Abstract
Dysfunctional beliefs are the central element in cognitive-behavioral conceptualizations of obsessive–compulsive disorder (OCD). The purpose of this study was to further elucidate the etiological role of preexisting dysfunctional beliefs in the occurrence of unwanted intrusive thoughts and neutralizing behaviors after a critical event by examining their predictive value and specificity in a prospective study with undergraduate students. The dysfunctional belief domains importance/control of thoughts (ICT), responsibility/threat (RT), and perfectionism/certainty (PC) were assessed at baseline 8 weeks prior to the critical event “exam situation” in N = 169 students. Exam-related unwanted intrusive thoughts and neutralizing behaviors, anxiety, and depression were assessed during the week immediately before the exam. Complete data for both baseline and follow-up were available for 79 participants (46%). After controlling for baseline obsessive–compulsive symptoms, anxiety, and depression, ICT but not RT or PC prospectively predicted exam-related intrusive thoughts and neutralizing behaviors, ICT also prospectively predicted depressive symptoms but not anxiety, and RT and PC both prospectively predicted anxiety but not depressive symptoms. Findings are partially consistent with cognitive models of OCD. They support the idea that ICT is a cognitive vulnerability factor for unwanted intrusive thoughts and neutralizing behaviors during a stressful event. Its predictive power was small and not specific to unwanted intrusive thoughts and neutralizing behaviors.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Notes
Results are available from the first author on request.
References
Abramowitz, J. S., & Deacon, B. J. (2006). Psychometric properties and construct validity of the Obsessive-Compulsive Inventory-Revised: Replication and extension with a clinical sample. Journal of Anxiety Disorders,20, 1016–1035. https://doi.org/10.1016/j.janxdis.2006.03.001.
Abramowitz, J. S., Fabricant, L. E., Taylor, S., Deacon, B. J., McKay, D., & Storch, E. A. (2014). The relevance of analogue studies for understanding obsessions and compulsions. Clinical Psychology Review,34, 206–217. https://doi.org/10.1016/j.cpr.2014.01.004.
Abramowitz, J. S., Khandker, M., Nelson, C. A., Deacon, B. J., & Rygwall, R. (2006). The role of cognitive factors in the pathogenesis of obsessive-compulsive symptoms: A prospective study. Behaviour Research and Therapy,44, 1361–1374. https://doi.org/10.1016/j.brat.2005.09.011.
Anholt, G. E., & Kalanthroff, E. (2013). Letter to the editor: Recent advances in research on cognition and emotion in OCD: A review. Current Psychiatry Reports,15, 1–4. https://doi.org/10.1007/s11920-013-0416-x.
Askland, K. D., Garnaat, S., Sibrava, N. J., Boisseau, C. L., Strong, D., Mancebo, M., … Eisen, J. (2015). Prediction of remission in obsessive compulsive disorder using a novel machine learning strategy. International Journal of Methods in Psychiatric Research, 24, 156–169. https://doi.org/10.1002/mpr.1463.
Asselmann, E., Wittchen, H. U., Lieb, R., Perkonigg, A., & Beesdo-Baum, K. (2017). Incident mental disorders in the aftermath of traumatic events: A prospective-longitudinal community study. Journal of Affective Disorders,227, 82–89. https://doi.org/10.1016/j.jad.2017.10.004.
Bahceci, B., Bagcioglu, E., Celik, F. H., Polat, S., Koroglu, A., Kandemir, G., et al. (2014). The role of obsessive beliefs in patients with major depressive disorder. International Journal of Psychiatry in Clinical Practice,18, 37–40. https://doi.org/10.3109/13651501.2013.859707.
Beck, A. T., Brown, G., Epstein, N., & Steer, R. A. (1988). An inventory for measuring clinical anxiety—Psychometric properties. Journal of Consulting and Clinical Psychology,56, 893–897. https://doi.org/10.1037/0022-006x.56.6.893.
Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for the Beck Depression Inventory-II. San Antonio, TX: Psychological Corporation.
