Modifying Obsessive-Compulsive Beliefs about Controlling One’s Thoughts

  • Eileen P. Stech
  • Jessica R. GrishamEmail author


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 multi-modal 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.


Cognitive bias modification Interpretation bias Obsessive-compulsive disorder Intrusive thoughts 


Compliance with Ethical Standards


The research was supported in part by an Australian Research Council Future Fellowship FT140100207 awarded to the second author.

Experiment Participants

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Conflict of Interest

Eileen P. Stech declares that she has no conflicts of interest. Jessica R. Grisham has received a research fellowship from Australian Research Council.


  1. 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(8), 1016–1035. doi: 10.1016/j.janxdis.2006.03.001.CrossRefPubMedGoogle Scholar
  2. 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, 1–12. doi: 10.1016/j.cpr.2014.01.004.CrossRefGoogle Scholar
  3. Abramowitz, J. S., Franklin, M. E., & Foa, E. B. (2002). Empirical status of cognitive-behavioral therapy for obsessive-compulsive disorder: A meta-analytic review. Romanian Journal of Cognitive and Behavioral Psychotherapies, 2, 89–104.Google Scholar
  4. Abramowitz, J. S., Nelson, C. A., Rygwall, R., & Khandker, M. (2007). The cognitive mediation of obsessive-compulsive symptoms: A longitudinal study. Journal of Anxiety Disorders, 21, 91–104. doi: 10.1016/j.janxdis.2006.05.003.CrossRefPubMedGoogle Scholar
  5. Amir, N., Kuckertz, J. M., Najmi, S., & Conley, S. L. (2015). Preliminary evidence for the enhancement of self-conducted exposures for OCD using cognitive bias modification. Cognitive Therapy and Research, 39, 424–440. doi: 10.1007/s10608-015-9675-7.CrossRefPubMedPubMedCentralGoogle Scholar
  6. Beadel, J. R., Smyth, F. L., & Teachman, B. A. (2014). Change processes during cognitive bias modification for obsessive compulsive beliefs. Cognitive Therapy and Research, 38, 103–119. doi: 10.1007/s10608-013-9576-6.CrossRefGoogle Scholar
  7. Beard, C. (2011). Cognitive bias modification for anxiety: Current evidence and future directions. Expert Review of Neurotherapeutics, 11, 299–311. doi: 10.1586/ern.10.194.CrossRefPubMedPubMedCentralGoogle Scholar
  8. Black, M. J., & Grisham, J. R. (2016). Imagery versus verbal interpretive cognitive bias modification for compulsive checking. Behaviour Research and Therapy, 83, 45–52. doi: 10.1016/j.brat.2016.05.009.CrossRefPubMedGoogle Scholar
  9. Campos, A., & Pérez-Fabello, M. J. (2009). Psychometric quality of a revised version vividness of visual imagery questionnaire. Perceptual and Motor Skills, 108, 798–802. doi: 10.2466/pms.108.3.798-802.CrossRefPubMedGoogle Scholar
  10. Cella, D. F., & Perry, S. W. (1986). Reliability and concurrent validity of three visual-analogue mood scales. Psychological Reports, 59, 827–833. doi: 10.2466/pr0.1986.59.2.827.CrossRefPubMedGoogle Scholar
  11. Clark, D. A., & Purdon, C. (1993). New perspectives for a cognitive theory of obsessions. Australian Psychologist, 28, 161–167. doi: 10.1080/00050069308258896.CrossRefGoogle Scholar
  12. Clarke, P. J. F., Nanthakumar, S., Notebaert, L., Holmes, E. A., Blackwell, S. E., & MacLeod, C. (2014). Simply imagining sunshine, lollipops and rainbows will not budge the bias: The role of ambiguity in interpretive bias modification. Cognitive Therapy and Research, 38, 120–131. doi: 10.1007/s10608-013-9564-x.CrossRefPubMedGoogle Scholar
  13. Clerkin, E. M., Magee, J. C., & Parsons, E. M. (2014). Evaluating change in beliefs about the importance/control of thoughts as a mediator of CBM-I and responses to an ICT stressor. Journal of Obsessive-Compulsive and Related Disorders, 3, 311–318. doi: 10.1016/j.jocrd.2014.07.002.CrossRefPubMedPubMedCentralGoogle Scholar
