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Appraisals of intrusive thoughts : an examination of the cognitive theory of obsessions Corcoran, Kathleen Marie 2006

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A P P R A I S A L S OF INTRUSIVE  THOUGHTS;  A N E X A M I N A T I O N OF T H E COGNITIVE T H E O R Y OF OBSESSIONS by KATHLEEN MARIE CORCORAN  B A . , M c G i l l University,  1997  M . A . , University o f British Columbia, 2002  A THESIS S U B M I T T E D IN P A R T I A L F U L F I L M E N T OF THE REQUIREMENTS FOR THE DEGREE D O C T O R OF  OF  PHILOSOPHY in  THE F A C U L T Y OF G R A D U A T E STUDIES (Psychology)  T H E U N I V E R S I T Y OF BRITISH  COLUMBIA  December 2006  © Kathleen Marie Corcoran, 2006  Abstract O b s e s s i v e - c o m p u l s i v e disorder ( O C D ) is characterized b y recurrent u n w a n t e d intrusive thoughts that e v o k e e n o r m o u s distress and contribute to f u n c t i o n a l i m p a i r m e n t . C o g n i t i v e theories o f O C D posit that appraisals about the s i g n i f i c a n c e o f thoughts are c r i t i c a l i n the d e v e l o p m e n t and persistence o f obsessions. In h i s theory; R a c h m a n (1997) suggests that appraisals o f u n w a n t e d thoughts d i s t i n g u i s h c l i n i c a l obsessions f r o m n o r m a l i n t r u s i v e thoughts; thoughts appraised as important and p e r s o n a l l y significant w i l l be upsetting and recur. M o r e o v e r , c o g n i t i v e theories propose that appraisals m o t i v a t e thought suppression, w h i c h results i n a p a r a d o x i c a l increase i n the frequency o f thoughts. T h i s dissertation project was designed to e x a m i n e several k e y tenets o f R a c h m a n ' s (1997) c o g n i t i v e theory o f obsessions. First, i f appraisals o f u n w a n t e d i n t r u s i v e thoughts are relevant to O C D , a p o s i t i v e relationship s h o u l d exist between appraisals a n d O C D s y m p t o m a t o l o g y . T o e x p l o r e this hypothesis, n o n c l i n i c a l participants i n Studies 1 and 2 read four vignettes, each p o r t r a y i n g a p r o t o t y p i c a l o b s e s s i o n o f aggressive, s e x u a l , b l a s p h e m o u s , and racist themes, and i n d i c a t e d their appraisals about the p e r s o n a l s i g n i f i c a n c e o f the intrusive thoughts. Questionnaires assessing o b s e s s i v e - c o m p u l s i v e ( O C ) s y m p t o m s , O C beliefs, and depression were also administered. R e s u l t s r e v e a l e d that appraisals o f the intrusive thoughts w e r e related to s u b c l i n i c a l O C s y m p t o m s and O C beliefs. M o r e o v e r , there was e v i d e n c e that appraisals v a r i e d a c c o r d i n g to thought content and thought frequency. S e c o n d , the c o g n i t i v e theory o f obsessions i m p l i c a t e s thought suppression i n the d e v e l o p m e n t and persistence o f obsessions. T h e purpose o f S t u d y 3 w a s to investigate whether the effects o f thought suppression w o u l d differ d e p e n d i n g o n the p e r s o n a l m e a n i n g o f the target thought. S i x t y h i g h r e l i g i o u s and 60 l o w r e l i g i o u s participants w e r e r a n d o m l y  assigned to suppress or not suppress a b l a s p h e m o u s target thought. N u m b e r o f thought recurrences, thought c o n t r o l effort, anxiety, and m o o d were assessed. R e s u l t s revealed that appraisals o f p e r s o n a l m e a n i n g , w h e n c o m b i n e d w i t h thought c o n t r o l effort, w e r e associated w i t h negative m o o d and increased anxiety. T h e r e w a s also p a r t i a l support that thought suppression h a d differential effects o n target thought frequency a c c o r d i n g to the p e r s o n a l m e a n i n g o f the target thought. T h e i m p l i c a t i o n s o f this research are d i s c u s s e d w i t h a focus o n the p r o p o s e d r o l e o f appraisals i n the d e v e l o p m e n t o f i n t r u s i v e thoughts.  IV  T a b l e of Contents Abstract  ii  T a b l e o f Contents  iv  List o f Tables List o f Figures  viii ix  Acknowledgements  x  C H A P T E R 1: I N T R O D U C T I O N  1  Behavioural Theories o f O C D  2  Cognitive Theories o f O C D  3  Salkovskis's Cognitive Theory o f O C D  4  R a c h m a n ' s Cognitive Theory o f Obsessions  5  U n w a n t e d Intrusive T h o u g h t s  9  A p p r a i s a l s o f U n w a n t e d Intrusive T h o u g h t s  10  N e u t r a l i z a t i o n and T h o u g h t S u p p r e s s i o n  12  Thought Suppression  13  Thought Suppression o f Personally Relevant Thoughts  14  Thought Suppression i n O C D  17  T h o u g h t S u p p r e s s i o n , A p p r a i s a l s , and N e g a t i v e A f f e c t  18  S u m m a r y o f T h o u g h t S u p p r e s s i o n Studies  19  T h e Present S t u d y  20  C H A P T E R 2: S T U D I E S 1 A N D 2  22  Study 1  25  Method  26  V  Participants  26  Measures  27  Procedure  32  R e s u l t s and D i s c u s s i o n  33  Preliminary Analyses  33  Vignette Appraisal Ratings  33  A p p r a i s a l R a t i n g s and O C D S y m p t o m a t o l o g y  35  C o m p a r i s o n o f H i g h O C and L o w O C Participants  35  A p p r a i s a l R a t i n g s b y T h e m a t i c C o n t e n t and Identity  36  Summary  37  Study 2 Method  39 40  Participants  40  Measures  40  Procedure  41  R e s u l t s and D i s c u s s i o n  41  Vignette Appraisal Ratings  41  A p p r a i s a l R a t i n g s and O C D S y m p t o m a t o l o g y  42  C o m p a r i s o n o f H i g h O C and L o w O C Participants  44  A p p r a i s a l R a t i n g s b y T h e m a t i c Content and T h o u g h t F r e q u e n c y  44  Summary  46  G e n e r a l D i s c u s s i o n (Studies 1 and 2)  47  vi  CHAPTER 3 - STUDY 3 Introduction  64 64  Methodological Considerations  67  Hypotheses  69  Method  71  Participants  71  Apparatus  72  Materials  72  Procedure  76  Results  81  Preliminary Analyses  81  Tests o f the M a i n H y p o t h e s e s  85  Discussion P o t e n t i a l E x p l a n a t i o n s for D i f f e r e n t i a l Effects o f T h o u g h t S u p p r e s s i o n  94 99  R e l e v a n c e to the T h o u g h t S u p p r e s s i o n Literature  100  Future D i r e c t i o n s and C o n c l u s i o n  104  C H A P T E R IV: C O N C L U S I O N  115  W h a t Other V a r i a b l e s Influence A p p r a i s a l s ?  119  Research A g e n d a  121  C l i n i c a l Implications  124  REFERENCES  127  APPENDICES  140  vii  Appendix A : Study 1 Materials  140  Vignettes ( " S e l f Version)  140  Vignette Appraisal Ratings ( " S e l f Version)  141  Vignettes ("Other" Version)  143  Vignette Appraisal Ratings ("Other" Version)  144  Appendix B : Study 2 Materials  146  Vignettes  146  Vignette Appraisal Ratings - L o w Frequency Vignettes  147  Vignette Appraisal Ratings - H i g h Frequency Vignettes  149  A p p e n d i x C : M e a s u r e s for S t u d y 3  151  Religious Screening Questionnaire  151  Vignette  153  R a t i n g Scales - T i m e 1  154  T h o u g h t C o n t r o l Strategies Q u e s t i o n n a i r e - T i m e 1  155  R a t i n g Scales - T i m e 2  156  T h o u g h t C o n t r o l Strategies Q u e s t i o n n a i r e - T i m e 2  157  A p p e n d i x D : U B C R e s e a r c h E t h i c s B o a r d ' s Certificates o f A p p r o v a l  158  Vlll  L i s t of Tables T a b l e 1: Intercorrelations B e t w e e n the V i g n e t t e T h e m e s for the " S e l f and " O t h e r " V e r s i o n s ( S t u d y 1)  56  T a b l e 2: C o r r e l a t i o n s B e t w e e n M e a n V i g n e t t e A p p r a i s a l R a t i n g and M e t a c o g n i t i v e M e a s u r e s , O C D S y m p t o m a t o l o g y , and D e p r e s s i o n ( S t u d y 1) T a b l e 3: V i g n e t t e A p p r a i s a l R a t i n g s b y T h e m e and Identity ( S t u d y 1)  57 58  T a b l e 4: Intercorrelations B e t w e e n the V i g n e t t e T h e m e s for the L o w F r e q u e n c y and H i g h F r e q u e n c y C o n d i t i o n s ( S t u d y 2)  59  T a b l e 5: C o r r e l a t i o n s B e t w e e n M e a n V i g n e t t e A p p r a i s a l R a t i n g and M e t a c o g n i t i v e M e a s u r e s , O C D S y m p t o m a t o l o g y , and D e p r e s s i o n ( S t u d y 2) T a b l e 6: V i g n e t t e A p p r a i s a l R a t i n g s b y T h e m e a n d F r e q u e n c y C o n d i t i o n ( S t u d y 2)  60 61  T a b l e 7: M e a n V i g n e t t e A p p r a i s a l R a t i n g s for H i g h and L o w O C Participants ( S t u d y 2 ) . . . . 62 T a b l e 8: M e a n s and Standard D e v i a t i o n s for A g e , O C D S y m p t o m s , O C B e l i e f s , B a s e l i n e N e g a t i v e A f f e c t , and A p p r a i s a l s o f the Target T h o u g h t  106  T a b l e 9: M e a n s and Standard D e v i a t i o n s for S u p p r e s s i o n E f f o r t , Target T h o u g h t F r e q u e n c y , and D i s c o m f o r t R a t i n g s , b y G r o u p , S u p p r e s s i o n Instructions, and Interval T a b l e 10: A n a l y s i s o f V a r i a n c e for Target T h o u g h t F r e q u e n c y  107 108  T a b l e 11: H i e r a r c h i c a l R e g r e s s i o n A n a l y s i s for V a r i a b l e s P r e d i c t i n g Post-task N e g a t i v e Affect T a b l e 12: H i e r a r c h i c a l R e g r e s s i o n A n a l y s i s for V a r i a b l e s P r e d i c t i n g A n x i e t y R a t i n g s  109 110  IX  L i s t of Figures F i g u r e 1: A v e r a g e appraisal ratings b y thematic content for h i g h and l o w frequency conditions F i g u r e 2: D i a g r a m o f the procedure for S t u d y 3  63 Ill  F i g u r e 3: R a w frequency o f target thought occurrences d u r i n g the thought suppression task. 112 F i g u r e 4: S i m p l e regression slopes o f the interaction b e t w e e n appraisals and thought c o n t r o l effort i n p r e d i c t i n g post-task negative affect  113  F i g u r e 5: S i m p l e regression slopes o f the interaction b e t w e e n appraisals and thought c o n t r o l effort i n p r e d i c t i n g post-task a n x i e t y ratings  114  Acknowledgements I w o u l d l i k e to a c k n o w l e d g e the f o l l o w i n g p e o p l e for their h e l p a n d support throughout m y dissertation research:  T o m y supervisor, S h e i l a R . W o o d y , P h . D . - thank y o u for y o u r n e v e r - e n d i n g support, encouragement, and guidance. Y o u are a w o n d e r f u l supervisor, a n d I cannot thank y o u e n o u g h for y o u r support and friendship.  T o Janet W e r k e r , P h . D . - I have a l w a y s a d m i r e d y o u r p a s s i o n for research a n d the strong support y o u p r o v i d e to y o u r students. T h a n k y o u for e n c o u r a g i n g m e to pursue graduate studies, and for y o u r constant support throughout m y studies.  T o m y c o m m i t t e e m e m b e r s , S t a n l e y R a c h m a n , P h . D . , and E r i c E i c h , P h . D . - thank y o u for the m a n y h e l p f u l suggestions.  T o J a s m i n e C a d y , D a v i d L i a n g , a n d C a r m e n M c L e a n , w h o assisted w i t h m a n y aspects o f this project - thank y o u for a l l o f y o u r h e l p !  T o m y w o n d e r f u l h u s b a n d , w i t h o u t w h o m I c o u l d not have a c c o m p l i s h e d m y g o a l o f c o m p l e t i n g a d o c t o r a l degree. T h a n k y o u for y o u r strength, sense o f h u m o u r , and constant support.  T o m y f a m i l y a n d to the m a n y friends w h o have supported m e throughout m y graduate studies - thank y o u !  1  C H A P T E R 1: I N T R O D U C T I O N  " T h e greatest d i s c o v e r y o f m y generation is that h u m a n beings c a n alter their l i v e s b y altering their attitudes o f m i n d . " - W i l l i a m James  O b s e s s i v e - c o m p u l s i v e disorder ( O C D ) , w h i c h affects a p p r o x i m a t e l y 2 - 3 % o f adults ( K a r n o , G o l d i n g , S o r e n s o n , & B u r n a m , 1988), is an a n x i e t y disorder characterized b y frequent and d i s t u r b i n g obsessions and ritualistic c o m p u l s i o n s . T h e obsessions, w h i c h consist o f u n w a n t e d , intrusive thoughts, images, or i m p u l s e s ( A m e r i c a n P s y c h i a t r i c A s s o c i a t i o n , 1994), are h i g h l y distressing and tend to p r o v o k e active resistance o f the thought i n the f o r m o f suppression and neutralization. W h i l e f u l l b l o w n obsessions are a u n i q u e characteristic o f O C D , it has been w e l l - e s t a b l i s h e d that m o s t p e o p l e experience u n w a n t e d intrusive thoughts ( R a c h m a n & de S i l v a , 1978; S a l k o v s k i s & H a r r i s o n , 1984). W h e r e a s m o s t people are not t r o u b l e d b y these thoughts and experience t h e m o n l y infrequently, patients w i t h O C D report recurrent, d i s t u r b i n g obsessions that interfere w i t h their f u n c t i o n i n g and q u a l i t y o f life ( A n t o n y , R o t h , S w i n s o n , H u t a , & D e v i n s , 1998; K h a n n a , Rajendra, & C h a n n a b a s a v a n n a , 1988; K o r a n , T h i e n e m a n n , & D a v e n p o r t , 1996). R e c e n t l y p r o p o s e d c o g n i t i v e theories o f O C D posit that d y s f u n c t i o n a l appraisals about the s i g n i f i c a n c e o f intrusive thoughts are c r i t i c a l i n transforming " n o r m a l " u n w a n t e d i n t r u s i v e thoughts into c l i n i c a l obsessions ( R a c h m a n , 1997, 1998; S a l k o v s k i s , 1985; S a l k o v s k i s , Forrester, & R i c h a r d s , 1998). In his c o g n i t i v e theory o f obsessions, R a c h m a n ( 1 9 9 7 ; 1998) argues that obsessions d e v e l o p w h e n i n d i v i d u a l s " c a t a s t r o p h i c a l l y m i s i n t e r p r e t " the m e a n i n g and personal  2  s i g n i f i c a n c e o f u n w a n t e d intrusive thoughts.  T h e s e dysfunctional appraisals p r o d u c e a n x i e t y  and distress and m o t i v a t e active resistance o f s u c h thoughts.  C o g n i t i v e theories o f O C D  further suggest that t r y i n g to c o n t r o l the thoughts is an ineffective strategy that contributes to a p a r a d o x i c a l increase i n the occurrence o f s u c h thoughts ( W e g n e r , S c h n e i d e r , Carter, & W h i t e , 1987).  T h u s , R a c h m a n proposes a m o d e l w h e r e b y i n t r u s i v e thoughts b e c o m e  i n c r e a s i n g l y frequent over t i m e w h e n they are appraised as p e r s o n a l l y significant and a c t i v e l y resisted. T h e purpose o f this dissertation project is to test several hypotheses from R a c h m a n ' s c o g n i t i v e theory o f obsessions w i t h a focus o n appraisals. T h e first g o a l is to c l a r i f y whether d y s f u n c t i o n a l appraisals o f s o c i a l l y unacceptable intrusive thoughts are related to s u b c l i n i c a l o b s e s s i v e - c o m p u l s i v e s y m p t o m s . T h e second g o a l is to investigate the interaction o f appraisals and suppression o f o b s e s s i o n - l i k e thoughts.  B e h a v i o u r a l Theories of O C D U n t i l f a i r l y recently, b e h a v i o u r a l m o d e l s o f O C D w e r e p r e d o m i n a n t i n the literature. T h e b e h a v i o u r a l account asserts that O C D is m a i n t a i n e d v i a an a n x i e t y r e d u c t i o n c i r c u i t ( R a c h m a n & H o d g s o n , 1980), w h e r e b y c o m p u l s i o n s are p e r f o r m e d i n an effort to reduce the a n x i e t y p r o d u c e d b y obsessions. F o r e x a m p l e , a person m a y b e c o m e h i g h l y a n x i o u s after h a v i n g an intrusive thought about getting contaminated f r o m t o u c h i n g a d i r t y faucet.  In  response to this upsetting thought, the p e r s o n m a y feel the urge to w a s h i n order to reduce anxiety. T h e s e escape and avoidance strategies (i.e., c o m p u l s i o n s and n e u t r a l i z a t i o n strategies) are n e g a t i v e l y r e i n f o r c e d because they reduce a n x i e t y associated w i t h the intrusive thoughts (i.e., obsessions). These strategies are also b e l i e v e d to m a i n t a i n a n x i e t y b y p r e v e n t i n g the i n d i v i d u a l from l e a r n i n g that a n x i e t y w o u l d d i m i n i s h n a t u r a l l y and that the feared consequences are u n l i k e l y to happen. T h u s , b e h a v i o u r a l m o d e l s o f O C D propose that  3  obsessions p r o v o k e a n x i e t y and that c o m p u l s i o n s b e c o m e h i g h l y r e w a r d i n g because they serve to decrease anxiety. W h i l e the b e h a v i o u r a l m o d e l has r e c e i v e d e m p i r i c a l support for the c o n n e c t i o n between c o m p u l s i o n s and a n x i e t y r e d u c t i o n ( H o d g s o n & R a c h m a n , 1972; R a c h m a n , D e S i l v a , & R o p e r , 1976; R o p e r , R a c h m a n , & H o d g s o n , 1973), it is less successful at e x p l a i n i n g the o r i g i n s o f obsessions ( T a y l o r , 2002). E x p o s u r e and response p r e v e n t i o n ( E X / R P ; M e y e r , 1966) w a s d e v e l o p e d as a treatment for O C D based o n the b e h a v i o u r a l m o d e l o f O C D .  I n E X / R P , patients w i t h O C D  are e x p o s e d to their feared s t i m u l i (for e x a m p l e , a d i r t y b a t h r o o m for a patient w i t h c o n t a m i n a t i o n obsessions) and prevented f r o m p e r f o r m i n g c o m p u l s i o n s . T h r o u g h repeated, p r o l o n g e d exposure, the a n x i e t y response is d i m i n i s h e d and patients learn that their feared outcomes do not occur. B e h a v i o r a l treatments s u c h as E X / R P have b e e n v e r y successful i n the treatment o f O C D .  I n a recent r e v i e w o f o u t c o m e studies, F o a and K o z a k (1996) reported  a response rate o f 8 3 % a m o n g m o r e than 3 0 0 clients i n v o l v e d i n the v a r i o u s studies o f exposure and response p r e v e n t i o n . F u r t h e r m o r e , they reported that 7 6 % o f patients r e m a i n e d responders at f o l l o w - u p (mean length o f f o l l o w - u p w a s 2.4 years). H o w e v e r , w h e n treatment refusers and treatment dropouts w e r e considered, treatment e f f i c a c y o f E X / R P w a s closer to 50%.  M o r e o v e r , E X / R P has been found to be less effective for patients w h o experience  obsessions w i t h o u t overt c o m p u l s i o n s ( S a l k o v s k i s & W e s t b r o o k , 1989).  Cognitive Theories of O C D C o g n i t i v e theories o f O C D have recently been p r o p o s e d i n an effort to redress some o f the l i m i t a t i o n s o f p r i o r m o d e l s ( P u r d o n & C l a r k , 1999; R a c h m a n , 1997, 1998; S a l k o v s k i s , 1985). These theories differ f r o m past c o n c e p t u a l i z a t i o n s o f O C D i n their emphasis o n m e t a c o g n i t i v e processes, or the w a y that people interpret and g i v e m e a n i n g to their thoughts  ( F l a v e l l , 1979). C o g n i t i v e m o d e l s o f O C D focus o n the r o l e o f appraisals, beliefs, and assumptions i n the maintenance o f obsessions and c o m p u l s i o n s . S p e c i f i c a l l y , these theories posit that appraisals o f u n w a n t e d intrusive thoughts mediate the r e l a t i o n s h i p b e t w e e n the o c c u r r e n c e o f i n t r u s i v e thoughts and anxiety; o n l y w h e n i n d i v i d u a l s attach undue s i g n i f i c a n c e to their u n w a n t e d i n t r u s i v e thought w i l l they experience increased a n x i e t y and the desire to resist or c o n t r o l their u n w a n t e d thoughts. Salkovskis's Cognitive Theory o f O C D S a l k o v s k i s ' s (1985) c o g n i t i v e analysis o f O C D w a s the first major attempt to v i e w O C D from a c o g n i t i v e perspective, a l t h o u g h earlier c o g n i t i v e theories o f O C D w e r e p r o p o s e d ( B e c k , 1976; C a r r , 1974; M c F a l l & W o l l e r s h e i m , 1979). In h i s theory, S a l k o v s k i s (1985) argued that obsessions d e v e l o p w h e n intrusive thoughts interact w i t h an i n d i v i d u a l ' s b e l i e f system i n s u c h a w a y as to g i v e rise to negative appraisals about the o c c u r r e n c e o f the intrusive thoughts. S a l k o v s k i s b e l i e v e d that w h e n i n t r u s i v e thoughts are appraised as m e a n i n g f u l or important, a n x i e t y and d i s c o m f o r t w i l l be p r o d u c e d . In response to the increase i n anxiety, i n d i v i d u a l s engage i n c o m p u l s i v e rituals or acts o f n e u t r a l i z a t i o n i n order to decrease a n x i e t y and negative affect. In contrast, w h e n u n w a n t e d i n t r u s i v e thoughts are appraised as unimportant, n o a n x i e t y w i l l result. In h i s m o d e l , S a l k o v s k i s (1985) p r o p o s e d that d y s f u n c t i o n a l appraisals related to r e s p o n s i b i l i t y p r e d o m i n a t e i n O C D and suggested that i n d i v i d u a l s w i t h O C D tend to b e l i e v e that they w i l l be r e s p o n s i b l e for h a r m c o m i n g to themselves or others i f they fail to act i n response to harm-related obsessions. S a l k o v s k i s defined r e s p o n s i b i l i t y appraisals as the " b e l i e f that one has p o w e r w h i c h is p i v o t a l to b r i n g about o r prevent s u b j e c t i v e l y c r u c i a l negative o u t c o m e s " ( S a l k o v s k i s , R a c h m a n , L a d o u c e u r , & Freeston, as c i t e d i n S a l k o v s k i s &  5  K i r k , 1997). F o r e x a m p l e , i f i n response to the i n t r u s i v e thought, " I m a y h a v e left the stove o n , " i n d i v i d u a l s m a k e the attribution that they w o u l d be p e r s o n a l l y r e s p o n s i b l e for their house b u r n i n g d o w n , they are m o r e l i k e l y to feel increased a n x i e t y and the desire to c h e c k the stove. S a l k o v s k i s suggested that other faulty appraisals c o m m o n l y f o u n d i n O C D i n c l u d e the i d e a that thoughts are equivalent to actions, that f a i l i n g to prevent h a r m is as b a d as c a u s i n g h a r m , that f a i l i n g to neutralize after an i n t r u s i o n is the same as w i s h i n g that the i n t r u s i o n were true, and that it is important to have c o n t r o l o v e r o n e ' s thoughts. S a l k o v s k i s ' s m o d e l (1985) also p l a c e d an important role o n the effects o f n e u t r a l i z a t i o n i n m a i n t a i n i n g the o b s e s s i v e - c o m p u l s i v e c y c l e . N e u t r a l i z i n g , w h i c h c a n be either overt (i.e., c o m p u l s i o n s ) or covert (i.e., m e n t a l rituals) is an attempt to u n d o , c a n c e l out, or compensate for the effects o f i n t r u s i v e thoughts ( R a c h m a n , Shafran, M i t c h e l l , Trant, & T e a c h m a n , 1996). S a l k o v s k i s asserted that there are several consequences o f neutralization. F i r s t , he suggested that n e u t r a l i z a t i o n results i n an i m m e d i a t e decrease i n distress, w h i c h is h i g h l y r e w a r d i n g and is l i k e l y to l e a d to increased use o f n e u t r a l i z a t i o n i n the future.  S e c o n d , because the feared events are u n l i k e l y (or i m p o s s i b l e ) , n e u t r a l i z a t i o n has  the appearance o f b e i n g effective for p r e v e n t i n g h a r m . T h i s effect, c o m b i n e d w i t h the r e d u c t i o n i n a n x i e t y that a c c o m p a n i e s n e u t r a l i z a t i o n , serves to strengthen the i n d i v i d u a l ' s beliefs. F i n a l l y , S a l k o v s k i s suggested that the n e u t r a l i z i n g b e h a v i o r i t s e l f w i l l b e c o m e a t r i g g e r i n g s t i m u l u s for future obsessions. R a c h m a n ' s C o g n i t i v e Theory o f Obsessions R a c h m a n (1997; 1998) p r o p o s e d a m o r e c o m p r e h e n s i v e c o g n i t i v e theory o f obsessions that b u i l d s u p o n the theory o f S a l k o v s k i s (1985). R a t h e r than f o c u s i n g e x c l u s i v e l y o n appraisals o f r e s p o n s i b i l i t y , R a c h m a n o u t l i n e d a theory suggesting that  6  appraisals about the personal significance  o f intrusive thoughts cause u n w a n t e d i n t r u s i v e  thoughts to d e v e l o p into c l i n i c a l obsessions. I n h i s theory, R a c h m a n (1997) argues that w h e n u n w a n t e d i n t r u s i v e thoughts are g i v e n undue i m p o r t a n c e o r "exaggerated s i g n i f i c a n c e " (p. 794), they w i l l b e c o m e p r o b l e m a t i c a n d upsetting.  S p e c i f i c a l l y , he states that "obsessions  are caused b y catastrophic misinterpretations o f the s i g n i f i c a n c e o f o n e ' s thoughts (images, i m p u l s e s ) . B y d e d u c t i o n : (a) the obsessions w i l l persist for as l o n g as these misinterpretations continue; a n d (b) the obsessions w i l l d i m i n i s h o r disappear as a f u n c t i o n o f the w e a k e n i n g / e l i m i n a t i o n o f these m i s i n t e r p r e t a t i o n s " ( R a c h m a n , 1997, p . 7 9 3 ) . In this m o d e l , R a c h m a n (1997) proposes that i n d i v i d u a l s first m a k e j u d g m e n t s about the meaning o f their u n w a n t e d intrusive thoughts, for e x a m p l e , "this thought i s i m m o r a l " or, "this thought is d i s g u s t i n g . " N e x t , he suggests that i n d i v i d u a l s m a k e appraisals about the significance  or personal meaning o f the i n t r u s i v e thoughts. F o r e x a m p l e , i n d i v i d u a l s m a y  interpret their u n w a n t e d i n t r u s i v e thoughts to s i g n i f y s o m e t h i n g important o r r e v e a l i n g about their innermost character, such as, "these obsessions m e a n that deep d o w n I a m an e v i l person, I a m dangerous, I a m u n r e l i a b l e , I m a y b e c o m e t o t a l l y u n c o n t r o l l a b l e . . . , I a m w e i r d , I a m g o i n g insane (and w i l l lose c o n t r o l ) , I a m a sinful person, I a m f u n d a m e n t a l l y i m m o r a l " ( R a c h m a n , 1997, p . 794). R a c h m a n argues that the m o s t c o m m o n types o f p r o b l e m a t i c appraisals f a l l into one o f three m a i n categories: "these h o r r i b l e thoughts m e a n I a m m a d , bad, or dangerous - o r a l l three" ( R a c h m a n , 2 0 0 3 , p . 6). T h i s i s a c r i t i c a l stage i n the m o d e l ; R a c h m a n b e l i e v e s that w h i l e it i s n o r m a l for p e o p l e to f i n d the content o f their thoughts d i s t u r b i n g , it is c o n s i d e r a b l y less c o m m o n for p e o p l e to appraise their thoughts as h a v i n g exaggerated s i g n i f i c a n c e . R a c h m a n further argues that appraisals about the s i g n i f i c a n c e o f i n t r u s i v e thoughts w i l l result i n m o o d  7  disturbance and anxiety, whereas u n w a n t e d i n t r u s i v e thoughts that are interpreted as s i m p l y " m e n t a l f l o t s a m " w i l l be d i s m i s s e d as unimportant and i n s i g n i f i c a n t and w i l l not l e a d to changes i n m o o d or anxiety. T h e r e s u l t i n g negative m o o d o n l y serves to increase the negative interpretations about the s i g n i f i c a n c e o f the thoughts and m a y also increase the frequency o f i n t r u s i v e thoughts. F i n a l l y , as a result o f appraisals o f exaggerated s i g n i f i c a n c e and the subsequent a n x i e t y and m o o d disturbance, R a c h m a n posits that i n d i v i d u a l s w i l l attempt to resist, suppress, or neutralize the obsessions i n order to "put matters r i g h t " ( R a c h m a n , 1997, p . 795). In the short term, thought c o n t r o l strategies s u c h as n e u t r a l i z a t i o n and suppression are b e l i e v e d to reduce distress and d i s c o m f o r t , m a k i n g t h e m h i g h l y r e w a r d i n g . H o w e v e r , o v e r t i m e thought c o n t r o l strategies strengthen obsessions because they interfere w i t h the natural r e d u c t i o n o f anxiety, and they preserve the b e l i e f that the feared consequence w o u l d have o c c u r r e d i f not for the n e u t r a l i z a t i o n . R a c h m a n also i m p l i c a t e s thought suppression i n the maintenance o f obsessions, suggesting that thought suppression d i r e c t l y increases the frequency o f obsessions due to the p a r a d o x i c a l effects o f suppression. F u r t h e r c o n t r i b u t i n g to the negative c y c l e , the increased frequency that c a n result from thought s u p p r e s s i o n and other thought c o n t r o l strategies i n turn m a k e s the u n w a n t e d thoughts seem e v e n m o r e important and p e r s o n a l l y m e a n i n g f u l . F o r e x a m p l e , it is not u n c o m m o n for patients to use the f o l l o w i n g l o g i c i n the interpretation o f their thoughts: " T h e v e r y fact that I a m e x p e r i e n c i n g these thoughts so frequently suggests that they must be m e a n i n g f u l . " I n this w a y , a v i c i o u s c y c l e o f d y s f u n c t i o n a l appraisals, thought c o n t r o l strategies, and increased frequency o f thoughts is established. I n s u m m a r y , R a c h m a n proposes a m o d e l w h e r e b y the "catastrophic m i s i n t e r p r e t a t i o n " o f the s i g n i f i c a n c e o f  thoughts is c r i t i c a l i n the d e v e l o p m e n t or maintenance o f obsessions. A s he states, the " m i s i n t e r p r e t a t i o n o f the intrusive thoughts as b e i n g v e r y important, p e r s o n a l l y significant, r e v e a l i n g and threatening or even catastrophic, has the effect o f t r a n s f o r m i n g a c o m m o n p l a c e nuisance into a torment" ( R a c h m a n , 1997, p . 794). T h e r e are a n u m b e r o f p r e d i c t i o n s that f o l l o w f r o m R a c h m a n ' s c o g n i t i v e theory o f obsessions. First, the theory is based o n the a s s u m p t i o n that u n w a n t e d i n t r u s i v e thoughts are s i m i l a r i n content to c l i n i c a l obsessions and that appraisals o f p e r s o n a l m e a n i n g d i s t i n g u i s h n o r m a l u n w a n t e d i n t r u s i v e thoughts f r o m c l i n i c a l obsessions. B a s e d o n this a s s u m p t i o n , the theory predicts that appraisals o f p e r s o n a l s i g n i f i c a n c e s h o u l d be related to obsessivec o m p u l s i v e s y m p t o m s . T h a t is, " p e o p l e w h o experience recurrent obsessions [ s h o u l d be] m o r e l i k e l y than p e o p l e w h o do not experience t h e m , to attach important, personal s i g n i f i c a n c e to their i n t r u s i v e thoughts" ( R a c h m a n , 1997, p . 793). S e c o n d , the theory predicts that the content o f i n t r u s i v e thoughts s h o u l d i n f l u e n c e d y s f u n c t i o n a l appraisals d e p e n d i n g o n the i n d i v i d u a l ' s b a c k g r o u n d and p e r s o n a l values. F o r e x a m p l e , for h i g h l y r e l i g i o u s i n d i v i d u a l s , u n w a n t e d i n t r u s i v e thoughts o f a b l a s p h e m o u s nature w o u l d be p a r t i c u l a r l y upsetting and most l i k e l y to l e a d to negative interpretations, but n o n r e l i g i o u s persons w o u l d not be expected to appraise such thoughts as p e r s o n a l l y relevant or significant e v e n i f they d i d o c c u r . T h i r d , thought c o n t r o l strategies s h o u l d contribute to increased frequency o f i n t r u s i v e thoughts. F i n a l l y , the theory w o u l d predict that d y s f u n c t i o n a l appraisals c o m b i n e d w i t h thought c o n t r o l strategies s u c h as thought s u p p r e s s i o n s h o u l d result i n increased anxiety, m o o d disturbance, and increased frequency o f i n t r u s i v e thoughts. T h e f o l l o w i n g literature r e v i e w w i l l focus o n research that is pertinent to R a c h m a n ' s theory o f obsessions. S p e c i f i c a l l y , the relevant literature o n u n w a n t e d i n t r u s i v e thoughts,  9  d y s f u n c t i o n a l appraisals o f u n w a n t e d i n t r u s i v e thoughts, and thought c o n t r o l strategies w i l l be r e v i e w e d .  U n w a n t e d Intrusive Thoughts O n c e b e l i e v e d to be q u a l i t a t i v e l y distinct, there is n o w c o n s i d e r a b l e e v i d e n c e that c l i n i c a l obsessions and " n o r m a l " u n w a n t e d i n t r u s i v e thoughts are m o r e a l i k e than they are different. I n their s e m i n a l series o f studies, R a c h m a n and de S i l v a (1978) f o u n d that n o n c l i n i c a l i n d i v i d u a l s experience u n w a n t e d i n t r u s i v e thoughts o f s i m i l a r content to c l i n i c a l obsessions. In their first study, 8 0 % o f n o n c l i n i c a l participants reported that they e x p e r i e n c e d i n t r u s i v e thoughts or images. I n their s e c o n d study, R a c h m a n and de S i l v a (1978) c o l l e c t e d e x a m p l e s o f i n t r u s i v e thoughts f r o m c l i n i c a l ( O C D ) and n o n c l i n i c a l participants u s i n g a structured i n t e r v i e w . A p a n e l o f s i x j u d g e s (5 p s y c h o l o g i s t s and 1 psychiatrist) c a t e g o r i z e d the thoughts as n o n c l i n i c a l or c l i n i c a l , but they w e r e unable to m a k e r e l i a b l e d i s t i n c t i o n s b e t w e e n c l i n i c a l obsessions and n o r m a l u n w a n t e d i n t r u s i v e thoughts based o n content alone. T h e investigators interpreted this result as suggesting that " c l i n i c a l obsessions are not as r e a d i l y d i s c e r n i b l e - e v e n to e x p e r i e n c e d c l i n i c i a n s - as m i g h t be e x p e c t e d " ( R a c h m a n & de S i l v a , 1978, p.239). R a c h m a n and de S i l v a (1978) also e x a m i n e d the s i m i l a r i t i e s and differences between obsessions reported b y the c l i n i c a l sample and u n w a n t e d i n t r u s i v e thoughts reported b y the n o n - c l i n i c a l sample. In a d d i t i o n to the content s i m i l a r i t i e s , u n w a n t e d i n t r u s i v e thoughts w e r e s i m i l a r to c l i n i c a l obsessions i n f o r m ; b o t h o c c u r r e d as thoughts or i m p u l s e s . H o w e v e r , c l i n i c a l obsessions differed from u n w a n t e d i n t r u s i v e thoughts i n a n u m b e r o f important w a y s . S p e c i f i c a l l y , c l i n i c a l obsessions were reported to o c c u r m o r e frequently, be m o r e intense, be m o r e e g o - d y s t o n i c , p r o d u c e m o r e d i s c o m f o r t , and lead to greater urges to neutralize.  10  M a n y studies have since e x a m i n e d u n w a n t e d i n t r u s i v e thoughts i n n o r m a l p o p u l a t i o n s , a n d these studies have c o n f i r m e d that u n w a n t e d i n t r u s i v e thoughts are a nearu n i v e r s a l experience (e.g., Freeston, L a d o u c e u r , T h i b o d e a u , & G a g n o n , 1 9 9 1 ; N i l e r & B e c k , 1989; P u r d o n & C l a r k , 1993; S a l k o v s k i s & H a r r i s o n , 1984). Studies also p r o v i d e e v i d e n c e that the u n w a n t e d i n t r u s i v e thoughts reported b y n o r m a l samples are o n a c o n t i n u u m o f severity w i t h c l i n i c a l obsessions. F o r e x a m p l e , P u r d o n a n d C l a r k (1993) reported a significant c o r r e l a t i o n b e t w e e n a measure o f intrusions a n d a measure o f obsessivec o m p u l s i v e s y m p t o m s i n a n o r m a l sample, suggesting that obsessions m a y be s i m p l y a m o r e intense a n d distressing variant o f an otherwise n o r m a l c o g n i t i v e process. T h e results o f these studies suggest that the u n w a n t e d i n t r u s i v e thoughts o f n o r m a l i n d i v i d u a l s c a n be studied as an analogue o f c l i n i c a l obsessions.  A p p r a i s a l s of U n w a n t e d Intrusive Thoughts T h e k e y tenet o f R a c h m a n ' s c o g n i t i v e theory o f obsessions (1997) i s that d y s f u n c t i o n a l appraisals o f u n w a n t e d intrusive thoughts contribute to a n escalating c y c l e o f increased anxiety, negative self-evaluation, urges to neutralize o r suppress, a n d increased frequency o f i n t r u s i v e thoughts. A c c o r d i n g to L a z a r u s (1991), appraisals refer to the " e v a l u a t i o n o f the s i g n i f i c a n c e o f k n o w l e d g e about what is h a p p e n i n g for o u r personal w e l l b e i n g " (p. 354). S i m i l a r l y , the O b s e s s i v e C o m p u l s i v e C o g n i t i o n s W o r k i n g G r o u p ( O C C W G ; 1997) defines appraisals as the " w a y s i n w h i c h m e a n i n g i s g i v e n to a s p e c i f i c event s u c h as the o c c u r r e n c e o f an i n t r u s i o n " (p. 670). T h e O C C W G contrasts appraisals  with  assumptions, w h i c h they define as enduring, t r a i t - l i k e beliefs. A p p r a i s a l s o f personal s i g n i f i c a n c e take o n different forms, s u c h as appraisals about the i m p o r t a n c e o f an i n t r u s i o n (i.e., "because I ' v e h a d this thought, it must be important"), appraisals about the p r o b a b i l i t y  11  o f the i n t r u s i o n a c t u a l l y o c c u r r i n g (i.e., "because I ' v e h a d this thought, the negative event is m o r e l i k e l y to h a p p e n " o r " h a v i n g a b a d thought is equivalent to c o m m i t t i n g the b a d deed"), and appraisals related to r e s p o n s i b i l i t y (i.e., "because I ' v e h a d this b a d thought, I must act to prevent the event f r o m o c c u r r i n g " ) . Consistent w i t h R a c h m a n ' s theory, p e o p l e w i t h O C D appraise their i n t r u s i v e thoughts as m o r e p e r s o n a l l y s i g n i f i c a n t than do i n d i v i d u a l s w i t h o u t O C D ( O C C W G , 2 0 0 1 , 2 0 0 3 , 2 0 0 5 ) . In a series o f studies c o n d u c t e d b y the O C C W G , O C D patients, a n x i e t y controls, and n o n c l i n i c a l c o n t r o l participants c o m p l e t e d the Interpretation o f Intrusions I n v e n t o r y (111-31), a w e l l - v a l i d a t e d instrument designed to measure d y s f u n c t i o n a l appraisals o f i d i o s y n c r a t i c i n t r u s i v e thoughts. A c r o s s a l l three studies, O C D patients s c o r e d h i g h e r o n the 111-31 than d i d the n o n c l i n i c a l and a n x i e t y disorder controls, d e m o n s t r a t i n g that they endorsed faulty appraisals o f their o b s e s s i o n a l thoughts to a greater extent than d i d the other groups. H o w e v e r , O C D patients d i d not score h i g h e r o n the i m p o r t a n c e o f thoughts subscale than d i d the a n x i e t y disorder c o n t r o l patients ( O C C W G , 2 0 0 3 ) , suggesting that appraisals about the i m p o r t a n c e o f thoughts m a y not be u n i q u e to O C D o r that the 111-31 does not adequately articulate the aspects o f i m p o r t a n c e o f thoughts that are u n i q u e to O C D . E n d o r s e m e n t o f appraisals o f intrusive thoughts has also b e e n found to correlate w i t h o b s e s s i v e - c o m p u l s i v e s y m p t o m s . In the O C C W G ( 2 0 0 1 ; 2 0 0 3 ; 2 0 0 5 ) studies d e s c r i b e d above, a s i g n i f i c a n t relationship w a s f o u n d b e t w e e n O C D patients' scores o n the 111-31 a n d their scores o n w e l l - v a l i d a t e d measures o f O C D s y m p t o m a t o l o g y , i n c l u d i n g the Y a l e - B r o w n O b s e s s i v e C o m p u l s i v e S c a l e ( G o o d m a n et a l . , 1989) and the P a d u a I n v e n t o r y ( S a n a v i o , 1988). T h i s relationship w a s also f o u n d w i t h i n n o n c l i n i c a l c o n t r o l groups. In a study o f n o r m a l undergraduates, P u r d o n and C l a r k (1994a) reported that p e r c e i v e d u n c o n t r o l l a b i l i t y  12  o f u n w a n t e d thoughts w a s related to the b e l i e f that the thought c o u l d c o m e true i n real life. H i g h scorers o n a measure o f o b s e s s i v e - c o m p u l s i v e s y m p t o m s w e r e m o r e l i k e l y to b e l i e v e the thought c o u l d c o m e true i n real life, and they endorsed stronger feelings o f guilt i n response to the thought. O t h e r appraisal d o m a i n s that correlate w i t h O C D s y m p t o m s i n c l u d e appraisals that one c o u l d act o n the intrusive thought ( P u r d o n & C l a r k , 1994a, 1994b), appraisals about c o n t r o l ( P u r d o n & C l a r k , 1994a), appraisals o f r e s p o n s i b i l i t y (Freeston, L a d o u c e u r , T h i b o d e a u , & G a g n o n , 1992), a n d appraisals about the s i g n i f i c a n c e o f the thought for o n e ' s p e r s o n a l i t y ( C l a r k & C l a y b o u r n , 1997).  