The aim of this thesis was to consider the role of appraisals of intrusive thoughts in the development of Obsessive-Compulsive Disorder. A narrative literature review explored the hypothesis that 'normal' intrusive thoughts lie on a continuum with clinical obsessions. The review discussed previous research on intrusive thoughts in nonclinical samples and drew comparisons with characteristics of clinical obsessions. An internet-based empirical investigation employed a randomised controlled trial design in order to test the effectiveness of an intervention based on normalising information in reducing problematic meta-cognitive beliefs. A large sample (N = 148) of young adults (aged 18-20 years) was screened in to the study based on high levels of problematic meta-cognitive beliefs. Participants completed questionnaire measures of meta-cognitive beliefs, obsessive-compulsive symptoms, reactions to intrusive thoughts and experiential avoidance. Participants completed an interactive quiz based on normalising information (experimental condition) or pet information (control condition). Significant reductions in problematic meta-cognitive beliefs and experiential avoidance were observed in both conditions, thus no additional benefit of normalising information was indicated. The implications of these findings are discussed in the context of the potential normalising effects of symptom monitoring. Overall this thesis supports the comparison of 'normal' intrusive thoughts and obsessions and suggests that negative appraisals, such as problematic metacognitive beliefs, may not be the only defining factor in the development of Obsessive-Compulsive Disorder.

Cognitive-behavioral therapy that includes exposure, or intentionally and systematically confronting feared situations, is the gold standard psychological treatment for obsessive-compulsive disorder. However, less than half of those who begin this treatment are considered to have recovered from their disorder at the end of treatment, and this number is even smaller in the months following the end of treatment. Leading theories regarding how treatment changes occur focus on reducing fear, and they do not include “voluntary” (i.e., operant) behaviors, such as avoidance, that are key features of the disorder. Acceptance-based approaches to exposure do not focus on fear reduction, but directly focus on changing “voluntary” behaviors. Combining these two perspectives could lead to a better understanding of how exposure works and, ultimately, lead to more effective and long-lasting psychological treatments for obsessive-compulsive disorder. The current study investigated whether accepting distress or attempting to reduce distress during exposure for intrusive thoughts led to different outcomes and whether they led to these outcomes in different ways. Participants with intrusive thoughts were randomized to three groups, Acceptance (n = 23), Regulation (n = 20), and Control (n = 21), and completed two sessions 1week apart. Participants in the Acceptance and Regulation groups completed a 30-minute exposure at session 1 and 6 days of 10-minute exposures at home; Control participants watched videos of the same lengths. Self-report questionnaires, measures of behavior, self-ratings, and physiological data were collected at both sessions. Results showed that Acceptance and Regulation groups decreased on measures of obsessive-compulsive symptom severity, rituals performed, self-rated distress, and skin conductance levels. Acceptance showed lower skin conductance and a statistical trend toward greater self-rated willingness to experience distress than Regulation, as well as greater psychological flexibility than Control. There were no between group differences in the number of exposure tasks completed during a behavioral test, psychological inflexibility, valued living, or heart rate. This study suggests that psychological flexibility and willingness to experience distress may paradoxically lead to decreased physiological arousal, findings which may inform future research and treatment approaches.