  14. Clerkin, E. M., & Teachman, B. A. (2011). Training interpretation biases among individuals with symptoms of obsessive compulsive disorder. Journal of Behavior Therapy and Experimental Psychiatry, 42, 337–343. doi: 10.1016/j.jbtep.2011.01.003.CrossRefPubMedPubMedCentralGoogle Scholar
  15. Cougle, J. R., & Lee, H. J. (2014). Pathological and non-pathological features of obsessive-compulsive disorder: Revisiting basic assumptions of cognitive models. Journal of Obsessive-Compulsive and Related Disorders, 3, 12–20. doi: 10.1016/j.jocrd.2013.11.002.CrossRefGoogle Scholar
  16. DeVellis, R. F. (2003). Scale development: Theory and applications (2nd ed.). Thousand Oaks: Sage Publications.Google Scholar
  17. Foa, E. B., Huppert, J. D., Leiberg, S., Langner, R., Kichic, R., Hajcak, G., & Salkovskis, P. M. (2002). The obsessive-Complusive inventory: Development and validation of a short version. Psychological Assessment, 14, 485–495. doi: 10.1037//1040-3590.14.4.485.CrossRefPubMedGoogle Scholar
  18. Hayes, A. (2013). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. New York: The Guilford Press.Google Scholar
  19. Heeren, A., Mogoase, C., Philippot, P., & McNally, R. J. (2015). Attention bias modification for social anxiety: A systematic review and meta-analysis. Clinical Psychology Review, 40, 76–90. doi: 10.1016/j.cpr.2015.06.001.CrossRefPubMedGoogle Scholar
  20. Henry, J. D., & Crawford, J. R. (2005). The short-form version of the depression anxiety stress scales (DASS-21): Construct validity and normative data in a large non-clinical sample. British Journal of Clinical Psychology, 44, 227–239. doi: 10.1348/014466505X29657.CrossRefPubMedGoogle Scholar
  21. Hertel, P. T., & Mathews, A. (2011). Cognitive bias modification: Past perspectives, current findings, and future applications. Perspectives on Psychological Science, 6(6), 521–536. doi: 10.1177/1745691611421205.CrossRefPubMedGoogle Scholar
  22. 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. doi: 10.1016/j.cpr.2006.12.004.CrossRefPubMedGoogle Scholar
  23. Koster, E. H. W., & Bernstein, A. (2015). Cognitive bias modification: Taking a step back to move forward? Journal of Behavior Therapy and Experimental Psychiatry, 49, 1–4. doi: 10.1016/j.jbtep.2015.05.006.CrossRefPubMedGoogle Scholar
  24. Kreindler, D., Levitt, A., Woolridge, N., & Lumsden, C. J. (2003). Portable mood mapping: The validity and reliability of analog scale displays for mood assessment via hand-held computer. Psychiatry Research, 120, 165–177. doi: 10.1016/S0165-1781(03)00196-3.CrossRefPubMedGoogle Scholar
  25. Lang, T. J., Moulds, M. L., & Holmes, E. A. (2009). Reducing depressive intrusions via a computerized cognitive bias modification of appraisals task: Developing a cognitive vaccine. Behaviour Research and Therapy, 47, 139–145. doi: 10.1016/j.brat.2008.11.002.CrossRefPubMedGoogle Scholar
  26. Longmore, R. J., & Worrell, M. (2007). Do we need to challenge thoughts in cognitive behavior therapy? Clinical Psychology Review, 27, 173–187. doi: 10.1016/j.cpr.2006.08.001.CrossRefPubMedGoogle Scholar
  27. Lorenzo-Luaces, L., Keefe, J. R., & DeRubeis, R. J. (2016). Cognitive-behavioral therapy: Nature and relation to non-cognitive behavioral therapy. Behavior Therapy. doi: 10.1016/j.beth.2016.02.012.Google Scholar
  28. Lovibond, P. F., & Lovibond, S. H. (1995). The structure of negative emotional states: Comparison of the depression anxiety stress scales (DASS) with the Beck depression and anxiety inventories. Behaviour Research and Therapy, 33, 335–343. doi: 10.1016/0005-7967(94)00075-U.CrossRefPubMedGoogle Scholar