Neutralization and Thought Suppression In the c o g n i t i v e theory o f obsessions, R a c h m a n argues that p e o p l e engage i n thought c o n t r o l strategies s u c h as n e u t r a l i z a t i o n and thought suppression i n an effort to reduce the d i s c o m f o r t p r o d u c e d b y u n w a n t e d intrusive thoughts. T h e s e thought c o n t r o l strategies, i n turn, are b e l i e v e d to contribute to anxiety, negative m o o d , and the persistence o f obsessions because perfect thought c o n t r o l is i m p o s s i b l e . T y p i c a l thought c o n t r o l strategies f a l l into three m a i n categories: escape a n d a v o i d a n c e strategies, t h i n k i n g attentively strategies, and n o effortful response (Freeston et a l . , 1991). F u r t h e r m o r e , p e o p l e tend to engage i n m a n y different strategies i n response to their intrusive thoughts (Freeston, L a d o u c e u r , P r o v e n c h e r , & B l a i s , 1995), i n c l u d i n g distraction, s e e k i n g reassurance, p h y s i c a l action, r e p l a c i n g the i n t r u s i v e thought w i t h another thought, a n a l y z i n g the thought, t a l k i n g about the thought, thought s t o p p i n g , t r y i n g to c o n v i n c e o n e s e l f that the thought is unimportant, and d o i n g n o t h i n g (Freeston et a l . , 1995; 1994a). T h e s e strategies are v e r y s i m i l a r to those used b y O C D patients (Freeston & L a d o u c e u r , 1997), although O C D patients tend to engage i n a greater n u m b e r o f response strategies, spend  13  longer attempting to c o n t r o l their thoughts, and engage i n m o r e repetitions than do i n d i v i d u a l s w i t h o u t O C D ( L a d o u c e u r et a l . , 2 0 0 0 ) . Thought Suppression T h o u g h t s u p p r e s s i o n is a c o m m o n l y used thought c o n t r o l strategy that is b e l i e v e d to d i r e c t l y contribute to an increase i n the frequency o f thoughts and u l t i m a t e l y to the d e v e l o p m e n t and maintenance o f O C D . T h o u g h t suppression is the attempt to b l o c k , stop, or otherwise r i d the m i n d o f the i n t r u s i v e thought, w h i c h c a n i n c l u d e strategies s u c h as thoughts t o p p i n g or concentrating o n a different topic ( R a c h m a n et a l . , 1996). I n h i s w r i t i n g s , W e g n e r defines thought suppression as the " c o n s c i o u s a v o i d a n c e o f a thought" ( W e g n e r et al., 1987, p.6). R a c h m a n argues that w h e n i n d i v i d u a l s m a k e " c a t a s t r o p h i c " appraisals o f the s i g n i f i c a n c e o f a thought, they are m o t i v a t e d to a c t i v e l y resist these thoughts, often e m p l o y i n g thought s u p p r e s s i o n strategies. C o n s i d e r a b l e e v i d e n c e suggests that suppression strategies m a y p a r a d o x i c a l l y increase the frequency o f thoughts. T h e i r o n i c effects o f thought suppression w e r e first investigated b y W e g n e r and colleagues (1987). I n this c l a s s i c study, participants w h o w e r e instructed to suppress thoughts o f a w h i t e bear e x p e r i e n c e d a greater frequency o f target thoughts than d i d participants instructed to express the thoughts f r o m the outset. T h i s h i g h e r frequency o f target thoughts w a s f o u n d w h e n participants w e r e attempting to a c t i v e l y suppress the thoughts (the " i m m e d i a t e enhancement" effect) as w e l l as w h e n s u p p r e s s i o n instructions were later r e m o v e d and participants were t o l d to freely express the thoughts (the " r e b o u n d " effect). S i n c e the p u b l i c a t i o n o f this first thought s u p p r e s s i o n study, a considerable b o d y o f literature has emerged r e p l i c a t i n g the i r o n i c effects o f thought s u p p r e s s i o n ( C l a r k , B a l l , &  14  P a p e , 1991; C l a r k , W i n t o n , & T h y n n , 1993; H a r v e y & B r y a n t , 1998; M c N a l l y & R i c c i a r d i , 1996; W e g n e r & G o l d , 1995), w i t h most studies f i n d i n g e v i d e n c e o f thought r e b o u n d f o l l o w i n g a p e r i o d o f suppression. H o w e v e r , the thought s u p p r e s s i o n literature has been m i x e d , w i t h some studies f i n d i n g no e v i d e n c e o f a p a r a d o x i c a l effect o f suppression (see A b r a m o w i t z , T o l i n , & Street, 2 0 0 1 ; P u r d o n & C l a r k , 2 0 0 0 ; W e n z l a f f & W e g n e r , 2 0 0 0 , for t h o r o u g h r e v i e w s o f this literature). I n a recent meta-analysis, A b r a m o w i t z and colleagues (2001) e x a m i n e d 44 thought suppression studies and found a s m a l l to moderate effect size for the r e b o u n d effect ( C o h e n ' s d = 0.30) but no e v i d e n c e for an i n i t i a l enhancement effect ( C o h e n ' s d = -0.35). I n other w o r d s , the results o f the meta-analysis suggest that i n d i v i d u a l s are r e l a t i v e l y successful at suppressing a thought w h e n i n i t i a l l y instructed to do so. H o w e v e r , once s u p p r e s s i o n instructions are r e m o v e d , i n d i v i d u a l s w h o i n i t i a l l y suppressed thoughts tend to experience a h i g h e r frequency o f target thoughts r e l a t i v e to those w h o d i d not engage i n suppression. Thought Suppression o f Personally Relevant Thoughts Researchers interested i n O C D have attempted to study thought suppression as a potential factor i n O C D b y e x t e n d i n g the thought suppression p a r a d i g m to thoughts that are o f greater r e l e v a n c e to O C D (i.e., suppression o f p e r s o n a l l y relevant thoughts), thoughts that are m o r e s i m i l a r i n nature to obsessions, and b y d i r e c t l y s t u d y i n g thought s u p p r e s s i o n i n O C D patients. I n contrast to obsessions, w h i c h are p e r s o n a l l y relevant and upsetting, the early thought suppression studies e x a m i n e d suppression o f n o v e l , neutral targets such as " w h i t e bears" ( W e g n e r et a l . , 1987) and "green r a b b i t s " ( C l a r k et a l . , 1993). W i t h i n the past decade, research has e m e r g e d demonstrating that the p a r a d o x i c a l effects o f suppression m a y  15  extend to thoughts w i t h o b s e s s i o n a l or p e r s o n a l l y relevant content ( M c N a l l y & R i c c i a r d i , 1996; S a l k o v s k i s & C a m p b e l l , 1994; T r i n d e r & S a l k o v s k i s , 1994). S a l k o v s k i s and colleagues c o n d u c t e d t w o w e l l - d e s i g n e d , e c o l o g i c a l l y v a l i d studies i n v e s t i g a t i n g suppression o f p e r s o n a l l y relevant i n t r u s i v e thoughts. I n the S a l k o v s k i s and C a m p b e l l (1994) study, n o n c l i n i c a l participants r e p o r t i n g at least three i n t r u s i v e thoughts i n the past m o n t h i d e n t i f i e d an upsetting i n t r u s i v e thought and w e r e assigned to one o f four suppression c o n d i t i o n s (regular suppression, suppression w i t h general instructions to distract, suppression w i t h a s p e c i f i c d i s t r a c t i o n technique, and suppression w i t h instructions to not use distraction) or a m e n t i o n c o n t r o l c o n d i t i o n (think about a n y t h i n g , i n c l u d i n g the target thought). C o m p a r e d to the m e n t i o n c o n t r o l c o n d i t i o n , s u p p r e s s i o n o f p e r s o n a l l y relevant negative thoughts resulted i n a greater frequency o f target thoughts d u r i n g the suppression i n t e r v a l and after the suppression instructions w e r e lifted. I n a d d i t i o n , a l m o s t a l l suppression c o n d i t i o n s resulted i n a h i g h e r frequency o f target thoughts than the c o n t r o l c o n d i t i o n , w i t h the e x c e p t i o n o f participants instructed to use a specific d i s t r a c t i o n technique. I n an e x t e n s i o n o f this study, T r i n d e r and S a l k o v s k i s (1994) e x a m i n e d the l o n g - t e r m consequences o f suppression o f p e r s o n a l l y relevant i n t r u s i v e thoughts. I n this study, participants were assigned to suppress, m o n i t o r , or a c t i v e l y t h i n k about a p e r s o n a l l y relevant i n t r u s i v e thought o v e r a four-day p e r i o d . R e l a t i v e to the other t w o groups, participants w h o a c t i v e l y suppressed thoughts reported m o r e frequent intrusions and increased distress across a l l four days. I n a study c o m p a r i n g s u p p r e s s i o n o f neutral thoughts to p e r s o n a l l y relevant i n t r u s i v e thoughts, M c N a l l y and R i c c i a r d i (1996) f o u n d a r e b o u n d effect for negative p e r s o n a l l y relevant thoughts but not for neutral thoughts.  16  In contrast, several studies e x a m i n i n g suppression o f p e r s o n a l l y relevant thoughts failed to replicate the p a r a d o x i c a l effect o f suppression. K e l l y and K a h n (1994) e x a m i n e d the suppression o f negative p e r s o n a l l y relevant thoughts c o m p a r e d to neutral " w h i t e b e a r " thoughts. F o r participants i n the neutral thought c o n d i t i o n , but not the p e r s o n a l l y relevant thought c o n d i t i o n , i n i t i a l suppression was associated w i t h a r e b o u n d i n thought frequency d u r i n g the s e c o n d i n t e r v a l . R u t l e d g e (1998) also failed to f i n d e v i d e n c e o f a r e b o u n d effect for p e r s o n a l l y relevant thoughts. I n this study, a l l participants c o m p l e t e d three thought m o n i t o r i n g intervals; an i n i t i a l active e x p r e s s i o n i n t e r v a l w h i c h served as a baseline i n t e r v a l , a suppression i n t e r v a l , and a final e x p r e s s i o n i n t e r v a l . C o m p a r e d to the baseline e x p r e s s i o n interval, no p a r a d o x i c a l effect o f suppression w a s found. H o w e v e r , the results o f this study are difficult to interpret w i t h o u t a c o n t r o l group. S i m i l a r l y , S m a r i , B i r g i s d o t t i r , and B r y n j o l f s d o t t i r (1995) f o u n d n o evidence o f a r e b o u n d effect, t h o u g h they reported that participants h i g h i n o b s e s s i o n a l i t y h a d m o r e thoughts d u r i n g s u p p r e s s i o n than their l o w o b s e s s i o n a l i t y counterparts. M e t h o d o l o g i c a l differences l i k e l y contribute to the c o n t r a d i c t o r y results across studies and m a k e c o m p a r i s o n s difficult. T h o u g h t suppression studies have e m p l o y e d different research designs, participants, c o n t r o l c o n d i t i o n s (expression, m e n t i o n - c o n t r o l , do not suppress), target thoughts, r e c o r d i n g methods, and length o f thought m o n i t o r i n g intervals. O n the basis o f qualitative and quantitative r e v i e w s , A b r a m o w i t z and colleagues (2001) and P u r d o n and C l a r k (2000) p r o p o s e d m e t h o d o l o g i c a l r e c o m m e n d a t i o n s to m a x i m i z e effect sizes and relevance to O C D , s u c h as i n c l u s i o n o f e c o l o g i c a l l y v a l i d c o n t r o l c o n d i t i o n s , thoughts w i t h o b s e s s i o n a l content, and methods o f r e c o r d i n g thoughts that are less sensitive to response bias.  17  Studies c o n d u c t e d w i t h the i n c l u s i o n o f these m e t h o d o l o g i c a l r e c o m m e n d a t i o n s suggest that e v e n w h e n suppression does not lead to an increase i n p e r s o n a l l y relevant thoughts, it m a y interfere w i t h the natural decrease o f s u c h thoughts. I n one s u c h study, P u r d o n and C l a r k (2001) c o m p a r e d the effects o f suppressing p o s i t i v e p e r s o n a l l y relevant, negative p e r s o n a l l y relevant, and neutral thoughts. S p e c i f i c " d o not suppress" instructions were u s e d i n an attempt to discourage participants i n the c o n t r o l c o n d i t i o n f r o m e n g a g i n g i n natural suppression attempts.  W h i l e there w a s no e v i d e n c e o f enhancement or r e b o u n d for  any o f the target thoughts, the researchers n o t e d that suppression e l i m i n a t e d the natural d e c a y i n frequency o b s e r v e d a m o n g participants under n o n s u p p r e s s i o n instructions. S i m i l a r l y , B e l l o c h and colleagues (2004) reported that participants i n c o n t r o l c o n d i t i o n s s h o w e d a d e c l i n e i n target thought frequency across three p e r i o d s . In contrast, participants i n the suppression c o n d i t i o n s reported s i m i l a r l y h i g h l e v e l s o f target thoughts across a l l intervals, suggesting that thought suppression m a y interfere w i t h the n o r m a l d e c l i n e i n the frequency o f p e r s o n a l l y relevant thoughts. Thought Suppression i n O C D S o m e e x p e r i m e n t a l thought suppression studies have b e e n c o n d u c t e d w i t h O C D patients. Janeck and C a l a m a r i (1999) e x p l o r e d the effect o f suppressing p e r s o n a l l y relevant intrusive thoughts i n 32 O C D patients and 33 n o r m a l controls. C o n t r a r y to the hypothesis, O C D patients d i d not s h o w a stronger p a r a d o x i c a l effect o f thought s u p p r e s s i o n than n o r m a l controls. H o w e v e r , O C D patients w e r e m o r e l i k e l y than n o r m a l controls to experience a r e b o u n d o f their thoughts. P u r d o n , R o w a , and A n t o n y (2005) reported s i m i l a r f i n d i n g s . F i f t y i n d i v i d u a l s w i t h O C D w e r e p r i m e d w i t h their m o s t upsetting o b s e s s i o n a l thought and w e r e instructed to suppress or not suppress the thought. N o effect o f s u p p r e s s i o n w a s f o u n d .  18  In contrast, T o l i n , A b r a m o w i t z , P r z e w o r s k i , and F o a (2002) c o m p a r e d O C D , a n x i e t y controls, and n o r m a l controls o n the suppression o f neutral " w h i t e bear" thoughts and o b s e r v e d a r e b o u n d effect o n l y for the O C D participants. In a s e c o n d study, O C D participants instructed to suppress s h o w e d a faster response t i m e to " w h i t e bear" targets i n a l e x i c a l d e c i s i o n task than to distracter w o r d s or n o n w o r d s . W h i l e m o r e studies are needed w i t h c l i n i c a l samples, the results o f the current studies o f O C D patients s h o w s o m e evidence o f a p a r a d o x i c a l effect for neutral thoughts ( T o l i n et a l . , 2 0 0 2 ) , but less e v i d e n c e o f r e b o u n d for p e r s o n a l l y relevant thoughts (Janeck & C a l a m a r i , 1999; P u r d o n et a l . , 2 0 0 5 ) . A t first b l u s h , these results suggest that thought suppression m a y not be an important m e c h a n i s m i n the persistence o f obsessions. H o w e v e r , T o l i n et a l . (2002) argue that O C D patients d e v e l o p c o m p r e h e n s i v e strategies to resist their obsessions, w h i c h m a y a l l o w t h e m to m o r e e f f e c t i v e l y c o n t r o l their obsessions w i t h i n a short-term laboratory setting. A n o t h e r p o s s i b i l i t y is that O C D patients m a y a c t i v e l y resist their o w n obsessions i n the context o f a thought suppression study e v e n w h e n instructed to not suppress their thoughts. Therefore, it is p o s s i b l e that p e r s o n a l l y relevant obsessions are less l i k e l y to demonstrate the i r o n i c effects o f suppression i n laboratory studies. T h o u g h t S u p p r e s s i o n , A p p r a i s a l s , and N e g a t i v e A f f e c t R a c h m a n (1997, 1998) posits that negative affect ( d y s p h o r i a and anxiety) are consequences o f this c y c l e o f appraisals o f p e r s o n a l s i g n i f i c a n c e , thought suppression, recurrences o f the target thought, and strengthening o f the o r i g i n a l appraisals. A s i m i l a r v i e w w a s p r o p o s e d b y P u r d o n and C l a r k (1993; 1999; 2 0 0 1 ) , w h o suggest that appraisals about failures o f thought c o n t r o l w i l l contribute to negative m o o d and distress. T o test this idea, P u r d o n (2001) e x a m i n e d whether appraisals o f the i m p o r t a n c e o f c o n t r o l l i n g thoughts,  19  thought-action f u s i o n , and e g o - d y s t o n i c i t y w o u l d predict anxiety, m o o d , and thought frequency i n a thought suppression task. E i g h t y - f o u r students w e r e r a n d o m l y assigned to suppress or not suppress their most upsetting intrusive thought. A f t e r f i n i s h i n g the task, participants c o m p l e t e d a questionnaire m e a s u r i n g appraisals o f target thought recurrences d u r i n g the thought suppression task. A l t h o u g h no p a r a d o x i c a l effect o f thought suppression w a s evident for target thought frequency, negative appraisals o f target thought recurrences d u r i n g the suppression task p r e d i c t e d negative affect f o l l o w i n g the task. S p e c i f i c a l l y , a n x i e t y and d y s p h o r i a w e r e p r e d i c t e d b y appraisals about the l i k e l i h o o d o f the thought c o m i n g true and appraisals about the extent to w h i c h thought recurrences i n d i c a t e d s o m e t h i n g negative about the self. U s i n g this same questionnaire i n a study w i t h O C D patients, P u r d o n and colleagues (2005) f o u n d that appraisals about thought recurrences p r e d i c t e d a n x i e t y and d i s c o m f o r t ratings f o l l o w i n g thought suppression. S p e c i f i c a l l y , appraisals about the thought c o m i n g true i n real life or i n d i c a t i n g negative features o f o n e ' s p e r s o n a l i t y w e r e associated w i t h greater d i s c o m f o r t , and appraisals about the need to c o n t r o l thoughts w e r e related to negative m o o d . In a different study, the total frequency o f thoughts reported d u r i n g a s u p p r e s s i o n task w a s associated w i t h negative appraisals o f b e i n g out o f c o n t r o l and d i s l i k e o f the thought ( K e l l y & K a h n , 1994). S u m m a r y o f T h o u g h t S u p p r e s s i o n Studies W h i l e there has been considerable interest i n e x a m i n i n g whether the i r o n i c effects o f suppression c a n be studied as a causal factor i n v o l v e d i n O C D , research has s h o w n m i x e d support for a r e l a t i o n s h i p b e t w e e n s u p p r e s s i o n and increased frequency o f p e r s o n a l l y relevant thoughts. A l t h o u g h a n u m b e r o f studies have r e p l i c a t e d the p a r a d o x i c a l effects o f  20  suppression w i t h p e r s o n a l l y relevant thoughts ( M c N a l l y & R i c c i a r d i , 1996; S a l k o v s k i s & C a m p b e l l , 1994; T r i n d e r & S a l k o v s k i s , 1994), some have f o u n d that s u p p r e s s i o n interferes w i t h the natural decrease i n thought frequency ( B e l l o c h et a l . , 2 0 0 4 ; P u r d o n & C l a r k , 2 0 0 1 ) , and others have f o u n d n o negative effects o f s u p p r e s s i o n for p e r s o n a l l y relevant thoughts ( K e l l y & K a h n , 1994; R u t l e d g e , 1998). A l s o pertinent to c o g n i t i v e theories o f obsessions, h o w e v e r , is the important f i n d i n g that perfect thought suppression is i m p o s s i b l e . N o study has reported c o m p l e t e e l i m i n a t i o n o f target thoughts t h r o u g h suppression, m e a n i n g that thought suppression efforts i n e v i t a b l y fail. T h e r e is a g r o w i n g b o d y o f literature e x a m i n i n g the relationship b e t w e e n (failed) attempts to suppress p e r s o n a l l y relevant thoughts and subsequent negative affect.  The Present Study T h e purpose o f this dissertation project is to test several hypotheses f r o m R a c h m a n ' s (1997, 1998) c o g n i t i v e theory o f obsessions as they relate to a n o n c l i n i c a l p o p u l a t i o n . S p e c i f i c a l l y , this project w a s d e s i g n e d to e x a m i n e R a c h m a n ' s assertion that appraisals o f p e r s o n a l s i g n i f i c a n c e o f i n t r u s i v e thoughts are important i n the persistence o f obsessions. T h e goals o f this project w e r e t w o - f o l d . First, i f appraisals o f u n w a n t e d i n t r u s i v e thoughts are relevant to O C D , a p o s i t i v e relationship s h o u l d exist b e t w e e n appraisals o f s o c i a l l y unacceptable thoughts ( s i m i l a r to obsessions) and O C D s y m p t o m a t o l o g y . T h u s , the a i m o f the first t w o studies w a s to determine whether appraisals o f p r o t o t y p i c a l obsessive thoughts w e r e related to obsessive c o m p u l s i v e s y m p t o m s i n a n o n c l i n i c a l sample. W h e r e a s p r e v i o u s studies established a r e l a t i o n s h i p between appraisals and obsessive c o m p u l s i v e s y m p t o m s , n o studies to date have e x a m i n e d h o w n o n c l i n i c a l participants appraise i n t r u s i v e thoughts m o r e t y p i c a l o f obsessions. Studies 1 and 2 also e x a m i n e d whether appraisals o f i n t r u s i v e thoughts  21  w o u l d v a r y as a f u n c t i o n o f t w o t h e o r e t i c a l l y important variables, thought content and thought frequency. S e c o n d , R a c h m a n ' s c o g n i t i v e theory o f obsessions posits that appraisals o f p e r s o n a l s i g n i f i c a n c e m o t i v a t e thought c o n t r o l efforts, w h i c h together result i n negative affect and recurrence o f the u n w a n t e d thoughts. I n contrast, w h e n i n t r u s i v e thoughts are appraised as unimportant, the c o g n i t i v e theory predicts that i n d i v i d u a l s s h o u l d be less m o t i v a t e d to c o n t r o l their thoughts, experience less a n x i e t y and negative m o o d , and be less l i k e l y to experience thought recurrences. In order to e x a m i n e these hypotheses, the t h i r d study w a s designed to investigate the i n t e r a c t i o n o f appraisals and thought suppression o n o b s e s s i o n - l i k e thoughts. S p e c i f i c a l l y , the t h i r d study e x a m i n e d whether thought suppression w o u l d have differential effects d e p e n d i n g o n the p e r s o n a l m e a n i n g o f the target thought.  22  C H A P T E R 2: STUDIES 1 A N D 2 The purpose o f Studies 1 and 2 w a s to e x a m i n e w h e t h e r the p r e v i o u s l y established r e l a t i o n s h i p b e t w e e n appraisals a n d O C D s y m p t o m s w o u l d r e m a i n e v e n w h e n i n t r u s i v e thoughts m o r e t y p i c a l o f O C D w e r e e m p l o y e d . P r e v i o u s studies have p r o v i d e d e v i d e n c e o f a relationship b e t w e e n d y s f u n c t i o n a l appraisals o f p e r s o n a l l y relevant i n t r u s i v e thoughts and O C s y m p t o m s ( C l a r k & C l a y b o u r n , 1997; Freeston et a l . , 1992; O C C W G , 2 0 0 1 , 2 0 0 3 , 2 0 0 5 ; P u r d o n & C l a r k , 1994a, 1994b). H o w e v e r , one potential c o n f o u n d o f p r e v i o u s studies is that the content and severity o f the thoughts reported b y O C D patients m a y differ f r o m that reported b y n o r m a l c o n t r o l s , w h i c h m a y a r t i f i c i a l l y increase the c o r r e l a t i o n b e t w e e n appraisals and O C D s y m p t o m s . A l t h o u g h it has been w e l l - e s t a b l i s h e d that the vast m a j o r i t y o f p e o p l e experience u n w a n t e d i n t r u s i v e thoughts o f s i m i l a r content to those reported b y i n d i v i d u a l s w i t h O C D ( R a c h m a n & de S i l v a , 1978; S a l k o v s k i s & H a r r i s o n , 1984), the t y p i c a l i n t r u s i v e thoughts reported b y n o n c l i n i c a l participants tend to be less abhorrent a n d less s o c i a l l y unacceptable than the types o f thoughts most c o m m o n l y reported b y patients w i t h O C D .  F o r example, i n  studies c o n d u c t e d w i t h n o n c l i n i c a l samples, the m o s t c o m m o n l y reported i n t r u s i v e thoughts i n c l u d e : " r u n n i n g the car o f f the r o a d , " " l e a v i n g the heat or stove o n thereby c a u s i n g an a c c i d e n t " ( P u r d o n & C l a r k , 1994a), " l e a v i n g the house w i t h o u t d o i n g s o m e t h i n g important to prevent b u r g l a r y o r accident", " w h e n u s i n g a sharp object that I w i l l slit m y w r i s t o r throat o r otherwise h a r m m y s e l f or " s a y i n g s o m e t h i n g rude or i n s u l t i n g to others" ( C l a r k , P u r d o n , & B y e r s , 2 0 0 0 ) . I n contrast, t y p i c a l obsessions reported b y O C D patients i n c l u d e e x a m p l e s s u c h as: " I w i l l p u s h an e l d e r l y m a n under the o n c o m i n g t r a i n , " " I w i l l stab m y m o t h e r , " " I w i l l s e x u a l l y m o l e s t a y o u n g c h i l d , " and " I w i l l shout f o u l , obscene language i n c h u r c h "  23  (examples f r o m R a c h m a n , 2 0 0 3 , p p . 5 - 6). Therefore, it c o u l d be argued that n o n c l i n i c a l i n d i v i d u a l s endorse fewer d y s f u n c t i o n a l appraisals o f their o w n i n t r u s i v e thoughts s i m p l y because the thought content is less s o c i a l l y unacceptable than that reported b y O C D patients. T h i s p r o b l e m was h i g h l i g h t e d b y the O C C W G (2001), w h o noted that n o n c l i n i c a l participants h a d m o r e d i f f i c u l t y i d e n t i f y i n g p e r s o n a l e x a m p l e s o f i n t r u s i v e thoughts, and therefore endorsed fewer d y s f u n c t i o n a l appraisals o f these thoughts, a r t i f i c i a l l y i n f l a t i n g the c o r r e l a t i o n b e t w e e n appraisals and O C s y m p t o m s . In order to address this potential c o n f o u n d i n the literature, Studies 1 and 2 were d e s i g n e d to e x a m i n e h o w n o n c l i n i c a l i n d i v i d u a l s appraise thoughts m o r e t y p i c a l o f O C D . In a d d i t i o n , few studies have e x a m i n e d whether the content o f i n t r u s i v e thoughts is related to appraisals o f p e r s o n a l s i g n i f i c a n c e despite the fact that the content o f obsessions is k n o w n to v a r y c o n s i d e r a b l y across the disorder. T h e m o s t c o m m o n themes f o u n d i n obsessions are those o f aggression, b l a s p h e m y , and unacceptable s e x u a l thoughts ( R a c h m a n , 1998; R a c h m a n & H o d g s o n , 1980) G i v e n the heterogeneity o f the content o f obsessions, C l a r k and colleagues (2000) argued that o b s e s s i o n a l content s h o u l d be m o r e c l o s e l y c o n s i d e r e d i n appraisal studies to determine whether thematic content w i l l influence appraisals. In one o f the few studies to do so, C l a r k and colleagues (2000) f o u n d that the content o f i n t r u s i v e thoughts d i f f e r e n t i a l l y i n f l u e n c e d appraisals. S p e c i f i c a l l y , differences e m e r g e d b e t w e e n appraisals o f unacceptable s e x u a l and n o n - s e x u a l i n t r u s i v e thoughts and the c o n t r o l l a b i l i t y o f s u c h thoughts. T h e results o f the C l a r k et a l . study p r o v i d e p r e l i m i n a r y evidence that the thematic content o f i n t r u s i v e thoughts m a y i n f l u e n c e r e s u l t i n g appraisals and suggest that content is an important v a r i a b l e to c o n s i d e r i n future studies.  24  A n o t h e r v a r i a b l e that is l i k e l y to i n f l u e n c e appraisals o f i n t r u s i v e thoughts is thought frequency. T h e c l i n i c a l obsessions o f patients w i t h O C D are s i g n i f i c a n t l y m o r e frequent than the i n t r u s i v e thoughts o f n o n c l i n i c a l participants ( R a c h m a n & de S i l v a , 1978). I n their s e m i n a l study, R a c h m a n a n d de S i l v a (1978) reported that patients w i t h O C D e x p e r i e n c e d obsessive thoughts o n average 10 times per day, c o m p a r e d to the n o n c l i n i c a l frequency o f less than once per day, o r e v e n less than once per w e e k . T h i s c o n s i d e r a b l e difference i n frequency b e t w e e n c l i n i c a l obsessions and n o n c l i n i c a l i n t r u s i v e thoughts m a y be at least p a r t i a l l y responsible for the differences i n appraisals between n o n c l i n i c a l i n d i v i d u a l s a n d patients w i t h O C D . T h e purpose o f Studies 1 and 2 w a s to investigate w h e t h e r the relationship between appraisals o f p e r s o n a l s i g n i f i c a n c e and O C D s y m p t o m s w o u l d r e m a i n w h e n n o n c l i n i c a l i n d i v i d u a l s w e r e asked to evaluate i n t r u s i v e thoughts m o r e t y p i c a l o f O C D . M o r e o v e r , these studies w e r e d e s i g n e d to determine whether differences w o u l d emerge i n appraisals o f personal s i g n i f i c a n c e d e p e n d i n g u p o n thematic content and frequency o f the intrusive thoughts. I n b o t h studies, participants read vignettes p o r t r a y i n g p r o t o t y p i c a l obsessive thoughts c o v e r i n g themes o f aggression, b l a s p h e m y , r a c i s m , and sex. V i g n e t t e s are frequently used i n the study o f O C D as they p r o v i d e a means for assessing h o w n o n c l i n i c a l i n d i v i d u a l s interpret situations that feature i n obsessions (e.g., R i s k i n d , A b r e u , Strauss, & H o l t , 1997). I n S t u d y 1, participants i n d i c a t e d their appraisals o f each vignette, and analyses e x p l o r e d the relationship b e t w e e n appraisals and O C D s y m p t o m a t o l o g y . M o r e o v e r , the appraisal ratings for each vignette w e r e c o m p a r e d to e x a m i n e whether appraisals v a r i e d as a function o f thematic content. T h e a i m o f S t u d y 2 w a s to replicate the results o f S t u d y 1 a n d to e x p l o r e the i m p a c t o f thought frequency o n appraisals o f obsessive thoughts.  25  Studv 1 The goals o f S t u d y 1 w e r e to investigate h o w n o n c l i n i c a l participants appraise p r o t o t y p i c a l obsessions, to e x p l o r e the relationship b e t w e e n appraisals and obsessive c o m p u l s i v e s y m p t o m s , and to e x a m i n e whether appraisals o f p e r s o n a l s i g n i f i c a n c e w o u l d v a r y a c c o r d i n g to the thematic content o f the obsessions. T o e x p l o r e these questions, n o n c l i n i c a l participants read four vignettes d e p i c t i n g p r o t o t y p i c a l obsessions c o v e r i n g aggressive, b l a s p h e m o u s , racist, and unacceptable s e x u a l themes, and they c o m p l e t e d appraisal ratings for each obsessive thought. T h e i n c l u s i o n o f four different themes a l l o w e d for a direct e x a m i n a t i o n o f whether appraisals w o u l d v a r y a c c o r d i n g to the content o f the intrusive thoughts. T w o versions o f the vignettes were used i n the study; a " S e l f v e r s i o n , i n w h i c h participants i m a g i n e d that they e x p e r i e n c e d the u n w a n t e d thoughts, and an " O t h e r " v e r s i o n , i n w h i c h participants i m a g i n e d that a close friend e x p e r i e n c e d the thoughts.  This  m a n i p u l a t i o n was i n c l u d e d based o n p r e v i o u s e v i d e n c e that p e o p l e tend to v i e w the potential consequences o f an i n t r u s i v e thought m o r e n e g a t i v e l y i f they feel they are responsible rather than i f someone else is r e s p o n s i b l e ( M e n z i e s , H a r r i s , C u m m i n g , & E i n s t e i n , 2 0 0 0 ) . I n a d d i t i o n , e x a m i n i n g h o w n o r m a l i n d i v i d u a l s are l i k e l y to r e s p o n d to p r o t o t y p i c a l obsessions is o f c l i n i c a l utility. Patients w i t h O C D tend to c o n c e a l their obsessions, often out o f the c o n c e r n that they w i l l be j u d g e d n e g a t i v e l y ( N e w t h & R a c h m a n , 2 0 0 1 ) . In c o g n i t i v e treatments o f O C D , patients are encouraged to discuss the content o f their obsessions w i t h trusted friends and f a m i l y m e m b e r s i n order to h e l p n o r m a l i z e the experience and to c o n f i r m that others w i l l not j u d g e t h e m n e g a t i v e l y . Y e t n o research to date has investigated h o w  26  n o n c l i n i c a l i n d i v i d u a l s are l i k e l y to appraise p r o t o t y p i c a l obsessions. T h u s , the i n c l u s i o n o f an " O t h e r " v e r s i o n o f the vignettes a l l o w e d for the e m p i r i c a l i n v e s t i g a t i o n o f this question. T h r e e p r i m a r y research questions g u i d e d this study. First, are appraisals o f the o b s e s s i o n - l i k e u n w a n t e d thoughts correlated w i t h o b s e s s i v e - c o m p u l s i v e s y m p t o m s a m o n g n o r m a l i n d i v i d u a l s ? B a s e d o n the results o f p r e v i o u s studies, p a r t i c i p a n t s ' appraisals o f the obsessive thoughts p o r t r a y e d i n the vignettes w e r e expected to be associated w i t h obsessivec o m p u l s i v e s y m p t o m s , and participants w i t h a h i g h l e v e l o f o b s e s s i v e - c o m p u l s i v e s y m p t o m s w e r e expected to endorse m o r e d y s f u n c t i o n a l appraisals o f the vignettes than w e r e participants w i t h few o b s e s s i v e - c o m p u l s i v e s y m p t o m s . S e c o n d , a m o n g n o r m a l i n d i v i d u a l s , do appraisals v a r y d e p e n d i n g o n the thematic content o f u n w a n t e d thoughts? T h i r d , w i l l i d e n t i t y ( s e l f or other) i n f l u e n c e appraisals o f the u n w a n t e d thoughts? Participants w h o read the " O t h e r " vignettes w e r e expected to endorse fewer O C appraisals o f the vignettes than those w h o read the " S e l f vignettes.  Method Participants Participants were 122 m e m b e r s o f the u n i v e r s i t y c o m m u n i t y . Participants were recruited f r o m the D e p a r t m e n t o f P s y c h o l o g y participant p o o l and from posters p l a c e d around the u n i v e r s i t y c a m p u s . Participants r e c e i v e d bonus course credit or $10 r e m u n e r a t i o n for p a r t i c i p a t i o n i n the study. T h e m e a n age o f the participants w a s 21.4 years (SD = 5.53), and 6 3 . 9 % o f the participants w e r e w o m e n . O f participants w h o reported their ethnic or r a c i a l group, 4 3 . 8 % i d e n t i f i e d themselves as C a u c a s i a n , 4 7 . 1 % i d e n t i f i e d as A s i a n , and 9 . 0 % i d e n t i f i e d other r a c i a l or ethnic b a c k g r o u n d s .  