Graham C L Davey, Frances Meeten , Georgina Barnes & Suzanne R Dash University of Sussex, UK

1. Aversive intrusive thoughts as contributors to inflated responsibility, intolerance of uncertainty, and thought-action fusion Graham C L Davey, Frances Meeten, Georgina Barnes & Suzanne R Dash University of Sussex, UK

2. What are Clinical Constructs? • “Inferred states or processes derived most often from the clinical experiences of researchers or clinicians in their interactions with patients” (Davey, 2003) • Clinical Constructs have various functions: • To help understand psychopathology symptoms • To provide a basis for developing interventions • To link thoughts, beliefs and cognitive processes to subsequent symptoms (often in an implied causal manner)

3. Examples of Clinical Constructs in OCD Research • Inflated Responsibility (Salkovskis, 1985) • Intolerance of Uncertainty (Dugas et al., 1998) • Thought-Action Fusion (Shafran & Rachman, 2002)

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

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

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

7. The Present Studies • Previous research has demonstrated a causal effect of Constructs such as RESP, IU and TAF on OCD symptoms • Present studies reversed this experimental procedure • Investigated the effect of “symptoms” (thinking forced aversive thoughts) on measures of Constructs such as IR, IU and TAF

8. Experiment 1 • Exposure to Obsessive Aversive Thoughts (28 obsessive statements vs 4 obsessive/24 neutral statements)in a nonclinical population • Effects on measures of: • Inflated Responsibility (Responsibility Attitude Scale) • Intolerance of Uncertainty (Intolerance of Uncertainty Scale) • Thought-Action Fusion (Thought Fusion Instrument, TFI) • Constructs measured (1) on composite VAS scales, and (2) on full validated questionnaires

9. Statements • Aversive Statements • “I will harm someone I love” • “I will push someone under a train or bus” • Neutral Statements • “I will have my usual breakfast” • “I will meet someone I know” • Rachman & DeSilva (1978); Berry & Laskey (2012)

10. Results – Experiment 1 Mean composite ratings of RESP (p<.05), IU (ns) and TAF (p<.05) by high and low obsessive thought groups

11. Results – Experiment 1 Mean full questionnaire scores for RAS (p<.05), IUS (ns) and TFI (p<.05) for high and low obsessions groups

12. Experiment 2 • Exposure to Obsessive Aversive Thoughts (28 obsessive statements vs 4 obsessive/24 neutral statements)in a nonclinical population • Self-relevant vs Non-self-relevant • Effects on measures of: • Inflated Responsibility (Responsibility Attitude Scale) • Intolerance of Uncertainty (Intolerance of Uncertainty Scale) • Thought-Action Fusion (Thought Fusion Instrument, TFI) • Constructs measured (1) on composite VAS scales, and (2) on full validated questionnaires

13. Results – Experiment 2 Mean composite ratings of RESP (ns), IU (sig effect of Obsessions + interaction) and TAF (sig effect of Obsessions) by high and low obsessive thought groups

14. Results – Experiment 2 Mean full questionnaire scores for RAS (sig interaction, p<.05), IUS (sig Main effect of obsessions, p<.05) and TFI (sig interaction, p=.05) for high and low obsessions groups

15. High Obsessions/Self-Referent Groups • RAS scores were comparable to obsessional and anxious clinical samples • TFI scores were higher than control norms but not as high as clinical population norms • Scores on the IUS were higher that student population norms, but not as high as clinical norms

16. Mediating Factors • No clear mediation models were observed • In some cases negative mood (sadness and anxiety) significantly mediated Responsibility measures (e.g. Experiment 1) • In other cases, construct measures (e.g. TAF and IU) mediated the relationship between obsession group and sadness/anxiety

17. Conclusions • Experiencing aversive uncontrollable thoughts may facilitate appraisal processes directly implicated in OCD • Appraisals such as RESP, IU and TAF would not necessarily have to be etiological precursors of OCD symptoms • Bidirectionality would be expected if symptoms, constructs and negative moods are all part of a functional ‘threat management’ network • The development of clinical constructs may need more care to prevent adaptive processes being confused with dysfunctional symptoms in the construct’s definition