  29. MacLeod, C. (2012). Cognitive bias modification procedures in the management of mental disorders. Current Opinion in Psychiatry, 25, 114–120. doi: 10.1097/YCO.0b013e32834fda4a.CrossRefPubMedGoogle Scholar
  30. MacLeod, C., Koster, E. H. W., & Fox, E. (2009). Whither cognitive bias modification research? Commentary on the special section articles. Journal of Abnormal Psychology, 118, 89–99. doi: 10.1037/a0014878.CrossRefPubMedGoogle Scholar
  31. MacLeod, C., & Mathews, A. (2012). Cognitive bias modification approaches to anxiety. Annual Review of Clinical Psychology, 8, 189–217. doi: 10.1146/annurev-clinpsy-032511-143052.CrossRefPubMedGoogle Scholar
  32. Marks, D. F. (1973). Visual imagery differences in the recall of pictures. British Journal of Psychology, 64, 17–24. doi: 10.1111/j.2044-8295.1973.tb01322.x.CrossRefPubMedGoogle Scholar
  33. Mathews, A., & Mackintosh, B. (2000). Induced emotional interpretation bias and anxiety. Journal of Abnormal Psychology, 109, 602–615. doi: 10.1037//0021-843X.109.4.602.CrossRefPubMedGoogle Scholar
  34. McKay, D., Abramowitz, J. S., Calamari, J. E., Kyrios, M., Radomsky, A., Sookman, D., et al. (2004). A critical evaluation of obsessive-compulsive disorder subtypes: Symptoms versus mechanisms. Clinical Psychology Review, 24, 283–313. doi: 10.1016/j.cpr.2004.04.003.CrossRefPubMedGoogle Scholar
  35. Menne-Lothmann, C., Viechtbauer, W., Höhn, P., Kasanova, Z., Haller, S. P., Drukker, M., et al. (2014). How to boost positive interpretations? A meta-analysis of the effectiveness of cognitive bias modification for interpretation. PloS One, 9, 1–26. doi: 10.1371/journal.pone.0100925.CrossRefGoogle Scholar
  36. Mobini, S., Mackintosh, B., Illingworth, J., Gega, L., Langdon, P., & Hoppitt, L. (2014). Effects of standard and explicit cognitive bias modification and computer-administered cognitive-behaviour therapy on cognitive biases and social anxiety. Journal of Behavior Therapy and Experimental Psychiatry, 45, 272–279. doi: 10.1016/j.jbtep.2013.12.002.CrossRefPubMedPubMedCentralGoogle Scholar
  37. Moulding, R., Coles, M. E., Abramowitz, J. S., Alcolado, G. M., Alonso, P., Belloch, A., et al. (2014). Part 2. They scare because we care: The relationship between obsessive intrusive thoughts and appraisals and control strategies across 15 cities. Journal of Obsessive-Compulsive and Related Disorders, 3, 280–291. doi: 10.1016/j.jocrd.2014.02.006.CrossRefGoogle Scholar
  38. 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(3), 475–484. doi: 10.1016/j.janxdis.2007.03.012
  39. 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, 1527–1542. doi: 10.1016/j.brat.2004.07.010.CrossRefGoogle Scholar
  40. Olatunji, B. O., Rosenfield, D., Tart, C. D., Cottraux, J., Powers, M. B., & Smits, J. A. J. (2013). Behavioral versus cognitive treatment of obsessive-compulsive disorder: An examination of outcome and mediators of change. Journal of Consulting and Clinical Psychology, 81, 415–428. doi: 10.1037/a0031865.CrossRefPubMedGoogle Scholar
  41. Öst, L. G., Havnen, A., Hansen, B., & Kvale, G. (2015). Cognitive behavioral treatments of obsessive–compulsive disorder. A systematic review and meta-analysis of studies published 1993–2014. Clinical Psychology Review, 40, 156–169. doi: 10.1016/j.cpr.2015.06.003.CrossRefPubMedGoogle Scholar
  42. Preacher, K. J., & Hayes, A. (2004). SPSS and SAS procedures for estimating indirect effects in simple mediation models. Behavior Research Methods, Instruments, & Computers, 36, 717–731. doi: 10.3758/BF03206553.CrossRefGoogle Scholar
  43. Rachman, S. (1997). A cognitive theory of obsessions. Behaviour Research and Therapy, 35, 793–802. doi: 10.1016/S0005-7967(97)00040-5.CrossRefPubMedGoogle Scholar