27  Measures V i g n e t t e A p p r a i s a l R a t i n g s . F o u r vignettes w e r e created for the purpose o f this study. E a c h vignette p o r t r a y e d an e x a m p l e o f a p r o t o t y p i c a l o b s e s s i o n , c o v e r i n g u n w a n t e d aggressive ( " i m p u l s e to stab y o u r n i e c e w i t h a sharp k i t c h e n k n i f e " ) , b l a s p h e m o u s ("image o f u r i n a t i n g o n the B i b l e " ) , racist ("the thought ' N i g g e r ! ' intrudes into y o u r m i n d " ) , and unacceptable s e x u a l ("thought about h a v i n g sex w i t h y o u r brother") themes. Participants w e r e r a n d o m l y assigned to receive one o f t w o n e a r l y i d e n t i c a l v e r s i o n s o f the vignettes; h a l f r e c e i v e d a " S e l f v e r s i o n i n w h i c h they w e r e a s k e d to i m a g i n e that they e x p e r i e n c e d the u n w a n t e d i n t r u s i v e thoughts, and the other h a l f r e c e i v e d an " O t h e r " v e r s i o n i n w h i c h they w e r e instructed to i m a g i n e that a close friend e x p e r i e n c e d the u n w a n t e d i n t r u s i v e thoughts. Participants c o m p l e t e d sixteen questions assessing d y s f u n c t i o n a l appraisals o f each intrusive thought. F o r these questions, participants rated the degree to w h i c h they agreed w i t h each statement, o n a scale f r o m 0 ("not at a l l " ) to 8 ( " t o t a l l y / d e f i n i t e l y " ) . T h e s e questions assessed appraisal d o m a i n s related to p e r s o n a l s i g n i f i c a n c e , i n c l u d i n g personal meaning (e.g., " T o what extent does this thought r e v e a l s o m e t h i n g important about y o u ? " ) , thought-action fusion (e.g., " T o what extent is h a v i n g this thought is j u s t as b a d as acting o n i t ? " ) , disapproval (e.g., " T o what extent do y o u f i n d this thought d i s t u r b i n g ? " ) , uncontrollability  (e.g., " T o what extent does this thought m e a n that y o u m i g h t lose c o n t r o l  and do s o m e t h i n g a w f u l ? " ) , threat (e.g., " T o what extent does this thought m e a n that y o u are a dangerous p e r s o n ? " ) , a n d negative self-evaluation  (e.g., " T o w h a t extent does this thought  m e a n that y o u are a b a d , w i c k e d person?"). T e n o f the 16 questions w e r e d r a w n f r o m the P e r s o n a l S i g n i f i c a n c e S c a l e ( P S S ; R a c h m a n , 2 0 0 3 ) . T h e r e m a i n i n g questions w e r e d e v e l o p e d for the purpose o f this study and w e r e based o n questionnaires c o m m o n l y used to  28  assess o b s e s s i v e - c o m p u l s i v e appraisals, i n c l u d i n g the D i s t r e s s i n g T h o u g h t s Q u e s t i o n n a i r e ( D T Q ; C l a r k & de S i l v a , 1985), the T h o u g h t A c t i o n F u s i o n scale ( T A F ; Shaffan, T h o r d a r s o n , & R a c h m a n , 1996), and the R e s p o n s i b i l i t y Interpretations Q u e s t i o n n a i r e ( R I Q ; S a l k o v s k i s et a l . , 2 0 0 0 ) . A n a d d i t i o n a l question m e a s u r i n g thought a c c e p t a b i l i t y , " H o w b a d or e v i l do y o u t h i n k this thought i s ? " was rated o n a 0 - 100 scale. In a d d i t i o n to the vignette appraisal ratings, participants c o m p l e t e d three measures o f o b s e s s i v e - c o m p u l s i v e m e t a c o g n i t i o n , one measure o f o b s e s s i v e - c o m p u l s i v e s y m p t o m s , and one measure o f depression. Interpretation o f Intrusions Inventory. T h e Interpretation o f Intrusions Inventory (III3 1 ; O C C W G , 2001) w a s i n c l u d e d to measure p a r t i c i p a n t s ' appraisals o f their p e r s o n a l u n w a n t e d i n t r u s i v e thoughts. T h e III-31 consists o f 31 questions d e s i g n e d to measure the m e a n i n g and s i g n i f i c a n c e p e o p l e assign to their u n w a n t e d i n t r u s i v e thoughts. T h e 111-31 p r o v i d e s a t h o r o u g h d e f i n i t i o n o f u n w a n t e d intrusive thoughts and instructs participants to list t w o p e r s o n a l e x a m p l e s . A f t e r i d e n t i f y i n g u n w a n t e d i n t r u s i v e thoughts, participants rate h o w r e c e n t l y they e x p e r i e n c e d the i n t r u s i v e thoughts, h o w frequently they experience the intrusive thoughts, and the l e v e l o f distress caused b y s u c h thoughts. F i n a l l y , they rate the degree to w h i c h they b e l i e v e each o f 31 statements relating to their i n t r u s i v e thoughts o n a scale f r o m 0 ("I d i d not b e l i e v e this i d e a at a l l " ) to 100 ("I w a s c o m p l e t e l y c o n v i n c e d this i d e a was true"). E x a m p l e s o f appraisal statements i n c l u d e d o n the 111-31 are: " H a v i n g this intrusive thought means that I c o u l d lose c o n t r o l o f m y m i n d ; " " H a v i n g this intrusive thought means I a m a terrible p e r s o n ; " and " T h e m o r e I t h i n k about these things, the greater the r i s k they w i l l c o m e true."  29  T h e 111-31 w a s d e s i g n e d to measure three t h e o r e t i c a l l y d e r i v e d subscales: appraisals o f r e s p o n s i b i l i t y , o v e r - i m p o r t a n c e o f thoughts, and c o n t r o l o f intrusions. H o w e v e r , the subscales are h i g h l y intercorrelated and the O C C W G r e c o m m e n d s u s i n g o n l y the total score ( O C C W G , 2 0 0 5 ) . T h e 111-31 has demonstrated g o o d to excellent internal consistency, r a n g i n g f r o m a = .79 to a =.93 ( O C C W G , 2 0 0 3 ) . It has s h o w n g o o d test-retest r e l i a b i l i t y , w i t h r e l i a b i l i t y coefficients r a n g i n g f r o m r = .64 to r = .68 ( O C C W G , 2 0 0 3 ) . T h e 111-31 has also demonstrated g o o d convergent v a l i d i t y w i t h other measures o f o b s e s s i o n a l i t y ( O C C W G , 2 0 0 3 ) , but its d i s c r i m i n a n t v a l i d i t y is less strong as it s h o w e d o v e r l a p w i t h measures o f general a n x i e t y and depression. O b s e s s i v e B e l i e f s Q u e s t i o n n a i r e . A short f o r m o f the O b s e s s i v e B e l i e f s Q u e s t i o n n a i r e ( O B Q - 4 4 ; O C C W G , 2003) w a s used to assess O C beliefs. W h e r e a s the 111-31 measures h o w i n d i v i d u a l s appraise s p e c i f i c u n w a n t e d i n t r u s i v e thoughts, the O B Q - 4 4 measures m o r e general b e l i e f d o m a i n s and assumptions. T h e O B Q - 4 4 consists o f 4 4 questions c o v e r i n g three e m p i r i c a l l y - d e r i v e d subscales: 1) r e s p o n s i b i l i t y for h a r m , 2) p e r f e c t i o n i s m and intolerance for uncertainty, and 3) i m p o r t a n c e and c o n t r o l o f thoughts. F o r e x a m p l e , O B Q - 4 4 questions i n c l u d e : " F o r m e , not p r e v e n t i n g h a r m is as b a d as c a u s i n g h a r m " , " I f I h a v e aggressive thoughts or i m p u l s e s about m y l o v e d ones, this means I m a y secretly w a n t to hurt t h e m " , and, " I s h o u l d be upset i f I m a k e a m i s t a k e . " Participants rate the degree to w h i c h each statement reflects the w a y that they t h i n k m o s t o f the t i m e , o n a 7p o i n t L i k e r t scale. T h e O B Q - 4 4 has demonstrated g o o d to excellent internal c o n s i s t e n c y i n b o t h c l i n i c a l and n o n c l i n i c a l samples, w i t h C r o n b a c h alphas r a n g i n g f r o m .89 - .95 ( O C C W G , 2 0 0 5 ) . T h e O B Q has been f o u n d to d i s c r i m i n a t e O C D patients from i n d i v i d u a l s w i t h other a n x i e t y  30  disorders and n o n c l i n i c a l samples ( O C C W G , 2 0 0 5 ) , p r o v i d i n g e v i d e n c e o f its c r i t e r i o n v a l i d i t y . In a d d i t i o n , the O B Q - 4 4 demonstrates g o o d convergent v a l i d i t y w i t h the P a d u a I n v e n t o r y ( S a n a v i o , 1988), a measure o f O C D s y m p t o m s , and it has demonstrated s o m e evidence o f d i s c r i m i n a n t v a l i d i t y . A l t h o u g h n o i n f o r m a t i o n is currently a v a i l a b l e o n the testretest r e l i a b i l i t y o f the O B Q - 4 4 , the full v e r s i o n o f the O b s e s s i v e B e l i e f s Q u e s t i o n n a i r e ( O B Q - 8 7 ; O C C W G , 2001) has demonstrated g o o d test-retest r e l i a b i l i t y , r a n g i n g f r o m r = .67 to r = .82 i n a student s a m p l e ( O C C W G , 2 0 0 3 ) . G i v e n that the three subscales o f the O B Q 4 4 are h i g h l y correlated w i t h b o t h the total score and w i t h each other, o n l y the total score w a s used i n this study. T h o u g h t - A c t i o n F u s i o n Scale. T h e T h o u g h t - A c t i o n F u s i o n S c a l e ( T A P ; Shafran et al., 1996) was i n c l u d e d to measure beliefs related to thought-action fusion. T h o u g h t - a c t i o n fusion refers to t w o distinct beliefs: h a v i n g unacceptable thoughts is equivalent to e n g a g i n g i n the b e h a v i o u r ( M o r a l T A P ) ; and t h i n k i n g about negative events m a k e s the events m o r e l i k e l y to o c c u r ( L i k e l i h o o d T A P ) . F o r each o f the 19 statements, participants indicate their agreement o n a 5-point L i k e r t scales. E x a m p l e s o f statements i n c l u d e : " H a v i n g a b l a s p h e m o u s thought is almost as sinful to m e as a b l a s p h e m o u s a c t i o n , " and " I f I t h i n k o f m y s e l f b e i n g i n a car accident this increases the r i s k that I w i l l have a car accident." T h e T A F has demonstrated g o o d internal consistency, w i t h C r o n b a c h alphas r a n g i n g from .75 .96 ( R a s s i n , M e r c k e l b a c h , M u r i s , & S c h m i d t , 2 0 0 1 ; Shafran et a l . , 1996). In a d d i t i o n , R a s s i n and colleagues (2001) report that the T A F possessed moderate test-retest r e l i a b i l i t y (r = .52) and demonstrated significant correlations w i t h other measures o f o b s e s s i o n a l i t y i n c l u d i n g the M O C I and P a d u a Inventory.  31  O b s e s s i v e - C o m p u l s i v e Inventory - R e v i s e d . S y m p t o m s o f o b s e s s i v e - c o m p u l s i v e disorder w e r e assessed w i t h the O b s e s s i v e - C o m p u l s i v e I n v e n t o r y - R e v i s e d ( O C I - R ; F o a et a l . , 2 0 0 2 ; H a j c a k , H u p p e r t , S i m o n s , & F o a , 2 0 0 4 ) . T h e O C I - R is an 18-item abbreviated v e r s i o n o f the o r i g i n a l O b s e s s i v e - C o m p u l s i v e Inventory ( O C I ; F o a , K o z a k , S a l k o v s k i s , C o l e s , & A m i r , 1998). O n a scale from 0 (not at all) to 4 (extremely), participants rate the extent to w h i c h they have been distressed or bothered b y O C D s y m p t o m s w i t h i n the past m o n t h . T h e O C I - R total score demonstrates excellent internal consistency, r a n g i n g from C r o n b a c h ' s alphas o f .81 ( F o a et a l . , 2002) to .88 ( H a j c a k et a l . , 2 0 0 4 ) , and excellent testretest r e l i a b i l i t y (r = .82; F o a et a l . , 2 0 0 2 ) . H a j c a k and colleagues (2004) report moderate convergent v a l i d i t y w i t h another measure o f O C D s y m p t o m s , the M a u d s l e y O b s e s s i v e C o m p u l s i v e Inventory ( H o d g s o n & R a c h m a n , 1977), and excellent convergent v a l i d i t y w i t h the P a d u a I n v e n t o r y ( S a n a v i o , 1988). I n a d d i t i o n , the O C I - R w a s f o u n d to be a distinct construct f r o m depression and w o r r y , p r o v i d i n g e v i d e n c e o f its d i s c r i m i n a n t v a l i d i t y . T h e O C I - R p r o v i d e s e m p i r i c a l l y d e r i v e d c u t - o f f scores m a k i n g it useful for d i s c r i m i n a t i n g b e t w e e n i n d i v i d u a l s l i k e l y to r e c e i v e a d i a g n o s i s o f O C D and those u n l i k e l y to receive s u c h a d i a g n o s i s . F o a and colleagues (2002) reported that a c u t - o f f score o f 21 a c h i e v e d the best s e n s i t i v i t y and s p e c i f i c i t y for d i s c r i m i n a t i n g b e t w e e n an O C D sample and a n o r m a l c o n t r o l sample. A t this c u t - o f f score, the O C I - R a c h i e v e d a s e n s i t i v i t y o f 6 5 . 6 % and a s p e c i f i c i t y o f 6 3 . 9 % . A c u t - o f f score o f 21 w a s used i n the current study to c l a s s i f y participants as h i g h versus l o w o n o b s e s s i v e - c o m p u l s i v e s y m p t o m a t o l o g y . B e c k D e p r e s s i o n I n v e n t o r y (BDI-IT). T h e B e c k D e p r e s s i o n I n v e n t o r y ( B D I - I I ; B e c k , Steer, & B r o w n , 1996) is a 2 1 - i t e m self-report i n v e n t o r y . It is one o f the m o s t c o m m o n l y used self-report measures o f depression, and is accepted to be one o f the better measures o f  32  this construct. T h e B D I - I I has demonstrated h i g h internal c o n s i s t e n c y , w i t h coefficient alphas r a n g i n g f r o m .91 ( D o z o i s , D o b s o n , & A h n b e r g , 1998) to .93 ( B e c k et a l . , 1996) a m o n g c o l l e g e samples. T h e B D I - I I has also demonstrated g o o d test-retest r e l i a b i l i t y , w i t h correlations r a n g i n g f r o m r = .93 ( B e c k et a l . , 1996) to r = .96 ( S p r i n k l e et a l . , 2 0 0 2 ) . T h e convergent v a l i d i t y o f the B D I - I I is supported b y a significant c o r r e l a t i o n o f r = .71 ( B e c k et a l . , 1996) w i t h another measure o f depression, the H a m i l t o n R a t i n g S c a l e for D e p r e s s i o n ( H R S D ; H a m i l t o n , 1960, 1967) and b y a strong c o r r e l a t i o n o f r = .83 ( S p r i n k l e et a l . , 2 0 0 2 ) w i t h depressed m o o d s y m p t o m s from the Structured C l i n i c a l I n t e r v i e w for D S M - I V A x i s I D i s o r d e r s ( S C I D - I ; First, Spitzer, G i b b o n , & W i l l i a m s , 1997). Procedure Participants c o m p l e t e d this study i n groups o f up to ten, d e p e n d i n g o n the n u m b e r o f participants w h o attended a g i v e n testing session. T h i s w a s done i n part to enhance a n o n y m i t y for the participants i n an effort to m i n i m i z e s o c i a l l y desirable r e s p o n d i n g . A f t e r p r o v i d i n g i n f o r m e d consent, each participant w a s r a n d o m l y assigned to c o m p l e t e either the " S e l f or the " O t h e r " v e r s i o n o f the vignettes. Participants read the four vignettes and c o m p l e t e d the vignette appraisal ratings. A f t e r c o m p l e t i n g the vignette questionnaire, participants i d e n t i f i e d a p e r s o n a l e x a m p l e o f an u n w a n t e d i n t r u s i v e thought. T o a i d participants i n this task, the experimenter read a l o u d the III-31 instructions, w h i c h p r o v i d e a d e f i n i t i o n o f u n w a n t e d i n t r u s i v e thoughts and i n c l u d e a list o f c o m m o n l y reported examples. A f t e r i d e n t i f y i n g an u n w a n t e d i n t r u s i v e thought that they h a d e x p e r i e n c e d , participants c o m p l e t e d the r e m a i n i n g questionnaires. U p o n c o m p l e t i o n , participants sealed their c o m p l e t e d questionnaires i n an envelope before r e t u r n i n g t h e m to the experimenter i n b a t c h f o r m to ensure a n o n y m i t y . A f u l l d e b r i e f i n g f o l l o w e d .  33  Results and Discussion Preliminary Analyses G r o u p E q u i v a l e n c e . P r e l i m i n a r y analyses c o n f i r m e d that participants i n the " S e l f and " O t h e r " c o n d i t i o n w e r e equivalent i n terms o f gender d i s t r i b u t i o n , 0.25, p > .50, ethnic c o m p o s i t i o n , % (1, N= 2  (\,N=  121) =  122) = 0.30, p > .50, and age o f the participants,  t (119) = 0.66, p > .50. Importantly, participants i n the " S e l f and " O t h e r " vignette c o n d i t i o n d i d not differ o n measures o f o b s e s s i o n a l i t y or depression, i n c l u d i n g the III-31 total score, t (120) = 0.20,/? > .50, the O B Q - 4 4 total score, t (120) = 0.02,/? > .50, the O C I - R total score, t (120) = -0.88,/? > .25, the T A F total score, / (120) = -1.09,/? > .25, or the B D I - I I , t (120) - 0.22, p > . 5 0 . These analyses indicate that the r a n d o m assignment procedure s u c c e s s f u l l y 1  p r o d u c e d r e l a t i v e l y c o m p a r a b l e groups. Vignette Appraisal Ratings Internal consistency. T h e sixteen L i k e r t - t y p e scale questions f r o m the vignette questionnaire w e r e e x a m i n e d for internal consistency and item-total correlations. T h e a l p h a r e l i a b i l i t i e s w e r e c a l c u l a t e d for each vignette separately and then averaged together. T h e vignette appraisal ratings demonstrated strong internal c o n s i s t e n c y , w i t h C r o n b a c h ' s a l p h a r a n g i n g from 0.89 to 0.94 for the i n d i v i d u a l vignettes, and a v e r a g i n g 0.91 for b o t h the S e l f and O t h e r c o n d i t i o n . Intercorrelations b e t w e e n the vignette themes are presented i n T a b l e 1. A s w o u l d be expected, the appraisal ratings w e r e m o d e r a t e l y to h i g h l y correlated across themes. C o r r e l a t i o n s w i t h measures o f O C m e t a c o g n i t i v e beliefs. T o e x a m i n e the r e l a t i o n s h i p b e t w e e n the vignette appraisal ratings and w e l l - v a l i d a t e d measures o f O C m e t a c o g n i t i o n , P e a r s o n c o r r e l a t i o n coefficients were c a l c u l a t e d b e t w e e n the vignette appraisal ratings and  34  the 111-31, the O B Q - 4 4 , a n d the T A P . G i v e n the h i g h o v e r l a p b e t w e e n the appraisal ratings across vignette themes, o n l y the m e a n appraisal r a t i n g w a s used i n these analyses. A s predicted, the vignette appraisal ratings w e r e m o d e r a t e l y to s t r o n g l y correlated w i t h a l l measures o f O C m e t a c o g n i t i o n (see T a b l e 2). B e c a u s e the vignette appraisal ratings w e r e also s i g n i f i c a n t l y correlated w i t h the B D I - I I , p a r t i a l correlations w e r e then c a l c u l a t e d b e t w e e n the m e a n vignette appraisal r a t i n g a n d the O C m e t a c o g n i t i v e measures c o n t r o l l i n g for the B D I - I I . A l l correlations between the vignette questionnaire and the O C m e t a c o g n i t i v e measures r e m a i n e d s i g n i f i c a n t a n d moderate to strong i n m a g n i t u d e . T h e s e analyses c o n f i r m e d that p a r t i c i p a n t s ' appraisals o f the i n t r u s i v e thoughts presented i n the vignettes w e r e m e a n i n g f u l l y associated w i t h their appraisals o f their o w n p e r s o n a l u n w a n t e d thoughts (the 111-31), as w e l l as w i t h measures o f o b s e s s i v e - c o m p u l s i v e appraisals a n d beliefs m o r e b r o a d l y (the O B Q - 4 4 a n d T A F ) . D e s c r i p t i v e i n f o r m a t i o n . M e a n s and standard d e v i a t i o n s for the vignette appraisal ratings are presented i n T a b l e 3. A s c a n be seen, p a r t i c i p a n t s ' appraisal ratings w e r e g e n e r a l l y quite l o w , f a l l i n g i n the "not at a l l " to " s o m e w h a t " range, suggesting that participants endorsed few d y s f u n c t i o n a l appraisals o f the s i g n i f i c a n c e o f the i n t r u s i v e thoughts. I n contrast, w h e n a s k e d to r e s p o n d to the question, " H o w b a d or e v i l do y o u t h i n k this thought i s " o n a 0 ("not at a l l bad") to 100 ("the w o r s t I c a n i m a g i n e " ) scale, p a r t i c i p a n t s ' responses ranged from means o f 35 (for the b l a s p h e m o u s vignette) to 63 (for the aggressive vignette) i n the " O t h e r " c o n d i t i o n , and from means o f 50 (for the b l a s p h e m o u s vignette) to 73 (for the aggressive vignette) i n the " S e l f c o n d i t i o n . T h u s , participants j u d g e d the thoughts themselves to be m o d e r a t e l y b a d or e v i l , but o n average, they d i d not to attach undue s i g n i f i c a n c e to the m e a n i n g o f the thoughts (as i n d i c a t e d b y the l o w appraisal ratings).  35  A p p r a i s a l R a t i n g s and O C D S y m p t o m a t o l o g y T o e x p l o r e whether appraisals o f the o b s e s s i o n - l i k e thoughts w e r e associated w i t h O C D s y m p t o m a t o l o g y , a P e a r s o n c o r r e l a t i o n coefficient w a s c a l c u l a t e d c o m p a r i n g the vignette appraisal ratings w i t h the O C I - R . U n l i k e the measures o f o b s e s s i v e - c o m p u l s i v e m e t a c o g n i t i o n , w h i c h assess O C appraisals and O C beliefs, the O C I - R is a measure o f O C D s y m p t o m severity. T h e m e a n vignette appraisal rating w a s m o d e r a t e l y correlated w i t h the O C I - R , r = 0.37, p < .001. In order to ensure that the significant c o r r e l a t i o n w a s not due s o l e l y to negative affect, a partial c o r r e l a t i o n w a s c a l c u l a t e d c o n t r o l l i n g for the B D I - I I . T h e c o r r e l a t i o n b e t w e e n the m e a n vignette appraisal r a t i n g and the O C I - R r e m a i n e d significant and moderate i n m a g n i t u d e , r = 0.27, p < .01. A p a r t i a l c o r r e l a t i o n w a s also c a l c u l a t e d b e t w e e n the m e a n vignette appraisal r a t i n g and the B D I - I I , c o n t r o l l i n g for the effects o f the O C I - R total score. W h e n the O C I - R total score w a s c o n t r o l l e d for, the c o r r e l a t i o n b e t w e e n the vignette appraisal ratings and the B D I - I I was n o longer significant, r = .04, p > .50, suggesting that the a s s o c i a t i o n between the vignette appraisal ratings and the B D I - I I was spurious. These results c o n f i r m that appraisals o f p e r s o n a l s i g n i f i c a n c e o f the o b s e s s i o n - l i k e thoughts w e r e related to O C D s y m p t o m a t o l o g y o v e r and above negative affect m o r e b r o a d l y . C o m p a r i s o n o f H i g h O C and L o w O C Participants In order to c o m p a r e the appraisal ratings o f participants w h o scored w i t h i n the c l i n i c a l range for O C D s y m p t o m a t o l o g y w i t h those w h o scored w i t h i n the n o r m a l range, participants w e r e d i v i d e d into t w o groups based o n their total O C I - R score. A s r e c o m m e n d e d b y F o a and colleagues (2002), participants were d i v i d e d into those w h o scored above the c l i n i c a l c u t o f f i n the range o f O C D patients (42 participants, m e a n O C I - R score = 3 1 . 1 5 , range 21 - 51), and those w h o scored b e l o w the c l i n i c a l c u t o f f i n the range o f  36  n o n c l i n i c a l i n d i v i d u a l s (80 participants, m e a n O C I - R score = 12.00, range 3 - 20). N e x t , an independent samples t-test w a s c o n d u c t e d c o m p a r i n g h i g h and l o w O C participants o n their m e a n vignette appraisal rating. T h i s analysis d i r e c t l y e x a m i n e d w h e t h e r participants w h o scored i n the range o f O C D patients w o u l d endorse m o r e d y s f u n c t i o n a l appraisals o f the vignettes than w o u l d participants w h o scored i n the range o f n o n c l i n i c a l samples. R e s u l t s o f the t-test c o n f i r m e d that h i g h O C participants endorsed greater appraisals o f personal s i g n i f i c a n c e o f the vignettes ( M = 2.39, SD = 1.06) than d i d l o w O C participants ( M = 1.97, SD = 1.05), t (120) = 2.11,/? < .05, r = .19. A p p r a i s a l R a t i n g s b y T h e m a t i c C o n t e n t and Identity T o e x a m i n e whether d y s f u n c t i o n a l appraisals w o u l d v a r y d e p e n d i n g o n the content o f intrusive thoughts (the s e c o n d research question) and to e x p l o r e whether vignette perspective w o u l d i n f l u e n c e appraisal ratings (the t h i r d research question), the vignette appraisal ratings w e r e u s e d as the dependent v a r i a b l e i n a 4 ( T h e m a t i c Content: A g g r e s s i v e , B l a s p h e m o u s , R a c i s t , S e x u a l ; w i t h i n - p a r t i c i p a n t s factor) b y 2 (Identity: Self, Other) b e t w e e n - w i t h i n analysis o f v a r i a n c e ( A N O V A ) . T h e G r e e n h o u s e - G e i s s e r adjustment w a s u s e d to correct for v i o l a t i o n o f the a s s u m p t i o n o f s p h e r i c i t y for the repeated measures factor. R e s u l t s o f the A N O V A r e v e a l e d no m a i n effect o f Identity, F ( 1,120) = 1.57,/? > .10, n  2 p  = .01,  demonstrating that w h e n c o l l a p s i n g across vignettes, n o significant differences e m e r g e d b e t w e e n appraisals as a f u n c t i o n o f i d e n t i t y o f the subject i n the vignettes. R e s u l t s d i d r e v e a l a significant m a i n effect o f T h e m a t i c Content, F (2.73, 327.58) = 30.55,/? < . 0 0 0 1 , n  2 p  T u k e y ' s m e t h o d o f post-hoc c o m p a r i s o n s was e m p l o y e d to e x a m i n e this m a i n effect.  = .20. This  m e t h o d o f m u l t i p l e c o m p a r i s o n s e m p l o y s a f a m i l y - w i s e T y p e - I error rate, m a i n t a i n i n g c o n t r o l o v e r r i s k o f T y p e - 1 error. These c o m p a r i s o n s r e v e a l e d that participants endorsed  37  appraisals o f personal s i g n i f i c a n c e to the greatest extent for the A g g r e s s i v e vignette (M = 2.67, SD = 1.44), f o l l o w e d b y the S e x u a l ( M = 2.06, SD = 1.23; q (4, 1 2 1 ) =  8.89,/?<.01)  and R a c i s t vignettes (M= 2.02, SD = 1.21; g (4, 121) = 8.38,/? < .01), w h i c h i n turn r e c e i v e d m o r e d y s f u n c t i o n a l appraisals than the B l a s p h e m o u s vignette (M=  1.70, SD = 1.24; 4.16 < q  (4, 121) < 5.94,/? < .05). N o differences emerged between the S e x u a l and R a c i s t vignettes, q (4, 121) = 0 . 5 7 , / ? > . 1 0 . There w a s a trend for an interaction o f T h e m a t i c C o n t e n t b y Identity, F (2.73, 327.58) = 2.47, /? = .068, n  2 p  = .02. T o e x p l o r e this w e a k effect, s i m p l e m a i n effects analyses  were c o n d u c t e d c o m p a r i n g " S e l f and " O t h e r " appraisal ratings across the different vignette themes. N o differences were f o u n d between the S e l f and Other c o n d i t i o n for the A g g r e s s i v e , S e x u a l , or B l a s p h e m o u s vignettes, F's (1, 120) < 2.60,p's > .10, n  2 p  < .03. Participants rated  the R a c i s t vignette s l i g h t l y m o r e n e g a t i v e l y i n the " S e l f c o n d i t i o n than i n the " O t h e r " c o n d i t i o n , F (1, 120) = 3.15,/? = .08, r |  2 p  = .03, but this effect w a s not strong e n o u g h to be  statistically significant at the p < .05 l e v e l . Summary T h e current study w a s the first to e x a m i n e h o w n o n c l i n i c a l participants appraise intrusive thoughts m o r e t y p i c a l o f O C D . Consistent w i t h the extant literature ( C l a r k & C l a y b o u r n , 1997; Freeston et a l . , 1992; O C C W G , 2 0 0 1 , 2 0 0 3 , 2 0 0 5 ; P u r d o n & C l a r k , 1994a, 1994b), d y s f u n c t i o n a l appraisals o f the o b s e s s i o n - l i k e thoughts w e r e correlated w i t h o b s e s s i v e - c o m p u l s i v e s y m p t o m s i n this sample o f n o n c l i n i c a l participants. M o r e o v e r , those participants w h o scored i n the c l i n i c a l range for O C D w e r e f o u n d to report m o r e appraisals o f personal s i g n i f i c a n c e than were those participants w h o scored i n the n o n c l i n i c a l range. These findings b u i l d u p o n past studies and demonstrate that i n d i v i d u a l s h i g h i n O C  38  s y m p t o m s are m o r e l i k e l y than those l o w i n O C s y m p t o m s to appraise o b s e s s i o n - l i k e thoughts as important a n d p e r s o n a l l y significant. In response to the s e c o n d research question, a p p r a i s a l ratings v a r i e d d e p e n d i n g o n the thematic content o f the u n w a n t e d thoughts presented i n the vignettes. I n the current study, participants w e r e m o r e l i k e l y to endorse appraisals o f p e r s o n a l s i g n i f i c a n c e for the aggressive vignette, f o l l o w e d b y the unacceptable s e x u a l and racist vignettes, f o l l o w e d b y the b l a s p h e m o u s vignette. T h e s e results support the f i n d i n g s o f C l a r k et a l . (2000) and suggest that appraisals v a r y to some extent based o n the content o f i n t r u s i v e thoughts. T h e final g o a l o f the study w a s to e x p l o r e w h e t h e r vignette i d e n t i t y w o u l d i n f l u e n c e appraisals o f the u n w a n t e d thoughts. N o differences emerged b e t w e e n appraisals o f the s e l f a n d other vignettes, suggesting that i n d i v i d u a l s m a k e s i m i l a r attributions about the p e r s o n a l m e a n i n g and i m p o r t a n c e o f thoughts regardless o f the i d e n t i t y o f the subject p o r t r a y e d i n the vignettes. T h i s last f i n d i n g p r o v i d e s evidence that p e o p l e j u d g e the occurrence o f s o c i a l l y unacceptable i n t r u s i v e thoughts s i m i l a r l y , whether a s k e d to i m a g i n e that t h e y h a v e the thought themselves or whether someone else has it. T h e present study h a d an important m e t h o d o l o g i c a l error i n that the w o r d i n g o f the vignettes w a s not h e l d constant across themes. W h e r e a s three o f the vignettes stated that the obsessive thought o c c u r r e d " f r o m t i m e to t i m e , " the racist vignette i n d i c a t e d that the thought c a m e to m i n d " w h e n e v e r y o u see a p e r s o n o f c o l o u r . " T h i s difference i n the d e s c r i b e d frequency o f thought occurrence m a y have i n f l u e n c e d appraisal ratings. T h e c o g n i t i v e theory o f obsessions h y p o t h e s i z e s that thought frequency contributes to appraisals, w i t h h i g h e r frequency o f thought occurrence r e i n f o r c i n g appraisals o f p e r s o n a l s i g n i f i c a n c e . Therefore, it is p o s s i b l e that participants endorsed d y s f u n c t i o n a l appraisals o f the racist  39 vignette to a greater extent than they would have had the instructions been held constant across vignettes. This error was corrected in Study 2. Study 2  A second study explored whether appraisals vary depending on the frequency of intrusive thoughts. Moreover, this second study was designed to examine whether a similar pattern of appraisals would emerge across the four content themes with the inclusion of new exemplars of obsession-like thoughts. Several research questions guided the second study. The primary goal was to replicate the findings of Study 1 with new vignettes using the same four content themes, although the self-other perspective manipulation was not included in Study 2. Accordingly, the first research question was whether the differences in appraisals observed across content themes in Study 1 would be replicated. The second research question was whether appraisals would differ depending on the frequency with which the unwanted intrusive thought occurred. Participants were expected to regard more frequently occurring thoughts as more personally meaningful. The final research question was whether the observed relationship between appraisals of the obsession-like thoughts and obsessivecompulsive symptoms would emerge with the inclusion of new vignettes. To explore these questions, a new sample of participants read four new vignettes covering the same themes as in the first study. A fully repeated measures design was used in which all participants completed appraisal ratings for all four vignettes in both a low frequency and a high frequency condition.  40  Method Participants Participants w e r e 281 students e n r o l l e d i n P s y c h o l o g y classes at the U n i v e r s i t y o f B r i t i s h C o l u m b i a . P a r t i c i p a n t s w e r e recruited t h r o u g h the D e p a r t m e n t o f P s y c h o l o g y v o l u n t e e r participant p o o l . T h e o n l y e x c l u s i o n c r i t e r i o n w a s that participants r e q u i r e d w r i t t e n f l u e n c y i n the E n g l i s h language. T h e m e a n age o f the participants w a s 20.3 years (SD = 2.2), and 5 9 . 9 % o f the participants w e r e w o m e n . O f participants w h o reported their ethnic o r r a c i a l group, 30.9%> i d e n t i f i e d themselves as C a u c a s i a n , 47.8%) i d e n t i f i e d as A s i a n , a n d 21.2%o i d e n t i f i e d other r a c i a l or ethnic b a c k g r o u n d s . A l l participants r e c e i v e d b o n u s 2  course credit for their p a r t i c i p a t i o n i n the study. Measures V i g n e t t e A p p r a i s a l R a t i n g s . F o u r n e w vignettes w e r e created for the p u r p o s e o f this study. A s i n S t u d y 1, each vignette p o r t r a y e d a p r o t o t y p i c a l o b s e s s i o n i n v o l v i n g one o f four different themes: aggressive ( " y o u have a sudden, h o r r i f i c i m p u l s e to r u n an e l d e r l y pedestrian o v e r w h i l e d r i v i n g y o u r car"), b l a s p h e m o u s ( " y o u h a v e the sudden, i n t r u s i v e thought, 'Jesus C h r i s t w a s a r a v i n g l u n a t i c ! " ' ) , racist ( " y o u pass a recent i m m i g r a n t o n the street and y o u have the sudden, i n t r u s i v e thought, ' Y o u d o n ' t b e l o n g here! G o b a c k to y o u r o w n c o u n t r y ! ' " ) , and s e x u a l ( " y o u have a sudden, i n t r u s i v e s e x u a l thought about a c h i l d " ) . F o r each vignette, participants w e r e asked to c o m p l e t e the appraisal ratings t w i c e ; once i m a g i n i n g that they e x p e r i e n c e d the thought " f r o m t i m e to t i m e , " a n d a s e c o n d t i m e i m a g i n i n g that they e x p e r i e n c e d that thought "quite frequently (several times per w e e k ) . " T h e appraisal ratings w e r e i d e n t i c a l to those used i n S t u d y 1.  41  S y m p t o m M e a s u r e s . P a r t i c i p a n t s c o m p l e t e d the same five questionnaires used i n S t u d y 1, m e a s u r i n g o b s e s s i v e - c o m p u l s i v e m e t a c o g n i t i o n (111-31, O B Q - 4 4 , a n d T A F ) , o b s e s s i v e - c o m p u l s i v e s y m p t o m a t o l o g y ( O C I - R ) , and depression ( B D I - I I ) . Procedure Participants p i c k e d up the questionnaire p a c k a g e i n the laboratory, w h e r e they r e c e i v e d instructions for the study. U p o n c o m p l e t i o n , participants returned their questionnaires to the laboratory, r e c e i v e d a full d e b r i e f i n g , and were g i v e n course credit for their p a r t i c i p a t i o n i n the study. O f the 300 questionnaires distributed to students, 2 8 0 were returned c o m p l e t e , and 1 w a s returned p a r t i a l l y c o m p l e t e .  Results and Discussion Vignette Appraisal Ratings Internal consistency. T h e 16 L i k e r t - t y p e scale questions f r o m each vignette w e r e e x a m i n e d for internal c o n s i s t e n c y and item-total correlations. T h e a l p h a r e l i a b i l i t i e s were c a l c u l a t e d for each vignette separately and then averaged together. C r o n b a c h ' s alphas for the i n d i v i d u a l vignettes ranged from 0.92 to 0.95 and averaged 0.93 i n b o t h the l o w and h i g h frequency c o n d i t i o n s . Intercorrelations a m o n g the different vignette theme appraisal ratings are presented i n T a b l e 4. A s i n S t u d y 1, the vignette appraisal ratings w e r e m o d e r a t e l y to h i g h l y correlated across themes. C o r r e l a t i o n s w i t h measures o f O C m e t a c o g n i t i v e beliefs. T o e x a m i n e the degree o f relationship b e t w e e n the vignette appraisal ratings and w e l l - v a l i d a t e d measures o f O C m e t a c o g n i t i o n , P e a r s o n c o r r e l a t i o n coefficients w e r e c a l c u l a t e d b e t w e e n the h i g h and l o w frequency  vignette appraisal ratings and the 111-31, the O B Q - 4 4 , and the T A F . A s i n S t u d y 1,  c o r r e l a t i o n coefficients were also c a l c u l a t e d w i t h the B D I - I I to e x a m i n e the degree o f  42  relationship b e t w e e n the appraisal ratings and negative affect. A s presented i n T a b l e 5, the h i g h and l o w vignette appraisal ratings w e r e m o d e r a t e l y to s t r o n g l y correlated w i t h the measures o f O C appraisals and O C beliefs, and they w e r e w e a k l y correlated w i t h the B D I - I I . A f t e r c o n t r o l l i n g for the B D I - I I , a l l correlations between the vignette appraisal ratings and the O C measures r e m a i n e d significant, and moderate to strong i n m a g n i t u d e ( r ' s ranged f r o m .35 - .52, allp's < .001). These analyses c o n f i r m that the vignette appraisals ratings w e r e m e a n i n g f u l l y associated w i t h w e l l - v a l i d a t e d measures o f O C appraisals a n d O C beliefs, and that they were less s t r o n g l y related to depressive s y m p t o m s . D e s c r i p t i v e i n f o r m a t i o n . M e a n s and standard d e v i a t i o n s for the vignette appraisal ratings are presented i n T a b l e 6. A n e x a m i n a t i o n o f this table s h o w s that p a r t i c i p a n t s ' appraisal ratings for the l o w frequency c o n d i t i o n w e r e c o m p a r a b l e to the ratings f o u n d i n S t u d y 1, w i t h participants e n d o r s i n g m e a n appraisals o f the p e r s o n a l s i g n i f i c a n c e o f the o b s e s s i o n - l i k e thoughts i n the "not at a l l " to " s o m e w h a t " range. A s expected, the appraisal ratings for the h i g h frequency c o n d i t i o n were c o n s i d e r a b l y m o r e elevated across a l l four vignette themes, g e n e r a l l y b y a f u l l standard d e v i a t i o n . In contrast to the r e l a t i v e l y l o w appraisal ratings, participants reported moderate to h i g h d i s a p p r o v a l o f the i n t r u s i v e thoughts, w i t h responses to the question " H o w b a d or e v i l do y o u t h i n k this thought i s " r a n g i n g f r o m means o f 34 (for the b l a s p h e m o u s vignette) to 71 (for the s e x u a l vignette) i n the l o w frequency c o n d i t i o n , and from 40 (for the b l a s p h e m o u s vignette) to 82 (for the s e x u a l vignette) i n the h i g h frequency c o n d i t i o n . A p p r a i s a l R a t i n g s and O C D S y m p t o m a t o l o g y T o e x p l o r e whether participants' appraisals o f the o b s e s s i o n - l i k e thoughts were associated w i t h O C D s y m p t o m a t o l o g y , correlations were c a l c u l a t e d c o m p a r i n g the vignette  43  appraisal ratings w i t h the O C I - R . A s d i s p l a y e d i n T a b l e 5, the appraisal ratings for b o t h frequency c o n d i t i o n s w e r e l o w to m o d e r a t e l y correlated w i t h the O C I - R . W h e n partial correlations were c a l c u l a t e d c o n t r o l l i n g for the B D I - I I , correlations r e m a i n e d significant i n b o t h the l o w frequency (r = 0.28, p < .001) and the h i g h frequency c o n d i t i o n (r = 0.18,/? < .01). P a r t i a l correlations w e r e also c a l c u l a t e d b e t w e e n the vignette appraisal ratings and the B D I - I I , c o n t r o l l i n g for the effects o f the O C I - R total score. W h e n the O C I - R total score w a s c o n t r o l l e d for, correlations b e t w e e n the vignette appraisal ratings and the B D I - I I w e r e no longer significant ( l o w frequency, r = .07,p > .25; h i g h frequency, r = .03,p > .50). T h e s e results suggest that the vignette appraisal ratings w e r e related to the o b s e s s i v e - c o m p u l s i v e s y m p t o m a t o l o g y to a greater degree than to depression. V i s u a l i n s p e c t i o n o f the pattern o f correlations presented i n T a b l e 5 s h o w s that the correlations b e t w e e n the vignette appraisal ratings and the measures o f O C m e t a - c o g n i t i v e beliefs and O C s y m p t o m a t o l o g y w e r e larger i n the l o w frequency c o n d i t i o n than i n the h i g h frequency c o n d i t i o n . I n order to statistically e x a m i n e this pattern, the m a g n i t u d e o f the c o r r e l a t i o n coefficients b e t w e e n the vignette appraisal ratings and measures o f O C m e t a c o g n i t i o n and O C s y m p t o m a t o l o g y w e r e c o m p a r e d i n the t w o frequency c o n d i t i o n s u s i n g the procedure r e c o m m e n d e d b y M e n g , R o s e n t h a l , and R u b i n (1992) for c o m p a r i n g dependent correlations. These analyses revealed that appraisals o f the o b s e s s i o n - l i k e thoughts w e r e m o r e s t r o n g l y associated w i t h O C m e t a c o g n i t i v e measures (the 111-31, O B Q - 4 4 , and T A F ) i n the l o w frequency c o n d i t i o n than i n the h i g h frequency c o n d i t i o n ( S t e i g e r ' s Z * ranged f r o m 2.22 to 2.64, p < .05). S i m i l a r l y , the l o w frequency vignette appraisal ratings w e r e m o r e h i g h l y correlated w i t h the O C I - R than were the appraisals o f h i g h frequency thoughts (Steiger's Z *  44  = 3.39, p < .01). These results demonstrate that p a r t i c i p a n t s ' appraisals o f the infrequently o c c u r r i n g thoughts w e r e m o r e h i g h l y correlated w i t h O C m e t a c o g n i t i v e beliefs and O C s y m p t o m s than w e r e appraisals o f the frequently o c c u r r i n g thoughts. C o m p a r i s o n o f H i g h O C and L o w O C Participants In the n e x t analyses, appraisal ratings w e r e c o m p a r e d b e t w e e n participants w h o scored i n the c l i n i c a l range w i t h ratings o f those w h o scored i n the n o n c l i n i c a l range for o b s e s s i v e - c o m p u l s i v e s y m p t o m s . Participants were d i v i d e d into t w o groups based o n the O C I - R c l i n i c a l c u t - o f f score o f 2 1 .  Independent-samples M e s t s w e r e c o n d u c t e d c o m p a r i n g  the vignette appraisal ratings o f 112 h i g h O C participants ( m e a n O C I - R score = 3 3 . 