Belloch, A., Morillo, C., Luciano, J. V., Garcia-Soriano, G., Cabedo, E., & Carrio, C. (2010). Dysfunctional belief domains related to obsessive-compulsive disorder: A further examination of their dimensionality and specificity. Spanish Journal of Psychology,13, 376–388. https://doi.org/10.1017/S1138741600003930.
Bolton, D., Dearsley, P., Madronal-Luque, R., & Baron-Cohen, S. (2002). Magical thinking in childhood and adolescence: Development and relation to obsessive compulsion. British Journal of Developmental Psychology,20, 479–494. https://doi.org/10.1348/026151002760390819.
Brakoulias, V., Starcevic, V., Berle, D., Milicevic, D., Hannan, A., & Martin, A. (2014). The relationships between obsessive-compulsive symptom dimensions and cognitions in obsessive–compulsive disorder. Psychiatric Quarterly,85, 133–142. https://doi.org/10.1007/s11126-013-9278-y.
Calleo, J. S., Hart, J., Bjoergvinsson, T., & Stanley, M. A. (2010). Obsessions and worry beliefs in an inpatient OCD population. Journal of Anxiety Disorders,24, 903–908. https://doi.org/10.1016/j.janxdis.2010.06.015.
Clark, D. A. (2002). Cognitive perspective on obsessive compulsive disorder and depression: Distinct and related features. In R. O. Frost & G. Steketee (Eds.), Cognitive approaches to obsessions and compulsions: Theory, assessment, and treatment (pp. 233–250). New York: Pergamon.
Clark, D. A., & Purdon, C. (2016). Still cognitive after all these years? Perspectives for a cognitive behavioural theory of obsessions and where we are 30 years later: A commentary. Australian Psychologist,51, 14–17. https://doi.org/10.1111/ap.12200.
Coles, M. E., & Horng, B. (2006). A prospective test of cognitive vulnerability to obsessive–compulsive disorder. Cognitive Therapy and Research,30, 723–734. https://doi.org/10.1007/s10608-006-9033-x.
Coles, M. E., Pietrefesa, A. S., Schofield, C. A., & Cook, L. M. (2008). Predicting changes in obsessive compulsive symptoms over a six-month follow-up: A prospective test of cognitive models of obsessive compulsive disorder. Cognitive Therapy and Research,32, 657–675. https://doi.org/10.1007/s10608-007-9132-3.
Coles, M. E., Schofield, C. A., & Nota, J. A. (2015). Initial data on recollections of pathways to inflated responsibility beliefs in patients with obsessive-compulsive disorder. Behavioural and Cognitive Psychotherapy,43, 385–395. https://doi.org/10.1017/s1352465813001112.
Costarelli, V., & Patsai, A. (2012). Academic examination stress increases disordered eating symptomatology in female university students. Eating and Weight Disorders,17, e164–e169. https://doi.org/10.1007/BF03325343.
Ertle, A., Wahl, K., Bohne, A., Moritz, S., Kordon, A., & Schulte, D. (2008). The dimensions of obsessive beliefs: An analysis of the Obsessive-Beliefs Questionnaire (OBQ) for the German language area. Zeitschrift für Klinische Psychologie und Psychotherapie,37, 263–271. https://doi.org/10.1026/1616-3443.37.4.263.
Fergus, T. A., & Carmin, C. N. (2014). The validity and specificity of the short-form of the Obsessive Beliefs Questionnaire (OBQ). Journal of Psychopathology and Behavioral Assessment,36, 318–328. https://doi.org/10.1007/s10862-013-9398-6.
Fergus, T. A., & Wu, K. D. (2010). Do symptoms of generalized anxiety and obsessive-compulsive disorder share cognitive processes? Cognitive Therapy and Research,34, 168–176. https://doi.org/10.1007/s10608-009-9239-9.