  44. Rachman, S. (1998). A cognitive theory of obsessions: Elaborations. Behaviour Research and Therapy, 36, 385–401. doi: 10.1016/S0005-7967(97)10041-9.CrossRefPubMedGoogle Scholar
  45. Rachman, S., & de Silva, P. (1978). Abnormal and normal obsessions. Behaviour Research and Therapy, 16, 233–248. doi: 10.1016/0005-7967(78)90022-0.CrossRefPubMedGoogle Scholar
  46. Rosaalcazar, A., Sanchezmeca, J., Gomezconesa, A., & Marinmartinez, F. (2008). Psychological treatment of obsessive–compulsive disorder: A meta-analysis. Clinical Psychology Review, 28, 1310–1325. doi: 10.1016/j.cpr.2008.07.001.CrossRefGoogle Scholar
  47. Salemink, E., & van den Hout, M. (2010). Validation of the “recognition task” used in the training of interpretation biases. Journal of Behavior Therapy and Experimental Psychiatry, 41(2), 140–144. doi: 10.1016/j.jbtep.2009.11.006.CrossRefPubMedGoogle Scholar
  48. Salemink, E., Wolters, L., & de Haan, E. (2015). Augmentation of treatment as usual with online cognitive bias modification of interpretation training in adolescents with obsessive compulsive disorder: A pilot study. Journal of Behavior Therapy and Experimental Psychiatry, 49, 112–119. doi: 10.1016/j.jbtep.2015.02.003.CrossRefPubMedGoogle Scholar
  49. Salkovskis, P. M. (1985). Obsessional-compulsive problems: A cognitive-behavioural analysis. Behaviour Research and Therapy, 23, 571–583. doi: 10.1016/0005-7967(85)90105-6.CrossRefPubMedGoogle Scholar
  50. Salkovskis, P. M. (1989). Cognitive-behavioural factors and the persistence of intrusive thoughts in obsessional problems. Behaviour Research and Therapy, 27, 677–682. doi: 10.1016/0005-7967(89)90152-6.CrossRefPubMedGoogle Scholar
  51. Taylor, S., Coles, M. E., Abramowitz, J. S., Wu, K. D., Olatunji, B. O., Timpano, K. R., et al. (2010). How are dysfunctional beliefs related to obsessive-compulsive symptoms? Journal of Cognitive Psychotherapy, 24, 165–176. doi: 10.1891/0889-8391.24.3.165.CrossRefGoogle Scholar
  52. 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. doi: 10.1023/A:1026351711837.CrossRefGoogle Scholar
  53. 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. doi: 10.1016/j.brat.2005.03.007.CrossRefPubMedGoogle Scholar
  54. Torkan, H., Blackwell, S. E., Holmes, E. A., Kalantari, M., Neshat-Doost, H. T., Maroufi, M., & Talebi, H. (2014). Positive imagery cognitive bias modification in treatment-seeking patients with major depression in Iran: A pilot study. Cognitive Therapy and Research, 38, 132–145. doi: 10.1007/s10608-014-9598-8.CrossRefPubMedPubMedCentralGoogle Scholar
  55. Wilhelm, S., Berman, N. C., Keshaviah, A., Schwartz, R. A., & Steketee, G. (2015). Mechanisms of change in cognitive therapy for obsessive compulsive disorder: Role of maladaptive beliefs and schemas. Behaviour Research and Therapy, 65, 5–10. doi: 10.1016/j.brat.2014.12.006.CrossRefPubMedGoogle Scholar
  56. Williams, A. D., & Grisham, J. R. (2013). Cognitive bias modification (CBM) of obsessive compulsive beliefs. BMC Psychiatry, 13, 256–265. doi: 10.1186/1471-244X-13-256.CrossRefPubMedPubMedCentralGoogle Scholar
  57. Williams, J., & MacKinnon, D. P. (2008). Resampling and distribution of the product methods for testing indirect effects in complex models. Structural Equation Modeling: A Multidisciplinary Journal, 15, 23–51. doi: 10.1080/10705510701758166.CrossRefGoogle Scholar
  58. Woody, S. R., Whittal, M. L., & McLean, P. D. (2011). Mechanisms of symptom reduction in treatment for obsessions. Journal of Consulting and Clinical Psychology, 79(5), 653–664. doi: 10.1037/a0024827.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  1. 1.School of PsychologyUniversity of New South WalesSydneyAustralia

Personalised recommendations