9 3 , SD = 10.34, range = 21 - 70) w i t h the ratings o f 168 l o w O C participants ( m e a n O C I - R score = 10.98, SD = 5.16, range = 0 - 20). R e s u l t s o f the M e s t s r e v e a l e d that h i g h O C participants endorsed greater appraisals o f p e r s o n a l s i g n i f i c a n c e o f the i n t r u s i v e thoughts than d i d l o w O C participants i n b o t h the l o w , t (278) = 5.27, p < . 0 0 1 , r = .30, a n d the h i g h frequency c o n d i t i o n s , t (278) = A.\2,p  < . 0 0 1 , r = .24 (see T a b l e 7 for means and  SDs).  A p p r a i s a l R a t i n g s b y T h e m a t i c C o n t e n t and T h o u g h t F r e q u e n c y T o e x a m i n e whether appraisals w o u l d v a r y a c c o r d i n g to thematic content o f the i n t r u s i v e thoughts and to e x p l o r e potential differences b e t w e e n the H i g h and L o w frequency c o n d i t i o n s , the vignette appraisal ratings were u s e d as the dependent v a r i a b l e i n a 4 ( T h e m a t i c Content: A g g r e s s i v e , B l a s p h e m o u s , R a c i s t , S e x u a l ) b y 2 ( F r e q u e n c y : H i g h , L o w ) repeated measures A N O V A , w i t h repeated-measures o n b o t h factors. T h e G r e e n h o u s e G e i s s e r adjustment w a s u s e d to correct for v i o l a t i o n s o f the a s s u m p t i o n o f s p h e r i c i t y for b o t h factors. R e s u l t s o f the A N O V A r e v e a l e d a significant m a i n effect o f T h e m a t i c Content, F (2.59, 725.32) = 2 3 0 . 8 9 , / ? < . 0 0 0 1 , n  2 p  = .45. T u k e y ' s m e t h o d o f post-hoc c o m p a r i s o n s  45  i n d i c a t e d that participants endorsed m o r e p e r s o n a l l y significant appraisals o f the S e x u a l vignette ( M = 4.44, SD = 1.56), f o l l o w e d b y the A g g r e s s i v e (M=  3.26, SD = 1.35), R a c i s t (M  = 2.93, SD = 1.41), and B l a s p h e m o u s vignettes ( M = 2 . 1 1 , SD = 1.42). A l l m e a n differences w e r e significant (6.05 < q < 29.14, p < .01). M o r e o v e r , there w a s a strong m a i n effect o f F r e q u e n c y , F (1, 280) = 815.04,/? < . 0 0 0 1 , n  2 p  = .74, s u c h that the o b s e s s i o n - l i k e thoughts i n  the H i g h F r e q u e n c y c o n d i t i o n w e r e associated w i t h greater appraisals o f p e r s o n a l significance (M= 3.88, SD = 1.24) than w e r e the o b s e s s i o n - l i k e thoughts i n the L o w F r e q u e n c y c o n d i t i o n ( M = 2.48, SD = 1.11). T h e significant m a i n effects w e r e q u a l i f i e d b y a s i g n i f i c a n t T h e m a t i c C o n t e n t b y F r e q u e n c y interaction, F (2.82, 789.82) =,p < .001, n  2 p  = .20 (see F i g u r e 1). T o e x p l o r e this  interaction, s i m p l e m a i n effects analyses w e r e c o n d u c t e d c o m p a r i n g appraisal ratings for H i g h and L o w F r e q u e n c y c o n d i t i o n s across the different vignette themes. In a l l cases, the H i g h F r e q u e n c y vignettes w e r e appraised m o r e n e g a t i v e l y than the L o w F r e q u e n c y vignettes; q's (2, 280) ranged f r o m 19.83 - 34.90,/? 's < .01. T o further e x p l o r e the interaction, s i m p l e m a i n effects analyses w e r e c o n d u c t e d c o m p a r i n g differences i n appraisals o f the vignette themes i n the H i g h and L o w F r e q u e n c y c o n d i t i o n s . These analyses r e v e a l e d a significant s i m p l e effect o f T h e m a t i c Content i n b o t h the H i g h F r e q u e n c y , F (2.67, 747.94) = 276.82,/? < . 0 0 0 1 , np = .50, and the L o w F r e q u e n c y c o n d i t i o n s , F (2.47, 690.28) = 128.58,/? < . 0 0 0 1 , 2  n  p  = .32. In the H i g h F r e q u e n c y c o n d i t i o n , T u k e y ' s m e t h o d o f post-hoc c o m p a r i s o n s  revealed that participants appraised the S e x u a l vignette as m o r e p e r s o n a l l y m e a n i n g f u l , f o l l o w e d b y the A g g r e s s i v e , R a c i s t , and B l a s p h e m o u s vignettes. A l l m e a n differences w e r e significant; q's (4, 280) ranged f r o m 8.84 to 33.99,p's < .01. I n the L o w F r e q u e n c y c o n d i t i o n , T u k e y ' s post-hoc c o m p a r i s o n s r e v e a l e d that the S e x u a l vignette was again  46  associated w i t h the greatest negative appraisals, f o l l o w e d b y the A g g r e s s i v e and R a c i s t vignettes, w h i c h d i d not differ f r o m one another, q (4, 280) = 0.83,p > .10, f o l l o w e d b y the B l a s p h e m o u s vignette. A l l m e a n differences, w i t h the e x c e p t i o n o f the difference b e t w e e n the A g g r e s s i v e and R a c i s t vignettes, were significant; q's (4, 280) ranged f r o m 10.26 to 2 2 . 3 9 , p's<.  01.  Summary In k e e p i n g w i t h the findings f r o m S t u d y 1, the results o f S t u d y 2 revealed that appraisals v a r i e d a c c o r d i n g to thematic content, w i t h a s i m i l a r , but not i d e n t i c a l , pattern o f differences e m e r g i n g b e t w e e n the four vignette themes. In the current study, participants w e r e m o s t l i k e l y to attach p e r s o n a l s i g n i f i c a n c e to the o c c u r r e n c e o f unacceptable s e x u a l thoughts, f o l l o w e d b y the aggressive, racist, and b l a s p h e m o u s thoughts. T h e fact that a different pattern o f appraisal ratings emerged i n the t w o studies suggests that specific features o f the thoughts o v e r and above thematic content m a y be c r i t i c a l i n h o w such thoughts are appraised, a p o s s i b i l i t y that w i l l be c o n s i d e r e d m o r e f u l l y i n the general d i s c u s s i o n that f o l l o w s . A p p r a i s a l s also v a r i e d as a f u n c t i o n o f frequency o f thought occurrence; as p r e d i c t e d from the c o g n i t i v e theory o f obsessions, participants endorsed m o r e negative appraisals o f the o b s e s s i o n - l i k e thoughts i n the h i g h frequency than i n the l o w frequency  condition.  A s i n S t u d y 1, appraisals o f the o b s e s s i o n - l i k e thoughts w e r e correlated w i t h o b s e s s i v e - c o m p u l s i v e s y m p t o m s , p r o v i d i n g a d d i t i o n a l e v i d e n c e for the r e l a t i o n s h i p b e t w e e n appraisals and obsessionality. S o m e w h a t u n e x p e c t e d l y , the m a g n i t u d e o f the correlations b e t w e e n appraisals and measures o f o b s e s s i v e - c o m p u l s i v e m e t a c o g n i t i o n and obsessive-  47  c o m p u l s i v e s y m p t o m s w a s stronger i n the l o w than i n the h i g h frequency c o n d i t i o n . T h i s f i n d i n g w i l l be d i s c u s s e d i n the general d i s c u s s i o n that f o l l o w s .  General Discussion (Studies 1 and 2) T h e current studies were designed to e x p l o r e h o w n o n c l i n i c a l participants appraise p r o t o t y p i c a l obsessive thoughts. T h e a s s o c i a t i o n b e t w e e n appraisals o f p e r s o n a l s i g n i f i c a n c e and o b s e s s i v e - c o m p u l s i v e s y m p t o m s had already been established i n the literature, so the a i m s o f the current studies were to e x a m i n e h o w n o n c l i n i c a l participants appraise intrusive thoughts m o r e t y p i c a l o f O C D and to determine w h e t h e r appraisals w o u l d v a r y as a f u n c t i o n o f thematic content and thought frequency. A c r o s s b o t h studies, appraisals o f i n t r u s i v e thoughts w e r e correlated w i t h o b s e s s i v e - c o m p u l s i v e s y m p t o m s , as m e a s u r e d b y the O C I - R . F u r t h e r m o r e , participants w i t h O C D s y m p t o m s i n the c l i n i c a l range w e r e m o r e l i k e l y to endorse appraisals o f p e r s o n a l s i g n i f i c a n c e to the o b s e s s i o n - l i k e thoughts than w e r e participants w i t h s y m p t o m s i n the n o n c l i n i c a l range. T h u s , clear e v i d e n c e emerged demonstrating that i n d i v i d u a l s w i t h s u b c l i n i c a l O C D s y m p t o m s were m o r e l i k e l y than those w i t h o u t O C D s y m p t o m s to attach undue p e r s o n a l s i g n i f i c a n c e to u n w a n t e d intrusive thoughts. These results are consistent w i t h the extant research ( C l a r k & C l a y b o u r n , 1997; F r e e s t o n et a l . , 1992; O C C W G , 2 0 0 1 , 2 0 0 3 , 2 0 0 5 ; P u r d o n & C l a r k , 1994a, 1994b) and demonstrate that the p r e v i o u s l y established r e l a t i o n s h i p b e t w e e n appraisals and O C D s y m p t o m s w a s not due to differences i n the content o f i n t r u s i v e thoughts reported b y O C D patients and n o r m a l controls. A n important f i n d i n g w a s that appraisals v a r i e d b y thematic content and thought frequency. C l e a r differences e m e r g e d i n appraisals as a f u n c t i o n o f thought content, w i t h participants e n d o r s i n g the strongest personal appraisals o f the aggressive and s e x u a l vignettes  48  i n Studies 1 and 2 r e s p e c t i v e l y , and the weakest personal appraisals for the b l a s p h e m o u s vignette i n both studies. In the o n l y other study to investigate differences i n appraisal processes b y thought content, C l a r k and colleagues (2000) found that appraisals differed b e t w e e n s e x u a l and n o n s e x u a l i n t r u s i v e thoughts. T h u s , the content o f obsessions m a y be an important v a r i a b l e i n f l u e n c i n g appraisals o f i n t r u s i v e thoughts. W h y m i g h t s o m e i n t r u s i v e thoughts be associated w i t h greater d y s f u n c t i o n a l appraisals than others? S e v e r a l variables deserve c o n s i d e r a t i o n . O n e v a r i a b l e o f theoretical i m p o r t a n c e is the extent to w h i c h i n t r u s i v e thoughts v i o l a t e s o c i a l n o r m s . R a c h m a n (1998) argues that the p r i m a r y themes o f obsessions are those that contradict the p r i n c i p l e s o f a l l m o r a l systems. In the current studies, participants w e r e most l i k e l y to endorse appraisals o f p e r s o n a l s i g n i f i c a n c e for the vignettes that d e s c r i b e d h a r m i n g a c h i l d w i t h a k n i f e (the aggressive vignette f r o m the first study) and h a v i n g a s e x u a l thought about a c h i l d (the s e x u a l vignette f r o m the s e c o n d study). O n the surface, these thoughts appear to contradict s o c i a l n o r m s to a greater extent than do the other i n t r u s i v e thoughts presented i n the vignettes. A related p o s s i b i l i t y is that the aggressive and s e x u a l i n t r u s i v e thoughts m a y have contradicted p a r t i c i p a n t s ' p e r s o n a l values m o r e than the other i n t r u s i v e thoughts.  Cognitive  theories o f O C D a l l share the v i e w that thoughts o p p o s i n g an i n d i v i d u a l s ' m o r a l s or sense o f s e l f are m o s t l i k e l y to be subject to distorted appraisals and d e v e l o p into p r o b l e m a t i c obsessions ( P u r d o n & C l a r k , 1999; R a c h m a n , 1998; S a l k o v s k i s , 1985). Indeed, the results o f a recent study suggest that distressing i n t r u s i v e thoughts w e r e d i s t i n g u i s h e d from m o r e acceptable i n t r u s i v e thoughts i n the degree to w h i c h they contradicted v a l u e d aspects o f the self ( R o w a & Purdon, 2003).  49  A t h i r d v a r i a b l e that m a y influence appraisals i n v o l v e s the i d e n t i f i e d " v i c t i m " i n the obsession. In the current studies, the thoughts m o s t associated w i t h appraisals o f p e r s o n a l s i g n i f i c a n c e w e r e those that featured y o u n g c h i l d r e n . R a c h m a n (1998) suggests that the " v i c t i m s " w h o tend to appear m o s t c o m m o n l y i n obsessions are the v u l n e r a b l e m e m b e r s o f society (i.e., the y o u n g , the e l d e r l y ) . H e argues that i n t r u s i v e thoughts i n v o l v i n g helpless m e m b e r s o f s o c i e t y are the m o s t repugnant and m o r a l l y objectionable, a n d thus the most l i k e l y to be n e g a t i v e l y appraised. T o further this point, R a c h m a n (1998) states that "people rarely (ever?) have h a r m obsessions about strong p e o p l e w h o are capable o f d e f e n d i n g themselves - there are no A r n o l d S c h w a r t z e n e g g e r o b s e s s i o n s " (p. 387). Therefore, v u l n e r a b i l i t y o f the " v i c t i m " d e s c r i b e d i n each vignette m a y have i n f l u e n c e d appraisals, s u c h that participants m a y be m o r e l i k e l y to attach greater s i g n i f i c a n c e to i n t r u s i v e thoughts about h a r m i n g v u l n e r a b l e persons. F u t u r e studies are needed to e x a m i n e whether these and other features o f obsessions are important i n i n f l u e n c i n g appraisals o f i n t r u s i v e thoughts. In b o t h studies, participants w e r e least l i k e l y to appraise the b l a s p h e m o u s i n t r u s i v e thoughts as p e r s o n a l l y s i g n i f i c a n t or r e v e a l i n g . T h i s result m a y have b e e n an artifact o f the current samples, as the U n i v e r s i t y o f B r i t i s h C o l u m b i a is a r e l a t i v e l y secular c o m m u n i t y . O n e m i g h t expect that different results w o u l d emerge i n a s a m p l e d r a w n f r o m a m o r e r e l i g i o u s c o m m u n i t y . It is also p o s s i b l e that the b l a s p h e m o u s vignettes r e c e i v e d l o w e r appraisals o f p e r s o n a l s i g n i f i c a n c e based o n the questionnaire u s e d to measure appraisals. D a n g e r themes w e r e p r o m i n e n t i n the vignette appraisal r a t i n g questionnaire, w i t h m a n y o f the questions referring to p o t e n t i a l l y dangerous outcomes (e.g., " T o w h a t extent w o u l d this thought m e a n that y o u m i g h t lose c o n t r o l and do s o m e t h i n g a w f u l , " a n d " T o what extent w o u l d this thought m e a n y o u are a dangerous person?"). In this w a y , it is not s u r p r i s i n g that  50  intrusive thoughts related to dangerous outcomes (i.e., the aggressive and s e x u a l vignettes) r e c e i v e d h i g h e r scores o n the appraisal ratings than d i d i n t r u s i v e thoughts related to b l a s p h e m y . F u t u r e studies c o u l d redress this l i m i t a t i o n b y i n c l u d i n g a p p r a i s a l items that are d i r e c t l y relevant to b l a s p h e m y (e.g., " T o what extent does this thought represent a s i n ? " ) . In S t u d y 2, appraisal ratings w e r e f o u n d to v a r y as a f u n c t i o n o f thought frequency, w i t h participants attaching m o r e m e a n i n g and s i g n i f i c a n c e to the vignettes i n the h i g h frequency c o n d i t i o n than i n the l o w frequency c o n d i t i o n . T h a t frequency w o u l d differentially affect appraisals is i n t u i t i v e and also c l e a r l y i n k e e p i n g w i t h hypotheses f r o m the c o g n i t i v e theory o f obsessions. R a c h m a n (1998) h y p o t h e s i z e d a r e c i p r o c a l relationship b e t w e e n thought frequency and appraisals s u c h that " c a t a s t r o p h i c " appraisals o f the s i g n i f i c a n c e o f thoughts results i n an escalation i n the frequency o f thoughts, w h i c h i n turn reinforces appraisals o f the s i g n i f i c a n c e o f the thoughts (i.e., "the v e r y fact that I a m h a v i n g this thought so often suggests that the thought must be important i n s o m e w a y " ) . T h e results o f S t u d y 2 are consistent w i t h this hypothesis and suggest that h i g h e r frequency o f thought occurrence is i n d e e d related to increased appraisals about the s i g n i f i c a n c e o f thoughts. A n u n e x p e c t e d f i n d i n g that emerged i n S t u d y 2 w a s that the correlations between appraisals and o b s e s s i v e - c o m p u l s i v e s y m p t o m s w e r e stronger i n the l o w frequency than i n the h i g h frequency c o n d i t i o n . T h i s suggests that appraisals o f l o w frequency thoughts are m o r e related to s u b c l i n i c a l o b s e s s i v e - c o m p u l s i v e s y m p t o m s (as demonstrated b y the h i g h e r c o r r e l a t i o n b e t w e e n appraisals and O C D s y m p t o m s ) than are appraisals o f h i g h frequency thoughts (as demonstrated b y the w e a k e r correlations b e t w e e n appraisals and O C D s y m p t o m s ) . O n the one h a n d , this f i n d i n g is consistent w i t h the c o g n i t i v e m o d e l o f obsessions, i n w h i c h R a c h m a n (1997) c l e a r l y suggests that o c c a s i o n a l i n t r u s i v e thoughts  51  d e v e l o p into frequent, c l i n i c a l obsessions as the result o f appraisals o f p e r s o n a l s i g n i f i c a n c e . P u t another w a y , the c o g n i t i v e m o d e l is based o n the p r e m i s e that i n t r u s i v e thoughts start o f f as infrequent, a n d b e c o m e frequent o v e r t i m e due to appraisals. H o w e v e r , o n the other h a n d , the current f i n d i n g s suggest that w h e n i n t r u s i v e thoughts o c c u r r e l a t i v e l y frequently, e v e n i n d i v i d u a l s l o w i n O C D s y m p t o m a t o l o g y endorse appraisals o f p e r s o n a l s i g n i f i c a n c e thereby w e a k e n i n g the r e l a t i o n s h i p b e t w e e n appraisals a n d O C s y m p t o m s . T h i s has i m p l i c a t i o n s for the c o g n i t i v e theory o f obsessions, suggesting that frequent i n t r u s i v e thoughts that d e v e l o p s u d d e n l y w o u l d l i k e l y be appraised b y most p e o p l e (even those w i t h o u t obsessivec o m p u l s i v e s y m p t o m s ) as m e a n i n g s o m e t h i n g negative a n d p e r s o n a l . E t i o l o g i c a l studies are needed to better understand h o w obsessions d e v e l o p . In general, n o n c l i n i c a l participants i n the current study endorsed r e l a t i v e l y f e w p e r s o n a l appraisals o f the i n t r u s i v e thoughts presented i n the vignettes. T h a t is, the m e a n appraisal ratings for the i n t r u s i v e thoughts were i n the l o w to moderate range. It c o u l d be argued that these l o w appraisal ratings indicate that the i n t r u s i v e thoughts i n c l u d e d i n the vignettes w e r e not s u f f i c i e n t l y upsetting i n content to p r o d u c e negative appraisals. T h i s interpretation is not l i k e l y , h o w e v e r , g i v e n that participants tended to j u d g e the vignette thoughts as " b a d . " M o r e o v e r , the intrusive thoughts i n c l u d e d i n Studies 1 a n d 2 w e r e c h o s e n because they represent s o m e o f the m o r e upsetting obsessions reported b y c l i n i c a l samples. T h e fact that participants j u d g e d the thoughts to be " b a d , " yet d i d not attach exaggerated s i g n i f i c a n c e to the meaning o f the thoughts, suggests that n o n c l i n i c a l i n d i v i d u a l s appear able to m a k e some d i s t i n c t i o n b e t w e e n " b a d thoughts" a n d " b a d p e o p l e . " T h e r e i s one clear e x c e p t i o n to this c o n c l u s i o n , h o w e v e r . I n S t u d y 2 , the s e x u a l i n t r u s i v e thought i n the h i g h frequency c o n d i t i o n stands out f r o m a l l o f the others.  This  52  thought r e c e i v e d c o n s i d e r a b l y h i g h e r appraisals ratings o f p e r s o n a l s i g n i f i c a n c e than a n y o f the other i n t r u s i v e thoughts i n b o t h S t u d y 1 and S t u d y 2. I n fact, for the h i g h frequency sexual vignette, o v e r 3 0 % o f participants i n d i c a t e d a m e a n appraisal r a t i n g above 6 o n a 0 (no agreement w i t h appraisal statements) to 8 (total agreement w i t h appraisal statements) scale, i n d i c a t i n g strong endorsement o f appraisals o f p e r s o n a l s i g n i f i c a n c e . In contrast, the o n l y other vignette to have e v e n 1 0 % o f participants indicate appraisal ratings above 6 w a s the h i g h frequency aggressive vignette (as w e l l as the l o w frequency s e x u a l vignette). Therefore, it appears that there was s o m e t h i n g about the i n t r u s i v e s e x u a l thought about a c h i l d , p a r t i c u l a r l y a frequently o c c u r r i n g one, that hit a nerve w i t h m a n y o f the participants i n this study. T h i s f i n d i n g is important i n that it suggests that n o r m a l i n d i v i d u a l s attach considerable p e r s o n a l s i g n i f i c a n c e to the frequent occurrence o f s o m e types o f i n t r u s i v e thoughts. Participants m a y have c o n c e p t u a l i z e d the subject o f this vignette as a p e d o p h i l e as they appraised the target thought. T h e results f r o m these studies have several c l i n i c a l i m p l i c a t i o n s . First, the findings f r o m the current studies c o u l d be used to educate patients about h o w " n o r m a l " i n d i v i d u a l s appraise p r o t o t y p i c a l obsessions. A n important c o m p o n e n t o f m a n y c o g n i t i v e treatments is c h a l l e n g i n g d y s f u n c t i o n a l appraisals. T h e results from these studies demonstrate that most p e o p l e are able to disregard i n t r u s i v e thoughts as b e n i g n and unimportant, i n f o r m a t i o n that c o u l d be u s e d to h e l p patients challenge the v a l i d i t y o f their o w n d y s f u n c t i o n a l appraisals. S e c o n d , patients w i t h O C D tend to c o n c e a l their obsessions out o f a fear that they w i l l be j u d g e d n e g a t i v e l y ( N e w t h & R a c h m a n , 2 0 0 1 ) . In treatment, patients are often encouraged to reveal the content o f their obsessive thoughts to c l o s e friends and f a m i l y i n order to help d i s c o n f i r m their fears. T h e results f r o m the " O t h e r " c o n d i t i o n f r o m S t u d y 1 c o u l d be used to  53  educate patients o n h o w p e o p l e w i t h o u t O C D are l i k e l y to r e s p o n d to h e a r i n g about p r o t o t y p i c a l obsessions. I n this study, participants rated thoughts that o c c u r r e d for themselves (for w h o m they have f u l l info o n the p e r s o n a l i t y characteristics and m o r a l i t y ) or for another person. T h e results s h o w e d that participants d i d not d i s t i n g u i s h b e t w e e n these, suggesting that they do not need s p e c i a l i n f o r m a t i o n about the p e r s o n ' s "true i n n e r s e l f to j u d g e i n t r u s i v e thoughts as harmless. T h e findings f r o m these studies also suggest that c l i n i c i a n s s h o u l d use s o m e c a u t i o n w h e n r e c o m m e n d i n g that patients d i s c l o s e the content o f their obsessions. F o r one, the current results suggest that patients s h o u l d be careful i n h o w they discuss the frequency o f their obsessions; patients are m o r e l i k e l y to e l i c i t a negative r e a c t i o n i f they e m p h a s i z e the frequency o f certain types o f obsessions. F u r t h e r m o r e , the results suggest that the content o f the obsessions is important; i n the current studies, participants w e r e m o s t l i k e l y to endorse p e r s o n a l l y s i g n i f i c a n t appraisals o f thoughts i n v o l v i n g y o u n g c h i l d r e n a n d thoughts w i t h aggressive a n d s e x u a l content. Therefore, it m i g h t be important to c o a c h patients about h o w to reveal obsessions that contradict s o c i a l mores. M o r e o v e r , patients m i g h t need to educate their confidants about the nature o f O C D a l o n g w i t h r e v e a l i n g the content o f their thoughts i n order to p r o v i d e an e x p l a n a t i o n for the obsessions. T h e r e w e r e several l i m i t a t i o n s to the current studies. Importantly, the questions used to measure p e r s o n a l l y s i g n i f i c a n t appraisals w e r e d e v e l o p e d for the purpose o f this study, a n d have not undergone p s y c h o m e t r i c v a l i d a t i o n . U n f o r t u n a t e l y , it w a s not p o s s i b l e to use the IlT-31, a w e l l - v a l i d a t e d measure o f appraisals, because m a n y o f the questions o n the 111-31 w e r e not relevant to the h y p o t h e t i c a l vignettes u s e d i n these studies. Instead, the m a j o r i t y o f the appraisal questions used i n the current studies w e r e based o n the P e r s o n a l S i g n i f i c a n c e  54  S c a l e , a questionnaire d e v e l o p e d b y R a c h m a n (2003) to assess appraisals o f p e r s o n a l significance, the core construct o f R a c h m a n ' s theory. T h e vignette appraisal ratings w e r e f o u n d to possess h i g h internal c o n s i s t e n c y and to correlate s t r o n g l y w i t h w e l l v a l i d a t e d measures o f O C appraisals (the 111-31) and O C beliefs (the O B Q - 4 4 ) , p r o v i d i n g support for their v a l i d i t y . N o n e t h e l e s s , this represents an important w e a k n e s s o f the current studies. T h i s also underscores a broader l i m i t a t i o n o f studies that attempt to e x a m i n e appraisal processes. M e t a c o g n i t i o n is inherently a difficult topic to study; a s k i n g p e o p l e to reflect u p o n and evaluate their o w n thoughts is c o m p l i c a t e d and c o n f u s i n g . M o r e o v e r , m a n y measures have been d e v e l o p e d to e x a m i n e d y s f u n c t i o n a l appraisals (see O C C W G ,  1997, for  a r e v i e w o f the questionnaires d e v e l o p e d to measure O C D - r e l e v a n t appraisals and beliefs), and there is s t i l l m u c h debate o n w h i c h u n d e r l y i n g constructs are m o s t relevant to O C D . T h u s , it w i l l be important for c o n t i n u e d research to e x a m i n e O C D - s p e c i f i c measures o f cognition. W h i l e the current studies p r o v i d e d e v i d e n c e that appraisals v a r y b y thematic content and thought frequency, other p o t e n t i a l l y c r i t i c a l v a r i a b l e s w e r e not i n c l u d e d i n this study. F o r one, the e m o t i o n a l i m p a c t o f the obsessions presented i n the vignettes w a s not c o n t r o l l e d for, and m a y have g i v e n rise to different types o f e m o t i o n a l responses. F o r e x a m p l e , the vignettes c o n t a i n i n g unacceptable s e x u a l themes m a y have p r o d u c e d e m o t i o n s s u c h as shock, fear, and disgust, whereas the vignettes c o n t a i n i n g b l a s p h e m o u s themes m a y have been associated w i t h shame and guilt. I n order to better understand the appraisal process, it w i l l be important to elucidate the influence o f the e m o t i o n a l i m p a c t o f the obsession, i n a d d i t i o n to o f other features o f obsessions s u c h as the degree o f s o c i a l u n a c c e p t a b i l i t y , the extent to w h i c h obsessions contradict p e r s o n a l values, and the i d e n t i f i e d " v i c t i m " i n the obsession.  55  T h e s e and other p o t e n t i a l l y relevant variables s h o u l d be c o n s i d e r e d i n future studies to better understand the influences o n personal appraisals o f u n w a n t e d i n t r u s i v e thoughts. A n o t h e r d i r e c t i o n for future research is to delineate m e c h a n i s m s o f change i n the treatment o f O C D . I f d y s f u n c t i o n a l appraisals are indeed c a u s a l i n the d e v e l o p m e n t or maintenance o f O C D , it w i l l be important to establish that changes i n d y s f u n c t i o n a l appraisals a c c o m p a n y s y m p t o m r e m i s s i o n i n O C D . T o this effect, F r e e s t o n and colleagues (1997) f o u n d that a decrease i n d y s f u n c t i o n a l appraisals w a s associated w i t h i m p r o v e m e n t i n s y m p t o m s i n a s a m p l e o f patients r e c e i v i n g c o g n i t i v e treatment for O C D .  M o r e studies o f  this topic are needed to determine whether d y s f u n c t i o n a l appraisals are c a u s a l l y associated with O C D symptoms. T o c o n c l u d e , d y s f u n c t i o n a l appraisals o f i n t r u s i v e thoughts are central to c o g n i t i v e theories o f O C D and are r e c e i v i n g considerable e m p i r i c a l attention i n the literature. T h e results f r o m Studies 1 and 2 p r o v i d e support for a relationship b e t w e e n appraisals o f p e r s o n a l s i g n i f i c a n c e and o b s e s s i v e - c o m p u l s i v e s y m p t o m s , c o n f i r m i n g that d y s f u n c t i o n a l appraisals m a y be an important target i n c l i n i c a l interventions (Freeston et a l . , 1997). M o r e o v e r , the results f r o m the current studies h i g h l i g h t the i m p o r t a n c e o f e x a m i n i n g features o f obsessions that d i f f e r e n t i a l l y affect appraisals. T h e results o f the current studies p r o v i d e evidence that thematic content and thought frequency are t w o s u c h variables; further i n v e s t i g a t i o n o f variables that m a y i n f l u e n c e appraisal processes is warranted.  T a b l e 1: Intercorrelations B e t w e e n the V i g n e t t e T h e m e s for the " S e l f and " O t h e r " V e r s i o n s ( S t u d y 1) Aggressive  Blasphemous  Racist  Sexual  -  .46  .63  .65  Blasphemous  .59  -  .43  .66  Racist  .58  .58  -  .62  Sexual  .76  .74  .52  Aggressive  C o r r e l a t i o n s above d i a g o n a l are for the " S e l f V e r s i o n (n = 61); correlations b e l o w the d i a g o n a l are for the " O t h e r " v e r s i o n (n = 61). A l l correlations significant at the B o n f e r r o n i correlated a l p h a l e v e l ofp < .003.  57  T a b l e 2: C o r r e l a t i o n s B e t w e e n M e a n V i g n e t t e A p p r a i s a l R a t i n g and M e t a c o g n i t i v e M e a s u r e s , O C D S y m p t o m a t o l o g y , and D e p r e s s i o n (Study 1) M e a n Vignette Appraisal Rating Pearson Correlation  Partial Correlation  Interpretation o f Intrusions Inventory  .41  .38  Obsessive Beliefs Questionnaire  .51  .48  T h o u g h t - A c t i o n F u s i o n Scale  .39  .35  .34  .27  .22  —  Metacognitive Measures  OCD  Symptomatology  Obsessive-Compulsive  Inventory  Depression B e c k Depression  a  Inventory  P a r t i a l c o r r e l a t i o n c o n t r o l l i n g for B D I - I I .  N o t e : A f t e r a p p l y i n g the B o n f e r r o n i correction, correlations above r > 0.25 r e m a i n e d significant atp < .006 (N=  122).  3  58  T a b l e 3: V i g n e t t e A p p r a i s a l R a t i n g s b y T h e m e and Identity ( S t u d y 1) Aggressive  Blasphemous  Racist  Sexual  Mean  SD  Mean  SD  Mean  SD  Mean  SD  Self Version  2.62  1.45  1.88  1.35  2.21  1.22  2.23  1.30  Other V e r s i o n  2.73  1.43  1.52  1.11  1.83  1.18  1.90  1.14  N o t e : Participants i n d i c a t e d their agreement w i t h appraisals o f p e r s o n a l s i g n i f i c a n c e o n a 0 ("not at a l l " ) to 8 ( " t o t a l l y / d e f i n i t e l y " ) scale.  T a b l e 4: Intercorrelations B e t w e e n the V i g n e t t e T h e m e s for the L o w F r e q u e n c y and H i g h F r e q u e n c y C o n d i t i o n s ( S t u d y 2) Aggressive  Blasphemous  Racist  Sexual  -  .45  .59  .33  Blasphemous  .38  -  .55  .22  Racist  .50  .55  -  .37  Sexual  .58  .26  .51  Aggressive  C o r r e l a t i o n s above d i a g o n a l are for the L o w F r e q u e n c y c o n d i t i o n ; correlations b e l o w the d i a g o n a l are for the H i g h F r e q u e n c y c o n d i t i o n . A l l correlations significant at the B o n f e r r o n i correlated alpha l e v e l ofp < .003 (N= 281).  60  T a b l e 5: C o r r e l a t i o n s B e t w e e n M e a n V i g n e t t e A p p r a i s a l R a t i n g and M e t a c o g n i t i v e M e a s u r e s , O C D S y m p t o m a t o l o g y , and D e p r e s s i o n ( S t u d y 2) M e a n Vignette Appraisal Rating L o w Frequency  H i g h Frequency  Interpretation o f Intrusions Inventory  .56  .48  Obsessive Beliefs Questionnaire  .47  .38  T h o u g h t - A c t i o n F u s i o n Scale  .57  .48  .37  .23  .25  .15  Metacognitive Measures  O C D Symptomatology O b s e s s i v e - C o m p u l s i v e Inventory Depression B e c k D e p r e s s i o n Inventory  N o t e : A f t e r a p p l y i n g the B o n f e r r o n i c o r r e c t i o n , correlations o f r > 0.17 r e m a i n e d significant at/?<.005 (TV-281).  61  T a b l e 6: V i g n e t t e A p p r a i s a l R a t i n g s b y T h e m e and F r e q u e n c y C o n d i t i o n ( S t u d y 2) Aggressive  Blasphemous  Sexual  Racist  Mean  SD  Mean  SD  Mean  SD  Mean  SD  L o w Frequency  2.35  1.44  1.71  1.36  2.30  1.40  3.58  1.76  H i g h Frequency  4.16  1.59  2.51  1.63  3.57  1.62  5.30  1.58  N o t e : Participants i n d i c a t e d their agreement w i t h appraisals o f p e r s o n a l s i g n i f i c a n c e o n a 0 ("not at a l l " ) to 8 ( " t o t a l l y / d e f i n i t e l y " ) scale.  62  T a b l e 7: M e a n V i g n e t t e A p p r a i s a l R a t i n g s for H i g h and L o w O C Participants ( S t u d y 2) O C Symptomatology L o w O C Participants  H i g h O C Participants  (N = 168)  (N = 112)  M  SD  M  SD  L o w Frequency  2.21  1.00  2.90  1.15  H i g h Frequency  3.65  1.27  4.25  1.10  Note: O C = Obsessive-compulsive  63  F i g u r e 1: A v e r a g e appraisal ratings b y thematic content for h i g h and l o w frequency conditions  - • — High Frequency - L o w Frequency  (ao "  .s -*->  Pi  "3  5  '§ 4 a. < c 3 1)  1 0 Aggressive  Blasphemous  Racist  Vignette Theme  Sexual  64  CHAPTER 3- STUDY 3 Introduction In h i s c o g n i t i v e theory o f obsessions, R a c h m a n (1997) argues that i n d i v i d u a l s w i t h O C D attach e x c e s s i v e s i g n i f i c a n c e and i m p o r t a n c e to their u n w a n t e d i n t r u s i v e thoughts. These "catastrophic misinterpretations" o f the s i g n i f i c a n c e o f thoughts i n turn p r o d u c e a n x i e t y and distress, and m o t i v a t e active resistance o f s u c h thoughts. P a r a d o x i c a l l y , active resistance o f thoughts is b e l i e v e d to be an ineffective strategy that contributes to an increase i n the occurrence o f s u c h thoughts ( W e g n e r et a l . , 1987).  T h u s , R a c h m a n proposes a  d y n a m i c m o d e l w h e r e b y d y s f u n c t i o n a l appraisals o f thoughts, c o m b i n e d w i t h active resistance o f s u c h thoughts, leads to a v i c i o u s c y c l e o f anxiety, resistance, and increased frequency o f i n t r u s i v e thoughts. S t u d y 3 o f this dissertation project w a s d e s i g n e d to d i r e c t l y e x a m i n e this d y n a m i c m o d e l o f O C D and investigate the c o m b i n e d effects o f d y s f u n c t i o n a l appraisals and thought suppression o n the frequency o f i n t r u s i v e thoughts, anxiety, and m o o d state. R a c h m a n ' s c o g n i t i v e theory o f obsessions assigns c r i t i c a l roles to d y s f u n c t i o n a l appraisals and thought suppression i n the persistence o f obsessions. A s r e v i e w e d i n C h a p t e r 1, e m p i r i c a l studies offer support for several aspects o f this theory. F i r s t , c o r r e l a t i o n a l studies, i n c l u d i n g Studies 1 and 2 f r o m this dissertation project, p r o v i d e e v i d e n c e o f a r e l a t i o n s h i p b e t w e e n d y s f u n c t i o n a l appraisals and o b s e s s i v e - c o m p u l s i v e s y m p t o m s , although they do not establish causality. T h e y cannot rule out, for e x a m p l e , the p o s s i b i l i t y that m o r e frequently o c c u r r i n g i n t r u s i v e thoughts cause changes i n appraisals rather than the appraisals c a u s i n g m o r e frequent intrusions.  A s e c o n d l i n e o f evidence relevant to R a c h m a n ' s theory demonstrates that thought suppression contributes to a p a r a d o x i c a l increase i n the frequency o f thoughts, a l t h o u g h the findings have been m i x e d . W h i l e s o m e studies have f o u n d an i r o n i c effect o f suppression w i t h p e r s o n a l l y relevant thoughts, m a n y have not. T h e r e are a n u m b e r o f potential explanations for these discrepant findings, i n c l u d i n g m e t h o d o l o g i c a l differences.  One  i n t r i g u i n g p o s s i b i l i t y is that the inconsistent results m a y be a f u n c t i o n o f differences i n the p e r s o n a l m e a n i n g and s i g n i f i c a n c e o f the target thoughts u s e d i n v a r i o u s studies.  Even  a m o n g studies that e x p l i c i t l y u s e d p e r s o n a l l y generated target thoughts, participants m a y have selected target thoughts that differed c o n s i d e r a b l y w i t h respect to their personal s i g n i f i c a n c e or degree o f distress associated w i t h t h e m . C o g n i t i v e theories o f O C D w o u l d predict that differences i n appraisals about the m e a n i n g o f the target thoughts w o u l d lead to c o r r e s p o n d i n g differences i n the results o f suppression. In a d d i t i o n , w h i l e a n u m b e r o f studies e x a m i n e d suppression o f p e r s o n a l l y relevant negative thoughts, w h i c h better reflect the k i n d s o f thoughts e x p e r i e n c e d b y patients w i t h O C D , the use o f p e r s o n a l l y relevant thoughts introduces other important confounds. First, because participants each select a u n i q u e target thought, there is no c o n s i s t e n c y across participants and internal v a l i d i t y is w e a k e n e d . S e c o n d , w h i l e a n u m b e r o f studies have attempted to c o m p a r e the suppression o f p e r s o n a l l y relevant thoughts w i t h neutral thoughts, these studies failed to c o n t r o l for the v a l e n c e and n o v e l t y o f the target thought. P e r s o n a l l y relevant thoughts differ f r o m neutral " w h i t e b e a r " thoughts i n a n u m b e r o f important w a y s . T h e y are m o r e negative, m o r e m e a n i n g f u l , and l a c k n o v e l t y , c o m p a r e d to " w h i t e bear" thoughts. M o r e o v e r , as suggested b y T o l i n (2002), i n d i v i d u a l s have experience w i t h their o w n p e r s o n a l l y relevant thoughts, and m a y have d e v e l o p e d i d i o s y n c r a t i c strategies for  66  d e a l i n g w i t h these thoughts that m a k e s u c h thoughts less l i k e l y to demonstrate a p a r a d o x i c a l effect o f suppression w i t h i n a laboratory s u p p r e s s i o n task. Therefore, the purpose o f the current study w a s to e x a m i n e whether the effects o f thought suppression w o u l d v a r y as a f u n c t i o n o f p e r s o n a l m e a n i n g o f the target thought, and r e s u l t i n g d y s f u n c t i o n a l appraisals about the thought. S p e c i f i c a l l y , this study a i m e d to b u i l d o n p r e v i o u s thought suppression studies b y i n v e s t i g a t i n g w h e t h e r p e r s o n a l m e a n i n g o f the target thought w o u l d interact w i t h suppression effort to influence thought frequency, m o o d , and anxiety. B a s e d o n the c o g n i t i v e theory o f obsessions, appraisals about the personal s i g n i f i c a n c e o f the target thought w e r e expected to moderate the effects o f thought suppression o n subsequent frequency o f thoughts, self-reported anxiety, and m o o d . T h i s q u a s i - e x p e r i m e n t a l study w a s also d e s i g n e d to address several l i m i t a t i o n s i n the extant thought s u p p r e s s i o n literature. In a departure f r o m thought suppression studies that i n c l u d e d p e r s o n a l l y relevant thoughts, the current study i n c l u d e d a s i n g l e , n o v e l , target thought i n order to m a i n t a i n e x p e r i m e n t a l c o n t r o l o v e r the task and increase the internal v a l i d i t y o f the study. T o e x a m i n e the influence o f p e r s o n a l m e a n i n g o f the thought, t w o distinct groups o f participants w e r e selected based o n the hypothesis that the groups w o u l d differ i n their appraisals o f the target thought. S p e c i f i c a l l y , a b l a s p h e m o u s thought w a s selected to serve as the target thought for the suppression task, and t w o different groups o f participants were recruited o n the basis o f r e l i g i o s i t y . T h e first group c o n s i s t e d o f h i g h l y r e l i g i o u s i n d i v i d u a l s and the second group consisted o f participants for w h o m r e l i g i o n was unimportant. H i g h l y r e l i g i o u s participants w e r e expected to endorse greater appraisals o f p e r s o n a l s i g n i f i c a n c e o f the target thought than were participants for w h o m r e l i g i o n w a s unimportant.  