Modifying Obsessive-Compulsive Beliefs about Controlling One’s Thoughts

Abstract

Cognitive models of obsessive-compulsive disorder propose that beliefs about the importance of and need to control thoughts (ICT) are central to the maintenance of the disorder. Cognitive Bias Modification for Interpretation (CBM-I) can be used to experimentally test this theory and may also have clinical utility as an adjunct therapeutic tool. The current study extended previous research to investigate whether two CBM-I sessions (one within and one outside the laboratory) would augment effects on obsessive-compulsive beliefs and behavior. We randomly allocated undergraduate participants high in ICT beliefs to a Positive (n = 30) or Control (n = 36) CBM-I condition and conducted multimodal assessments immediately following the first training and at one-week follow-up. As predicted, participants in the Positive condition reported a reduction in obsessive-compulsive beliefs from baseline to follow-up (partial η 2 = .42), whereas those in the Control condition did not. Participants responded more adaptively to the ICT relevant stressor task at follow-up compared to post-intervention, but there was no significant difference between conditions. Likewise, participants reported a reduction in obsessive symptoms over time that did not differ between conditions. The findings are considered in light of cognitive models of OCD, and clinical implications are discussed.

The Impact of Modifying Interpretive Bias on Contamination-Related Obsessive–Compulsive Symptoms

“…Before this, we must address the issue that our positive training, relative to neutral training, did not lead to a greater reduction in self-reported symptoms of contaminationrelated OCD. This finding that an increase in adaptive interpretative bias without a subsequent reduction in self-reported OCD symptoms is consistent with a significant proportion of the literature on CBM-I for OCD (Beadel et al, 2014;Black & Grisham, 2018;Stech & Grisham, 2017;Wong et al, 2021b). A possible explanation is that one short training session might have been sufficient to reduce interpretive bias but was an inadequate dose for affecting meaningful change on questionnaires related to the individuals' primary concern, which typically frame symptoms as stable and traitlike constructs (e.g., 'I find it difficult to touch garbage or dirty things').…”

“…CBM-I has seen increasing application in experimental investigations of the proposed causal relation between misappraisals of significance and OCD symptoms. Relative to control training, which differs by study, CBM-I is able to reduce responsibility beliefs (Grisham et al, 2014), beliefs about the importance of and need to control thoughts (Clerkin et al, 2014;Stech & Grisham, 2017), negative beliefs about memory and uncertainty (Black & Grisham, 2018), and perfectionism (Wong et al, 2021b). Unfortunately, CBM-I's clinical application in OCD is currently limited partly because these studies have reported mixed findings regarding its impact on symptom reduction and behaviour.…”