Obsessive Compulsive Disorder (OCD) is classified as an anxiety disorder characterized by distressing persistent unwanted ideas or impulses (obsessions) and urges and/or compulsion to do something to relieve the associated anxiety caused by the obsession. The thematic content of the obsessions are highly variable, ranging from symmetry, contamination to aggressive concerns. Compulsions tend to be linked to the obsessions, but can also be idiosyncratic to the intrusive thought. According to the cognitive model, Obsessive-compulsive disorder (OCD) is maintained by various belief factors such as an inflated sense of responsibility, overestimation of threat and the over-control of thoughts. Despite much support for this hypothesis, there is a lack of specificity. This series of studies sought to determine the relationship between a number of cognitive beliefs and appraisal processes and obsessive-compulsive symptoms. This thesis presents the results of three studies. The first study was designed to investigate the hypothesis that certain beliefs are more prevalent in OCD, compared with other anxiety disorders. The second study expands on earlier findings by examining whether the six metacognitive beliefs proposed by the Obsessive Compulsive Cognitions Working Group, (OCCWG; 1997, 2001, & 2003) correlate with specific symptom-based OCD subtypes. The final study addresses some of the methodological weaknesses inherent in retrospective self-report measures by replicating the study using experimental techniques. Most importantly, this research was conducted from within the theoretical framework of Rachman (1993) and Salkovskis (1989) models which emphasise the misinterpretation of significance of the intrusive thoughts. The first study explored the relationship between thought-action fusion (TAF) and inflated responsibility beliefs across individuals diagnosed with obsessive compulsive disorder (OCD), an anxiety disorder other than OCD (anxious controls; AC), and a non-anxious control group (NAC). It was hypothesized that the OCD group would evidence significantly higher inflated responsibility and TAF scores, compared to the AC and NAC groups. In this study, non-clinical and clinical participants were recruited for research. The non-clinical group was comprised of undergraduate students (n = 22: mean age = 26.8; SD = 9.2). The clinical groups included 20 participants with OCD as their primary diagnosis (mean age = 32.1; SD = 11.9) and 21 individuals diagnosed with another anxiety disorder (mean age = 32.2; SD = 10.9). To measure inflated responsibility beliefs and thought action fusion, self-report questionnaires were administered to the participants. The results of this study demonstrated that inflated responsibility beliefs, while present in other anxiety disorders, were significantly higher in participants with OCD, even after controlling for depressed mood and TAF levels. No group differences emerged between the OCD and anxious groups on measures of TAF. Thus, it can be tentatively concluded that inflated responsibility beliefs may have a more robust relationship with OCD than TAF beliefs, which appear to act as a general vulnerability factor occurring along a continuum of anxiety disorders. The second study examined the associations between the six OCD-related beliefs: control of thoughts, importance of thoughts, responsibility, intolerance of uncertainty, overestimation of threat and perfectionism and five empirically derived OCD subgroups. Clinical participants with a primary diagnosis with OCD (n = 67: mean age = 38.0; SD = 11.7) were recruited over a period of two years from the Anxiety Disorders Unit. Participant responses were cluster analysed to form five stable groups: aggressive obsessions-checking compulsions (n = 22: mean age = 26.8; SD = 9.2); contamination obsessions-cleaning compulsions (n = 22: mean age = 26.8; SD = 9.2); symmetry concerns-ordering/arranging compulsions (n = 22: mean age = 26.8; SD = 9.2); hoarding obsessions-hoarding compulsions (n = 22: mean age = 26.8; SD = 9.2); and miscellaneous obsessions -miscellaneous compulsions (n = 22: mean age = 26.8; SD = 9.2). The second found that intolerance of uncertainty was significantly related to the contamination subgroup. While responsibility and threat estimation beliefs were higher in the aggressive-checking subgroup, these differences did not reach statistical significance. No other significant results were found, however, there was a non-significant trend for perfectionism beliefs to be higher in symmetry-ordering and hoarding subgroup. Following the results of this study, questions remained about whether the lack of significant findings reflected the generality of these beliefs or were due to methodological differences. This led to the development of the final study presented in this thesis. The purpose of the final study was to investigate whether the second study was limited by the method of assessment (e.g. self-report questionnaires). This study was unique, as it was the first of its kind to experimentally manipulate all six beliefs in empirically derived OCD subtypes. Twenty participants (mean age = 45.0; SD = 11.0) were chosen from the second study to form the following priori groups: contamination (n = 4: mean age = 44.5; SD = 9.5); aggressive (n = 6: mean age = 46.5; SD = 7.2); hoarding (n = 4: mean age = 47.2; SD = 6.9); and symmetry (n = 6: mean age = 41.8; SD = 17.4). Six behavioural experiments designed to reflect one of the six OCCWG beliefs were specifically developed and administered to the groups. Baseline scores were obtained using self-report questionnaires. The study found strong support for the use of experimental paradigms over self-report measures, as several significant interactions between cognitive beliefs and OCD symptom-based subtypes were found. Specifically, the hoarding subgroup evidenced significantly higher overall thought action fusion scores compared to those in the contamination group. The symmetry subgroup exhibited significantly higher anxiety than the aggressive group during the perfectionism task and demonstrated significantly higher scores on several items measuring perfectionism compared to the contamination group. Finally, over-estimation of threat beliefs was significantly higher in the contamination thoughts. No statistically significant group differences were found for controllability of thoughts, responsibility and intolerance of uncertainty. In conclusion, these studies collectively showed that in some cases of OCD certain beliefs appear highly applicable, whereas in others they are not. This finding may explain why some OCD patients have poor treatment outcomes as the beliefs and appraisals were highly variable across groups. These findings are of both theoretical and clinical significance because they add to the growing understanding that OCD may consist of distinct clusters of symptoms with different underlying motivations and beliefs. This finding is of clinical significance because treatment guidelines for OCD can become more specific, factoring into the therapy situation these underlying beliefs and appraisal processes. Lastly, the findings regarding inflated responsibility deserve special mention, given the significance of this construct in contemporary cognitive models. The results of the present studies were mixed with regard to responsibility as only the first study found a significant result. It appears that, like the other belief domains proposed by the OCCWG, responsibility may not be specific to all types of OCD and current cognitive models may benefit was shifting the emphasis to other belief domains.