67  T h e use o f a single, n o v e l , target thought conferred a n u m b e r o f benefits. F o r one, it increased the internal v a l i d i t y o f the e x p e r i m e n t a l d e s i g n , b y m a i n t a i n i n g c o n t r o l o v e r the s t i m u l u s . In a d d i t i o n , it a l l o w e d for the e x a m i n a t i o n o f whether the effects o f thought suppression w o u l d v a r y as a f u n c t i o n o f appraisals o f p e r s o n a l m e a n i n g w i t h o u t the c o n f o u n d o f p r i o r experience w i t h the specific thought. T h u s , the target thought w a s selected to v a r y b y group o n p e r s o n a l m e a n i n g w h i l e b e i n g less l i k e l y to v a r y b y n o v e l t y or p e r s o n a l experience. A n o n c l i n i c a l s a m p l e w a s appropriate for t w o reasons. First, as d i s c u s s e d earlier, n o n c l i n i c a l i n d i v i d u a l s experience u n w a n t e d i n t r u s i v e thoughts (e.g., F r e e s t o n et a l . , 1 9 9 1 ; N i l e r & B e c k , 1989; P u r d o n & C l a r k , 1993; R a c h m a n & de S i l v a , 1978; S a l k o v s k i s & H a r r i s o n , 1984). S e c o n d , g i v e n that the purpose o f this study w a s to e x a m i n e the r o l e o f appraisals o f p e r s o n a l m e a n i n g and thought s u p p r e s s i o n as a m o d e l for the d e v e l o p m e n t o f obsessions, it w a s important to e x a m i n e this i n i n d i v i d u a l s w h o h a d less experience w i t h suppression. Methodological Considerations In recent r e v i e w s o f the thought suppression literature ( A b r a m o w i t z et a l . , 2 0 0 1 ; P u r d o n & C l a r k , 2 0 0 0 ) , authors have c o m m e n t e d o n the d i f f i c u l t y i n d r a w i n g c o n c l u s i o n s across studies due to the m a n y m e t h o d o l o g i c a l differences b e t w e e n studies. F o r e x a m p l e , studies have e m p l o y e d different research designs, participants, c o n t r o l c o n d i t i o n s , target thoughts, target thought r e c o r d i n g methods, and length o f thought m o n i t o r i n g intervals. M o r e o v e r , m a n y thought suppression studies have been c r i t i c i z e d a l o n g m e t h o d o l o g i c a l grounds. F o r e x a m p l e , a n u m b e r o f the studies e m p l o y e d c r o s s - o v e r designs ( K e l l y & K a h n , 1994; M c N a l l y & R i c c i a r d i , 1996; R u t l e d g e , 1998), i n w h i c h participants were first  68  instructed to suppress or express the target thought, after w h i c h the instructions were reversed.  C r o s s - o v e r designs have been c r i t i c i z e d for c o n f o u n d i n g instructions (i.e.,  suppress v s . express) w i t h experience w i t h the task (see P u r d o n & C l a r k , 2 0 0 0 for a c o m p l e t e r e v i e w o f m e t h o d o l o g i c a l concerns i n early thought suppression studies). I n response to this c r i t i c i s m , studies n o w e m p l o y a c o n t r o l c o n d i t i o n i n w h i c h the c o n t r o l group is instructed to m o n i t o r occurrences o f the target thought d u r i n g b o t h intervals rather than first express and then suppress target thoughts. S i m i l a r l y , studies have differed i n type o f c o n t r o l c o n d i t i o n , w i t h some studies e m p l o y i n g e x p r e s s i o n instructions ( K e l l y & K a h n , 1994; R u t l e d g e , 1998) i n w h i c h participants are t o l d to a c t i v e l y t h i n k about the target thought, whereas other studies have used " m e n t i o n " controls ( M c N a l l y & R i c c i a r d i , 1996; S a l k o v s k i s & C a m p b e l l , 1994; S m a r i et a l . , 1995; T r i n d e r & S a l k o v s k i s , 1994), w h e r e participants are t o l d to t h i n k about w h a t e v e r they l i k e , i n c l u d i n g the target thought. E x p r e s s i o n instructions have been c r i t i c i z e d for l a c k i n g i n e c o l o g i c a l v a l i d i t y , as i n d i v i d u a l s w i t h O C D v e r y s e l d o m t r y to a c t i v e l y t h i n k about m a t e r i a l that is upsetting to t h e m ( P u r d o n & C l a r k , 2 0 0 0 ) . A n u m b e r o f m o r e recent studies have used " d o not suppress" instructions i n an attempt to prevent participants f r o m e n g a g i n g i n suppression attempts ( P u r d o n , 2 0 0 1 ; P u r d o n & C l a r k , 2 0 0 1 ; P u r d o n et a l . , 2 0 0 5 ) . Studies have also differed i n the m e t h o d used to r e c o r d thought occurrences.  Some  studies u s e d v e r b a l or w r i t t e n stream instructions, i n w h i c h participants r e c o r d e d a l l thoughts into an audio recorder or o n paper, w h i l e others u s e d b e l l rings o r k e y presses to m a r k thought occurrences. A s d i s c u s s e d i n recent r e v i e w s ( A b r a m o w i t z et a l . , 2 0 0 1 ; P u r d o n & C l a r k , 2 0 0 0 ) , overt methods o f r e c o r d i n g thoughts m a y be sensitive to participant r e a c t i v i t y and r e p o r t i n g bias, m a k i n g t h e m less appropriate for tasks i n v o l v i n g upsetting or undesirable  69  target thoughts. Studies have also v a r i e d w i t h regards to the content o f thoughts to be suppressed. K e l l y and K a h n (1994) and R u t l e d g e (1998) used p e r s o n a l l y relevant negative thoughts that w e r e m o r e a k i n to w o r r i e s than to obsessions, whereas other studies i n c l u d e d target thoughts that w e r e m o r e o b s e s s i o n - l i k e i n nature ( B e l l o c h et a l . , 2 0 0 4 ; P u r d o n , 2 0 0 1 ; P u r d o n & C l a r k , 2 0 0 1 ; S a l k o v s k i s & C a m p b e l l , 1994; T r i n d e r & S a l k o v s k i s , 1994). T h e current study w a s d e s i g n e d to i n c l u d e m a n y o f the m e t h o d o l o g i c a l r e c o m m e n d a t i o n s suggested b y A b r a m o w i t z and colleagues (2001) and P u r d o n and C l a r k (2000) i n order to o v e r c o m e p r e v i o u s l i m i t a t i o n s i n the literature. Target thought occurrence w a s r e c o r d e d w i t h an unobtrusive m e t h o d to m i n i m i z e participant response bias. M o r e o v e r , the c o n t r o l group r e c e i v e d " d o not suppress" instructions i n an attempt to reduce p a r t i c i p a n t s ' natural tendency to try to c o n t r o l u n w a n t e d thoughts. " D o not suppress" instructions are also o f greater c l i n i c a l relevance, i n that they i n v o l v e an active strategy (as o p p o s e d to m o n i t o r o n l y instructions) that m a y p r o v e useful w i t h patients. F i n a l l y , an o b s e s s i o n - l i k e thought was selected to serve as the target thought. Hypotheses T h e present study w a s designed to investigate several k e y tenets o f R a c h m a n ' s c o g n i t i v e theory o f obsessions. S p e c i f i c a l l y , this study a i m e d to e x a m i n e whether appraisals o f p e r s o n a l s i g n i f i c a n c e and thought s u p p r e s s i o n w o u l d exert direct and interactive effects o n the frequency o f thoughts, anxiety, and m o o d . I h y p o t h e s i z e d that thought suppression and appraisals o f p e r s o n a l m e a n i n g w o u l d each act as m a i n effects i n p r e d i c t i n g frequency o f thoughts, anxiety, and negative affect. I further h y p o t h e s i z e d an i n t e r a c t i o n b e t w e e n thought suppression and appraisals s u c h that the effects o f thought s u p p r e s s i o n w o u l d v a r y as a function o f the p e r s o n a l m e a n i n g o f the target thought.  70  T h e r e w e r e several s p e c i f i c hypotheses o f the current study. F i r s t , consistent w i t h the results o f recent thought suppression studies that used s i m i l a r m e t h o d o l o g i c a l features ( B e l l o c h et a l . , 2 0 0 4 ; P u r d o n & C l a r k , 2 0 0 1 ) , s u p p r e s s i o n w a s expected to attenuate the natural d e c a y i n target thought frequency o v e r t i m e . S e c o n d , I sought to e x a m i n e whether appraisals o f p e r s o n a l s i g n i f i c a n c e w o u l d moderate the effects o f suppression. T h e c o g n i t i v e theory o f O C D proposes that intrusive thoughts appraised as p e r s o n a l l y m e a n i n g f u l w i l l p r o d u c e a n x i e t y and m o t i v a t e suppression attempts, r e s u l t i n g i n a p a r a d o x i c a l increase i n thoughts. I n contrast, the c o g n i t i v e theory o f O C D predicts that i n t r u s i v e thoughts appraised as i n s i g n i f i c a n t and irrelevant w i l l neither g i v e rise to a n x i e t y n o r m o t i v a t e suppression, and therefore s h o u l d be less l i k e l y to p r o d u c e an increase i n thoughts. B a s e d o n this theory, I h y p o t h e s i z e d that suppression w o u l d result i n a m o r e robust r e b o u n d effect i n the h i g h m e a n i n g c o m p a r e d to the l o w m e a n i n g group. T h i r d , based o n the c o g n i t i v e theory o f obsessions, I p r e d i c t e d that w h e n the target thought w a s appraised as h i g h i n p e r s o n a l m e a n i n g , participants w o u l d rate target thought occurrences as m o r e distressing and less acceptable than w h e n the target thought was l o w i n p e r s o n a l m e a n i n g . S i m i l a r l y , I p r e d i c t e d that participants i n the suppression c o n d i t i o n w o u l d be m o r e distressed b y target thought occurrences and rate s u c h occurrences as less acceptable than participants i n the " d o not suppress" c o n d i t i o n because the occurrences represent a failure o f thought c o n t r o l . M o r e o v e r , I p r e d i c t e d an interaction b e t w e e n s u p p r e s s i o n c o n d i t i o n and p e r s o n a l m e a n i n g o f the thought s u c h that h i g h l y r e l i g i o u s participants i n the suppression c o n d i t i o n w o u l d rate target thought occurrences as m o r e distressing and less acceptable than w o u l d the other participants.  71  F o u r t h , c o g n i t i v e theories predict that d y s f u n c t i o n a l appraisals o f intrusive thoughts w i l l lead to m o o d disturbance and increased anxiety. T h o u g h t c o n t r o l efforts, because l a r g e l y unsuccessful, are also b e l i e v e d to contribute to negative m o o d and anxiety. Therefore, I h y p o t h e s i z e d that appraisals o f the s i g n i f i c a n c e o f the target thought and thought c o n t r o l effort w o u l d each act as m a i n effects i n p r e d i c t i n g negative m o o d and anxiety. M o r e o v e r , I p r e d i c t e d an interaction o f d y s f u n c t i o n a l appraisals and thought c o n t r o l effort o n m o o d and anxiety.  Method Participants O n e hundred and twenty participants w e r e recruited from the u n i v e r s i t y c a m p u s and s u r r o u n d i n g c o m m u n i t y . H i g h l y r e l i g i o u s i n d i v i d u a l s (n = 60) f r o m C h r i s t i a n b a c k g r o u n d s were recruited from r e l i g i o u s colleges, l o c a l churches, and p s y c h o l o g y classes.  Individuals  w h o w e r e l o w i n r e l i g i o u s i n v o l v e m e n t (n = 60) were recruited from p s y c h o l o g y classes, the general u n i v e r s i t y c o m m u n i t y , n o n - r e l i g i o u s c l u b s , and n o n - r e l i g i o u s organizations i n the c o m m u n i t y (e.g., c o m m u n i t y centres, libraries). I n d i v i d u a l s w e r e selected for p a r t i c i p a t i o n based o n responses to a screening questionnaire o f r e l i g i o s i t y and p r o f i c i e n c y i n E n g l i s h . Participants selected for the h i g h r e l i g i o u s sample were o f the C h r i s t i a n faith, reported strong p e r s o n a l i n v o l v e m e n t i n r e l i g i o n , and attended r e l i g i o u s activities at least w e e k l y . In fact, 5 1 . 7 % reported between 1 - 6 hours p a r t i c i p a t i o n i n r e l i g i o u s activities per w e e k , and the r e m a i n i n g 4 8 . 3 % reported greater than 6 hours o f w e e k l y i n v o l v e m e n t i n r e l i g i o u s a c t i v i t y . Participants selected for the l o w r e l i g i o u s sample reported no w e e k l y p a r t i c i p a t i o n i n r e l i g i o u s a c t i v i t y and d e n i e d a n y influence o f r e l i g i o n o n their personal beliefs. A l l participants were fluent i n E n g l i s h and w e r e at least 18 years o f age.  72  M o s t o f the participants were w o m e n ( 7 4 . 2 % ) , and the gender ratio was s i m i l a r across r e l i g i o u s groups, % (l,N=  120) = .04, p > .50. T h e m e a n age o f the participants w a s 22.8  years (SD = 7.8), w i t h n o differences across groups, F(l,  118) = 0.40,/? > .50, n  2 p  = 0.003.  A p p r o x i m a t e l y h a l f o f participants were C a u c a s i a n (50.9%>), w i t h the r e m a i n d e r i n d i c a t i n g that they w e r e f r o m A s i a n (38.4%) or other ethnic b a c k g r o u n d s ( 1 0 . 9 % ) . T h e groups d i d not differ o n ethnic c o m p o s i t i o n , j  (2, N = 120) = 5.15,/? = .08. Participants h a d an average o f  2  14.8 years o f e d u c a t i o n and there w e r e no differences across groups, F ( 1 , 118) = 0.02,/? > .50, n  p  < . 0 0 1 . F i n a l l y , 8 0 . 8 % o f the participants w e r e s i n g l e , 7 . 5 % w e r e m a r r i e d , and the  r e m a i n d e r w e r e c o h a b i t a t i n g or i n l o n g - t e r m relationships. T h e groups d i d not differ w i t h regards to r e l a t i o n s h i p status, % (2, N = 120) = 5.18,/? = .08. 2  Apparatus T h e thought suppression task was presented o n a P e n t i u m I V desktop c o m p u t e r r u n n i n g S u p e r l a b software. A l l instructions were presented o n a 1 9 - i n c h c o l o u r m o n i t o r i n a quiet, distraction-free r o o m , and participant responses w e r e r e c o r d e d v i a keypress. Materials S c r e e n i n g Q u e s t i o n n a i r e . A b r i e f screening questionnaire assessed r e l i g i o s i t y and E n g l i s h p r o f i c i e n c y o f potential participants. F o u r questions assessed p a r t i c i p a n t s ' l e v e l o f r e l i g i o u s p a r t i c i p a t i o n and degree o f c o m m i t m e n t to r e l i g i o u s a c t i v i t i e s . These questions w e r e based o n a questionnaire d e v e l o p e d b y S i c a , N o v a r a , and S a n a v i o (2002). A n a d d i t i o n a l t w o questions assessed p r o f i c i e n c y i n E n g l i s h . O b s e s s i v e B e l i e f s Q u e s t i o n n a i r e . T h e b r i e f v e r s i o n o f the O b s e s s i v e B e l i e f s Q u e s t i o n n a i r e ( O B Q - 4 4 ; O C C W G , 2005) was used to assess beliefs and assumptions related to O C D .  See the d e s c r i p t i o n from S t u d y 1 for m o r e i n f o r m a t i o n o n this measure.  73  Obsessive-Compulsive  Inventory - Revised. S y m p t o m s o f o b s e s s i v e - c o m p u l s i v e  disorder w e r e assessed w i t h the O b s e s s i v e - C o m p u l s i v e I n v e n t o r y - R e v i s e d ( O C I - R ; F o a et al., 2 0 0 2 ; H a j c a k et a l , 2 0 0 4 ) . See the d e s c r i p t i o n from S t u d y 1 for m o r e i n f o r m a t i o n o n this measure. P o s i t i v e and N e g a t i v e A f f e c t S c h e d u l e . T h e P o s i t i v e and N e g a t i v e A f f e c t S c h e d u l e ( P A N A S ; W a t s o n , C l a r k , & T e l l e g e n , 1988) is a 2 0 - i t e m self-report scale that measures p o s i t i v e a n d negative m o o d states. T h e scale consists o f 10 adjectives d e s c r i b i n g p o s i t i v e e m o t i o n s (e.g., e x c i t e d , enthusiastic) a n d 10 adjectives d e s c r i b i n g negative e m o t i o n s (e.g., scared, upset), y i e l d i n g t w o affect scores. Participants rate the degree to w h i c h they feel each e m o t i o n o n a scale f r o m 1 ("very s l i g h t l y o r not at a l l " ) to 5 ( " e x t r e m e l y " ) . F o r the current study, o n l y the P A N A S negative affect ( N A ) scale w a s i n c l u d e d , as the c o g n i t i v e theory o f obsessions makes n o p r e d i c t i o n s about a n association b e t w e e n d y s f u n c t i o n a l appraisals a n d p o s i t i v e affect. T h e P A N A S N A scale w a s a d m i n i s t e r e d before a n d after the thought suppression task i n order to measure potential changes i n m o o d . A t each t i m e point, participants rated the extent to w h i c h they felt each e m o t i o n at that present time. T h e P A N A S scales have s h o w n excellent internal c o n s i s t e n c y , w i t h a C r o n b a c h ' s a l p h a o f .85 for negative affect w h e n "present m o m e n t " instructions were u s e d ( W a t s o n et al., 1988). T h e P A N A S scales have also s h o w n excellent convergent a n d divergent v a l i d i t y . Importantly, the P A N A S scales have also been s h o w n to b e sensitive to changes i n m o o d ( W a t s o n et a l . , 1988). N o t a b l y , the negative affect scale, but not the p o s i t i v e affect scale, w a s f o u n d to correlate w i t h p e r c e i v e d stress. I n a d d i t i o n , the P A N A S scales are often u s e d as m a n i p u l a t i o n c h e c k s i n m o o d i n d u c t i o n studies ( P h i l l i p s , S m i t h , & G i l h o o l y , 2 0 0 2 ; Srivastava, Sharma, & M a n d a l , 2003).  74  P e r s o n a l S i g n i f i c a n c e S c a l e . A n abbreviated v e r s i o n o f the P e r s o n a l S i g n i f i c a n c e S c a l e ( P S S ; R a c h m a n , 2 0 0 3 ) w a s i n c l u d e d i n this study to measure d y s f u n c t i o n a l appraisals related to the p e r s o n a l s i g n i f i c a n c e o f the target b l a s p h e m o u s thought. S e v e n o f the o r i g i n a l t w e n t y questions w e r e not appropriate for the purpose o f this study, a n d so o n l y the thirteen questions o f relevance to the present study w e r e selected. F o r each question, participants w e r e asked to i m a g i n e that they e x p e r i e n c e d the target thought a n d to rate the extent to w h i c h they agreed w i t h statements r e l a t i n g to the target thought o n a scale f r o m 0 (not at all) to 8 (totally agree). F o r e x a m p l e , the P S S i n c l u d e s the f o l l o w i n g questions: " T o what extent w o u l d this thought m e a n that y o u are a b a d , w i c k e d p e r s o n ? " a n d " T o what extent w o u l d this m e a n that y o u s h o u l d fight against and resist these t h o u g h t s ? " T h e P S S is a r e c e n t l y d e v e l o p e d instrument that has not undergone p s y c h o m e t r i c v a l i d a t i o n , a l t h o u g h it is c u r r e n t l y b e i n g u s e d i n f e d e r a l l y funded research o n obsessions ( M . W h i t t a l , p e r s o n a l c o m m u n i c a t i o n , September 2 0 0 4 ) . It w a s i n c l u d e d i n the present study because it measures a core construct o f R a c h m a n ' s c o g n i t i v e theory o f obsessions for w h i c h n o v a l i d a t e d measure exists. I n the current study, the P S S demonstrated strong internal consistency, w i t h C r o n b a c h ' s a l p h a = .90. M o r e o v e r , i n p r e v i o u s data c o l l e c t e d i n o u r laboratory, the 13 questions o f the P S S used i n the present study correlated s t r o n g l y w i t h the Interpretation o f Intrusions I n v e n t o r y (the 111-31), r = .64. I n a d d i t i o n , the P S S correlated p o o r l y w i t h measures unrelated to the construct o f appraisals, s u c h as baseline negative affect (r = -.13). E g o - D y s t o n i c Q u e s t i o n n a i r e - D i s l i k e . S e v e n questions from the E g o - D y s t o n i c Q u e s t i o n n a i r e ( E D Q ; P u r d o n , i n press) w e r e i n c l u d e d i n this study to measure the extent to w h i c h participants d i s l i k e d the target b l a s p h e m o u s thought and the degree to w h i c h the target thought c o n f l i c t e d w i t h their m o r a l s . U n l i k e the P S S , w h i c h measures d y s f u n c t i o n a l  appraisals about the personal significance  o f the thought, the E D Q - D measures j u d g m e n t s  about the thought itself. F o r e x a m p l e , the E D Q - D i n c l u d e s the f o l l o w i n g statements: " T h i s thought is upsetting because it violates m y sense o f m o r a l i t y and d e c e n c y , " and " T h i s thought c o n f l i c t s w i t h m y personality, or, m y sense o f ' w h o I a m . ' " P a r t i c i p a n t s rate the extent to w h i c h they agree or disagree w i t h each statement as it a p p l i e d to the target b l a s p h e m o u s thought o n a 7-point L i k e r t scale. W h i l e the E D Q - D is a n e w l y d e v e l o p e d measure that has not undergone p s y c h o m e t r i c v a l i d a t i o n , it demonstrated strong internal c o n s i s t e n c y i n the current study, w i t h C r o n b a c h ' s a l p h a = 0.94. M o r e o v e r , it demonstrated an expected pattern o f correlations, w i t h a m o d e r a t e l y strong a s s o c i a t i o n w i t h the other measure o f appraisals, the P S S (r = - . 4 4 ) , and no association w i t h measures unrelated to the 3  construct o f appraisals, s u c h as baseline P A N A S - N A (r = -.06). T h o u g h t S u p p r e s s i o n T a s k R a t i n g Scales. A f t e r each thought m o n i t o r i n g p e r i o d , participants c o m p l e t e d three r a t i n g scales, m e a s u r i n g : (1) the a c c e p t a b i l i t y o f target thought occurrences ( " H o w acceptable w a s it to y o u to have s o m e thoughts related to the story?"), rated o n a 1 ( " c o m p l e t e l y acceptable") to 7 ( " c o m p l e t e l y unacceptable") scale; (2) the a n x i e t y caused b y occurrences o f the target thought ( " H o w a n x i o u s d i d y o u feel as a result o f thoughts related to the story?"), rated o n a 1 ("not at a l l a n x i o u s " ) to 7 ( " e x t r e m e l y a n x i o u s " ) scale; and (3) suppression effort ( " H o w hard d i d y o u try to get r i d o f thoughts related to the story?"), rated o n a 1 ( " d i d not t r y at a l l " ) to 7 ("tried m y hardest to p u s h thoughts from m y m i n d " ) scale. T h e suppression effort r a t i n g served as a m a n i p u l a t i o n c h e c k for the thought suppression task. T h o u g h t C o n t r o l Strategies Questionnaire. T h e T h o u g h t C o n t r o l Strategies Q u e s t i o n n a i r e ( T C S Q ) w a s i n c l u d e d to measure p a r t i c i p a n t s ' use o f thought c o n t r o l  76  strategies d u r i n g each i n t e r v a l o f the thought suppression task. T h e T C S Q w a s designed for this study based o n items f r o m the C o g n i t i v e Intrusions Q u e s t i o n n a i r e (Freeston et a l . , 1991) and the R e v i s e d O b s e s s i v e Intrusions I n v e n t o r y ( P u r d o n & C l a r k , 1994b). T h e T C S Q consists o f 9 questions that ask participants to rate the extent to w h i c h they u s e d v a r i o u s strategies i n response to target thought occurrences d u r i n g the m o n i t o r i n g task o n a scale f r o m 1 (never) to 5 (constantly). E x a m p l e s o f questions i n c l u d e : " S a i d ' s t o p ' to m y s e l f , " " T r i e d to replace the thought w i t h another," and " D i s t r a c t e d m y s e l f w i t h the things around m e . " T h e T C S Q demonstrated g o o d internal consistency, w i t h C r o n b a c h ' s a l p h a = 0.80. M o r e o v e r , it d i s p l a y e d p r e l i m i n a r y e v i d e n c e o f convergent v a l i d i t y , i n that it correlated w i t h the suppression effort ratings for b o t h Interval 1 (r = .54) and Interval 2 (r = .42). H o w e v e r , it also correlated w i t h b a s e l i n e P A N A S - N A ratings (r = .28, p < .0001) suggesting the pretask negative m o o d w a s related to thought c o n t r o l effort d u r i n g the task. Procedure P o t e n t i a l participants c o m p l e t e d a b r i e f s c r e e n i n g questionnaire o v e r the telephone or v i a e - m a i l to determine e l i g i b i l i t y for this study. I n d i v i d u a l s w h o met study c r i t e r i a w e r e i n v i t e d to participate i n the study and w e r e s c h e d u l e d for an appointment. O n the d a y o f the s c h e d u l e d appointment, participants w e r e b r i e f e d o n the nature o f the study, and they p r o v i d e d i n f o r m e d consent. Participants were i n f o r m e d that the purpose o f the study w a s to e x p l o r e what p e o p l e t h i n k about different k i n d s o f thoughts, to e x a m i n e h o w p e o p l e r e s p o n d to their thoughts, and to determine the effectiveness o f different methods o f r e s p o n d i n g to thoughts. A f t e r p r o v i d i n g i n f o r m e d consent, h a l f o f the participants w e r e r a n d o m l y assigned to c o m p l e t e the O C D measures (the O B Q - 4 4 and the O C I - R ) ; the other h a l f c o m p l e t e d the  77  O C D measures u p o n c o m p l e t i o n o f the thought s u p p r e s s i o n task (see F i g u r e 2 for a d i a g r a m o f the procedure). P r i o r to b e g i n n i n g the thought s u p p r e s s i o n task, a l l participants c o m p l e t e d the P A N A S N A scale to assess baseline m o o d a n d then w e r e r a n d o m l y assigned to the " S u p p r e s s " (n = 60) o r " D o N o t S u p p r e s s " (n = 60) c o n d i t i o n . Participants were then seated i n front o f the computer, i n a distraction-free r o o m , w h e r e they r e c e i v e d instructions for the thought s u p p r e s s i o n task. T h e thought suppression task b e g a n w i t h a o n e - m i n u t e practice trial to orient participants to the requirements o f the task. A l l participants r e c e i v e d the f o l l o w i n g instructions for the practice trial: Y o u w i l l be asked to m o n i t o r y o u r thoughts for t w o separate f i v e - m i n u t e intervals. W e w o u l d l i k e y o u to get some practice w i t h this m e t h o d before y o u b e g i n . D u r i n g the next m i n u t e , w e w o u l d l i k e y o u to m o n i t o r y o u r thoughts. D u r i n g this t i m e , y o u m a y t h i n k about a n y t h i n g y o u l i k e , i n c l u d i n g thoughts about Starbucks, other coffee  shops, or anything related to coffee. I f a thought about Starbucks, other coffee shops, or anything related to coffee s h o u l d c o m e into y o u r m i n d , please press the spacebar. It is important that y o u press the spacebar a n y t i m e y o u h a v e a thought about  Starbucks, other coffee shops, or anything related to coffee. Please continue i n the same w a y for the full m i n u t e . Participants w e r e g i v e n o n e m i n u t e to m o n i t o r their thoughts, after w h i c h the experimenter answered questions a n d c l a r i f i e d details o f the task as necessary. F o l l o w i n g the practice trial, participants read the f o l l o w i n g short vignette, w h i c h i n c l u d e d the target b l a s p h e m o u s thought (listed b e l o w i n italics): Y o u decide to volunteer at a l o c a l soup k i t c h e n that serves p e o p l e w h o are h o m e l e s s , most o f w h o m are also m e n t a l l y i l l . A s y o u start t a l k i n g to the p e o p l e w h o r e g u l a r l y  78  c o m e for a hot m e a l , y o u learn m o r e about them. O n e w o m a n has d e l u s i o n s that she is a n agent o f the Space P o l i c e , here o n earth to m o n i t o r activities and report b a c k to the m o t h e r ship. O n e o f the m e n b e l i e v e s he i s Jesus C h r i s t and engages i n s o m e b e h a v i o u r consistent w i t h that belief. A t first y o u s i m p l y see h i m as h a v i n g a d e l u s i o n , b u t later, y o u b e g i n to p o n d e r the p h i l o s o p h i c a l q u e s t i o n o f h o w a true m e s s i a h m i g h t b e treated i n t o d a y ' s society. W h a t i f this m a n r e a l l y w e r e Jesus? W h a t i s the difference b e t w e e n this m a n and Jesus C h r i s t h i m s e l f ? A f t e r s e r v i n g the patrons, y o u sit d o w n at a table w i t h f e l l o w volunteers, w a i t i n g for the m i n i s t e r at the soup k i t c h e n to b e g i n s a y i n g grace. A s the m i n i s t e r starts to pray, y o u f i n d y o u r s e l f l o o k i n g up at the c r u c i f i x h a n g i n g above the soup k i t c h e n . W h i l e l o o k i n g at the c r u c i f i x , y o u s u d d e n l y h a v e a thought, "Jesus Christ was not the Messiah; Jesus Christ was just a raving lunatic\"  T h e thought is a c c o m p a n i e d b y a n i m a g e o f Jesus  C h r i s t as a p s y c h o t i c h o m e l e s s m a n r o a m i n g the streets t a l k i n g to h i m s e l f . A f t e r r e a d i n g this vignette, participants c o m p l e t e d the questionnaires assessing their j u d g m e n t s o f the target thought (the E D Q - D ) and appraisals o f the p e r s o n a l s i g n i f i c a n c e o f the thought (the P S S ) . N e x t , participants re-read the vignette i n order to p r i m e the story, a n d then they b e g a n the thought suppression task. D u r i n g the first i n t e r v a l o f the thought suppression task, participants w e r e g i v e n either " S u p p r e s s " o r " D o N o t S u p p r e s s " instructions, dependent u p o n their r a n d o m assignment. Participants i n the suppress c o n d i t i o n r e c e i v e d the f o l l o w i n g instructions, based o n the instructions used i n S a l k o v s k i s and C a m p b e l l (1994) and P u r d o n and C l a r k (2001): D u r i n g the next five minutes, y o u w i l l be asked to m o n i t o r y o u r thoughts.  During  this t i m e , y o u m a y t h i n k about a n y t h i n g y o u l i k e , h o w e v e r , we ask that you try as  79  hard as you can to suppress all thoughts related to the story you read, i n c l u d i n g thoughts related to "Jesus C h r i s t , " "Jesus C h r i s t w a s not the M e s s i a h " o r "Jesus C h r i s t w a s j u s t a r a v i n g l u n a t i c . " I f one o f these thoughts o r a s i m i l a r thought s h o u l d c o m e into y o u r m i n d , please press the space b a r a n d try to remove it from your mind immediately.  It is important that y o u try as hard as you can to remove this thought  from your mind w h e n e v e r it occurs. A n y t i m e y o u h a v e a thought about the story s u c h as "Jesus C h r i s t , " "Jesus C h r i s t w a s not the M e s s i a h " o r "Jesus C h r i s t w a s j u s t a r a v i n g l u n a t i c , " please press the space bar. P l e a s e c o n t i n u e i n the same w a y for the full five m i n u t e s . Participants i n the " D o N o t S u p p r e s s " c o n d i t i o n r e c e i v e d s i m i l a r instructions, but they w e r e s p e c i f i c a l l y instructed not to suppress the thought. P a r t i c i p a n t s i n this c o n d i t i o n r e c e i v e d the f o l l o w i n g instructions: D u r i n g the next five m i n u t e s , y o u w i l l be asked to m o n i t o r y o u r thoughts. D u r i n g this time, y o u m a y t h i n k about a n y t h i n g y o u l i k e , i n c l u d i n g thoughts related to the story y o u read s u c h as "Jesus C h r i s t , " "Jesus C h r i s t w a s not the M e s s i a h " o r "Jesus C h r i s t w a s j u s t a r a v i n g l u n a t i c . " I f one o f these thoughts o r a s i m i l a r thought s h o u l d c o m e into y o u r m i n d , please press the space bar, and continue to let all thoughts flow through your mind. It is important that y o u try not to control your thoughts but instead simply allow all thoughts to come into your mind freely.  A n y t i m e y o u have a  thought about the story s u c h as "Jesus C h r i s t , " "Jesus C h r i s t w a s not the M e s s i a h " o r "Jesus C h r i s t w a s j u s t a r a v i n g l u n a t i c , " please press the space bar. Please c o n t i n u e i n the same w a y for the full five minutes.  80  Participants m o n i t o r e d their thoughts for five m i n u t e s and pressed the spacebar w h e n e v e r a target thought entered their m i n d . A t the end o f the five m i n u t e s , participants m a d e ratings o f suppression effort, a n x i e t y caused b y target thought occurrences, and a c c e p t a b i l i t y o f target thought occurrences, and they c o m p l e t e d the T h o u g h t C o n t r o l Strategies Q u e s t i o n n a i r e . Participants then r e c e i v e d instructions for the s e c o n d i n t e r v a l o f the thought s u p p r e s s i o n task. D u r i n g this second i n t e r v a l , a l l participants r e c e i v e d " D o N o t S u p p r e s s " instructions. T h e instructions were n e a r l y i d e n t i c a l for b o t h c o n d i t i o n s , except for the instructions e n c l o s e d i n brackets b e l o w : D u r i n g the next five minutes, w e a g a i n ask that y o u m o n i t o r y o u r thoughts.  [During  this t i m e / T h i s t i m e , h o w e v e r ] , y o u m a y t h i n k about a n y t h i n g y o u l i k e , i n c l u d i n g thoughts related to the story y o u read s u c h as "Jesus C h r i s t , " "Jesus C h r i s t w a s not the M e s s i a h " or "Jesus C h r i s t w a s just a r a v i n g l u n a t i c . " I f one o f these thoughts or a s i m i l a r thought s h o u l d c o m e into y o u r m i n d , please press the space bar and continue to let a l l thoughts f l o w t h r o u g h y o u r m i n d . It is important that y o u t r y not to c o n t r o l y o u r thoughts but instead s i m p l y a l l o w a l l thoughts to c o m e into y o u r m i n d freely. A n y t i m e y o u have a thought about the story s u c h as "Jesus C h r i s t , " "Jesus C h r i s t w a s not the M e s s i a h " or "Jesus C h r i s t was just a r a v i n g l u n a t i c , " please press the space bar. P l e a s e continue i n the same w a y for the full five m i n u t e s . " Participants m o n i t o r e d their thoughts for five m i n u t e s and pressed the spacebar w h e n e v e r a target thought entered their m i n d . A t the end o f the five m i n u t e s , participants c o m p l e t e d the three ratings scales (suppression effort, anxiety, and a c c e p t a b i l i t y ) and the T h o u g h t C o n t r o l Strategies Q u e s t i o n n a i r e for the second t i m e . Participants also c o m p l e t e d the P A N A S N A r a t i n g for a s e c o n d t i m e to measure post-task m o o d . T h o s e participants assigned to c o m p l e t e  81  the O C D measures at the end o f the task d i d so at this t i m e (no order effects were o b s e r v e d , so this factor w i l l not be c o n s i d e r e d further i n this document). F i n a l l y , a l l participants w e r e debriefed and thanked for their p a r t i c i p a t i o n .  Results Preliminary Analyses S y m p t o m measures and baseline m o o d . Importantly, the H i g h R e l i g i o u s and L o w R e l i g i o u s groups d i d not differ w i t h respect to o b s e s s i v e - c o m p u l s i v e s y m p t o m s as measured b y the O C I - R , t (117) = -0.84,/? > .25, d = 0.16, or O C beliefs as m e a s u r e d b y the O B Q - 4 4 , t (118) = 0.56,/? > .50, d = 0.10. See T a b l e 8 for means and standard d e v i a t i o n s across groups. M o r e o v e r , the groups d i d not differ o n b a s e l i n e P A N A S - N A ratings, £ (118) = -0.65, p > .50, J=0.12. M a n i p u l a t i o n check. T o e x a m i n e whether participants f o l l o w e d e x p e r i m e n t a l instructions, the s u p p r e s s i o n effort ratings w e r e used as the dependent v a r i a b l e i n a 2 ( G r o u p : H i g h R e l i g i o u s v s . L o w R e l i g i o u s ) b y 2 (Instructions: " S u p p r e s s " v s . " D o N o t Suppress") b y 2 (Interval: 1 v s . 2; within-subjects factor) repeated measures a n a l y s i s o f variance ( A N O V A ) . M e a n s and standard d e v i a t i o n s for suppression effort ratings are presented i n T a b l e 9. R e s u l t s o f the A N O V A r e v e a l e d a significant m a i n effect o f Interval, F ( 1 , 1 1 6 ) = 145.13,/? < .0001, n  p  = .56, w i t h h i g h e r suppression ratings d u r i n g Interval 1 than Interval 2. R e s u l t s  also r e v e a l e d a s i g n i f i c a n t m a i n effect o f Instructions, F ( 1 , 116) = 2 5 . 3 7 , p < . 0 0 0 1 , n  2 p  =  .18, w i t h h i g h e r s u p p r e s s i o n ratings i n the " S u p p r e s s " c o n d i t i o n than the " D o N o t S u p p r e s s " c o n d i t i o n . T h e r e w a s n o m a i n effect o f R e l i g i o n , F ( 1 , 116) = 0.12,/? > .50, n  2 p  = .001,  suggesting that s u p p r e s s i o n effort d i d not differ as a f u n c t i o n o f r e l i g i o u s i n v o l v e m e n t . Importantly, the m a i n effects w e r e q u a l i f i e d b y a significant Instructions b y Interval  82  interaction, F(l,  116) = 66.47,/? < . 0 0 0 1 , n  interaction, F (1, 116) = 2.90,/? = .09, n interactions ( a l l F's < 1.0,p's > .25, n  2 p  2 p  2 p  = .36, and a trend for an Interval b y R e l i g i o n  = .02. T h e r e w e r e no other 2 - w a y o r 3 - w a y  < .01).  T o e x a m i n e the significant Instructions b y Interval interaction, s i m p l e m a i n effects analyses w e r e c o n d u c t e d c o m p a r i n g suppression effort ratings across the different instruction c o n d i t i o n s d u r i n g Interval 1 and Interval 2. These results c o n f i r m e d that participants c o m p l i e d w i t h the e x p e r i m e n t a l instructions; d u r i n g Interval 1, participants i n the " S u p p r e s s " c o n d i t i o n reported s i g n i f i c a n t l y greater suppression effort than d i d participants i n the " D o N o t S u p p r e s s " c o n d i t i o n , F (1, 116) = 60.39,/? < . 0 0 0 1 , n  2 p  = .34, whereas d u r i n g Interval 2,  no differences emerged b e t w e e n c o n d i t i o n s , F (1, 116) = 0.43,/? > .50, n  2 p  = .004.  