Foa, E. B., Huppert, J. D., Leiberg, S., Langner, R., Kichic, R., Hajcak, G., et al. (2002). The obsessive-compulsive inventory: Development and validation of a short version. Psychological Assessment,14, 485–496. https://doi.org/10.1037//1040-3590.14.4.485.
Foa, E. B., Kozak, M. J., Salkovskis, P. M., Coles, M. E., & Amir, N. (1998). The validation of a new obsessive-compulsive disorder scale: The obsessive-compulsive inventory. Psychological Assessment,10, 206–214. https://doi.org/10.1037/1040-3590.10.3.206.
Folkman, S., & Lazarus, R. S. (1985). If it changes it must be a process: Study of emotion and coping during three stages of a college examination. Journal of Personality and Social Psychology,48, 150–170. https://doi.org/10.1037/0022-3514.48.1.150.
Frost, R. O., Krause, M. S., Mcmahon, M. J., Peppe, J., Evans, M., Mcphee, A. E., et al. (1993). Compulsivity and superstitiousness. Behaviour Research and Therapy,31, 423–425. https://doi.org/10.1016/0005-7967(93)90101-Y.
Gilbert, D. G., Stunkard, M. E., Jensen, R. A., Detwiler, F. R. J., & Martinko, J. M. (1996). Effects of exam stress on mood, cortisol, and immune functioning: Influences of neuroticism and smoker-non-smoker status. Personality and Individual Differences,21, 235–246. https://doi.org/10.1016/0191-8869(96)00065-7.
Gmelch, G., & Felson, R. (1980). Can a lucky charm get you through organic chemistry? Psychology Today,14, 75–78.
Gönner, S., Leonhart, R., & Ecker, W. (2008). The obsessive-compulsive inventory-revised (OCI-R): Validation of the German version in a sample of patients with OCD, anxiety disorders, and depressive disorders. Journal of Anxiety Disorders,22, 734–749. https://doi.org/10.1016/j.janxdis.2007.07.007.
Goodman, W. K., Price, L. H., Rasmussen, S. A., Mazure, L., Delgado, P., Heninger, G. R., et al. (1989). The Yale-Brown obsessive compulsive scale, II: Validity. Archives of General Psychiatry,46, 1012–1016. https://doi.org/10.1001/archpsyc.1989.01810110048007.
Grisham, J. R., & Williams, A. D. (2009). Cognitive control of obsessional thoughts. Behaviour Research and Therapy,47, 395–402. https://doi.org/10.1016/j.brat.2009.01.014.
Gustavson, D. E., du Pont, A., Whisman, M. A., & Miyake, A. (2018). Evidence for transdiagnostic repetitive thinking and its association with rumination, worry, and depression and anxiety symptoms: A commonality analysis. Collabra: Psychology, 4, 1–18. https://doi.org/10.1525/collabra.128.
Hautzinger, M., Bailer, M., Worall, H., & Keller, F. (1994). BDI: beck-depressions-inventar, testhandbuch (2nd ed.). Bern: Huber.
Henze, G. I., Zankert, S., Urschler, D. F., Hiltl, T. J., Kudielka, B. M., Pruessner, J. C., et al. (2017). Testing the ecological validity of the Trier Social Stress Test: Association with real-life exam stress. Psychoneuroendocrinology,75, 52–55. https://doi.org/10.1016/j.psyneuen.2016.10.002.
Hezel, D. M., & McNally, R. J. (2016). A theoretical review of cognitive biases and deficits in obsessive-compulsive disorder. Biological Psychology,121, 221–232. https://doi.org/10.1016/j.biopsycho.2015.10.012.
Hofer, P. D., Wahl, K., Meyer, A. H., Miche, M., Beesdo-Baum, K., Wittchen, H.-U., et al. (2018). The role of behavioral inhibition, perceived parental rearing, and adverse life events in adolescents and young adults with incident obsessive-compulsive disorder. Journal of Obsessive-Compulsive and Related Disorders,19, 116–123. https://doi.org/10.1016/j.jocrd.2018.10.003.
