based assessment measures, and for a further understanding of the degree to which mental contamination is related to other aspects of OCD symptomatology and/or to established cognitive constructs relevant to OCD. We assessed the psychometric properties of three new measures of mental contamination (the Vancouver Obsessional Compulsive Inventory – Mental Contamination Scale, the Contamination Sensitivity Scale, and the Contamination Thought-Action Fusion Scale) in participants diagnosed with OCD (n = 57), participants diagnosed with an anxiety disorder other than OCD (n = 24) and in undergraduate student controls (n = 410). For some of these analyses, our OCD sample was subdivided into those with contamination-related symptoms and concerns (n = 30) and those whose OCD excluded concerns related to contamination fear (n = 27). Results showed that the three new scales had excellent psychometric properties, including internal consistency, convergent and divergent validity, and discriminant validity. Further, the new measures accounted for significant unique variance in OCD symptoms over and above that accounted for by depression, anxiety, traditional contact-based contamination, and OCD beliefs. Results are discussed in terms of the clinical utility of the scales, and of the nature of contamination fears in OCD.

Obsessions – particularly those directly relating to causing harm – often contain or imply evaluative dimensions about the self, reflecting a fear as to who the person might be – or might become. Following from research indicating that such beliefs are relevant to OCD, and the wider literature in social psychology regarding ‘feared’ or ‘undesired’ self-guides, the current study describes the development and validation of a new questionnaire—the Fear of Self Questionnaire, in 8- and 20-item versions. The questionnaire was piloted in two non-clinical samples ( n =258; n =292). Exploratory and confirmatory factor analyses supported the unidimensionality of the measure. The questionnaire showed a strong internal inconsistency, and good divergent and convergent validity, including strong relationships to obsessional symptoms and with other processes implicated in cognitive models of OCD (e.g. obsessive beliefs, inferential confusion). Implications are discussed.