T o e x p l o r e the trend for an Interval b y R e l i g i o n interaction, s i m p l e m a i n effects analyses w e r e c o n d u c t e d c o m p a r i n g the suppression effort ratings o f H i g h R e l i g i o u s versus L o w R e l i g i o u s participants d u r i n g Intervals 1 and 2. These analyses r e v e a l e d no differences i n suppression effort ratings between H i g h and L o w R e l i g i o u s participants d u r i n g Interval 1, F ( l , 116) = 1.23,/? > .25, n  2 p  = .01, or d u r i n g Interval 2, F ( l , 116) = 0.83,/? > .25, n  2 p  = .01.  T o further e x p l o r e participants' use o f effortful thought c o n t r o l strategies, the total score f r o m the T h o u g h t C o n t r o l Strategies Q u e s t i o n n a i r e w a s entered into a 2 ( G r o u p : H i g h R e l i g i o u s vs. L o w R e l i g i o u s ) b y 2 (Instructions: " S u p p r e s s " v s . " D o N o t Suppress") b y 2 (Interval: 1 vs. 2; within-subjects factor) A N O V A .  M e a n s and standard deviations are  presented i n T a b l e 9. R e s u l t s o f the A N O V A revealed a significant m a i n effect o f Interval, F ( 1 , 1 1 6 ) = 96.39,/? < 0 . 0 0 0 1 , n  2 p  = .45, w i t h higher thought c o n t r o l effort ratings d u r i n g  Interval 1 than Interval 2, and a significant m a i n effect o f Instructions, F (1, 116) = 4.79,/? =  83  0.03, r | p = .04, w i t h higher ratings i n the " S u p p r e s s " c o n d i t i o n than the " D o N o t S u p p r e s s " 2  c o n d i t i o n . T h e r e w a s no m a i n effect for R e l i g i o n , F ( l , 116) = 2.42, p > .10, n / = .02. These m a i n effects w e r e q u a l i f i e d b y a significant Instructions b y Interval interaction, F ( l , 116) = 33.78,p< 0.001, n  2 p  = .23. S i m p l e m a i n effects analyses r e v e a l e d that d u r i n g  Interval 1, participants i n the " S u p p r e s s " c o n d i t i o n used m o r e effortful thought c o n t r o l strategies than d i d participants i n the " D o N o t S u p p r e s s " c o n d i t i o n , F (1, 1 1 6 ) = 19.01,/? < 0.001, n  p  = .14. D u r i n g Interval 2 , there were n o differences i n effortful thought c o n t r o l  strategies b e t w e e n c o n d i t i o n s , F (I, 116) = 0.13,p > 0.5, r ) = .001. T h i s further c o n f i r m s 2  p  that participants g i v e n suppression instructions used m o r e strategies to t r y to c o n t r o l their thoughts than participants g i v e n " D o N o t S u p p r e s s " instructions. There w e r e n o other significant t w o - w a y interactions, F's < 2.0,p's > .25, r i  2 P  < .02,  although there w a s a statistical trend for a three-way interaction o f Instructions b y Interval b y G r o u p , F (1, 116) = 3.36, p = 0.07, n , = .03. T o understand the nature o f this potential 2  p  interaction, t w o f o l l o w - u p 2 ( G r o u p : H i g h R e l i g i o u s v s . L o w R e l i g i o u s ) b y 2 (Interval: 1 v s . 2; within-subjects factor) A N O V A s w e r e c o n d u c t e d for the " S u p p r e s s " a n d " D o N o t S u p p r e s s " c o n d i t i o n s separately. In the " S u p p r e s s " c o n d i t i o n , the A N O V A revealed a significant m a i n effect o f Interval i n the expected d i r e c t i o n , F (1, 58) = 106.77, p< 0.001, r ) = .65, a significant interaction o f Interval b y G r o u p , F (1, 58) = 4 . 5 3 , p = 0.04, n no m a i n effect o f G r o u p , F (1, 58) = 1.43,/? > .10, r |  2 p  2 p  2 p  = .07, but  = .02. F o l l o w - u p analyses o f the  Interval b y G r o u p interaction revealed that d u r i n g Interval 1, there w e r e no differences between H i g h a n d L o w R e l i g i o u s participants, F (1, 58) = 0.01,/? > .50, n  2 p  < .01. H o w e v e r ,  d u r i n g Interval 2, H i g h R e l i g i o u s participants s h o w e d a trend towards u s i n g m o r e effortful thought c o n t r o l strategies than L o w R e l i g i o u s participants, F (1, 58) = 3.88,/? = .05, r | p = 2  84  0.06.  In the " D o N o t S u p p r e s s " c o n d i t i o n , the A N O V A r e v e a l e d a s i g n i f i c a n t m a i n effect o f  Interval, F ( 1 , 58) = 9.37,/? = .003, n  2 p  = .14, w i t h participants u s i n g m o r e effortful thought  c o n t r o l strategies d u r i n g Interval 1 than d u r i n g Interval 2. T h e r e w a s n o m a i n effect o f G r o u p , F(l,  58) = 1.03,p > .25, n  p  = .02, n o r an Interval b y G r o u p interaction, F (I, 58) =  0.12,/?>.50, Ti <.01. 2  p  A p p r a i s a l s o f the b l a s p h e m o u s thought. Participants c o m p l e t e d appraisal ratings o f the target b l a s p h e m o u s thought p r i o r to b e g i n n i n g the e x p e r i m e n t a l thought suppression task. A n important a s s u m p t i o n u n d e r l y i n g the hypotheses i n the current study w a s that h i g h l y r e l i g i o u s participants w o u l d endorse m o r e p e r s o n a l l y significant appraisals o f the target b l a s p h e m o u s thought than w o u l d l o w r e l i g i o u s participants. In order to test this a s s u m p t i o n , total scores f r o m the t w o appraisal measures, the P S S and the E D Q - D , w e r e entered into t w o separate 2 ( G r o u p : H i g h R e l i g i o u s v s . L o w R e l i g i o u s ) b y 2 (Instructions: " S u p p r e s s " vs. " D o N o t Suppress") A N O V A s . R e l i g i o u s participants were expected to have h i g h e r P S S scores than l o w r e l i g i o u s participants, i n d i c a t i n g greater d y s f u n c t i o n a l appraisals o f p e r s o n a l significance o f the target thought. F u r t h e r m o r e , it was expected that r e l i g i o u s participants w o u l d f i n d the target b l a s p h e m o u s thought m o r e e g o - d y s t o n i c than w o u l d l o w r e l i g i o u s participants, as i n d i c a t e d b y l o w e r scores o n the E D Q - D . N o differences w e r e expected w i t h respect to Instructions, w h i c h w a s i n c l u d e d as a factor i n the A N O V A s as a c h e c k o n r a n d o m assignment to groups. See T a b l e 8 for means for the P S S and E D Q - D . F o r the P S S ratings, results r e v e a l e d a significant m a i n effect o f G r o u p , F(l,  116) = 16.08,/? < 0 . 0 0 0 1 , n  2 p  = .12. C o n s i s t e n t w i t h  the study hypotheses, H i g h R e l i g i o u s participants endorsed m o r e d y s f u n c t i o n a l appraisals o f the target b l a s p h e m o u s thought than d i d L o w R e l i g i o u s participants. T h e r e was n o m a i n  85  effect o f Instructions, F ( 1 , 116) = 0.61, p > .25, n  2 p  < . 0 1 , and no s i g n i f i c a n t interaction, F  (1, 116) = 039, p > .50, r|p < .01. 2  A s i m i l a r pattern o f results emerged for the E D Q - D ratings. T h e results i n d i c a t e d a significant m a i n effect for G r o u p , F ( 1 , 116) = 89.95,/? < 0 . 0 0 0 1 , n  = .44. T h e H i g h  2 p  R e l i g i o u s participants rated the target thought as m o r e e g o - d y s t o n i c than d i d the L o w R e l i g i o u s participants. T h e r e w a s no m a i n effect o f Instructions, F ( 1 , 116) = 0.40,/? > .50, n  2 p  < . 0 1 , and no significant interaction, F ( l , 116) = 0.12,/? > .50, n  2 p  < .01.  These results p r o v i d e strong support for the u n d e r l y i n g rationale o f the study. T h a t is, the significant m a i n effect o f G r o u p c o n f i r m s that h i g h l y r e l i g i o u s participants w e r e m o r e l i k e l y to appraise the target b l a s p h e m o u s thought as p e r s o n a l l y significant (as measured b y the P S S ) and to j u d g e the target thought as m o r e e g o - d y s t o n i c (as m e a s u r e d b y the E D Q - D ) than were participants for w h o m r e l i g i o n was unimportant. These results also c o n f i r m that participants i n the " S u p p r e s s " and " D o N o t S u p p r e s s " c o n d i t i o n s d i d not differ o n prem a n i p u l a t i o n appraisal ratings. Tests o f the M a i n H y p o t h e s e s H y p o t h e s e s 1 and 2 - Effects o f suppression and p e r s o n a l m e a n i n g o n target thought frequency. T h e p r i m a r y questions o f interest i n this study w e r e w h e t h e r appraisals o f p e r s o n a l s i g n i f i c a n c e and thought suppression w o u l d exert direct and interactive effects o n the frequency o f target thoughts. T o e x a m i n e these hypotheses, target thought frequency as measured b y keypress w a s used as the dependent v a r i a b l e i n a 2 ( G r o u p : H i g h R e l i g i o u s v s . L o w R e l i g i o u s ) b y 2 (Instructions: " S u p p r e s s " vs. " D o N o t Suppress") b y 2 (Interval: 1 vs. 2, w i t h i n subjects factor) A N O V A . A l o g a r i t h m i c transformation w a s a p p l i e d to the frequency  86  data i n order to correct for a significant p o s i t i v e s k e w i n the data. R a w means and standard deviations across groups and intervals are presented i n T a b l e 9. T h e r e w e r e no m a i n effects o f Instructions, Interval, or G r o u p , i n d i c a t i n g that target thought frequency w a s g e n e r a l l y c o m p a r a b l e across l e v e l s o f these v a r i a b l e s (see T a b l e 10 for the c o m p l e t e A N O V A table). H o w e v e r , as illustrated i n F i g u r e 3, a significant Interval b y Instructions i n t e r a c t i o n w a s observed. T o break d o w n this interaction, s i m p l e m a i n effects analyses w e r e p e r f o r m e d c o m p a r i n g target thought frequency across Intervals i n the " S u p p r e s s " and " D o N o t S u p p r e s s " c o n d i t i o n . These analyses r e v e a l e d that participants i n the " D o N o t S u p p r e s s " c o n d i t i o n s h o w e d a significant r e d u c t i o n i n the frequency o f target thoughts from Interval 1 to Interval 2, F ( l , 116) = 13.69,/? < 0 . 0 0 1 , n  v  2  = .10. In contrast,  participants i n the " S u p p r e s s " c o n d i t i o n s h o w e d a m a r g i n a l l y significant increase i n the frequency  o f target thoughts from Interval 1 to Interval 2,  F  ( 1 , 116) = 3.14,/? < 0.08,  rj = p  2  .03. T h u s , hypothesis 1 w a s p a r t i a l l y supported; whereas participants i n the " D o N o t S u p p r e s s " c o n d i t i o n s h o w e d a significant decrease i n target thoughts o v e r t i m e , participants instructed to suppress the thought reported an increase i n thoughts, a l t h o u g h this increase w a s not strong e n o u g h to be statistically significant. R e s u l t s o f the A N O V A also revealed a m a r g i n a l l y significant three-way Interval b y Instructions b y G r o u p interaction. T h e presence o f a t h r e e - w a y i n t e r a c t i o n indicates that the Interval b y Instructions i n t e r a c t i o n d e s c r i b e d above differed b e t w e e n H i g h R e l i g i o u s and L o w R e l i g i o u s participants. T o e x p l i c a t e the nature o f this interaction, t w o f o l l o w - u p 2 (Instructions: " S u p p r e s s " v s . " D o N o t Suppress") b y 2 (Interval: 1 vs. 2) A N O V A s were c o n d u c t e d for the H i g h R e l i g i o u s and L o w R e l i g i o u s groups separately. In the H i g h R e l i g i o u s group, n o m a i n effects o f Interval or Instructions were o b s e r v e d , F ' s ( 1 , 58) < 2.00,  87  p's > .15, rj < .04. Importantly, a significant Interval b y Instructions i n t e r a c t i o n emerged, F 2  p  (1, 5 8 ) = 15.54,/? < . 0 0 0 1 , n  2 p  = .21. T o break d o w n this interaction, s i m p l e m a i n effects  analyses w e r e p e r f o r m e d c o m p a r i n g target thought frequency across Intervals for the " S u p p r e s s " and " D o N o t S u p p r e s s " c o n d i t i o n s separately. T h e s e analyses r e v e a l e d that participants g i v e n s u p p r e s s i o n instructions s h o w e d a m a r g i n a l l y s i g n i f i c a n t increase i n target thought frequency f r o m Interval 1 to Interval 2, F (1, 58) = 3.24,/? = 0.08, n  2 p  =.05, whereas  participants g i v e n " D o N o t S u p p r e s s " instructions s h o w e d a significant decrease i n target thought frequency f r o m Interval 1 to Interval 2, F (1, 58) = 14.25,/? < 0 . 0 0 1 , n  2 p  =.20.  M o r e o v e r , d u r i n g Interval 1 participants i n the " D o N o t S u p p r e s s " c o n d i t i o n reported h i g h e r target thought frequency than d i d participants i n the " S u p p r e s s " c o n d i t i o n , F ( l , 58) = 8.29,/? < 0.01, n  p  =.12, whereas d u r i n g Interval 2 this pattern w a s reversed s u c h that participants i n  the " S u p p r e s s " c o n d i t i o n reported s i g n i f i c a n t l y h i g h e r target thought frequency than d i d participants i n the " D o N o t S u p p r e s s " c o n d i t i o n , F ( 1 , 58) = 7.25, p < 0.01, n  2 p  =.11. T h i s  pattern is consistent w i t h a p a r a d o x i c a l effect o f thought suppression w i t h i n the H i g h R e l i g i o u s sample. In the L o w R e l i g i o u s group, results o f the 2 (Instructions: " S u p p r e s s " vs. " D o N o t Suppress") b y 2 (Interval: 1 vs. 2) A N O V A revealed a trend for a m a i n effect o f Instructions, F (1, 58) = 3.18,/? = .08, n  2 p  =.05, w h e r e b y participants i n the " D o N o t  S u p p r e s s " c o n d i t i o n reported m o r e target thoughts across intervals than d i d those i n the " S u p p r e s s " c o n d i t i o n . T h e r e w a s n o m a i n effect o f Interval, F ( 1 , 58) = 0.26, p > .50, r | .01, and no Instructions b y Interval interaction, F ( l , 58) = 2.17,/? > .10, n  2 p  2 p  = .04. T h i s  pattern is c l e a r l y not consistent w i t h a p a r a d o x i c a l effect o f thought suppression.  Instead,  this pattern suggests that for participants i n the L o w R e l i g i o u s sample, i n i t i a l suppression  <  88  instructions resulted i n fewer target thoughts across intervals than d i d i n i t i a l n o n s u p p r e s s i o n . These results p r o v i d e support for hypothesis 2, demonstrating the thought s u p p r e s s i o n h a d differential effects o n target thought frequency d e p e n d i n g o n the p e r s o n a l m e a n i n g o f the target thought. H y p o t h e s i s 3: A n x i e t y and a c c e p t a b i l i t y ratings. T h e c o g n i t i v e theory o f obsessions predicts that the suppression o f a p e r s o n a l l y m e a n i n g f u l thought s h o u l d l e a d to increased a n x i e t y and e v a l u a t i o n o f target thought recurrences as unacceptable. In order to e x a m i n e these p r e d i c t i o n s , p a r t i c i p a n t s ' a n x i e t y ratings and target thought a c c e p t a b i l i t y ratings w e r e e x a m i n e d . F o l l o w i n g each i n t e r v a l o f the thought suppression task, participants rated their l e v e l o f a n x i e t y o n a 1 ("not at a l l a n x i o u s " ) to 7 ( " e x t r e m e l y a n x i o u s " ) r a t i n g scale and the a c c e p t a b i l i t y o f target thought occurrences o n a separate 1 ("totally unacceptable") to 7 ( " c o m p l e t e l y acceptable") r a t i n g scale. M e a n s and standard d e v i a t i o n s are presented i n T a b l e 9. A n x i e t y ratings were entered into a 2 ( G r o u p : H i g h R e l i g i o u s v s . L o w R e l i g i o u s ) b y 2 (Instructions: " S u p p r e s s " vs. " D o N o t Suppress") b y 2 (Interval: Interval 1 vs. Interval 2; within-subjects factor) A N O V A . 7.83,/? = .006, f]  p  T h e r e w a s a significant m a i n effect o f G r o u p , F ( 1 , 116) =  = .06, w i t h h i g h l y r e l i g i o u s participants r e p o r t i n g h i g h e r levels o f a n x i e t y  than l o w r e l i g i o u s participants across b o t h intervals. T h e r e w a s also a significant m a i n effect o f Interval, F ( 1 , 116) = 3 8 . 9 5 , / ) < . 0 0 0 1 , rj = .25, i n d i c a t i n g that participants reported an 2  p  o v e r a l l decrease i n a n x i e t y l e v e l s f r o m Interval 1 to Interval 2 w h i c h l i k e l y reflects general adjustment to the procedures and setting. C o n t r a r y to the hypotheses, there was no m a i n effect o f Instructions, n o r w e r e there any significant interactions (F's < 2.0, p's > .10, tj  2 p  .02).  <  89  T h o u g h t a c c e p t a b i l i t y ratings were entered into a 2 ( G r o u p : H i g h R e l i g i o u s v s . L o w R e l i g i o u s ) b y 2 (Instructions: " S u p p r e s s " vs. " D o N o t Suppress") b y 2 (Interval: 1 v s . 2, within-subjects factor) A N O V A .  R e s u l t s r e v e a l e d a m a i n effect o f G r o u p , F(l,  116) =  2 2 . 2 9 , / » < 0 . 0 0 1 , n = . 1 6 , w i t h h i g h l y r e l i g i o u s participants r a t i n g target thought occurrences 2  p  as less acceptable than the l o w r e l i g i o u s participants. T h e r e w a s also a m a i n effect o f Interval, F ( l , 116) = 4.04,/? = 0.047, n  2 p  = 0 3 , w h e r e b y thought a c c e p t a b i l i t y ratings w e r e  l o w e r d u r i n g Interval 1 than d u r i n g Interval 2. T h e r e w a s no m a i n effect o f Instructions, F (1, 116) = 0.35, p>.  50, n < . 0 1 . 2  p  T h e m a i n effect o f Interval w a s q u a l i f i e d b y a significant Interval b y Instructions interaction, F ( 1 , 116) = 4.04, p = 0.047, n  2 p  =.03. T o break d o w n this interaction, s i m p l e  m a i n effects analyses w e r e p e r f o r m e d c o m p a r i n g thought a c c e p t a b i l i t y ratings across Intervals for the " S u p p r e s s " and " D o N o t S u p p r e s s " c o n d i t i o n s separately. These analyses r e v e a l e d that participants g i v e n suppression instructions rated the target thought as less acceptable d u r i n g Interval 1 ( w h e n under "suppress" instructions) than d u r i n g Interval 2 ( w h e n suppression instructions were r e m o v e d ) , F (1, 116) = 8.07, p = 0.005, / / = 0.06. N o 2  p  s u c h differences w e r e o b s e r v e d for participants i n the " D o N o t S u p p r e s s " c o n d i t i o n , F (1, 116) = 0.00,p=  1.00, ? ; < . 0 1 . 2  p  W h i l e there w e r e n o other significant t w o - w a y interactions ( a l l F ' s < 2.5,/? 's > .10, n  p  < .02), a trend e m e r g e d for a three-way i n t e r a c t i o n o f Instructions b y Interval b y G r o u p , F  (1, 116) = 2.02, p = 0.09, n ,  2 p  = .02. T o understand the nature o f this interaction, t w o f o l l o w -  up 2 ( G r o u p : H i g h R e l i g i o u s v s . L o w R e l i g i o u s ) b y 2 (Interval: 1 v s . 2; within-subjects factor) A N O V A s were c o n d u c t e d for the " S u p p r e s s " and " D o N o t S u p p r e s s " c o n d i t i o n s separately. In the " S u p p r e s s " c o n d i t i o n , the A N O V A r e v e a l e d a s i g n i f i c a n t m a i n effect o f  Interval, F ( l , 58) = 9.83, p = 0.003, r|p = .14, and a significant m a i n effect o f G r o u p , 2  58) = 6.34, p = .02, r )  2 p  F(l,  = .01. T h e r e w a s also a trend for an Interval b y G r o u p interaction, F  (1, 58) = 3.72,/? = 0.06, n  2 p  = .06. F o l l o w - u p analyses o f the Interval b y G r o u p interaction  revealed that d u r i n g Interval 1, there w e r e no differences b e t w e e n H i g h and L o w R e l i g i o u s participants, F (1, 58) = 2 . 6 3 , p > .10, n , = .04. H o w e v e r , d u r i n g Interval 2, H i g h R e l i g i o u s 2  p  participants rated target thought occurrences as s i g n i f i c a n t l y less acceptable than L o w R e l i g i o u s participants, F (1, 58) = 9.99,p = .003, r |  2 p  = 0.15. In the " D o N o t S u p p r e s s "  c o n d i t i o n , the A N O V A revealed a significant m a i n effect o f G r o u p , F (1, 58) = 16.53,/? < .0001, U p = .22, w i t h H i g h R e l i g i o u s participants r a t i n g target thought occurrences as less 2  acceptable than L o w R e l i g i o u s participants across b o t h intervals. T h e r e w a s n o m a i n effect o f Interval, F (1, 58) = 0.00,/? > .50, n = 0.36,/? > .50, n  2 p  2 p  < .01, and n o Interval b y G r o u p interaction F (1, 58)  <.01.  H y p o t h e s i s 4: Post-task negative affect and anxiety. R e g r e s s i o n analyses were c o n d u c t e d to e x a m i n e whether appraisals o f p e r s o n a l s i g n i f i c a n c e and thought c o n t r o l effort w o u l d be related to post-task a n x i e t y and m o o d . W h e r e a s the p r e v i o u s analyses w e r e c o n d u c t e d to investigate differences across levels o f group ( h i g h l y r e l i g i o u s v s . l o w r e l i g i o u s ) and instructions ("Suppress" v s . " D o N o t Suppress"), the current regression analyses w e r e c o n d u c t e d to e x a m i n e whether appraisals o f the target thought and thought c o n t r o l effort w o u l d predict negative m o o d and anxiety, apart f r o m group status or instructions. T h e regression analyses differed f r o m the analyses o f v a r i a n c e i n a n u m b e r o f important w a y s . T h e analyses o f v a r i a n c e w e r e c o n d u c t e d to investigate differences across levels o f group ( h i g h l y r e l i g i o u s v s . l o w r e l i g i o u s ) and instructions ( " S u p p r e s s " vs. " D o N o t Suppress"). In those analyses, group status w a s u s e d as a p r o x y for appraisals; h i g h l y  91  r e l i g i o u s participants w e r e expected to differ from l o w r e l i g i o u s participants i n the extent to w h i c h they attached exaggerated p e r s o n a l s i g n i f i c a n c e to the target b l a s p h e m o u s thought. W h i l e this a s s u m p t i o n w a s warranted (as a group, h i g h l y r e l i g i o u s participants endorsed greater appraisals o f p e r s o n a l s i g n i f i c a n c e o f the target thought), there was also considerable v a r i a t i o n i n appraisals ratings w i t h i n b o t h the h i g h and l o w r e l i g i o u s groups. Therefore, the regression analyses w e r e c o n d u c t e d to e x a m i n e whether post-task m o o d and a n x i e t y w o u l d be p r e d i c t e d based o n p a r t i c i p a n t s ' u n i q u e appraisal ratings and thought c o n t r o l effort, apart from group status or instructions. T h u s , the regression analyses a l l o w e d for an e x a m i n a t i o n o f the c o n t i n u o u s variables, rather than the d i c h o t o m o u s variables u s e d i n the analyses o f variance. T h e c o g n i t i v e theory predicts a d y n a m i c m o d e l w h e r e b y i n t r u s i v e thoughts, w h e n appraised as p e r s o n a l l y significant and subjected to attempts at thought c o n t r o l , result i n m o o d disturbance and increased anxiety. T o test this m o d e l , t w o separate regression analyses w e r e c o n d u c t e d e x a m i n i n g post-task negative affect and post-task a n x i e t y ratings. In each a n a l y s i s , p r e - e x p e r i m e n t a l appraisals o f p e r s o n a l s i g n i f i c a n c e o f the target thought (as m e a s u r e d b y the P S S ) and use o f thought c o n t r o l strategies d u r i n g the thought suppression task ( T C S Q ratings across b o t h intervals) served as the p r i m a r y predictors. F u r t h e r m o r e , the i n t e r a c t i o n t e r m o f appraisals and thought c o n t r o l effort was added to the m o d e l s to e x a m i n e whether the c o m b i n a t i o n o f appraisals and thought c o n t r o l w o u l d contribute to the p r e d i c t i o n o f negative affect and a n x i e t y o v e r and above the m a i n effects. In each regression equation, baseline m o o d and O C D s y m p t o m severity w e r e entered . o n Step 1 to c o n t r o l for these variables. F r e q u e n c y o f target thought occurrences w a s entered o n Step 2 to e x a m i n e whether thought frequency w o u l d be associated w i t h m o o d and anxiety.  92  P r e - e x p e r i m e n t a l appraisals ratings a n d thought c o n t r o l effort r a t i n g w e r e entered o n Step 3, and the appraisals b y thought c o n t r o l effort i n t e r a c t i o n t e r m w a s entered o n the fourth a n d final step. In the first regression equation, post-task negative affect served as the dependent v a r i a b l e . P r e l i m i n a r y analyses w e r e c o n d u c t e d i n order to evaluate the assumptions o f m u l t i p l e regression. L o g a r i t h m i c transformations w e r e a p p l i e d to the b a s e l i n e a n d post-task P A N A S - N A ratings, the P S S ratings, a n d the total thought frequency ratings, i n order to reduce skewness a n d reduce the n u m b e r o f outliers. A n e x a m i n a t i o n o f the residuals a n d C o o k ' s distance values r e v e a l e d one case that exerted undue i n f l u e n c e o n the m o d e l , so this case w a s r e m o v e d from the analysis. I n order to reduce m u l t i c o l l i n e a r i t y , the p r e d i c t o r variables w e r e centered a n d the interaction t e r m w a s created f r o m the cross-products o f the centered v a r i a b l e s f o l l o w i n g the r e c o m m e n d a t i o n s o f A i k e n and W e s t ( 1 9 9 1 ) . T h e results o f the h i e r a r c h i c a l regression analysis are presented i n T a b l e 11. A f t e r c o n t r o l l i n g for baseline m o o d a n d O C D severity, appraisals a n d thought c o n t r o l effort b o t h e m e r g e d as s i g n i f i c a n t u n i q u e predictors o f post-task negative affect, s u c h that h i g h e r appraisals o f p e r s o n a l s i g n i f i c a n c e and greater thought c o n t r o l effort w e r e associated w i t h increased post-task negative affect. T h e s e m a i n effects w e r e m o d e r a t e d b y an appraisals b y thought c o n t r o l effort interaction. T o c l a r i f y the nature o f this interaction, post-hoc s i m p l e slopes analyses w e r e c o n d u c t e d . F o l l o w i n g the procedures r e c o m m e n d e d b y A i k e n and W e s t (1991), the interaction w a s e x a m i n e d b y c o m p a r i n g participants w h o endorsed h i g h appraisals o f p e r s o n a l s i g n i f i c a n c e (1 SD above the m e a n P S S ratings) w i t h participants w h o endorsed l o w appraisals o f p e r s o n a l s i g n i f i c a n c e (1 SD b e l o w the m e a n P S S ratings).  As  d i s p l a y e d i n F i g u r e 4, for participants w h o endorsed h i g h appraisals o f the target thought,  93  thought c o n t r o l effort p r e d i c t e d negative m o o d , /? = 0.42, p < . 0 0 1 . H o w e v e r , for participants w h o endorsed l o w appraisals, thought c o n t r o l effort d i d not predict negative m o o d , /? = 0.13, p > .10. These results demonstrate that the c o m b i n a t i o n o f d y s f u n c t i o n a l appraisals and greater use o f thought c o n t r o l strategies p r e d i c t e d negative m o o d f o l l o w i n g the thought suppression task. In the s e c o n d h i e r a r c h i c a l regression analysis, post-task a n x i e t y ratings served as the dependent v a r i a b l e . P r e l i m i n a r y analyses w e r e c o n d u c t e d to e x a m i n e the assumptions o f regression. A s i n the first regression, an e x a m i n a t i o n o f the residuals and C o o k ' s distance values r e v e a l e d one case that exerted undue influence o n the m o d e l , so this case w a s r e m o v e d f r o m the analysis. T h e results o f the h i e r a r c h i c a l r e g r e s s i o n m o d e l are presented i n T a b l e 12. A f t e r c o n t r o l l i n g for baseline m o o d and O C D s y m p t o m severity, target thought frequency c o n t r i b u t e d u n i q u e v a r i a n c e to post-task a n x i e t y ratings. O n Step 3, d y s f u n c t i o n a l appraisals and thought c o n t r o l effort b o t h emerged as significant u n i q u e predictors o f posttask anxiety. O f note, after these t w o predictors w e r e entered into the equation, O C D severity n o l o n g e r c o n t r i b u t e d u n i q u e variance to the m o d e l . O n Step 4, the a d d i t i o n o f the t w o - w a y i n t e r a c t i o n t e r m o f d y s f u n c t i o n a l appraisals and thought c o n t r o l effort resulted i n a significant increase i n R . 2  In order to understand this significant interaction, post-hoc s i m p l e  slopes analyses w e r e c o n d u c t e d c o m p a r i n g participants w h o endorsed strong d y s f u n c t i o n a l appraisals w i t h those w h o endorsed few appraisals. A s depicted i n F i g u r e 5, these analyses r e v e a l e d that for participants w h o endorsed strong d y s f u n c t i o n a l appraisals o f the target thought, thought c o n t r o l effort w a s s i g n i f i c a n t l y related to a n x i e t y ratings, fi = 0.5\,p<  .001.  H o w e v e r , for participants w h o endorsed few d y s f u n c t i o n a l appraisals o f the target thought, thought c o n t r o l effort w a s not s i g n i f i c a n t l y associated w i t h anxiety, J3 - 0.08, p > .50. In  94  other words, as predicted by the cognitive theory of OCD, negative appraisals combined with strong efforts to control thoughts predicted post-task anxiety ratings. Discussion  The purpose of this study was to examine the direct and interactive effects of thought suppression and appraisals of personal meaning on thought frequency, mood, and anxiety. This study was quasi-experimental in design; while thought suppression was manipulated, personal meaning of the target thought was not. Instead, a single target thought was employed and two groups of participants were selected with the expectation that they would differ in the extent to which they endorsed appraisals of personal significance of the thought. The primary aim of this study was to investigate whether thought suppression would have differential effects when the target thought was personally meaningful (i.e., for the high religious group) versus when the target thought was unimportant (i.e., for the low religious group). The study hypotheses were examined using both an A N O V A approach as well as a regression approach. First, a series of analyses of variance were conducted exploring the direct and interactive effects of instructed thought suppression (suppress vs. do not suppress) and personal relevance of the target thought (high religious vs. low religious). These analyses showed support, albeit weak, for differential effect of thought suppression on target thought frequency, depending on the personal meaning of the target thought. When the target thought was meaningful, thought suppression caused the frequency of thoughts to persist or perhaps increase over time, whereas nonsuppression resulted in a significant decline in target thought frequency over time. In contrast, when the thought was less meaningful to participants, suppression did not lead to changes in the frequency of target thoughts. In fact,  95 participants in the suppression condition reported fewer thought recurrences across both intervals than did participants in the nonsuppression condition. Though only a weak effect, this finding is important because it suggests that suppression of a personally meaningful thought is counter-productive; rather than help push the thought out of the mind, suppression appears to keep the thought present in the mind. Suppression does not appear to have such an effect for target thoughts that are not meaningful. The cognitive theory of obsessions posits that thought suppression is more likely to be used when intrusive thoughts are appraised as personally significant or revealing, rather than when the thoughts are appraised as insignificant. The current findings suggest that when thoughts are appraised as significant, suppression may be particularly problematic. The cognitive theory also predicts that recurrences of personally meaningful intrusive thoughts should provoke anxiety, and that thought suppression should potentiate this effect. The analysis of variance provided mixed support for this prediction. Clear group differences emerged in anxiety ratings, with the highly religious participants reporting significantly more anxiety than the low religious participants, irrespective of instructions or interval. However, contrary to the study hypotheses, suppression instructions had no effect on anxiety. The current results suggest that personal meaning of the thought, but not thought suppression, was related to anxiety ratings. This result is interesting, and suggests that for the highly religious sample, having any thoughts related to blasphemy may have been anxiety provoking, regardless of whether they were instructed to suppress or not suppress such thoughts. Similarly, it is possible that overall thought frequency, rather than suppression instructions, was related to anxiety. Indeed, results from the regression analyses revealed that target thought frequency was a unique predictor of post-task anxiety ratings. By  extension, these results suggest that w h e n an i n t r u s i v e thought i s p e r s o n a l l y m e a n i n g f u l , a n y exemplars o f this thought m a y g i v e rise to anxiety. A s e c o n d set o f analyses w a s c o n d u c t e d to e x a m i n e the study hypotheses f r o m a different perspective. I n contrast to the A N O V A s , w h i c h a l l o w e d for an e x a m i n a t i o n o f what participants were instructed to d o , a n d h o w participants were expected to appraise the target thought, the regression analyses e x p l o r e d participants' reported use o f thought c o n t r o l strategies a n d their appraisals o f the target thought. These regression analyses r e v e a l e d a v e r y i n t r i g u i n g pattern o f results. First, p a r t i c i p a n t s ' appraisals o f the target thought as p e r s o n a l l y significant w e r e associated w i t h h i g h e r a n x i e t y a n d m o r e negative m o o d at the end o f the thought s u p p r e s s i o n task. S e c o n d , w o r k i n g harder to c o n t r o l thoughts w a s also associated w i t h h i g h e r post-task a n x i e t y a n d m o r e negative m o o d . M o s t i m p o r t a n t l y , appraisals a n d thought c o n t r o l strategies interacted s u c h that the c o m b i n a t i o n o f appraisals and thought c o n t r o l strategies w a s associated w i t h h i g h negative affect a n d h i g h anxiety. T h a t i s , appraisals or thought c o n t r o l strategies alone w e r e not associated w i t h negative affect. O n l y w h e n both w e r e present d i d participants report disturbed affect a n d increased a n x i e t y f o l l o w i n g the task. These results p r o v i d e strong support for the c o g n i t i v e theory, w h i c h states that appraisals o f p e r s o n a l s i g n i f i c a n c e , w h e n c o m b i n e d w i t h the use o f thought c o n t r o l strategies such as suppression, l e a d to an escalating c y c l e o f negative affect a n d increased anxiety. It i s s o m e w h a t p e r p l e x i n g that the findings f r o m the regression analyses p r o v i d e strong support for the c o g n i t i v e theory o f obsessions, whereas the f i n d i n g s f r o m the A N O V A s p r o v i d e o n l y w e a k support for this m o d e l . T h e r e are a n u m b e r o f p o s s i b l e explanations that m a y account for this d i s c r e p a n c y . F o r one, the A N O V A s e x a m i n e d group  97  differences between suppression and nonsuppression. A s discussed previously, these analyses examined what participants were instructed to do, whereas the regression analyses examined participants' reported use o f thought control strategies. While the results o f the manipulation check demonstrated that as a group, participants complied with experimental instructions, there was also considerable variability in the extent to which individual participants complied with the instructions. Some participants in the suppression condition endorsed relatively low suppression effort, and some participants in the " D o Not Suppress" condition endorsed considerably high suppression effort. Therefore, it is possible that individual differences in participants' motivation to use thought control strategies, or individual differences in participants' natural tendency to use such strategies, superceded experimentally imposed instructions. This suggests that an important avenue for future research w i l l be to examine individual differences i n natural suppression effort, natural motivation to control thoughts, as well as suppression ability, on subsequent mood, anxiety, and frequency o f thoughts. Moreover, it would be informative to explore how individual differences interact with suppression instructions within the context o f an experimental suppression paradigm. This study was also designed to examine whether thought suppression would have differential effects based on the personal meaning o f the target thought. To investigate this, high and low religious individuals were selected for participation in the study based on the expectation that these groups would differ in the extent to which they endorsed appraisals o f personal significance o f the target blasphemous thought. Preliminary analyses o f the data confirmed that this expectation was warranted; highly religious participants rated the target blasphemous thought as more ego-dystonic and endorsed greater appraisals o f personal  98  s i g n i f i c a n c e than d i d n o n - r e l i g i o u s participants. O f course, there w a s also c o n s i d e r a b l e w i t h i n - g r o u p v a r i a b i l i t y i n appraisals ratings, w h i c h w o u l d have affected the between-group c o m p a r i s o n s i n the A N O V A s , w h i l e not affecting the regression analyses. M o r e o v e r , the h i g h and l o w r e l i g i o u s participants w o u l d n a t u r a l l y v a r y a l o n g a n u m b e r o f d i m e n s i o n s b e y o n d p e r s o n a l m e a n i n g o f the target thought and these differences c o u l d have i m p a c t e d the current study i n u n k n o w n w a y s . F o r e x a m p l e , i n some samples, r e l i g i o u s i n d i v i d u a l s have endorsed h i g h e r levels o f s u b c l i n i c a l O C D s y m p t o m s and stronger o b s e s s i v e - c o m p u l s i v e beliefs than n o n r e l i g i o u s i n d i v i d u a l s ( A b r a m o w i t z , D e a c o n , W o o d s , & T o i i n , 2 0 0 4 ; S i c a et a l . , 2 0 0 2 ; Steketee, Q u a y , & W h i t e , 1991). N o s u c h differences e m e r g e d i n the current study; h i g h and l o w r e l i g i o u s i n d i v i d u a l s d i d not differ o n O C D s y m p t o m a t o l o g y , o b s e s s i v e - c o m p u l s i v e beliefs, or baseline negative affect, m a k i n g it u n l i k e l y that differences i n O C D s y m p t o m a t o l o g y or negative affect w o u l d alone account for the results o f this study. H o w e v e r , other potential differences related to r e l i g i o s i t y cannot be r u l e d out, suggesting that the current results need to be r e p l i c a t e d i n a different sample o f participants. It is also p o s s i b l e that the target b l a s p h e m o u s thought m a y not have resulted i n large e n o u g h between-group differences i n appraisals o f p e r s o n a l m e a n i n g . T h e g o a l w a s to select a target thought that w o u l d m a x i m i z e differences b e t w e e n the h i g h r e l i g i o u s sample and the l o w r e l i g i o u s s a m p l e w i t h respect to appraisals o f the p e r s o n a l s i g n i f i c a n c e o f the thought. A t the same t i m e , it w a s important that the target thought not be so offensive to the h i g h l y r e l i g i o u s participants that it presented an ethical p r o b l e m . P i l o t w o r k i n d i c a t e d that the target thought selected for this study met these criteria. H o w e v e r , d u r i n g the study d e b r i e f i n g , a n u m b e r o f the h i g h l y r e l i g i o u s participants c o m m e n t e d that the target thought w a s not " b a d  99  e n o u g h " to be upsetting to them. Therefore, it is p o s s i b l e that differences i n appraisal ratings b e t w e e n the h i g h and l o w r e l i g i o u s groups w e r e w e a k e r than p l a n n e d , suggesting that the A N O V A results m a y be s o m e w h a t conservative. T h i s p r o b l e m also p o i n t s to the larger issue o f s t u d y i n g obsessive p h e n o m e n o n . T h e content o f obsessions is often s o c i a l l y unacceptable and abhorrent, w h i c h creates ethical concerns r e g a r d i n g what content is appropriate for use i n research. W h e n taken together, the current f i n d i n g s l e n d support to R a c h m a n ' s m o d e l suggesting that appraisals about the p e r s o n a l s i g n i f i c a n c e o f i n t r u s i v e thoughts, w h e n c o m b i n e d w i t h thought c o n t r o l strategies, are associated w i t h a n x i e t y and negative m o o d . T h e f i n d i n g s also p r o v i d e some support for the m o r e s p e c i f i c hypothesis that suppression o f p e r s o n a l l y m e a n i n g f u l thoughts leads to a p a r a d o x i c a l r e b o u n d i n thought frequency. P o t e n t i a l E x p l a n a t i o n s for D i f f e r e n t i a l Effects o f T h o u g h t S u p p r e s s i o n It is interesting to q u e s t i o n w h y thought suppression m i g h t have differential effects o n frequency o f p e r s o n a l l y m e a n i n g f u l target thoughts than for u n i m p o r t a n t thoughts.  