Horowitz, M. J. (1975). Intrusive and repetitive thoughts after experimental stress: A summary. Archives of General Psychiatry,32, 1457–1463.
Julien, D., O'Connor, K. P., & Aardema, F. (2007). Intrusive thoughts, obsessions, and appraisals in obsessive-compulsive disorder: A critical review. Clinical Psychology Review,27, 366–383. https://doi.org/10.1016/j.cpr.2006.12.004.
Keinan, G. (2002). The effects of stress and desire for control on superstitious behavior. Personality and Social Psychology Bulletin,28, 102–108. https://doi.org/10.1177/0146167202281009.
Keinan, G., Friedland, N., & Even-Haim, G. (2000). The effect of stress and self-esteem on social stereotyping. Journal of Social and Clinical Psychology,19, 206–219. https://doi.org/10.1521/jscp.2000.19.2.206.
Kim, S. K., Mckay, D., Taylor, S., Tolin, D., Olatunji, B., Timpano, K., et al. (2016). The structure of obsessive compulsive symptoms and beliefs: A correspondence and biplot analysis. Journal of Anxiety Disorders,38, 79–87. https://doi.org/10.1016/j.janxdis.2016.01.003.
Kühner, C., Bürger, C., Keller, F., & Hautzinger, M. (2007). Reliability and validity of the revised Beck Depression Inventory (BDI-II): Results from German samples. Nervenarzt,78, 651–656. https://doi.org/10.1007/s00115-006-2098-7.
Lang, M., Kratky, J., Shaver, J. H., Jerotijevic, D., & Xygalatas, D. (2015). Effects of anxiety on spontaneous ritualized behavior. Current Biology,25, 1892–1897. https://doi.org/10.1016/j.cub.2015.05.049.
Lavender, A., Shubert, I., de Silva, P., & Treasure, J. (2006). Obsessive-compulsive beliefs and magical ideation in eating disorders. British Journal of Clinical Psychology,45, 331–342. https://doi.org/10.1348/014466505x53579.
Little, R. J. A. (1988). A test of missing completely at random for multivariate data with missing values. Journal of the American Statistical Association,83, 1198–1202. https://doi.org/10.1080/01621459.1988.10478722.
Mantz, S. C., & Abbott, M. J. (2017). The relationship between responsibility beliefs and symptoms and processes in obsessive compulsive disorder: A systematic review. Journal of Obsessive-Compulsive and Related Disorders,14, 13–26. https://doi.org/10.1016/j.jocrd.2017.04.002.
Margraf, J., & Ehlers, A. (1995). Deutschsprachige Adaption des Beck Anxiety Inventory [German adaptation of the Beck Anxiety Inventory (BAI)]. Bern: Huber.
Mazanec, M., Wahl, K., & Lieb, R. (2018). Associations between perceived exam stress and repetitive thoughts and behaviours: An ecological momentary assessment study. Manuscript in preparation.
Myers, S. G., Fisher, P. L., & Wells, A. (2008). Belief domains of the Obsessive Beliefs Questionnaire-44 (OBQ-44) and their specific relationship with obsessive-compulsive symptoms. Journal of Anxiety Disorders,22, 475–484. https://doi.org/10.1016/j.janxdis.2007.03.012.
Newman, D. A. (2014). Missing data: Five practical guidelines. Organizational Research Methods,17, 372–411. https://doi.org/10.1177/1094428114548590.
Novara, C., Pastore, M., Ghisi, M., Sica, C., Sanavio, E., & McKay, D. (2011). Longitudinal aspects of obsessive compulsive cognitions in a non-clinical sample: A five-year follow-up study. Journal of Behavior Therapy and Experimental Psychiatry,42, 317–324. https://doi.org/10.1016/j.jbtep.2011.01.007.
Obsessive Compulsive Cognitions Working Group. (1997). Cognitive assessment of obsessive-compulsive disorder. Behaviour Research and Therapy,35, 667–681. https://doi.org/10.1016/S0005-7967(97)00017-X.