Obsessive Compulsive Disorder (OCD) is classified as an anxiety disorder characterized by distressing persistent unwanted ideas or impulses (obsessions) and urges and/or compulsion to do something to relieve the associated anxiety caused by the obsession. The thematic content of the obsessions are highly variable, ranging from symmetry, contamination to aggressive concerns. Compulsions tend to be linked to the obsessions, but can also be idiosyncratic to the intrusive thought. According to the cognitive model, Obsessive-compulsive disorder (OCD) is maintained by various belief factors such as an inflated sense of responsibility, overestimation of threat and the over-control of thoughts. Despite much support for this hypothesis, there is a lack of specificity. This series of studies sought to determine the relationship between a number of cognitive beliefs and appraisal processes and obsessive-compulsive symptoms. This thesis presents the results of three studies. The first study was designed to investigate the hypothesis that certain beliefs are more prevalent in OCD, compared with other anxiety disorders. The second study expands on earlier findings by examining whether the six metacognitive beliefs proposed by the Obsessive Compulsive Cognitions Working Group, (OCCWG; 1997, 2001, & 2003) correlate with specific symptom-based OCD subtypes. The final study addresses some of the methodological weaknesses inherent in retrospective self-report measures by replicating the study using experimental techniques. Most importantly, this research was conducted from within the theoretical framework of Rachman (1993) and Salkovskis (1989) models which emphasise the misinterpretation of significance of the intrusive thoughts. The first study explored the relationship between thought-action fusion (TAF) and inflated responsibility beliefs across individuals diagnosed with obsessive compulsive disorder (OCD), an anxiety disorder other than OCD (anxious controls; AC), and a non-anxious control group (NAC). It was hypothesized that the OCD group would evidence significantly higher inflated responsibility and TAF scores, compared to the AC and NAC groups. In this study, non-clinical and clinical participants were recruited for research. The non-clinical group was comprised of undergraduate students (n = 22: mean age = 26.8; SD = 9.2). The clinical groups included 20 participants with OCD as their primary diagnosis (mean age = 32.1; SD = 11.9) and 21 individuals diagnosed with another anxiety disorder (mean age = 32.2; SD = 10.9). To measure inflated responsibility beliefs and thought action fusion, self-report questionnaires were administered to the participants. The results of this study demonstrated that inflated responsibility beliefs, while present in other anxiety disorders, were significantly higher in participants with OCD, even after controlling for depressed mood and TAF levels. No group differences emerged between the OCD and anxious groups on measures of TAF. Thus, it can be tentatively concluded that inflated responsibility beliefs may have a more robust relationship with OCD than TAF beliefs, which appear to act as a general vulnerability factor occurring along a continuum of anxiety disorders. The second study examined the associations between the six OCD-related beliefs: control of thoughts, importance of thoughts, responsibility, intolerance of uncertainty, overestimation of threat and perfectionism and five empirically derived OCD subgroups. Clinical participants with a primary diagnosis with OCD (n = 67: mean age = 38.0; SD = 11.7) were recruited over a period of two years from the Anxiety Disorders Unit. Participant responses were cluster analysed to form five stable groups: aggressive obsessions-checking compulsions (n = 22: mean age = 26.8; SD = 9.2); contamination obsessions-cleaning compulsions (n = 22: mean age = 26.8; SD = 9.2); symmetry concerns-ordering/arranging compulsions (n = 22: mean age = 26.8; SD = 9.2); hoarding obsessions-hoarding compulsions (n = 22: mean age = 26.8; SD = 9.2); and miscellaneous obsessions -miscellaneous compulsions (n = 22: mean age = 26.8; SD = 9.2). The second found that intolerance of uncertainty was significantly related to the contamination subgroup. While responsibility and threat estimation beliefs were higher in the aggressive-checking subgroup, these differences did not reach statistical significance. No other significant results were found, however, there was a non-significant trend for perfectionism beliefs to be higher in symmetry-ordering and hoarding subgroup. Following the results of this study, questions remained about whether the lack of significant findings reflected the generality of these beliefs or were due to methodological differences. This led to the development of the final study presented in this thesis. The purpose of the final study was to investigate whether the second study was limited by the method of assessment (e.g. self-report questionnaires). This study was unique, as it was the first of its kind to experimentally manipulate all six beliefs in empirically derived OCD subtypes. Twenty participants (mean age = 45.0; SD = 11.0) were chosen from the second study to form the following priori groups: contamination (n = 4: mean age = 44.5; SD = 9.5); aggressive (n = 6: mean age = 46.5; SD = 7.2); hoarding (n = 4: mean age = 47.2; SD = 6.9); and symmetry (n = 6: mean age = 41.8; SD = 17.4). Six behavioural experiments designed to reflect one of the six OCCWG beliefs were specifically developed and administered to the groups. Baseline scores were obtained using self-report questionnaires. The study found strong support for the use of experimental paradigms over self-report measures, as several significant interactions between cognitive beliefs and OCD symptom-based subtypes were found. Specifically, the hoarding subgroup evidenced significantly higher overall thought action fusion scores compared to those in the contamination group. The symmetry subgroup exhibited significantly higher anxiety than the aggressive group during the perfectionism task and demonstrated significantly higher scores on several items measuring perfectionism compared to the contamination group. Finally, over-estimation of threat beliefs was significantly higher in the contamination thoughts. No statistically significant group differences were found for controllability of thoughts, responsibility and intolerance of uncertainty. In conclusion, these studies collectively showed that in some cases of OCD certain beliefs appear highly applicable, whereas in others they are not. This finding may explain why some OCD patients have poor treatment outcomes as the beliefs and appraisals were highly variable across groups. These findings are of both theoretical and clinical significance because they add to the growing understanding that OCD may consist of distinct clusters of symptoms with different underlying motivations and beliefs. This finding is of clinical significance because treatment guidelines for OCD can become more specific, factoring into the therapy situation these underlying beliefs and appraisal processes. Lastly, the findings regarding inflated responsibility deserve special mention, given the significance of this construct in contemporary cognitive models. The results of the present studies were mixed with regard to responsibility as only the first study found a significant result. It appears that, like the other belief domains proposed by the OCCWG, responsibility may not be specific to all types of OCD and current cognitive models may benefit was shifting the emphasis to other belief domains.

