Belief domains of the Obsessive Beliefs Questionnaire-44 (OBQ-44) and their specific relationship with obsessive–compulsive symptoms

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Abstract

The Obsessive Beliefs Questionnaire-44 (OBQ-44) was developed by the Obsessive Compulsive Cognitions Working Group to measure beliefs considered important in the development and maintenance of obsessive–compulsive disorder (OCD). In this study an exploratory factor analysis of the questionnaire was conducted with a student population (n = 238). Results indicated four factors: (1) perfectionism and intolerance of uncertainty, (2) importance and control of thoughts, (3) responsibility, and (4) overestimation of threat. All four factors were positively associated with obsessive–compulsive symptoms and worry. A series of regression analyses was run to test the relative contributions of cognitive and metacognitive factors. In doing so, we controlled for worry and general threat. The metacognitive dimension of importance and control of thoughts emerged as a consistent unique predictor of overall obsessive–compulsive symptoms. Exploratory analyses of predictors of obsessive–compulsive symptom subtypes showed that metacognition and perfectionism contributed to different symptom domains. The data suggests that particular beliefs may be important in OCD.

Introduction

Obsessive–compulsive disorder (OCD) is characterized by recurrent obsessions or compulsions that provoke distress and interfere significantly with everyday functioning. Cognitive theorists have implicated several belief domains in the etiology of OCD, including responsibility (Salkovskis, 1985), metacognitive beliefs concerning the meaning and power of thoughts and the use of rituals to control them (Wells, 1997, Wells, 2000; Wells & Matthews, 1994), importance of thoughts (Rachman, 1997), perfectionism (Frost & Steketee, 1997), and intolerance of ambiguity (Carr, 1974).

These beliefs can be conceptualized as falling into two categories—metacognitive and cognitive. Metacognitive beliefs relate to the meaning and control of thoughts whereas cognitive beliefs are general or social beliefs. Cognitive and metacognitive models of OCD have been developed that incorporate these different types of belief. The different models share a number of common features (e.g., Shafran, 2005); particularly that it is the interpretation of intrusive thoughts that gives rise to obsessive–compulsive (o–c) problems. However, they differ in several respects especially the type of beliefs considered important. Wells and Matthews (1994) developed the first explicitly metacognitive model of OCD, which was then elaborated by Wells, 1997, Wells, 2000. This model emphasizes metacognitive beliefs about the power and importance of thoughts and the need to perform rituals to control thoughts and avert perceived danger. In contrast the model proposed by Salkovskis (1985) gives a central role to a non-metacognitive belief–responsibility. This is defined as “The belief that one has power which is pivotal to bring about or prevent subjectively crucial negative outcomes” (Salkovskis, Richards, & Forrester, 1995, p. 285).

A number of studies support each model by showing that metacognition (e.g., Emmelkamp & Aardema, 1999; Janeck, Calamari, Riemann, & Heffelfinger, 2003; Rassin, Merckelbach, Muris, & Spaan, 1999; Wells & Papageorgiou, 1998), and responsibility (e.g., Salkovskis et al., 2000, Shafran, 1997; Smari & Holmsteinsson, 2001) are related to OCD or o–c symptoms. Wells (1997) argues that responsibility is a by-product of metacognitions that makes little or no additional contribution to explaining OCD. In support of this, studies comparing the models have shown that metacognitions but not responsibility uniquely predict o–c symptoms when their intercorrelations and worry are controlled (Gwilliam, Wells, & Cartwright-Hatton, 2004; Myers & Wells, 2005). As well as metacognition and responsibility, studies have shown an association between other beliefs and OCD such as perfectionism (Frost & Steketee, 1997) and intolerance of uncertainty (Tolin, Abramowitz, Brigidi, & Foa, 2003).