Obsessive Compulsive Cognitions Working Group. (2003). Psychometric validation of the Obsessive Beliefs Questionnaire and the interpretation of intrusions inventory: Part I. Behaviour Research and Therapy,41, 863–878. https://doi.org/10.1016/S0005-7967(02)00099-2.
Obsessive Compulsive Cognitions Working Group. (2005). Psychometric validation of the Obsessive Belief Questionnaire and interpretation of intrusions inventory: Part 2. Factor analyses and testing of a brief version. Behaviour Research and Therapy,43, 1523–1543. https://doi.org/10.1016/j.brat.2004.07.010.
Olatunji, B. O., Ebesutani, C., & Tolin, D. F. (2019). A bifactor model of obsessive beliefs: Specificity in the prediction of obsessive-compulsive disorder symptoms. Psychological Assessment,31, 210–225. https://doi.org/10.1037/pas0000660.
O’Kearney, R., & Nicholson, C. (2008). Can a theory of mind disruption help explain OCD related metacognitive disturbances? Behaviour Change,25, 55–70. https://doi.org/10.1375/bech.25.2.55.
Parrish, C. L., & Radomsky, A. S. (2011). An experimental investigation of factors involved in excessive reassurance seeking: The effects of perceived threat, responsibility and ambiguity on compulsive urges and anxiety. Journal of Experimental Psychopathology,2, 44–62. https://doi.org/10.5127/jep.011110.
Pozza, A., & Dettore, D. (2014). The specificity of inflated responsibility beliefs to OCD: A systematic review and meta-analysis of published cross-sectional case-control studies. Research in Psychology and Behavioral Sciences,2, 75–85. https://doi.org/10.12691/rpbs-2-4-1.
Purdon, C., & Clark, D. A. (1993). Obsessive intrusive thoughts in nonclinical subjects. Part 1. Content and relation with depressive, anxious and obsessional symptoms. Behaviour Research and Therapy,31, 713–720. https://doi.org/10.1016/0005-7967(93)90001-b.
Purdon, C., Gifford, S., McCabe, R., & Antony, M. M. (2011). Thought dismissability in obsessive-compulsive disorder versus panic disorder. Behaviour Research and Therapy,49, 646–653. https://doi.org/10.1016/j.brat.2011.07.001.
Rachman, S. (1997). A cognitive theory of obsessions. Behaviour Research and Therapy,35, 793–802. https://doi.org/10.1016/s0005-7967(97)00040-5.
Rachman, S. (1998). A cognitive theory of obsessions: Elaborations. Behaviour Research and Therapy,36, 385–401. https://doi.org/10.1016/s0005-7967(97)10041-9.
Reuman, L., Buchholz, J., & Abramowitz, J. S. (2018). Obsessive beliefs, experiential avoidance, and cognitive fusion as predictors of obsessive-compulsive disorder symptom dimensions. Journal of Contextual Behavioral Science,9, 15–20. https://doi.org/10.1016/j.jcbs.2018.06.001.
Reynolds, M., & Salkovskis, P. M. (1991). The relationship among guilt, dysphoria, anxiety and obsessions in a normal population—An attempted replication. Behaviour Research and Therapy,29, 259–265. https://doi.org/10.1016/0005-7967(91)90116-k.
Rosseel, Y. (2012). lavaan: An R package for structural equation modeling. Journal of Statistical Software,48, 1–36.
Salkovskis, P., Shafran, R., Rachman, S., & Freeston, M. H. (1999). Multiple pathways to inflated responsibility beliefs in obsessional problems: Possible origins and implications for therapy and research. Behaviour Research and Therapy,37, 1055–1072. https://doi.org/10.1016/s0005-7967(99)00063-7.
Salkovskis, P. M. (1985). Obsessional-compulsive problems—A cognitive-behavioral analysis. Behaviour Research and Therapy,23, 571–583. https://doi.org/10.1016/0005-7967(85)90105-6.