This project investigated the metacognitive strategies used to appraise obsessive thoughts employed by individuals with different anxiety symptoms. Two hundred eighty-seven undergraduate students completed two repertory grids and three anxiety scales. The repertory grids respectively examined the appraisal process of intrusive thoughts both from the perspective of the rater and the rater's imagined average person. Variables quantified from the rep grid related to the construal process of raters' own intrusions, failed to demonstrate robust differences between OCD, non-OCD anxious, and non-anxious individuals. However, it appears that anxious individuals, not just those with OCD, use metacognitive strategies to suppress rigid constructions under perceived social evaluation. Future studies may wish to use related grid variables to explore the relation between obsessions and social anxiety.

No description available.

Thèse numérisée par la Division de la gestion de documents et des archives de l'Université de Montréal.

Thèse numérisée par la Division de la gestion de documents et des archives de l'Université de Montréal

Originally intended to be modeled after Eula Biss’s creative nonfiction essay “The Balloonists”—which tackles the subject of marriage via fragmented prose poems— “Gritting Teeth: A Memoir of Unhealthy Love” is a piece that has taken on a subject and form of its own. A memoirist like Vivian Gornick might not claim the writer’s piece, as it hesitates to offer a “story” in places. A memoirist like Sue William Silverman might not claim the piece, as it hesitates to be courageous at times. But this collage of song lyrics, research snippets, and even Craigslist postings works in conjunction with fragments from the writer’s two most “serious” romantic relationships, as well as fragments from her more recent romantic past, to create a piece that has given her an awareness of the unhealthy relationship behaviors she possesses, and with that, a tinge of hope for changing these behaviors in the future. To the woman who’s ever been obsessive about a boyfriend (or even a fling), the woman who’s married for ulterior motives, or the woman/man interested in peering into the recesses of a neurotic, obsessive, and generally warped female mind, the writer offers this memoir.

An introductory conversation with a new person I just met usually goes like this: So, where is your accent from ? Are you American? Well, yes, .....but no. Not really. I do have American citizenship and I lived in the US for fifteen years but I grew up in France. Ok, so you’re French? Well, yes, but .....not totally. My mother is French but my father is Tunisian. Ok, so you’re Tunisian? Well, yes, but... not wholly. I don’t speak Arabic, so I don’t totally feel Tunisian. So what are you? American? French? Tunisian? With my work, I ask the same questions. What is this? What does it do? How do I, the maker, relate to it? How does the viewer, the other side of the conversation, relate to it and understand it? Can we understand each other if we do not speak the same language? Who am I and who are you anyway?