One  p o s s i b i l i t y supported b y the present f i n d i n g s is that " c a t a s t r o p h i c " appraisals o f the p e r s o n a l s i g n i f i c a n c e o f a thought b e c o m e associated w i t h increased a n x i e t y and m o o d disturbance. T h i s negative m o o d and anxiety, i n turn, m a y interfere w i t h successful thought suppression. Indeed, there is e v i d e n c e to suggest that negative m o o d is associated w i t h greater d i f f i c u l t y suppressing thoughts ( W e n z l a f f , W e g n e r , & K l e i n , 1991; W e n z l a f f , W e g n e r , & R o p e r , 1988). M o r e o v e r , negative m o o d and a n x i e t y m a y act as a " c o g n i t i v e l o a d , " w h i c h has been s h o w n to enhance the p a r a d o x i c a l effects o f s u p p r e s s i o n (see W e n z l a f f & W e g n e r , 2 0 0 0 , for a r e v i e w o f this literature). I n this w a y , p e r s o n a l l y m e a n i n g f u l thoughts m a y be p a r t i c u l a r l y  100  sensitive to the i r o n i c effects o f suppression because they p r o v o k e negative m o o d and anxiety. A n o t h e r p o s s i b i l i t y is that w h e n an i n t r u s i v e thought is p e r s o n a l l y m e a n i n g f u l , i n d i v i d u a l s are m o r e m o t i v a t e d to e l i m i n a t e a l l occurrences o f the target thought. In the current study, h i g h l y r e l i g i o u s participants invested m o r e effort i n thought c o n t r o l strategies than d i d l o w r e l i g i o u s participants w h e n they w e r e asked to s i m p l y m o n i t o r their thoughts. W h e r e a s b o t h h i g h and l o w r e l i g i o u s participants reported s i m i l a r use o f thought c o n t r o l strategies w h e n d i r e c t l y instructed to suppress target thoughts, h i g h l y r e l i g i o u s participants endorsed greater use o f thought c o n t r o l strategies e v e n w h e n s u p p r e s s i o n instructions were r e m o v e d . T h u s , there is e v i d e n c e that the participants w h o h e l d m o r e appraisals o f p e r s o n a l m e a n i n g o f the target thought spontaneously e m p l o y e d m o r e thought c o n t r o l strategies than participants w h o d i d not h o l d s u c h appraisals. T h i s f i n d i n g is s i m i l a r to the results o f M u r i s and colleagues (1997), w h o f o u n d that spider p h o b i c s reported greater suppression effort o f spider-related targets than d i d i n d i v i d u a l s w i t h o u t a spider p h o b i a . T h i s tendency to use thought c o n t r o l strategies m a y be one o f the v e r y m e c h a n i s m s t h r o u g h w h i c h appraisals contribute to an i n c r e a s i n g frequency o f thoughts. P r o s p e c t i v e studies are needed to e x a m i n e w h e t h e r i n d i v i d u a l differences i n the use o f thought c o n t r o l strategies are associated w i t h increased frequency o f thoughts. R e l e v a n c e to the T h o u g h t S u p p r e s s i o n Literature H o w do the current f i n d i n g s fit w i t h the thought s u p p r e s s i o n literature? W h e n e x a m i n e d o v e r the entire sample w i t h o u t regard to group status, participants i n the "do not suppress" c o n d i t i o n reported a significant decrease i n target thoughts f r o m the first to the s e c o n d i n t e r v a l , whereas participants i n the suppression c o n d i t i o n d i d not s h o w this d e c l i n e ,  101  and their thought frequency even s h o w e d a m a r g i n a l l y significant increase o v e r t i m e . These results f r o m the c o m p l e t e sample are consistent w i t h past research r e p o r t i n g that thought suppression attenuated the natural decrease o f p e r s o n a l l y relevant thoughts o v e r t i m e ( B e l l o c h et a l . , 2 0 0 4 ; P u r d o n & C l a r k , 2 0 0 1 ) . W h e n the effects o f suppression w e r e e x a m i n e d separately d e p e n d i n g o n the p e r s o n a l m e a n i n g o f the target thought, h o w e v e r , differences e m e r g e d i n the effects o f thought suppression a c c o r d i n g to the m e a n i n g o f the thought. A n u m b e r o f past studies also f o u n d differences i n the o u t c o m e o f a thought suppression task a c c o r d i n g to the type o f thought suppressed ( M c N a l l y & R i c c i a r d i , 1996; P u r d o n & C l a r k , 2 0 0 1 ) . I n P u r d o n a n d C l a r k (2001), participants w e r e able to suppress neutral thoughts and positive p e r s o n a l l y relevant thoughts but not negative p e r s o n a l l y relevant thoughts. S i m i l a r l y , M c N a l l y a n d R i c c i a r d i (1996) reported a significant r e b o u n d effect for p e r s o n a l l y relevant negative thoughts i n contrast to the m o r e successful suppression for neutral thoughts. I n these past studies, the target thought differed b e t w e e n c o n d i t i o n s w i t h s o m e participants instructed to suppress neutral thoughts a n d others instructed to suppress p e r s o n a l l y relevant thoughts. A strength o f the current study w a s that the target thought w a s h e l d constant across participants, thereby c o n t r o l l i n g for v a l e n c e a n d n o v e l t y o f the target thought. W i t h these c o n t r o l s i n place, there w a s s o m e e v i d e n c e that thought suppression v a r i e d as a f u n c t i o n o f the p e r s o n a l m e a n i n g o f the thought. W h e n taken together, there is e m e r g i n g e v i d e n c e that thought suppression m a y have differential effects d e p e n d i n g o n the p e r s o n a l m e a n i n g o f the target thought. A n u m b e r o f studies have failed to demonstrate a n i r o n i c effect o f s u p p r e s s i o n w h e n participants' o w n negative thoughts served as the target thought ( K e l l y & K a h n , 1994; P u r d o n & C l a r k , 2 0 0 1 ; R u t l e d g e , 1998). W h a t m i g h t account for the differences b e t w e e n  102  studies? O t h e r than the m e t h o d o l o g i c a l differences already r e v i e w e d , another p o s s i b i l i t y is that the discrepant results are due to differences i n p r i o r experience w i t h the target thought. W h e r e a s participants i n the current study w e r e s u p p l i e d w i t h a n o v e l target thought, studies e x a m i n i n g n a t u r a l l y o c c u r r i n g targets use p a r t i c i p a n t - s u p p l i e d negative i n t r u s i v e thoughts. A s argued b y W e n z l a f f and W e g n e r (2000) and T o l i n et a l . (2002), p e o p l e m a y d e v e l o p extensive strategies to d e a l w i t h their o w n intrusive thoughts that w o r k i n the short term, thereby interfering w i t h the i r o n i c effects o f s u p p r e s s i o n i n a laboratory setting. M o r e o v e r , participants m a y have greater d i f f i c u l t y c o m p l y i n g w i t h e x p e r i m e n t a l instructions to suppress or not suppress w h e n they have d e v e l o p e d h a b i t u a l strategies for d e a l i n g w i t h their thoughts. A n o t h e r p o s s i b i l i t y suggested b y K e l l y and K a h n (1994) is that i n d i v i d u a l s m a y s u c c e s s f u l l y distract themselves f r o m their o w n intrusive thoughts w h e n i n a n o v e l setting, a w a y f r o m the triggers associated w i t h their u n w a n t e d i n t r u s i v e thoughts. F o r e x a m p l e , an i n d i v i d u a l bothered b y i n t r u s i v e thoughts o f h a r m i n g a c h i l d w i t h a k n i f e m a y o n l y h a v e d i f f i c u l t y suppressing this thought w h e n around c h i l d r e n or w h e n i n a setting that i n v o l v e s k n i v e s . W h e n i n the b l a n d laboratory e n v i r o n m e n t , it m a y be r e l a t i v e l y easy to distract o n e s e l f f r o m this type o f thought. T h e current study e x a m i n e d whether the effects o f thought suppression w o u l d differ a c c o r d i n g to the p e r s o n a l m e a n i n g o f the target thought w i t h o u t c o n f o u n d i n g p r i o r experience w i t h the target thought. F u t u r e studies are needed to h e l p tease apart the effects o f p e r s o n a l m e a n i n g and p r i o r experience o n the effects o f thought suppression. In a d d i t i o n , w h i l e a n u m b e r o f past studies e x a m i n e d s u p p r e s s i o n o f p e r s o n a l l y relevant target thoughts ( B e l l o c h et a l . , 2 0 0 4 ; K e l l y & K a h n , 1994; P u r d o n , 2 0 0 1 ; P u r d o n & C l a r k , 2 0 0 1 ; R u t l e d g e , 1998), these studies v a r i e d c o n s i d e r a b l y w i t h respect to the content o f the target thoughts used i n the suppression task, w i t h some studies e m p l o y i n g thoughts that  103  were s i m i l a r to obsessions ( B e l l o c h et a l , 2 0 0 4 ; P u r d o n , 2 0 0 1 ; P u r d o n & C l a r k , 2 0 0 1 ) , w h i l e others i n c l u d e d thoughts m o r e a k i n to w o r r i e s ( K e l l y & K a h n , 1994; R u t l e d g e , 1998). O b s e s s i o n s and w o r r i e s are k n o w n to differ i n b o t h appraisal processes and thought c o n t r o l strategies e m p l o y e d (Freeston & L a d o u c e u r , 1993; L a n g l o i s , F r e e s t o n , & L a d o u c e u r , 2 0 0 0 ) . T h u s , it is not s u r p r i s i n g that variations i n thought content w o u l d contribute to differences i n the o u t c o m e o f thought suppression studies. M o r e o v e r , past studies u s i n g p e r s o n a l l y relevant thoughts d i d not c o n t r o l for differences i n thought content w i t h i n participants. T h e content o f i n t r u s i v e thoughts is k n o w n to v a r y s i g n i f i c a n t l y across i n d i v i d u a l s , and it is l i k e l y that the i d i o s y n c r a t i c thoughts i d e n t i f i e d b y participants v a r y a l o n g several d i m e n s i o n s , i n c l u d i n g thought content (e.g., aggressive, b l a s p h e m o u s , sexual), degree o f s i m i l a r i t y to obsessions (as o p p o s e d to w o r r i e s or depressive r u m i n a t i o n s ) , and s o c i a l acceptability. A s demonstrated i n Studies 1 and 2, appraisals o f p e r s o n a l s i g n i f i c a n c e c a n v a r y as a f u n c t i o n o f thought content. T h u s , it is l i k e l y that w i t h i n - p a r t i c i p a n t v a r i a b i l i t y i n target thought content h a d an effect o n the results o f thought suppression studies. In the current study, h o l d i n g the content o f the target constant, and u s i n g an o b s e s s i o n - l i k e target thought, there w a s e v i d e n c e that the effects o f a thought suppression task v a r i e d a c c o r d i n g to the p e r s o n a l m e a n i n g o f the target thought. O f course, alternate explanations are p o s s i b l e . Importantly, the study w a s not f u l l y e x p e r i m e n t a l i n d e s i g n , l e a v i n g o p e n the p o s s i b i l i t y that the groups differed i n other w a y s b e y o n d the personal m e a n i n g o f the target thought. In a d d i t i o n , the questionnaires used to measure appraisals o f p e r s o n a l s i g n i f i c a n c e and thought c o n t r o l effort w e r e designed for the current study and h a v e not undergone f u l l p s y c h o m e t r i c v a l i d a t i o n . T h i s l i m i t a t i o n is not u n i q u e to the current study, but relates to the broader c h a l l e n g e o f attempting to assess metac o g n i t i o n . A s d i s c u s s e d i n C h a p t e r 2, one o f the p r i m a r y challenges o f s t u d y i n g c o g n i t i v e  104  theories o f O C D is that it is e x t r e m e l y difficult to measure w h a t p e o p l e t h i n k about their o w n thoughts. T h e d e f i n i t i o n and measurement o f core d o m a i n s o f obsessive c o m p u l s i v e appraisals and beliefs r e m a i n s an important area for future research. F u t u r e D i r e c t i o n s and C o n c l u s i o n T h e c o g n i t i v e theory proposes a process w h e r e b y n o r m a l i n t r u s i v e thoughts d e v e l o p into c l i n i c a l obsessions o v e r the course o f t i m e - m o r e than o v e r a few m i n u t e s as studied i n laboratory thought suppression studies. Therefore, it w i l l be important to b e g i n to study this question l o n g i t u d i n a l l y . I n the current study, thought frequency d u r i n g the s e c o n d i n t e r v a l w a s not d r a m a t i c a l l y different b e t w e e n the suppression and n o n s u p p r e s s i o n groups. H o w e v e r , the pattern o f thought recurrences suggests that suppression is associated w i t h a w e a k increase i n thoughts, whereas n o n s u p p r e s s i o n is associated w i t h a significant decrease i n thoughts, and it w o u l d have been interesting to e x a m i n e this pattern o v e r a l o n g e r t i m e p e r i o d . O n e study has f o u n d that suppression results i n sustained increases i n thoughts o v e r t i m e ( T r i n d e r & S a l k o v s k i s , 1994). T h u s , future studies s h o u l d e x a m i n e l o n g - t e r m suppression o f p e r s o n a l l y m e a n i n g f u l thoughts to e x a m i n e w h e t h e r s u p p r e s s i o n maintains thought frequency (or increases it) o v e r t i m e , or whether s u p p r e s s i o n is a successful strategy for d e a l i n g w i t h i n t r u s i v e thoughts. T o c o n c l u d e , the results o f this study add to an e m e r g i n g b o d y o f literature demonstrating that d y s f u n c t i o n a l appraisals o f p e r s o n a l s i g n i f i c a n c e and thought c o n t r o l are associated w i t h negative m o o d and anxiety. T h i s study also p r o v i d e s s o m e evidence that s u p p r e s s i o n o f negative, p e r s o n a l l y m e a n i n g f u l thoughts has deleterious effects o n thought frequency, whether b y i n c r e a s i n g the frequency o f thoughts, or b y interfering w i t h the otherwise natural d e c l i n e i n thoughts e v i d e n c e d b y the " D o N o t S u p p r e s s " groups.  105  P r o s p e c t i v e studies are needed to c l a r i f y the relative i m p o r t a n c e o f appraisals o f p e r s o n a l m e a n i n g and thought suppression i n the d e v e l o p m e n t and m a i n t e n a n c e o f u n w a n t e d i n t r u s i v e thoughts. A better understanding o f the relevant roles that these v a r i a b l e s p l a y w i l l h e l p refine the theories and treatments o f c l i n i c a l obsessions.  106  T a b l e 8: M e a n s a n d Standard D e v i a t i o n s for A g e , O C D S y m p t o m s , O C B e l i e f s , B a s e l i n e N e g a t i v e A f f e c t , a n d A p p r a i s a l s o f the Target T h o u g h t Group High Religion  M(SD)  L o w Religion  M(SD)  Age  22.35 (7.05)  23.25 ( 8 . 5 7 )  OCI-R  14.42 (9.59)  15.85 (9.10)  143.70 (36.42)  140.03 (34.88)  P A N A S Negative Affect  12.62 (2.92)  13.03 (4.02)  P S S Appraisals  1.71 (1.42)"  0.86 (0.83)*  EDQ-D  3.56 (1.52)"  5.91 (1.14)*  OBQ-44  Note: N = 6 0 i n each group. O C I - R = O b s e s s i v e C o m p u l s i v e I n v e n t o r y - R e v i s e d ; O B Q - 4 4 = O b s e s s i v e B e l i e f s Q u e s t i o n n a i r e ; P A N A S = P o s i t i v e and N e g a t i v e A f f e c t S c h e d u l e : P S S = P e r s o n a l S i g n i f i c a n c e S c a l e ; E D Q - D = E g o - D y s t o n i c i t y Q u e s t i o n n a i r e - D i s l i k e (note that lower scores o n the E D Q - D c o r r e s p o n d w i t h greater ratings e g o - d y s t o n i c i t y ) . W i t h i n each r o w , means w i t h different superscripts are s i g n i f i c a n t l y different from each other at/? < .05.  107  T a b l e 9: M e a n s a n d Standard D e v i a t i o n s for S u p p r e s s i o n Effort, Target T h o u g h t F r e q u e n c y , and D i s c o m f o r t R a t i n g s , b y G r o u p , S u p p r e s s i o n Instructions, and Interval S u p p r e s s i o n Instructions Suppress Interval 1 (Suppress)  M(SD)  D o N o t Suppress  Interval 2  Interval 1  Interval 2  ( N o Suppress) ( N o Suppress) ( N o Suppress)  M(SD)  M(SD)  M(SD)  H i g h Religiosity S u p p r e s s i o n Effort  4.33 (1.77)  1,80(1.13)  2.40(1.30)  2.10(1.32)  T h o u g h t C o n t r o l Effort  2.38 (0.59)  1.84 (0.71)  1.99 (0.67)  1.79 (0.60)  12.20(10.46)  17.37 (24.07)  17.10 (13.22)  11.70(12.66)  Anxiety Ratings  2.03 (1.22)  1.70(1.06)  2.56 (1.33)  1.87(1.14)  Acceptability Ratings  4.73 (1.70)  4.90 (1.75)  4.20(1.97)  4.30(2.12)  S u p p r e s s i o n Effort  4.80(1.61)  1.80 (0.89)  2.53 (1.17)  1.77 (1.04)  T h o u g h t C o n t r o l Effort  2.37 (0.53)  1.54 (0.43)  1.82 (0.58)  1.66 (.58)  10.40(13.10)  14.0(19.02)  18.60 (23.19)  16.33 (20.57)  A n x i e t y Ratings  1.83 (1.08)  1.33 (0.71)  1.83 (1.15)  1.23 (0.50)  Acceptability Ratings  5.40(1.48)  6.10(1.125)  6.03 (1.27)  5.93 (1.60)  Thought Frequency  L o w Religiosity  Thought Frequency  N o t e : S u p p r e s s i o n Effort = S u p p r e s s i o n Effort R a t i n g S c a l e ; T h o u g h t C o n t r o l Effort = T h o u g h t C o n t r o l Strategies Q u e s t i o n n a i r e ; T h o u g h t F r e q u e n c y = n u m b e r o f target thoughts recorded v i a k e y press; A n x i e t y R a t i n g s = A n x i e t y R a t i n g S c a l e ; A c c e p t a b i l i t y R a t i n g s = Acceptability Rating Scale.  T a b l e 10: A n a l y s i s o f V a r i a n c e for Target T h o u g h t F r e q u e n c y  Source  F  df  n  2 P  P  B e t w e e n Subjects Instructions  1  1.86  .02  .18  Group  1  0.38  .01  .54  Instruction X G r o u p  1  1.65  .01  .20  116  (0.48)  Interval  1  1.86  .02  .18  Interval X Instructions  1  14.97*  .11  .0001  Interval X G r o u p  1  0.43  <.01  .51  Interval X G r o u p X Instructions  1  3.36  Error Term W i t h i n Subjects  Error Term  116  f  .03  (0.04)  N o t e : V a l u e s e n c l o s e d i n parentheses represent m e a n square errors.  p<  f  .10, *p<  .05  .07  109  T a b l e 11: H i e r a r c h i c a l R e g r e s s i o n A n a l y s i s for V a r i a b l e s P r e d i c t i n g Post-task N e g a t i v e Affect Variable  B  SEB  fi  Step I Baseline Negative Affect  0.59  0 07  .61*  OCI-R  0.001  0 001  .14  Step 2 Baseline Negative Affect  0.59  0 07  .61*  OCI-R  0.001  0 001  .12  Frequency o f Thoughts  0.02  0 02  .11  Step 3 Baseline Negative Affect  0.53  0 07  .55*  OCI-R  0.00  0 001  -.01  Frequency o f Thoughts  0.02  0 02  .07  Appraisals o f Personal Significance  0.07  0 03  .16*  T h o u g h t C o n t r o l Effort  0.02  0 01  .26*  Step 4 Baseline Negative Affect  0.54  0 07  .55*  OCI-R  0.00  0 001  .01  Frequency o f Thoughts  0.01  0 02  .06  Appraisals o f Personal Significance  0.07  0 03  .16*  T h o u g h t C o n t r o l Effort  0.02  0 01  .28*  A p p r a i s a l s X T h o u g h t C o n t r o l Effort  0.06  0 03  .14*  R  2  RA J  .3  .43*  .44  .01  .54  .09*  .55  .02*  N o t e : N = 119; O C I - R = O b s e s s i v e C o m p u l s i v e Inventory - R e v i s e d ; * p < .05  110  T a b l e 12: H i e r a r c h i c a l R e g r e s s i o n A n a l y s i s for V a r i a b l e s P r e d i c t i n g A n x i e t y R a t i n g s Variable  B  SEB  fi  Step 1 Baseline Negative Affect  -0.10  0.19  -.05  OCI-R  .01  .01  .26*  Step 2 Baseline Negative Affect  -0.06  0.18  -.03  OCI-R  0.01  0.01  .21*  Frequency o f Thoughts  0.16  0.04  .32*  Step 3 Baseline Negative Affect  -0.21  0.17  -.10  OCI-R  0.01  0.01  .04  Frequency o f Thoughts  0.14  0.04  .28*  Appraisals o f Personal Significance  0.28  0.08  .29*  T h o u g h t C o n t r o l Effort  0.05  0.02  .28*  Step 4 Baseline Negative Affect  -0.21  0.17  -.10  OCI-R  0.01  0.01  .07  Frequency o f Thoughts  0.14  0.04  .28*  Appraisals o f Personal Significance  0.28  0.08  .29*  T h o u g h t C o n t r o l Effort  0.05  0.02  .30*  A p p r a i s a l s X T h o u g h t C o n t r o l Effort  0.19  0.07  .20*  R  2  RA 2  .06  .06  .16  .10*  .33  .16*  .36  .04*  N o t e : N = 119; O C I - R = O b s e s s i v e C o m p u l s i v e Inventory - R e v i s e d ; * p < .05  Ill  F i g u r e 2: D i a g r a m o f the procedure for S t u d y 3. Screening Questionnaire  L o w Religious Group  High Religious Group  O B Q - 4 4 and O C I - R  3  Baseline P A N A S - N A Rating  T h o u g h t S u p p r e s s i o n T a s k - Practice T r i a l  V i g n e t t e + A p p r a i s a l s R a t i n g s ( P S S and E D Q - D )  Suppress  D o N o t Suppress  Suppress  D o N o t Suppress  4 Interval 1 R a t i n g Scales and T C S Q  D o N o t Suppress  D o N o t Suppress  D o N o t Suppress  D o N o t Suppress  Interval 2 R a t i n g Scales and T C S Q  1 Post-Task P A N A S - N A Rating N o t e : O B Q - 4 4 = O b s e s s i v e B e l i e f s Q u e s t i o n n a i r e ; O C I - R = O b s e s s i v e C o m p u l s i v e Inventory - R e v i s e d ; P A N A S - N A = P o s i t i v e and N e g a t i v e A f f e c t S c h e d u l e - N e g a t i v e A f f e c t ; P S S = P e r s o n a l S i g n i f i c a n c e S c a l e ; T C S Q = T h o u g h t C o n t r o l Strategies Q u e s t i o n n a i r e ; H a l f o f the 3  participants were r a n d o m l y assigned to c o m p l e t e the O B Q - 4 4 and the O C I - R at the end o f the task.  112  F i g u r e 3: R a w frequency o f target thought occurrences d u r i n g the thought suppression task.  25 -,  Interval 1  Interval 2 T h o u g h t S u p p r e s s i o n Interval  113  F i g u r e 4: S i m p l e regression slopes o f the interaction b e t w e e n appraisals and thought c o n t r o l effort i n p r e d i c t i n g post-task negative affect.  12 10  0)  >  (30  H i g h Appraisals o f Personal Significance  2  H  L o w Appraisals o f Personal Significance  O  Low  High Thought C o n t r o l Effort  N o t e : N = 119; A p p r a i s a l s measured w i t h the P e r s o n a l S i g n i f i c a n c e S c a l e ( H i g h = + 1 SD, :  L o w = - 1 SD)  114  F i g u r e 5: S i m p l e regression slopes o f the interaction b e t w e e n appraisals a n d thought c o n t r o l effort i n p r e d i c t i n g post-task anxiety ratings.  G  1  2  Hi  -4—»  O  /  PH  H i g h Appraisals o f Personal Significance L o w Appraisals o f Personal Significance Low  High Thought C o n t r o l Effort  N o t e : N = 119; A p p r a i s a l s measured w i t h the P e r s o n a l S i g n i f i c a n c e S c a l e ( H i g h = + 1 SD, L o w = - 1 SD)  115  C H A P T E R IV: C O N C L U S I O N The purpose o f this dissertation project w a s to e x a m i n e several hypotheses f r o m R a c h m a n ' s (1997) c o g n i t i v e theory o f obsessions. Studies 1 and 2 w e r e c o n d u c t e d to investigate a fundamental p r e d i c t i o n o f the m o d e l , that appraisals o f p e r s o n a l s i g n i f i c a n c e o f s o c i a l l y unacceptable thoughts s h o u l d be related to o b s e s s i v e - c o m p u l s i v e s y m p t o m s . S t u d y 3 w a s designed to e x a m i n e whether the effects o f thought s u p p r e s s i o n w o u l d v a r y for thoughts appraised as m e a n i n g f u l versus those thoughts appraised as unimportant. T h i s final d i s c u s s i o n section w i l l r e v i e w the findings f r o m these three studies as they a p p l y to the c o g n i t i v e theory o f obsessions, w i l l set out a research agenda for future studies, and w i l l discuss the c l i n i c a l i m p l i c a t i o n s o f these f i n d i n g s . A p r i m a r y a i m o f this dissertation project w a s to e x a m i n e the c o n n e c t i o n b e t w e e n appraisals o f i n t r u s i v e thoughts and o b s e s s i v e - c o m p u l s i v e s y m p t o m s . I f appraisals are to be i m p l i c a t e d i n the d e v e l o p m e n t or persistence o f obsessions, they need, at a m i n i m u m , to be m e a n i n g f u l l y associated w i t h O C D s y m p t o m s . W h i l e a relationship b e t w e e n appraisals and O C D s y m p t o m s had b e e n established i n a n u m b e r o f earlier studies ( C l a r k & C l a y b o u r n , 1997; F r e e s t o n et a l . , 1992; O C C W G , 2 0 0 1 , 2 0 0 3 , 2 0 0 5 ; P u r d o n & C l a r k , 1994a, 1994b), one potential e x p l a n a t i o n for the p r e v i o u s findings was that the thought content l i k e l y differed b e t w e e n the i n t r u s i v e thoughts reported b y n o n c l i n i c a l p o p u l a t i o n s and the c l i n i c a l obsessions reported b y patients w i t h O C D .  T h e results f r o m Studies 1 and 2 p r o v i d e d clear  evidence for a relationship b e t w e e n appraisals o f i n t r u s i v e thoughts and s u b c l i n i c a l s y m p t o m s o f O C D , e v e n w h e n the content o f the i n t r u s i v e thoughts w a s h e l d constant across participants. F u r t h e r m o r e , the current studies w e r e the first to investigate h o w n o r m a l i n d i v i d u a l s appraise i n t r u s i v e thoughts m o r e characteristic o f O C D .  R e s u l t s r e v e a l e d that  116  e v e n w h e n a s k e d to evaluate o b s e s s i o n - l i k e thoughts o f upsetting and s o c i a l l y unacceptable content, n o r m a l i n d i v i d u a l s , b y and large, d i d not attach exaggerated s i g n i f i c a n c e to the thoughts. T h e s e findings are important i n that they suggest that most p e o p l e are able to d i s m i s s i n t r u s i v e thoughts as unimportant a n d i n s i g n i f i c a n t . W h e n t a k e n together w i t h past studies, the results from Studies 1 a n d 2 p r o v i d e support for the c o n n e c t i o n b e t w e e n appraisals a n d O C D s y m p t o m s , and represent an important first step i n v a l i d a t i n g the c o g n i t i v e m o d e l o f obsessions. Studies 1 a n d 2 also extended past research b y e x a m i n i n g factors that contribute to appraisals o f u n w a n t e d i n t r u s i v e thoughts. T h e results o f these studies demonstrated that appraisals o f i n t r u s i v e thoughts v a r i e d as a f u n c t i o n o f t w o t h e o r e t i c a l l y important factors: thought content a n d thought  frequency.  In terms o f content, n o n c l i n i c a l participants i n the  current studies w e r e m o s t l i k e l y to attach appraisals o f p e r s o n a l s i g n i f i c a n c e to the aggressive and unacceptable s e x u a l i n t r u s i v e thoughts, p r o v i d i n g p r e l i m i n a r y e v i d e n c e that p e o p l e attach m o r e s i g n i f i c a n c e to some types o f thoughts than to others. C l e a r differences also emerged i n appraisals o f p e r s o n a l s i g n i f i c a n c e b e t w e e n h i g h frequency a n d l o w  frequency  intrusive thoughts. W h e n the i n t r u s i v e thoughts w e r e infrequent, participants d i d not attach undue s i g n i f i c a n c e to the thoughts a n d w e r e able to d i s m i s s t h e m as r e l a t i v e l y unimportant. In contrast, w h e n the i n t r u s i v e thoughts w e r e d e s c r i b e d as o c c u r r i n g m o r e frequently (up to several times per w e e k ) , participants w e r e m o r e l i k e l y to attach greater m e a n i n g to the thoughts, p a r t i c u l a r l y to the intrusive thought w i t h unacceptable s e x u a l content.  While  g e n e r a l l y consistent w i t h R a c h m a n ' s (1997) theory o f obsessions, the results also suggest that n o r m a l i n d i v i d u a l s are m o r e l i k e l y to attach c o n s i d e r a b l e s i g n i f i c a n c e to i n t r u s i v e  117  thoughts under certain c o n d i t i o n s , s u c h as w h e n the thoughts h a v e p a r t i c u l a r l y objectionable content, or w h e n they o c c u r w i t h h i g h frequency. A n o t h e r a i m o f this dissertation project w a s to e x a m i n e the direct and interactive effects o f appraisals o f i n t r u s i v e thoughts and thought suppression. W h e r e a s Studies 1 and 2 h e l p e d establish the r e l a t i o n s h i p between appraisals and O C D s y m p t o m s , S t u d y 3 e m p l o y e d a m o r e r i g o r o u s research d e s i g n to investigate whether appraisals o f p e r s o n a l s i g n i f i c a n c e , w h e n c o m b i n e d w i t h thought suppression, w o u l d be associated w i t h increased frequency o f thoughts, anxiety, and m o o d disturbance. S e v e r a l findings were supportive o f the c o g n i t i v e theory o f obsessions ( R a c h m a n , 1997). First, target thought occurrences p r o d u c e d m o r e  ,  a n x i e t y w h e n the target b l a s p h e m o u s thought w a s h i g h i n p e r s o n a l m e a n i n g than w h e n it was l o w i n p e r s o n a l m e a n i n g , s u p p o r t i n g R a c h m a n ' s assertion that i n t r u s i v e thoughts that are appraised as m e a n i n g f u l w i l l p r o d u c e anxiety. S e c o n d , there w a s s o m e e v i d e n c e for a c o n n e c t i o n b e t w e e n p e r s o n a l m e a n i n g o f the target thought and use o f thought c o n t r o l strategies, suggesting that i n t r u s i v e thoughts appraised as important are m o r e l i k e l y to m o t i v a t e thought c o n t r o l attempts. A d d i t i o n a l l y , there w a s s o m e e v i d e n c e that thought suppression had differential effects for thoughts appraised as m e a n i n g f u l versus those thoughts appraised as unimportant. S p e c i f i c a l l y , c o m p a r e d to n o n s u p p r e s s i o n , suppression o f a p e r s o n a l l y m e a n i n g f u l thought resulted i n a w e a k increase i n the frequency o f target thoughts. M o r e o v e r , appraisals o f p e r s o n a l m e a n i n g , w h e n c o m b i n e d w i t h thought c o n t r o l effort, w e r e associated w i t h negative m o o d and increased anxiety. W h e n taken together, the studies o f this dissertation project m a d e a unique c o n t r i b u t i o n to the literature. First, the studies e x a m i n e d the c o g n i t i v e theory o f obsessions u s i n g b o t h c o r r e l a t i o n a l and q u a s i - e x p e r i m e n t a l designs. S e c o n d , the current studies w e r e  118  designed to e x a m i n e the i m p o r t a n c e o f appraisals o f i n t r u s i v e thoughts f r o m a different p o i n t o f v i e w from past studies. A s opposed to p r e v i o u s studies, w h i c h e m p l o y e d p e r s o n a l l y relevant thoughts i n the e x a m i n a t i o n o f appraisals a n d thought suppression, the current studies u s e d e x p e r i m e n t e r - s u p p l i e d i n t r u s i v e thoughts. I n the first t w o studies, participants read vignettes about p r o t o t y p i c a l obsessions and i n d i c a t e d their appraisals about these thoughts. In the t h i r d study, a s i n g l e target thought w a s e m p l o y e d a n d t w o distinct groups o f participants w e r e selected w i t h the expectation that they w o u l d differ i n the extent to w h i c h they endorsed negative appraisals o f the thought. T h i s represents a strength o f the current studies, i n that it p r o v i d e d increased c o n t r o l o v e r the s t i m u l i , i m p r o v e d the internal v a l i d i t y o f the studies, and a l l o w e d for the e x a m i n a t i o n o f appraisals o f p e r s o n a l s i g n i f i c a n c e free o f the c o n f o u n d o f p e r s o n a l experience w i t h the target thought. W h i l e there w e r e clear benefits to this m e t h o d o l o g y , the use o f e x p e r i m e n t e r - s u p p l i e d target thoughts m a y have i m p a c t e d appraisals o f the i n t r u s i v e thoughts. W h i l e the current studies w e r e d e s i g n e d to e x a m i n e the relevance o f appraisals o f personal significance O C D , it is quite p o s s i b l e that appraisals about responsibility  to  m a y have also b e e n a factor.  O n e p o t e n t i a l consequence o f u s i n g e x p e r i m e n t e r - s u p p l i e d , as o p p o s e d to p e r s o n a l l y relevant, target thoughts w a s that participants m a y have felt less r e s p o n s i b i l i t y for the thoughts. T h a t is, because the thoughts w e r e not a product o f their o w n m i n d they m a y have been less l i k e l y to attach personal s i g n i f i c a n c e to the thoughts. I f true, the appraisal ratings across a l l three studies w e r e l i k e l y l o w e r than they w o u l d have b e e n for p e r s o n a l l y relevant intrusive thoughts. T h i s m a y have been p a r t i c u l a r l y true for the r e l i g i o u s participants i n S t u d y 3, w h o m a y have felt less p e r c e i v e d r e s p o n s i b i l i t y for the b l a s p h e m o u s target thought, g i v e n that it w a s s u p p l i e d to t h e m b y the experimenter, rather than s o m e t h i n g they thought o f  119  themselves. T h i s sense o f decreased r e s p o n s i b i l i t y m i g h t have m a d e the thought suppression results w e a k e r than they w o u l d be for n a t u r a l l y o c c u r r i n g thoughts. Indeed, laboratory m a n i p u l a t i o n s d e s i g n e d to decrease p e r c e i v e d r e s p o n s i b i l i t y have been s h o w n to be associated w i t h decreases i n c o m p u l s i v e b e h a v i o r ( L a d o u c e u r et a l . , 1995; L o p a t k a & R a c h m a n , 1995; Shafran, 1997). Therefore, t h o u g h the current studies w e r e not d e s i g n e d to e x a m i n e r e s p o n s i b i l i t y , p e r c e i v e d r e s p o n s i b i l i t y m a y have p l a y e d a r o l e i n h o w participants appraised the i n t r u s i v e thoughts. F u t u r e studies s h o u l d e x a m i n e the potential r o l e o f p e r c e i v e d r e s p o n s i b i l i t y i n appraisals o f p e r s o n a l s i g n i f i c a n c e o f i n t r u s i v e thoughts. W h a t O t h e r V a r i a b l e s Influence A p p r a i s a l s ? These studies p r o v i d e clear e v i d e n c e that appraisals v a r y as a function o f thought content and thought frequency. N u m e r o u s other variables also u n d o u b t e d l y i n f l u e n c e appraisals o f personal s i g n i f i c a n c e . In R a c h m a n ' s (1997) c o g n i t i v e theory, he suggests that c o g n i t i v e biases and beliefs l i k e l y set the stage for appraisals o f the s i g n i f i c a n c e o f intrusive thoughts. T h e O C C W G defines beliefs as, " r e l a t i v e l y e n d u r i n g assumptions that are h e l d b y an i n d i v i d u a l and that are pan-situational rather than specific to a p a r t i c u l a r event" ( O C C W G , 1997, p . 670). T h i s d e f i n i t i o n is p a r t i a l l y based o n the w o r k o f A a r o n T . B e c k , w h o d i s c u s s e d the r o l e o f general beliefs i n the d e v e l o p m e n t o f e m o t i o n a l p r o b l e m s . B e c k a n d h i s colleagues stated that " r e l a t i v e l y stable c o g n i t i v e patterns f o r m the basis for the r e g u l a r i t y o f interpretations o f a p a r t i c u l a r set o f situations" ( B e c k , R u s h , S h a w , & E m e r y , 1979, p . 12). T h e s e general beliefs are purported to d e v e l o p based o n an i n d i v i d u a l ' s life experiences, culture, and r e l i g i o n . C o g n i t i v e m o d e l s o f e m o t i o n a l disorders posit that events (for e x a m p l e , u n w a n t e d intrusive thoughts) w i l l interact w i t h an i n d i v i d u a l ' s b e l i e f system to g i v e rise to p a r t i c u l a r types o f appraisals. I n the case o f O C D , general beliefs and c o g n i t i v e biases  120  related to h o w p e o p l e t h i n k about their o w n thoughts m a y m a k e p e o p l e m o r e v u l n e r a b l e to attach exaggerated s i g n i f i c a n c e to their thoughts. R a c h m a n (1997, 1998) suggests that thought-action f u s i o n is one s u c h c o g n i t i v e bias that m a k e s p e o p l e m o r e v u l n e r a b l e to a p p r a i s i n g i n t r u s i v e thoughts i n a negative w a y . A s d i s c u s s e d earlier i n this m a n u s c r i p t , thought-action fusion relates to t w o types o f beliefs: first, the b e l i e f that h a v i n g b a d thoughts is the m o r a l equivalent to e n g a g i n g i n b a d b e h a v i o u r , and second, the b e l i e f that t h i n k i n g about s o m e t h i n g increases the p r o b a b i l i t y o f its occurrence. S u c h beliefs p l a u s i b l y increase the l i k e l i h o o d o f m i s i n t e r p r e t i n g the s i g n i f i c a n c e o f u n w a n t e d thoughts. F o r e x a m p l e , an i n t r u s i v e thought about h a r m i n g a l o v e d one w o u l d be m o r e l i k e l y to be interpreted as m e a n i n g f u l and r e v e a l i n g for a person w h o h o l d s strong thought-action f u s i o n beliefs, than for a p e r s o n w h o does not b e l i e v e that thoughts are equivalent to actions. Indeed, the results o f Studies 1 and 2 r e v e a l e d that appraisals o f p e r s o n a l s i g n i f i c a n c e w e r e related to thought-action f u s i o n , p r o v i d i n g e v i d e n c e o f an a s s o c i a t i o n b e t w e e n T A F beliefs and appraisals o f i n t r u s i v e thoughts. M o r e o v e r , considerable research demonstrates that T A F beliefs are associated w i t h O C D s y m p t o m s (e.g., Shafran et a l . , 1996) O t h e r m e t a c o g n i t i v e beliefs are also l i k e l y to influence appraisals o f p e r s o n a l s i g n i f i c a n c e . M e t a c o g n i t i v e beliefs are beliefs about the i m p o r t a n c e g i v e n to thoughts, beliefs about the n e e d to c o n t r o l thoughts, and beliefs about the p o w e r o f thoughts ( W e l l s , 2000). T h e r e is e v i d e n c e that m e t a c o g n i t i v e beliefs are associated w i t h O C D s y m p t o m s ( G w i l l i a m , W e l l s , & C a r t w r i g h t - H a t t o n , 2 0 0 4 ; M y e r s & W e l l s , 2 0 0 5 ) , and that one subtype o f m e t a c o g n i t i v e belief, termed " c o g n i t i v e s e l f - c o n s c i o u s n e s s , " m a y be p a r t i c u l a r l y relevant to O C D ( C a r t w r i g h t - H a t t o n & W e l l s , 1997; Janeck, C a l a m a r i , R i e m a n n , & H e f f e l f i n g e r ,  121  2003).  