Salkovskis, P. M. (1999). Understanding and treating obsessive-compulsive disorder. Behaviour Research and Therapy,37, S29–S52. https://doi.org/10.1016/s0005-7967(99)00049-2.
Salkovskis, P. M., & Millar, J. F. A. (2016). Still cognitive after all these years? Perspectives for a cognitive behavioural theory of obsessions and where we are 30 years later. Australian Psychologist,51, 3–13. https://doi.org/10.1111/ap.12186.
Satow, L. (2012). Stress-und Coping-Inventar (SCI): Test- und Skalendokumentation. Retrieved from https://www.drsatow.de.
Schafer, J. L., & Graham, J. W. (2002). Missing data: Our view of the state of the art. Psychological Methods,7, 147–177.
Simic, N., & Manenica, I. (2012). Exam experience and some reactions to exam stress. Human Physiology,38, 67–72. https://doi.org/10.1134/s0362119712010161.
Steketee, G., Frost, R. O., & Cohen, I. (1998a). Beliefs in obsessive-compulsive disorder. Journal of Anxiety Disorders,12, 525–537. https://doi.org/10.1016/s0887-6185(98)00030-9.
Steketee, G., Van Noppen, B., Lam, J., & Shapiro, L. (1998b). Expressed emotion in families and the treatment of obsessive compulsive disorder. Session: Psychotherapy in Practice,4, 73–91.
Taylor, S., Coles, M. E., Abramowitz, J. S., Wu, K. D., Olatunji, B. O., Timpano, K. R., … Tolin, D. F. (2010). How are dysfunctional beliefs related to obsessive-compulsive symptoms? Journal of Cognitive Psychotherapy, 24, 165–176. https://doi.org/10.1891/0889-8391.24.3.165.
Tibi, L., van Oppen, P., van Balkom, A. J. L. M., Eikelenboom, M., Hendriks, G. J., & Anholt, G. E. (2018). The relationship between cognitions and symptoms in obsessive–compulsive disorder. Journal of Affective Disorders,225, 495–502. https://doi.org/10.1016/j.jad.2017.08.072.
Tolin, D. F., Brady, R. E., & Hannan, S. (2008). Obsessional beliefs and symptoms of obsessive–compulsive disorder in a clinical sample. Journal of Psychopathology and Behavioral Assessment,30, 31–42. https://doi.org/10.1007/s10862-007-9076-7.
Tolin, D. F., Woods, C. M., & Abramowitz, J. S. (2003). Relationship between obsessive beliefs and obsessive-compulsive symptoms. Cognitive Therapy and Research,27, 657–669. https://doi.org/10.1023/a:1026351711837.
Tolin, D. F., Worhunsky, P., & Maltby, N. (2006). Are "obsessive" beliefs specific to OCD? A comparison across anxiety disorders. Behaviour Research and Therapy,44, 469–480. https://doi.org/10.1016/j.brat.2005.03.007.
Vanderhasselt, M. A., Brose, A., Koster, E. H. W., & De Raedt, R. (2016). Co-variation between stressful events and rumination predicts depressive symptoms: An eighteen months prospective design in undergraduates. Behaviour Research and Therapy,87, 128–133. https://doi.org/10.1016/j.brat.2016.09.003.
Viar, M. A., Bilsky, S. A., Armstrong, T., & Olatunji, B. O. (2011). Obsessive beliefs and dimensions of obsessive-compulsive disorder: An examination of specific associations. Cognitive Therapy and Research,35, 108–117. https://doi.org/10.1007/s10608-011-9360-4.
Wahl, K., Schonfeld, S., Hissbach, J., Kusel, S., Zurowski, B., Moritz, S., … Kordon, A. (2011). Differences and similarities between obsessive and ruminative thoughts in obsessive-compulsive and depressed patients: A comparative study. Journal of Behavior Therapy and Experimental Psychiatry, 42, 454–461. https://doi.org/10.1016/j.jbtep.2011.03.002
Wheaton, M. G., Abramowitz, J. S., Berman, N. C., Riemann, B. C., & Hale, L. R. (2010). The relationship between obsessive beliefs and symptom dimensions in obsessive-compulsive disorder. Behaviour Research and Therapy,48, 949–954. https://doi.org/10.1016/j.brat.2010.05.027.
