The relevance of dysfunctional reasoning to OCD and its treatment: Further evidence for inferential confusion utilizing a new task-based measure.

BACKGROUND AND OBJECTIVES: Previous research has highlighted the role of dysfunctional reasoning processes (i.e. "inferential confusion") in the development and maintenance of Obsessive-Compulsive Disorder (OCD). Inferential confusion has previously been found to be a unique predictor of OC symptoms and has shown specificity for OCD. However, these findings have primarily relied on a single self-report questionnaire, and only a limited number of experimentations have been conducted to establish the specificity of inferential confusion to OCD with alternate measures. The current paper demonstrates the relationship of inferential confusion with OCD symptoms in clinical samples by using a task-based measure of inferential confusion. METHODS: Sixty-four OCD participants, as well as thirty anxious and thirty-four healthy controls completed the recently developed Dysfunctional Reasoning Processes Task (DRPT) and related measures. Thirty-five OCD participants then completed sixteen sessions of cognitive-behavioural therapy (CBT) and completed the same measures post-treatment. RESULTS: As predicted, dysfunctional reasoning was significantly more elevated for those with OCD relative to control groups. Reduced levels of dysfunctional reasoning during CBT were significantly associated with successful treatment outcome. LIMITATIONS: Clinical implications should be interpreted with caution due to the relatively small sample size. CONCLUSIONS: Our findings support the notion that inferential confusion is an important cognitive factor particularly relevant to OCD that needs to be directly addressed as a mechanism of change in CBT.

Reduced fear-of-self is associated with improvement in concerns related to repugnant obsessions in obsessive-compulsive disorder.

OBJECTIVE: The potential causal and maintaining role of vulnerable self-themes and beliefs about the self in obsessive-compulsive disorder (OCD) have received increasing attention from cognitive-behavioural theorists. This interest was translated into the development of a self-report measurement of the feared self (the fear of who one might be or become), a construct theoretically and empirically pertinent to unwanted thoughts and impulses in OCD (i.e., repugnant obsessions). METHOD: The current study aimed to provide converging evidence on the relevance of the feared self in OCD, by examining whether improvements in symptoms associated with repugnant obsessions (measured on the Vancouver Obsessional Compulsive Inventory [VOCI] obsessions subscale) would be predicted by reduced feared self-perceptions (measured on the Fear-of-Self Questionnaire [FSQ]) in a sample of 93 patients receiving psychotherapy for OCD. RESULTS: Using a series of hierarchical linear regression models, we found that treatment-related reductions on the FSQ significantly and uniquely predicted reductions on the VOCI obsessions subscale and the contamination subscale. CONCLUSIONS: The current study thus replicated previous research suggesting the relevance of the feared possible self in psychological disorders such as OCD, where negative self-perception is a dominant theme. PRACTITIONER POINTS: Current results suggest that changes in feared self-perceptions may be the mechanism through which OCD symptoms improve via therapy. Interventions specifically aimed at changing feared self-perceptions may prove effective in improving cognitive-behavioural treatments for OCD. One limitation of the current study is the lack of behavioural measures of OCD to supplement self-report measures of OCD. Another limitation is that the small number of patients receiving some of the treatments precludes investigations into which treatments may be more effective in altering feared self-perceptions.