The debate about which beliefs are most central to OCD is ongoing and several different measures have been developed. Many of these were utilized by the Obsessive Compulsive Cognitions Working Group (OCCWG, 2001), an international research group, to develop the 87 item Obsessive Beliefs Questionnaire (OBQ) which assesses several of the belief domains proposed as centrally important to OCD. The OBQ was designed to measure six conceptually derived domains: responsibility, importance of thoughts, control of thoughts, overestimation of threat, intolerance of uncertainty, and perfectionism. Responsibility refers to the belief that one is able and especially obligated to prevent subjectively important negative events. Importance of thoughts refers to the belief that the mere occurrence of thoughts implies that they are meaningful and dangerous. The control of thoughts domain measures beliefs that it is possible and necessary to control thoughts. Overestimation of threat refers to exaggerated beliefs in the likelihood and severity of harm occurring. The intolerance of uncertainty domain measures beliefs that it is necessary to be certain and that ambiguity is intolerable. Finally, perfectionism refers to beliefs that imperfection and mistakes cannot be tolerated.

The OBQ had good internal consistency and test–retest reliability, and the OCCWG encouraged other researchers to analyze it with clinical and non-clinical populations. However, intercorrelations between factors were high. In an attempt to reduce this overlap as well as the number of items, the OCCWG (2005) factor analyzed the OBQ using both clinical and non-clinical samples. Three factors emerged from 44 high loading items: responsibility/threat estimation, perfectionism/certainty, and importance/control of thoughts. Each factor was made up of two of the six domains from the original OBQ. The scales had good internal consistency and had less overlap.

The aim of the present study was two-fold: first, to carry out the first exploratory factor analyses of the OBQ-44. The OCCWG (2005) factor analyzed the OBQ-87 and produced three factors. They then retained the 44 high loading items. However, they did not factor analyze these 44 items. In a confirmatory analysis of the 44 items using a different population, the three factors were not a good fit (Woods, Tolin, & Abramowitz, 2004) suggesting that their factor structure required further exploration.

Second, we aimed to use the belief domains derived in the factor analysis, to ascertain the relative contribution of different types of beliefs to o–c symptoms.

In testing these relationships it is important to control for overlap between o–c symptoms and worry. Worry has been found to correlate positively with o–c symptoms (e.g., Tallis & de Silva, 1992; Wells & Papageorgiou, 1998) and some of the beliefs measured by the OBQ-44 have been implicated in worry (Beck, Emery, & Greenberg, 1985; Dugas, Freeston, & Ladouceur, 1997). Thus, any relationships found between OBQ-44 belief domains and o–c symptoms may be an artifact of the variance these variables share with worry. Most previous studies have not controlled for worry and the relationships obtained may be biased by such effects.

Section snippets

Participants and procedure

Two hundred and thirty eight students studying in a wide range of courses at The University of Manchester completed a battery of questionnaires on their own online. Everyone that took part was offered the chance to enter a £50 prize draw. One hundred and sixty seven (70.2%) of participants were female, 70 (29.4%) male, and 1 (.4%) participant did not state gender. Ages ranged from 18 to 59 years and the mean was 21.8. Two hundred and one participants (84.5%) identified themselves as White, 11

Factor analysis

The inter-item correlation matrix showed that a predominance of correlations were above .30 supporting their suitability for factoring. The Kaiser–Meyer–Olkin (KMO) measure of sampling adequacy was .94 again indicating that the data was suitable for factor analysis, as KMO scores above .90 are considered excellent (Hutcheson & Sofroniou, 1999). Bartlett's Test of Sphericity (Bartlett, 1954) was significant which again suggests that factor analysis was appropriate.

An exploratory factor analysis

Discussion

The OBQ (OCCWG, 2001) was designed to measure beliefs considered important in the development and maintenance of OCD. On the basis of factor analysis by the OCCWG (2005), the original OBQ was reduced to 44 items and 3 factors—responsibility/threat estimation, perfectionism/certainty, and importance/control of thoughts.

This study aimed to factor analyze the OBQ-44 and use the resulting factors to investigate hypothesized relationships between beliefs and o–c symptoms, while controlling for the

Acknowledgement

This study was conducted for partial completion of the first author's Ph.D. which is funded by the Medical Research Council.

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