C o g n i t i v e self-consciousness refers to the degree to w h i c h i n d i v i d u a l s are aware o f  their o w n thoughts and the extent to w h i c h they focus o n their thoughts. A n exaggerated awareness o f o n e ' s thoughts c o u l d increase the l i k e l i h o o d that an i n d i v i d u a l w o u l d n e g a t i v e l y appraise the s i g n i f i c a n c e o f their i n t r u s i v e thoughts. T h u s , i n d i v i d u a l differences s u c h as c o g n i t i v e self-consciousness or m e t a c o g n i t i v e beliefs l i k e l y c o m b i n e w i t h thought characteristics l i k e thought content and frequency to shape the w a y i n d i v i d u a l s appraise the occurrence o f u n w a n t e d intrusive thoughts. Research A g e n d a T h e results f r o m this dissertation project p r o v i d e a g o o d s p r i n g b o a r d for future studies. A natural e x t e n s i o n o f this w o r k w o u l d be to investigate i n d i v i d u a l differences i n h o w p e o p l e appraise the p e r s o n a l s i g n i f i c a n c e o f i n t r u s i v e thoughts. A s d i s c u s s e d above, the c o g n i t i v e theory predicts that some p e o p l e are m o r e v u l n e r a b l e to attaching s i g n i f i c a n c e to their thoughts than others ( R a c h m a n , 1997, 1998). F o r e x a m p l e , R a c h m a n (1998) suggests that p e o p l e o f "tender c o n s c i e n c e " (p. 390) are m o r e l i k e l y to b e v u l n e r a b l e to s u c h appraisals. M o r e o v e r , the theory posits that appraisals w i l l interact w i t h a p e r s o n ' s b e l i e f system and personal b a c k g r o u n d . Indeed, i n S t u d y 3 o f this dissertation, there w a s e v i d e n c e that appraisals o f the target b l a s p h e m o u s thought v a r i e d a c c o r d i n g to the r e l i g i o u s b a c k g r o u n d o f the participants. A n important next step i n understanding the c o n n e c t i o n b e t w e e n appraisals and O C D s y m p t o m s w i l l be to e x a m i n e the relevant factors, such as p e r s o n a l i t y traits or b e l i e f s , that m a k e p e o p l e m o r e v u l n e r a b l e to a p p r a i s i n g i n t r u s i v e thoughts as p e r s o n a l l y significant. F u r t h e r i n v e s t i g a t i o n o f the relevance o f thought-action fusion and other m e t a c o g n i t i v e beliefs is p a r t i c u l a r l y indicated.  122  T h e frequency results f r o m the current project have i m p l i c a t i o n s for the c o g n i t i v e theory that warrant further c o n s i d e r a t i o n . A n i m p l i c i t a s s u m p t i o n o f the c o g n i t i v e theory o f obsessions is that intrusive thoughts b e g i n as r e l a t i v e l y infrequent c o g n i t i v e p h e n o m e n a that increase i n frequency o v e r t i m e as a result o f " c a t a s t r o p h i c " appraisals. H o w e v e r , little is k n o w n about the actual e t i o l o g y o f obsessions. T h e r e is s o m e e v i d e n c e that i n t r u s i v e thoughts increase i n frequency d u r i n g times o f stress ( H o r o w i t z , 1975; R a c h m a n & H o d g s o n , 1980), and anecdotal reports suggest that for a m i n o r i t y o f i n d i v i d u a l s , o b s e s s i v e - c o m p u l s i v e disorder has a clear and p r o m i n e n t onset (de S i l v a & M a r k s , 1999; de S i l v a & R a c h m a n , 1998). T h e results o f S t u d y 2 suggest that i n t r u s i v e thoughts w i t h a m o r e dramatic onset w i l l be m o r e l i k e l y to be appraised as p e r s o n a l l y significant b y average p e o p l e (i.e., not those w i t h o b s e s s i v e - c o m p u l s i v e s y m p t o m s ) . Therefore, an important avenue for future research is to investigate the e t i o l o g y o f obsessions to determine the natural course o f i n t r u s i v e thoughts. L o n g i t u d i n a l studies a i m e d at i n v e s t i g a t i n g a group o f i n d i v i d u a l s w h o m a y be at increased r i s k o f e x p e r i e n c i n g intrusive thoughts are needed to m a p out the trajectory f r o m " n o r m a l " i n t r u s i v e thoughts to c l i n i c a l obsessions and to establish w h e t h e r appraisals o f intrusive thoughts are c a u s a l l y related to the d e v e l o p m e n t o f obsessions. O n e situation i n w h i c h there is a predictable s p i k e i n intrusive thoughts is d u r i n g p r e g n a n c y and s h o r t l y after c h i l d b i r t h , a t i m e w h e n m a n y parents (both mothers and fathers) experience an increase i n i n t r u s i v e thoughts related to their infants ( A b r a m o w i t z , S c h w a r t z , & M o o r e , 2 0 0 3 ; A b r a m o w i t z , S c h w a r t z , M o o r e , & L u e n z m a n n , 2 0 0 3 ) . T h i s presents an i d e a l o p p o r t u n i t y to e x a m i n e the natural course o f intrusive thoughts, and to e x p l o r e whether i n d i v i d u a l s w h o attach exaggerated s i g n i f i c a n c e to their i n t r u s i v e thoughts experience an increase i n the frequency o f i n t r u s i v e thoughts o v e r t i m e . S u c h studies are c u r r e n t l y b e i n g undertaken b y  123  several groups (see A b r a m o w i t z , K h a n d k e r , N e l s o n , D e a c o n , & R y g w a l l , 2 0 0 6 ; N . Fairbrother, p e r s o n a l c o m m u n i c a t i o n , September 2 0 0 4 ) , a n d they have the p o t e n t i a l to c l a r i f y the r o l e o f appraisals i n the e t i o l o g y o f O C D . In a d d i t i o n , the findings f r o m S t u d y 3 suggest the need for m o r e research e x a m i n i n g the c o n n e c t i o n b e t w e e n suppression o f p e r s o n a l l y m e a n i n g f u l thoughts a n d negative affect. A l t h o u g h several studies have investigated the c o n n e c t i o n b e t w e e n suppression a n d m o o d ( P u r d o n , 2 0 0 1 ; P u r d o n & C l a r k , 2 0 0 1 ; P u r d o n et a l . , 2 0 0 5 ; W e n z l a f f & L u x t o n , 2 0 0 3 ; W e n z l a f f et a l . , 1991), m o r e s u c h studies are warranted. I n particular, it w i l l be important to e x a m i n e not o n l y the influence o f suppression o n subsequent m o o d , but also the potential effects o f m o o d o n suppression. F o r e x a m p l e , there i s s o m e i n d i c a t i o n that negative m o o d interferes w i t h suppression o f negative thoughts ( W e n z l a f f et a l . , 1988) a n d that the p a r a d o x i c a l r e b o u n d o f thoughts is enhanced w h e n m o o d state (either p o s i t i v e or negative) is s i m i l a r d u r i n g suppression a n d subsequent e x p r e s s i o n ( W e n z l a f f et a l . , 1991). F u r t h e r m o r e , the results f r o m S t u d y 3 suggested that there w e r e important differences b e t w e e n instructed suppression a n d p a r t i c i p a n t s ' reported thought c o n t r o l effort. Therefore, another avenue for future studies w i l l be to e x p l o r e i n d i v i d u a l differences i n m o t i v a t i o n to suppress, success at suppression, a n d use o f thought c o n t r o l strategies.  F o r e x a m p l e , a l t h o u g h W e n z l a f f and h i s  colleagues (1988) have s h o w n that depressed persons have m o r e d i f f i c u l t y suppressing certain types o f thoughts, n o studies have c o m p a r e d the degree to w h i c h those w i t h O C D are able to use thought suppression i n a n adaptive w a y . I n fact, research has not c l a r i f i e d the c o n d i t i o n s under w h i c h thought suppression a n d other strategies o f thought c o n t r o l are functional versus m a l a d a p t i v e . F i n a l l y , studies that e x a m i n e the l o n g - t e r m effects o f thought  124  suppression are needed to determine whether thought suppression is i n d e e d i m p l i c a t e d i n the persistence o f o b s e s s i o n a l thoughts. Clinical Implications Importantly, the results o f this research have i m p l i c a t i o n s for the treatment o f obsessions and support the strategy o f targeting appraisals related to p e r s o n a l s i g n i f i c a n c e and thought suppression i n treatment. First, it m a y be useful to i n c l u d e an assessment o f patients' negative appraisals o f i n t r u s i v e thoughts a n d use o f thought c o n t r o l strategies i n the i n i t i a l e v a l u a t i o n . T h e vast m a j o r i t y o f c l i n i c a l i n t e r v i e w s focus o n the content o f obsessions and r e s u l t i n g c o m p u l s i o n s , but few s p e c i f i c a l l y target m a l a d a p t i v e appraisals or thought c o n t r o l strategies. T h i s i n f o r m a t i o n c o u l d p r o v e useful i n targeting treatment interventions to the patient's u n i q u e concerns. S e c o n d , once negative appraisals have b e e n identified, treatments that focus o n c h a l l e n g i n g the v a l i d i t y o f these appraisals and r e p l a c i n g t h e m w i t h m o r e adaptive and healthy interpretations o f the m e a n i n g o f i n t r u s i v e thoughts m a y p r o v e h e l p f u l . F i n a l l y , i n S t u d y 3 o f this dissertation, participants i n the " d o not suppress" group reported a s i g n i f i c a n t decrease i n the frequency o f thoughts o v e r t i m e . T h u s , i t i s apparent that u n w a n t e d thoughts n a t u r a l l y fade a w a y , m u c h l i k e anxiety, urges to engage i n c o m p u l s i o n s , and other unpleasant p s y c h o l o g i c a l experiences associated w i t h O C D . K n o w i n g that this is the natural course o f u n w a n t e d thoughts, i f they are not suppressed, c a n be h o p e f u l i n f o r m a t i o n for patients w h o are s t r u g g l i n g to drop the use o f thought c o n t r o l strategies d u r i n g treatment. A s s u c h , treatments that focus o n c h a l l e n g i n g m a l a d a p t i v e appraisals and r e d u c i n g patients' r e l i a n c e o n thought c o n t r o l strategies m a y p r o v e effective. Indeed, r e c e n t l y d e v e l o p e d c o g n i t i v e b e h a v i o u r a l treatments for obsessions that s p e c i f i c a l l y target appraisals  125  and attempt to n o r m a l i z e i n t r u s i v e thoughts are s h o w i n g i n i t i a l signs o f successful s y m p t o m r e d u c t i o n (Freeston, L e g e r , & L a d o u c e u r , 2 0 0 1 ; W i l l i a m s , S a l k o v s k i s , Forrester, & A l l s o p p , 2002). M o r e o v e r , other treatments such as A c c e p t a n c e and C o m m i t m e n t T h e r a p y ( A C T ; H a y e s , S t r o s a h l , & W i l s o n , 1999) m a y also be o f benefit. C o n s i d e r e d one o f the treatments i n the " t h i r d w a v e " o f b e h a v i o u r a l therapy, A C T targets m e t a c o g n i t i o n and thought c o n t r o l strategies b y e n c o u r a g i n g patients to c o n s i d e r "the p o s s i b l e benefits o f acceptance o f the o b s e s s i o n and other private events s u c h as anxiety o v e r attempting to c o n t r o l t h e m " ( T w o h i g , H a y e s , & M a s u d a , 2 0 0 6 , p. 7). A recent m u l t i p l e - b a s e l i n e study demonstrated that A C T w a s successful i n r e d u c i n g s y m p t o m s o f O C D ( T w o h i g et a l . , 2 0 0 6 ) . F u r t h e r research w i l l be necessary to determine the m e c h a n i s m s o f change i n the treatment o f O C D and to e x p l o r e whether changes i n appraisals and changes i n use o f suppression strategies result i n improvements i n O C D symptoms. C o l l e c t i v e l y , the results f r o m this dissertation project are supportive o f R a c h m a n ' s ( 1 9 9 7 , 1998) c o g n i t i v e t h e o r y o f obsessions, w h i c h suggests that appraisals o f i n t r u s i v e thoughts are i m p l i c a t e d i n O C D .  S p e c i f i c a l l y , the current studies demonstrated that  appraisals o f i n t r u s i v e thoughts are related to s u b c l i n i c a l O C D s y m p t o m s , that appraisals v a r y a c c o r d i n g to thought content and thought frequency, and that appraisals o f personal s i g n i f i c a n c e , w h e n c o m b i n e d w i t h thought c o n t r o l effort, are associated w i t h negative m o o d and anxiety. L o n g i t u d i n a l studies are needed to o u t l i n e the natural course o f intrusive thoughts and to e x a m i n e whether appraisals p l a y a causal r o l e i n the d e v e l o p m e n t o f obsessions. S i m i l a r l y , future studies that investigate the l o n g - t e r m effects o f suppression o n p e r s o n a l l y m e a n i n g f u l i n t r u s i v e thoughts w i l l h e l p facilitate o u r u n d e r s t a n d i n g o f the i m p o r t a n c e o f these v a r i a b l e s i n O C D .  126  Endnotes 1  G i v e n that the current s a m p l e w a s c o m p r i s e d o f a near e q u a l n u m b e r o f A s i a n a n d  C a u c a s i a n participants, potential group differences i n O C s y m p t o m s a n d vignette appraisal ratings w e r e e x a m i n e d . A s a group, the A s i a n participants scored h i g h e r o n the O B Q - 4 4 a n d the B D I - I I a n d they endorsed m o r e negative appraisals o f the b l a s p h e m o u s a n d racist vignettes. T o ensure that e t h n i c i t y w a s not acting as a moderator, a l l o f the p r i m a r y analyses w e r e r u n i n c l u d i n g e t h n i c i t y as a covariate. A l l reported s i g n i f i c a n t effects r e m a i n e d w h e n e t h n i c i t y w a s i n c l u d e d as a covariate i n the analyses. 2  A s i n S t u d y 1, A s i a n participants scored h i g h e r o n measures o f O C s y m p t o m s a n d  beliefs a n d the vignette appraisals w i t h the e x c e p t i o n o f the s e x u a l vignettes, w h i c h they rated e q u i v a l e n t l y to participants o f E u r o p e a n ethnicity. 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C r i t e r i o n v a l i d i t y , severity cut scores, a n d test-retest r e l i a b i l i t y o f the B e c k D e p r e s s i o n Inventory-II i n a u n i v e r s i t y c o u n s e l i n g center sample. Journal of Counseling Psychology,  49, 3 8 1 - 3 8 5 .  S r i v a s t a v a , S., S h a r m a , H . O . , & M a n d a l , M . K . (2003). M o o d i n d u c t i o n w i t h facial expressions o f e m o t i o n i n patients w i t h generalized a n x i e t y disorder. Depression  &  Anxiety, 18, 144-148. Steketee, G . , Q u a y , S., & W h i t e , K . (1991). R e l i g i o n a n d guilt i n O C D patients. Journal of Anxiety Disorders,  5, 3 5 9 - 3 6 7 .  T a y l o r , S. (2002). C o g n i t i o n i n obsessive c o m p u l s i v e disorder: A n o v e r v i e w . I n R . O . Frost & G . Steketee ( E d s . ) , Cognitive approaches  to obsessions and compulsions:  Theory,  assessment, and treatment, (pp. 1-12): P e r g a m o n / E l s e v i e r S c i e n c e Inc. T o l i n , D . 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W e g n e r , D . M . , & G o l d , D . B . (1995). F a n n i n g o l d flames: E m o t i o n a l and c o g n i t i v e effects o f suppressing thoughts o f a past relationship. Journal of Personality Psychology,  68, 7 8 2 - 7 9 2 .  & Social  W e g n e r , D . M . , S c h n e i d e r , D . J . , Carter, S. R . , & W h i t e , T . L . (1987). P a r a d o x i c a l effects o f thought suppression. Journal of Personality  & Social Psychology,  W e l l s , A . (2000). Emotional disorders and metacognition:  53, 5-13.  Innovative cognitive therapy.:  J o h n W i l e y & Sons L t d . W e n z l a f f , E . M . , & W e g n e r , D . M . (2000). T h o u g h t suppression. Annual Review of Psychology,  51, 5 9 - 9 1 .  W e n z l a f f , R . M . , & L u x t o n , D . D . (2003). T h e r o l e o f thought suppression i n depressive r u m i n a t i o n . Cognitive Therapy & Research, 27, 2 9 3 - 3 0 8 . W e n z l a f f , R . M . , W e g n e r , D . M . , & K l e i n , S. B . (1991). T h e r o l e o f thought suppression i n the b o n d i n g o f thought a n d m o o d . Journal of Personality  and Social Psychology,  60,  500-508. W e n z l a f f , R . M . , W e g n e r , D . M . , & R o p e r , D . W . (1988). D e p r e s s i o n a n d m e n t a l c o n t r o l : T h e resurgence o f u n w a n t e d negative thoughts. Journal of Personality Psychology,  and Social  55, 8 8 2 - 8 9 2 .  W i l l i a m s , T . I., S a l k o v s k i s , P . M . , Forrester, E . A . , & A l l s o p p , M . A . (2002). C h a n g e s i n s y m p t o m s o f O C D and appraisal o f r e s p o n s i b i l i t y d u r i n g c o g n i t i v e b e h a v i o u r a l treatment: A p i l o t study. Behavioural  and Cognitive Psychotherapy,  30, 6 9 - 7 8 .  140  APPENDICES Appendix A: Study 1 Materials Vignettes ("Self Version)  T h e f o l l o w i n g questionnaire consists o f four b r i e f scenarios, each o f w h i c h is f o l l o w e d b y a series o f questions. T h e scenarios are about u n u s u a l thoughts that p e o p l e sometimes have. Please read each scenario carefully, and then r e s p o n d the questions as h o n e s t l y as p o s s i b l e . Participants read the f o l l o w i n g vignettes: S c e n a r i o #1: A g g r e s s i v e V i g n e t t e I m a g i n e that y o u often go o v e r and b a b y s i t y o u r s i x - y e a r - o l d niece. O c c a s i o n a l l y , w h i l e b a b y s i t t i n g and p r e p a r i n g s a n d w i c h e s for y o u r l u n c h , y o u have a sudden, h o r r i f i c i m p u l s e to stab y o u r niece w i t h a sharp k i t c h e n k n i f e . Y o u are v e r y upset about h a v i n g this thought. S c e n a r i o #2: S e x u a l V i g n e t t e I m a g i n e that o c c a s i o n a l l y , w h i l e d r i v i n g to s c h o o l w i t h y o u r brother, y o u have a sudden i n t r u s i v e thought about h a v i n g sex w i t h y o u r brother. Y o u are n o t i c e a b l y upset about h a v i n g this thought. (Please note: I f y o u do not have a brother, i m a g i n e that y o u o c c a s i o n a l l y h a v e a sudden i n t r u s i v e thought about h a v i n g sex w i t h a close family member).  S c e n a r i o #3: B l a s p h e m o u s V i g n e t t e I m a g i n e that y o u are a v e r y r e l i g i o u s person. F r o m t i m e to t i m e w h i l e engaged i n silent prayer, y o u have a sudden, terrible i m a g e o f u r i n a t i n g o n the B i b l e . Y o u are v e r y upset b y this thought. (Please note: I f this does not relate to y o u r o w n r e l i g i o n , please i m a g i n e y o u r s e l f u r i n a t i n g o n a H o l y T e x t o f y o u r r e l i g i o n ) . S c e n a r i o #4: R a c i s t V i g n e t t e I m a g i n e that w h e n e v e r y o u see a p e r s o n o f c o l o u r , the thought " N i g g e r ! " intrudes into y o u r m i n d . Y o u are v e r y upset b y this thought, as y o u feel that y o u are an egalitarian person w i t h progressive politics.  141  Vignette Appraisal Ratings ("Self Version)  A f t e r r e a d i n g each vignette, participants c o m p l e t e d the f o l l o w i n g questions: N o w answer the f o l l o w i n g questions, u s i n g the f o l l o w i n g scale:  0  1  2  3  N o t at a l l  4  5  6  Somewhat  7  8 Totally/ Definitely  I m a g i n e that y o u h a d this thought. T o what extent w o u l d this thought: 1.  .. .reveal s o m e t h i n g important about y o u ?  0 1 2 3 4 5 6 7 8  2.  .. . m e a n that y o u m i g h t lose c o n t r o l and do s o m e t h i n g awful?  0 1 2 3 4 5 6 7 8  3.  .. . m e a n that y o u m i g h t go c r a z y one d a y ?  0 1 2 3 4 5 6 7 8  4.  .. . m e a n that y o u are a dangerous person?  0 1 2 3 4 5 6 7 8  5.  .. .mean that y o u are untrustworthy?  0 1 2 3 4 5 6 7 8  6.  .. .mean that one d a y y o u m i g h t a c t u a l l y carry out s o m e actions related to the thoughts?  0 1 2 3 4 5 6 7 8  7.  . . . m e a n that y o u are a b a d , w i c k e d person?  0 1 2 3 4 5 6 7 8  8.  .. . m e a n that y o u are w e i r d ?  0 1 2 3 4 5 6 7 8  9.  D o y o u t h i n k that y o u w o u l d a v o i d certain p e o p l e or places because o f this thought?  10.  D o y o u t h i n k y o u w o u l d be c r a z y or m e n t a l l y unstable because y o u h a d this thought?  11.  T o what extent do y o u f i n d this thought d i s t u r b i n g ?  0 1 2 3 4 5 6 7 8  0 1 2 3 4 5 6 7 8  0 1 2 3 4 5 6 7 8  142  12.  These thoughts w o u l d m e a n that I a m i m m o r a l .  0 1 2 3 4 5 6 7 8  13.  I w o u l d be c o n c e r n e d about b e i n g left unattended w i t h  0  children. 14.  I w o u l d feel c o m p e l l e d to take a c t i o n (i.e. report to the  I  believe that having this thought is mst as bad as acting on  It. would disapprove of myself for having this thought.  16.  I  17.  H o w b a d or e v i l do y o u t h i n k this thought is?  2 3 4 5 6 7 8  0 1 2 3 4 5 6 7 8  authorities, or report this to someone else). 15.  1  n  i  ~  -  ,  A  r  r  n  l ) l z 3 4 5 6  c  >  / o  0 1 2 3 4 5 6 7 8  The worst I can N o t at a l l b a d 0 18.  10  Neutral 20  30  40  50  imagine 60  70  80  90  B r i e f l y , what do y o u t h i n k about this thought? Is there a n y t h i n g y o u w o u l d do as a result o f h a v i n g this thought?  100  143  Vignettes ("Other" Version)  Participants r a n d o m l y assigned to the " O t h e r " v e r s i o n read the f o l l o w i n g vignettes: Scenario #1: A g g r e s s i v e V i g n e t t e Y o u r best friend approaches y o u l o o k i n g for advice. Y o u r friend confides i n y o u that o c c a s i o n a l l y w h i l e b a b y s i t t i n g her s i x - y e a r - o l d niece and p r e p a r i n g sandwiches  for  their l u n c h , she has a sudden, h o r r i f i c i m p u l s e to stab her niece w i t h a sharp k i t c h e n k n i f e . Y o u r friend e x p l a i n s that she is v e r y upset about h a v i n g this thought.  S c e n a r i o #2: S e x u a l V i g n e t t e Y o u r best friend approaches y o u l o o k i n g for advice. She confesses that o c c a s i o n a l l y , w h i l e d r i v i n g to s c h o o l w i t h her brother, she has a sudden i n t r u s i v e thought about h a v i n g sex w i t h her brother. She is n o t i c e a b l y upset about h a v i n g this thought.  Scenario #3: B l a s p h e m o u s V i g n e t t e Y o u r best friend, w h o is a v e r y r e l i g i o u s person, confides i n y o u that f r o m t i m e to t i m e w h i l e engaged i n silent prayer, he has a sudden, terrible i m a g e o f h i m s e l f u r i n a t i n g o n the B i b l e . H e is v e r y upset b y this thought. S c e n a r i o #4: R a c i s t V i g n e t t e Y o u r best friend approaches y o u i n a state o f distress. H e tells y o u that w h e n e v e r he sees a p e r s o n o f c o l o u r , the thought " N i g g e r ! " intrudes into his m i n d . H e is v e r y upset b y this thought, as he feels that he is an egalitarian p e r s o n w i t h progressive politics.  144  Vignette Appraisal Ratings ("Other" Version)  A f t e r r e a d i n g each vignette, participants c o m p l e t e d the f o l l o w i n g questions:  N o w answer the f o l l o w i n g questions, u s i n g the f o l l o w i n g scale: 0  1  2  3  N o t at a l l  4  5  6  7  8 Totally/  Somewhat  Definitely  T o what extent do these thoughts: 1. 2.  .. .reveal s o m e t h i n g important about y o u r friend? .. .mean that y o u r friend m i g h t lose c o n t r o l and do something awful?  0 1 2 3 4 5 6 7 8  0 1 2 3 4 5 6 7 8  3.  .. . m e a n that y o u r friend m i g h t go c r a z y one d a y ?  0 1 2 3 4 5 6 7 8  4.  .. .mean that y o u r friend is a dangerous person?  0 1 2 3 4 5 6 7 8  5.  .. . m e a n that y o u r friend is untrustworthy?  0 1 2 3 4 5 6 7 8  6.  . . . m e a n that one d a y y o u r friend m a y a c t u a l l y carry out s o m e actions related to the thoughts?  0 1 2 3 4 5 6 7 8  7.  .. .mean that y o u r friend is a b a d , w i c k e d person?  0 1 2 3 4 5 6 7 8  8.  .. .mean that y o u r friend is w e i r d ?  0 1 2 3 4 5 6 7 8  9.  D o y o u t h i n k that y o u r friend w o u l d a v o i d certain p e o p l e or places because o f this thought?  10.  D o y o u t h i n k y o u r friend is c r a z y or m e n t a l l y unstable because he/she has these thoughts?  11.  T o what extent do y o u f i n d this thought d i s t u r b i n g ?  0  1  2  3  4  5  6  7  8  0 1 2 3 4 5 6 7 8  0 1 2 3 4 5 6 7 8  145  12.  T h e s e thoughts m e a n that m y friend is i m m o r a l .  0 1 2 3 4 5 6 7 8  13.  I w o u l d be c o n c e r n e d l e a v i n g c h i l d r e n unattended w i t h m y friend.  14.  I w o u l d feel c o m p e l l e d to take a c t i o n (i.e. report to the  0 1 2 3 4 5 6 7 8  authorities, or report this to someone else). 15.  0 1 2 3 4 5 6 7 8  I b e l i e v e that h a v i n g this thought is just as b a d as a c t i n g  0 1 2 3 4 5 6 7 8  u p o n it. 16.  I d i s a p p r o v e o f m y friend for h a v i n g this thought.  0 1 2 3 4 5 6 7 8  17.  Y o u r friend is disturbed b y this thought. H o w b a d or e v i l do y o u t h i n k this thought i s ? The worst I can  N o t at a l l b a d 0 18.  10  Neutral 20  30  40  50  imagine 60  B r i e f l y , w h a t a d v i c e w o u l d y o u g i v e to y o u r friend?  70  80  90  100  146  Appendix B: Study 2 Materials Vignettes Scenario #1: A g g r e s s i v e V i g n e t t e Y o u d r i v e into s c h o o l everyday. F r o m t i m e to time, w h i l e y o u are stopped at a c r o s s w a l k w a i t i n g for an e l d e r l y pedestrian to cross the street, y o u have a sudden, h o r r i f i c i m p u l s e to r u n t h e m o v e r i n y o u r car. Y o u are v e r y upset about h a v i n g this thought.  Scenario #2: S e x u a l V i g n e t t e I m a g i n e that from t i m e to time, w h i l e h e l p i n g a y o u n g c h i l d (for e x a m p l e , a niece or n e p h e w ) use the w a s h r o o m , y o u have a sudden, intrusive s e x u a l thought about the c h i l d . Y o u are n o t i c e a b l y upset about h a v i n g this thought.  Scenario #3: B l a s p h e m o u s V i g n e t t e Y o u are a v e r y r e l i g i o u s person. F r o m t i m e to time w h i l e engaged i n silent prayer, y o u h a v e the sudden, intrusive thought "Jesus C h r i s t w a s a r a v i n g l u n a t i c ! " Y o u are n o t i c e a b l y upset b y this thought. Scenario #4: R a c i s t V i g n e t t e Y o u l i v e i n an area p o p u l a t e d b y people o f m a n y different ethnicities and c u l t u r a l b a c k g r o u n d s . F r o m t i m e to t i m e w h e n y o u pass a recent i m m i g r a n t o n the street, y o u have the sudden, intrusive thought " Y o u d o n ' t b e l o n g here! G o b a c k to y o u r o w n c o u n t r y ! " Y o u are v e r y upset b y this thought, as y o u feel that y o u are an egalitarian p e r s o n w i t h progressive politics.  147  Vignette Appraisal Ratings - Low Frequency Vignettes A f t e r r e a d i n g each vignette, participants c o m p l e t e d the f o l l o w i n g questions: N o w answer the f o l l o w i n g questions, u s i n g the f o l l o w i n g scale: 0  1  2  N o t at a l l  3  4  5  6  Somewhat  7  8  Totally/ Definitely  I m a g i n e that y o u have this thought from time to time (i.e. o n l y o c c a s i o n a l l y ) . T o what extent w o u l d this thought: .. .reveal s o m e t h i n g important about y o u ?  0 1 2 3 4 5 6 7 8  .. . m e a n that y o u m i g h t lose c o n t r o l and do s o m e t h i n g a w f u l ?  0 1 2 3 4 5 6 7 8  .. . m e a n that y o u m i g h t go c r a z y one day?  0 1 2 3 4 5 6 7 8  .. . m e a n that y o u are a dangerous person?  0 1 2 3 4 5 6 7 8  .. .mean that y o u are untrustworthy?  0 1 2 3 4 5 6 7 8  .. .mean that one d a y y o u m i g h t a c t u a l l y carry out some actions 0 1 2 3 4 5 6 7 8 related to the thoughts? .. . m e a n that y o u are a b a d , w i c k e d person?  0 1 2 3 4 5 6 7 8  .. . m e a n that y o u are w e i r d ?  0 1 2 3 4 5 6 7 8  D o y o u t h i n k that y o u w o u l d a v o i d certain p e o p l e o r places because o f this thought? D o y o u t h i n k y o u w o u l d be c r a z y o r m e n t a l l y unstable because y o u h a d this thought? T o w h a t extent d o y o u f i n d this thought d i s t u r b i n g ?  0 1 2 3 4 5 6 7 8  0 1 2 3 4 5 6 7 8  0 1 2 3 4 5 6 7 8  148  T h e s e thoughts w o u l d m e a n that I a m i m m o r a l .  0  I w o u l d be c o n c e r n e d about b e i n g left unattended w i t h c h i l d r e n .  0 1 2 3 4 5 6 7 8  I w o u l d feel c o m p e l l e d to take a c t i o n (i.e. report to the  1  2  3  4  5  6  7  8  0 1 2 3 4 5 6 7 8  authorities, or report this to someone else). I b e l i e v e that h a v i n g this thought is just as b a d as a c t i n g o n it.  I w o u l d d i s a p p r o v e o f m y s e l f for h a v i n g this thought.  0  1  2  3  4  5  6  7  8  0 1 2 3 4 5 6 7 8  H o w b a d or e v i l do y o u t h i n k this thought is? The worst I can N o t at a l l b a d 0  10  Neutral 20  30  40  50  imagine 60  70  80  90  100  B r i e f l y , w h a t do y o u t h i n k about this thought? Is there a n y t h i n g y o u w o u l d do as a result o f h a v i n g this thought?  149  Vignette Appraisal Ratings - High Frequency Vignettes N o w , i m a g i n e that y o u have this thought very frequently (i.e. the thought o c c u r s v e r y often, m a n y times a w e e k ) . A n s w e r the f o l l o w i n g questions, u s i n g the f o l l o w i n g scale: 0  1  2  N o t at a l l  3  4  5  6  Somewhat  7  8  Totally/ Definitely  I f y o u h a d this thought very frequently, to w h a t extent w o u l d this thought:  .. .reveal s o m e t h i n g important about y o u ?  .. .mean that y o u m i g h t lose c o n t r o l a n d d o s o m e t h i n g a w f u l ?  .. .mean that y o u m i g h t g o c r a z y one d a y ?  .. . m e a n that y o u are a dangerous person?  .. . m e a n that y o u are untrustworthy? .. .mean that one d a y y o u m i g h t a c t u a l l y c a r r y out s o m e actions related to the thoughts?  0 1 2 3 4 5 6 7 8  0 1 2 3 4 5 6 7 8  0 1 2 3 4 5 6 7 8  0 1 2 3 4 5 6 7 8  0 1 2 3 4 5 6 7 8  0 1 2 3 4 5 6 7 8  .. .mean that y o u are a b a d , w i c k e d person?  0 1 2 3 4 5 6 7 8  .. . m e a n that y o u are w e i r d ?  0 1 2 3 4 5 6 7 8  D o y o u t h i n k that y o u w o u l d a v o i d certain p e o p l e o r places because o f this thought? D o y o u t h i n k y o u w o u l d be c r a z y o r m e n t a l l y unstable because y o u h a d this thought? T o what extent d o y o u f i n d this thought disturbing?  0 1 2 3 4 5 6 7 8  0 1 2 3 4 5 6 7 8  0 1 2 3 4 5 6 7 8  150  R e m e m b e r to answer these questions as i f y o u have this thought very frequently.  These thoughts w o u l d m e a n that I a m i m m o r a l .  0 1 2 3 4 5 6 7 8  I w o u l d be c o n c e r n e d about b e i n g left unattended w i t h c h i l d r e n .  0 1 2 3 4 5 6 7 8  I w o u l d feel c o m p e l l e d to take a c t i o n (i.e. report to the authorities, or report this to someone else). I b e l i e v e that h a v i n g this thought is just as b a d as a c t i n g o n it.  I w o u l d d i s a p p r o v e o f m y s e l f for h a v i n g this thought.  0  1  2  0  1 2  3  4  3 4  5  6  5  7  6  8  7  8  0 1 2 3 4 5 6 7 8  H o w b a d or e v i l d o y o u t h i n k this thought i s ? The worst I can N o t at a l l b a d 0  10  Neutral 20  30  40  50  imagine 60  70  80  90  100  B r i e f l y , w h a t d o y o u t h i n k about this thought? Is there a n y t h i n g y o u w o u l d d o as a result o f h a v i n g this thought?  151 Appendix C : Measures for Study 3 Religious Screening Questionnaire  1) What is your current religious affiliation, i f any: none (religion is not an important part of my life) Catholic Protestant Other Christian, namely  ._  Jewish Islamic _Sikh Hindu Buddhist Agnostic Atheist Other, namely  2) What is your degree of personal involvement in your religion, on a scale from 0 which means no involvement to 100, which means deep involvement in religion: No Involvement 0  10  Deeply Involved 20  30  40  50  60  70  80  3) Have your manners been strongly influenced by religious principles? not at all somewhat quite a lot very much  90  100  152  4)  H o w much time do you devote to religious activities each week? none 1 - 2 hours 3 - 5 hours 6 - 1 0 hours 10 - 15 hours more than 15 hours  5) D o you regularly attend religious activities or events? No Yes. If yes, please ask for specifics, and check all that apply. Religious activities Religious schools Religious associations/clubs Religious services 6) If person indicated involvement in one o f the above, ask: H o w often do you attend (insert above answer or answers)? less than once a month 1 - 3 times per month once per week more than once per week daily 7) What is your native language (the language you first learned)?  8) If your native language is not English, for how many years have you spoken English?  153  Vignette Please read the f o l l o w i n g scenario carefully.  Y o u decide to volunteer at a l o c a l soup k i t c h e n that serves p e o p l e w h o are homeless, most o f w h o m are also m e n t a l l y i l l .  A s y o u start t a l k i n g to the  p e o p l e w h o r e g u l a r l y c o m e for a hot m e a l , y o u learn m o r e about them.  One  w o m a n has delusions that she is an agent o f the Space P o l i c e , here o n earth to m o n i t o r activities and report b a c k to the mother ship. O n e o f the m e n b e l i e v e s he is Jesus C h r i s t and engages i n some b e h a v i o u r consistent w i t h that belief. A t first y o u s i m p l y see h i m as h a v i n g a d e l u s i o n , but later, y o u b e g i n to ponder the p h i l o s o p h i c a l question o f h o w a true m e s s i a h m i g h t be treated i n t o d a y ' s society.  W h a t i f this m a n r e a l l y were Jesus?  W h a t is the difference  between this m a n and Jesus C h r i s t h i m s e l f ? A f t e r s e r v i n g the patrons, y o u sit d o w n at a table w i t h f e l l o w volunteers, w a i t i n g for the m i n i s t e r at the soup k i t c h e n to b e g i n s a y i n g grace. A s the m i n i s t e r starts to pray, y o u f i n d y o u r s e l f l o o k i n g up at the c r u c i f i x h a n g i n g above the soup k i t c h e n .  W h i l e l o o k i n g at  the c r u c i f i x , y o u s u d d e n l y have a thought, "Jesus C h r i s t w a s not the M e s s i a h ; Jesus C h r i s t w a s j u s t a r a v i n g l u n a t i c ! " T h e thought is a c c o m p a n i e d b y an i m a g e o f Jesus C h r i s t as a p s y c h o t i c homeless m a n r o a m i n g the streets t a l k i n g to h i m s e l f .  154  Rating Scales - Time 1 D u r i n g the p r e v i o u s m o n i t o r i n g p e r i o d . . . i)  .. . h o w h a r d d i d y o u t r y to get r i d o f thoughts related to the story, s u c h as "Jesus Christ was not the Messiah; Jesus Christ was a raving lunatic? "  D i d not t r y at all/let thoughts f l o w freely 1 2  ii)  Tried a little 3  T r i e d a lot 4  5  T r i e d y d e s t to p u s h thoughts from m y m i n d 6 7 m  n a r  ... h o w a n x i o u s d i d y o u feel as a result o f thoughts related to the story, s u c h as "Jesus Christ was not the Messiah; Jesus Christ was a raving lunatic? "  N o t at a l l  Mildly  Moderately  anxious  anxious  anxious  1  2  3  4  5  Extremely anxious 6  7  iii) .. . h o w acceptable w a s it to y o u to have s o m e thoughts related to the story, s u c h as "Jesus Christ was not the Messiah; Jesus Christ was a raving lunatic? " Completely  Moderately  Somewhat  unacceptable  unacceptable  unacceptable  1  2  3  Neutral 4  Somewhat  Moderately Completely  acceptable  acceptable  acceptable  5  6  7  155  Thought Control Strategies Questionnaire - Time 1  P l e a s e rate h o w often y o u used each o f the f o l l o w i n g strategies w h e n y o u h a d a thought about the story, s u c h as  "Jesus Christ was not the Messiah; Jesus Christ was a raving  lunatic!"  T r i e d to replace the thought w i t h another  4)  D i s t r a c t e d m y s e l f w i t h the things around m e  5) P e r f o r m e d a thought o r a c t i o n to neutralize the thought 6)  S a i d " s t o p " to m y s e l f  7) R e a s s u r e d m y s e l f that e v e r y t h i n g w a s o k a y 8)  S a i d a prayer  9)  Other:  Constantly  3)  A lot  2) D i s t r a c t e d m y s e l f b y t h i n k i n g s o m e t h i n g pleasant  Sometimes  irrational  A little  1) R e a s o n e d w i t h m y s e l f , t r y i n g to p r o v e that the thought was  Never  .. . d u r i n g the p r e v i o u s thought m o n i t o r i n g p e r i o d :  1  2  3  4  5  1  2  3  4  5  1  2  3  4  5  1  2  3  4  5  1  2  3  4  5  1  2  3  4  5  1  2  3  4  5  1  2  3  4  5  1  2  3  4  5  156 Rating Scales - Time 2  During the previous monitoring period... iv) .. .how hard did you try to get rid of thoughts related to the story, such as "Jesus Christ was not the Messiah; Jesus Christ was a raving lunatic? " Did not try at all/let thoughts flow freely 1 2  Tried a little 3  Tried a lot 4  5  Tried my hardest to push thoughts from my mind 6 7  v) ... how anxious did you feel as a result of thoughts related to the story, such as "Jesus Christ was not the Messiah; Jesus Christ was a raving lunatic? " Not at all anxious 1  2  Mildly anxious 3  Moderately anxious 5  4  6  Extremely anxious 7  vi) .. .how acceptable was it to you to have some thoughts related to the story, such as "Jesus Christ was not the Messiah; Jesus Christ was a raving lunatic? " Completely Moderately Somewhat unacceptable unacceptable unacceptable 1 2 3  Neutral 4  Somewhat Moderately Completely acceptable acceptable acceptable 5 6 7  T h o u g h t C o n t r o l Strategies Questionnaire - T i m e 2  Please rate h o w often y o u used each o f the f o l l o w i n g strategies w h e n y o u h a d a thought about the story, s u c h as  "Jesus Christ was not the Messiah; Jesus Christ was a raving lunatic!"  T r i e d to replace the thought w i t h another  4)  D i s t r a c t e d m y s e l f w i t h the things around m e  5) P e r f o r m e d a thought o r a c t i o n to neutralize the thought 6)  S a i d " s t o p " to m y s e l f  7) R e a s s u r e d m y s e l f that e v e r y t h i n g w a s o k a y 8)  S a i d a prayer  9)  Other:  Constantly  3)  A lot  D i s t r a c t e d m y s e l f b y t h i n k i n g s o m e t h i n g pleasant  Sometimes  2)  A little  1) R e a s o n e d w i t h m y s e l f , t r y i n g to p r o v e that the thought w a s irrational  Never  .. . d u r i n g the p r e v i o u s thought m o n i t o r i n g p e r i o d :  1  2  3  4  5  1  2  3  4  5  1  2  3  4  5  1  2  3  4  5  1  2  3  4  5  1  2  3  4  5  1  2  3  4  5  1  2  3  4  5  1  2  3  4  5  Appendix D : U B C Research Ethics Board's Certificates of Approval  

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