Zunhammer, M., Eberle, H., Eichhammer, P., & Busch, V. (2013). Somatic symptoms evoked by exam stress in university students: The role of alexithymia, neuroticism, anxiety and depression. PLoS ONE,8, e84911. https://doi.org/10.1371/journal.pone.0084911.
Zusne, L., & Jones, W. H. (1989). Anomalistic psychology: A study of magical thinking (2nd ed.). Hillsdale, NJ: Erlbaum.
Acknowledgements
We would like to thank Florence Allegro and Sven Degen for their help with the data collection.
Funding
This research was supported by a grant from the Freiwillige Akademische Gesellschaft (FAG) Basel (Grant No. Gesuch vom 29.3.2016). The FAG was not involved in the design of the study, in the collection, analysis, or interpretation of the data, in writing the report or the decision to submit the article for publication.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
Karina Wahl, Patrizia D. Hofer, Andrea H. Meyer and Roselind Lieb declare that they have no conflict of interest.
Informed Consent
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (Ethics Committee of the University of Basel; 043-15-1a) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.
Animal Rights
No animal studies were carried out by the authors for this article.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Appendix
Appendix
Development of the Stress-Related Thoughts and Behavior List (StressRTBL).
The StressRTBL was developed in two stages. To generate an item pool, 20 individuals with a university degree were provided with definitions of (a) unwanted intrusive thoughts and (b) neutralizing behaviors during a period of stressful exams at a university.
Participants were then asked to write down all unwanted intrusive thoughts and neutralizing behaviors that they had either experienced or heard of from other people. These answers were read by the first authors and items that were not clearly consistent with definitions, for example, because they were examples of longer ruminative processes rather than short intrusive thoughts (e.g., “I will never get through this. What if I never get a job?”), were excluded, resulting in a provisional item pool of 28 items. These items were presented to the first cohort of participants at baseline in 2016, n = 52. They were asked to rate whether they had ever experienced these thoughts or behaviors and to add their own unwanted intrusive thoughts and neutralizing behaviors related to previous exams. Their answers were again checked for appropriateness by the first author and sorted into three intrusive thought categories and five neutralizing behavior categories in the final list. The final category contained anticipated neutralizing behaviors on the day of the exam.
The thought categories were as follows:
- 1.
Fear of forgetting something important (e.g., “Did I accidentally miss a chapter?”), 5 items
- 2.
Fear of making a critical mistake (“Did I accidentally mix up the documents?”), 5 items
- 3.
Superstitious exam-related thoughts (“If I guess the time right, I’ll pass.”), 8 items
The behavior categories were as follows:
- 1.
Checking (e.g., “I have to flip through the documents repeatedly to make sure I have not missed anything.”), 5 items
- 2.
Ordering (e.g., “I have to arrange my pens in a certain way.”), 6 items
- 3.
Superstitious behavior (e.g., “I always have to wear the same sweater.”), 6 items
- 4.
Rigid rules or rituals (“I have to review each subject for exactly the same amount of time each day.”), 10 items
- 5.
Reassurance seeking (“I keep asking people if everything will be all right.”), 2 items; this category included anticipated neutralizing behaviors that the participant is likely to perform at the time of the exam (“I will kiss the exam before I hand it in.”), 16 items
Rights and permissions
About this article
Cite this article
Wahl, K., Hofer, P.D., Meyer, A.H. et al. Prior Beliefs About the Importance and Control of Thoughts are Predictive But Not Specific to Subsequent Intrusive Unwanted Thoughts and Neutralizing Behaviors. Cogn Ther Res 44, 360–375 (2020). https://doi.org/10.1007/s10608-019-10046-7
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10608-019-10046-7