Academic journal article Journal of Cognitive Psychotherapy

Beyond Belief: Incremental Prediction of Obsessive-Compulsive Disorder by Looming Vulnerability Illusions

Academic journal article Journal of Cognitive Psychotherapy

Beyond Belief: Incremental Prediction of Obsessive-Compulsive Disorder by Looming Vulnerability Illusions

Article excerpt

Cognitive models argue that obsessions and compulsions arise from distorted beliefs and exaggerated interpretations of intrusive thoughts. While these models have led to important advances, recent research has suggested the need to go beyond the factors the models identify. One new factor to consider may involve looming vulnerability, the production of dynamic mental scenarios of danger outcomes (e.g., contamination, harming, losing wanted possessions) as rushing through time and space and escalating in odds of harm for the self. Looming vulnerability is a different form of cognition that differs from belief factors because it concerns the process of anticipating noxious events as rapidly rising in risk rather than static beliefs about the final end states (e.g., responsibility, perfection). The present study tested looming vulnerability by examining a small cohort of 37 patients with obsessive-compulsive disorder (OCD). Results provide strong preliminary evidence that looming vulnerability in OCDrelated themes (e.g., contamination, hoarding, and pure obsessional) contributes significant and substantial variance to the prediction of obsessive compulsive symptom severity on the Yale-Brown Obsessive-Compulsive Scale beyond the effects of beliefs and interpretations. Thus, looming vulnerability may represent a different form of cognitive vulnerability for the development and persistence of clinical obsessions that warrants further investigation.

Keywords: beliefs in OCD; OCD subtypes; looming vulnerability; cognition in OCD; cognition in anxiety

Increasingly, cognitive factors are seen to be central to the development and maintenance of anxiety states and obsessive-compulsive symptoms in particular (Obsessive Compulsive Cognitions Working Group [OCCWG], 1997, 2001, 2003; Rachman, 1998; Salkovskis, 1985, 1999).With respect to obsessions, the cognitive model focuses on the appraisal of obsessional thoughts, images, doubts, and impulses as the source of distress rather than the content of the obsession itself (Rachman, 1993). Catastrophic misinterpretations of unwanted intrusive thoughts are hypothesized to occur and to create an attendant obsessional pattern if they are taken as an indication that the person may be, may have been, or may come to be responsible for harm or its prevention (Salkovskis, 1999). Accordingly, people who are prone to feel exaggerated responsibility, especially for preventing misfortunes, are more likely to make catastrophic misinterpretations of their unwanted intrusive thoughts, particularly when the thoughts/images/impulses involve potential harm to others (Salkovskis, 1999). In addition to the important role of inflated responsibility in OCD, other obsessional beliefs have been hypothesized to confer vulnerability for the development and persistence of OCD including: exaggerated threat, overimportance and need to control thoughts, perfectionism, and intolerance of uncertainty (OCCWG, 1997, 1999 , 2001, 2003; Frost & Steketee, 2003). For instance, Clark and Purdon's 1993) cognitive control theory of obsessions proposes that unrealistic beliefs about the possibility of controlling intrusive thoughts, combined with deliberate unrealistic efforts to control or eliminate the thoughts, are responsible for obsessional cycles. Thought control efforts inevitably fail, but the individual makes maladaptive self-appraisals about his or her lack of control that then lead to heightened control effort, further exacerbating and intensifying the obsessional cycle.

Based on this conceptualization, an international group of investigators (OCCWG, 1997, 2001, 2003, 2005) have developed and validated self-report measures to assess obsessive-compulsive beliefs (Obsessive Belief Questionnaire; OCCWG, 1997, 2001, 2003) and negative appraisals of intrusive thoughts/images/impulses (Interpretation of Intrusions Inventory; OCCWG, 1997, 2001, 2003) in large heterogeneous OCD samples. The Obsessional-Beliefs Questionnaire (OBQ) contains three coherent factors: (a) responsibility/threat, (b) perfectionism/certainty, and (c) importance/control of thoughts (OCCWG, 2003). …

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