464 TREATMENT OF SPECIFIC ANXIETY DISORDERS
Responsibility Interpretations Questionnaire (RIQ) to measure responsibility appraisals
(Salkovskis et al., 2000); (2) the Thought– Action Fusion Scale (TAF) to assess apprais-
als and beliefs that distressing thoughts can increase the likelihood of certain nega-
tive outcomes (TAF—Likelihood) and that bad thoughts are morally equivalent to bad
deeds (TAF—Morality; Shafran, Thordarson, & Rachman, 1996; for copy of scale,
see Rachman, 2003); (3) the Meta- Cognitive Beliefs Questionnaire to measure beliefs
about the importance and control of intrusive thoughts (D.A. Clark et al., 2003); and
(4) the Obsessive Beliefs Questionnaire (OBQ; Obsessive Compulsive Cognitions Work-
ing Group [OCCWG], 2003, 2005) which assesses the six belief domains of OCD pro-
posed by this research group (OCCWG, 1997). The OBQ has emerged as the self- report
measure with the strongest psychometric properties for the assessment of belief content
relevant to OCD. A copy of the OBQ and the Interpretations of Intrusions Inventory can
be found in Frost and Steketee (2002).
A number of tentative conclusions can be reached about the beliefs in OCD based
on these questionnaire studies. Generally, individuals with OCD endorse the OCCWG
beliefs (see Table 11.2), TAF, and responsibility significantly more than nonobsessional
anxious and nonclinical comparison groups, and there is a close association between
these schematic constructs and OC symptom measures (e.g., Abramowitz, Whiteside,
Lynam, & Kalsy, 2003b; Amir, Freshman, Ramsey, Neary, & Brigidi, 2001; OCCWG,
2001, 2003; Sica et al., 2004; Steketee et al., 1998; Tolin et al., 2006). Moreover, cog-
nitive interventions that directly target belief change produce significant decreases in
anxiety and other relevant symptoms in OCD patients (e.g., Fisher & Wells, 2005; Rhé-
aume & Ladouceur, 2000; Wilson & Chambless, 2005).
However, it is apparent that some of the belief domains like TAF—Likelihood and
importance/control of thoughts may be more specific to OCD than other beliefs such
as threat estimation or inflated responsibility (e.g., Myers & Wells, 2005; Tolin et al.,
2006). Most of the belief measures have strong correlations with generalized anxiety,
worry, and even depression (e.g., Hazlett- Stevens, Zucker, & Craske, 2002; OCCWG,
2001, 2003) and the distinctiveness of the belief domains has been called into question
(OCCWG, 2003, 2005). Furthermore, some of the beliefs may be more relevant for
certain OCD subtypes than others (Julien et al., 2006), and there may be a significant
number of OCD patients who do not endorse these dysfunctional beliefs (Calamari et
al., 2006; Taylor et al., 2006). Inflated responsibility and intolerance of uncertainty
beliefs may be more relevant to compulsive checking than to other types of OCD (Foa,
Sacks, Tolin, Prezworski, & Amir, 2002; Tolin et al., 2003). Finally, it is apparent that
endorsement of OCD-relevant beliefs declines significantly with good response to CBT
or exposure and response prevention (ERP) (Emmelkamp, van Oppen, & van Balkom,
2002; O’Connor, Todorov, Robillard, Borgeat, & Brault, 1999; Whittal, Thordarson,
& McLean, 2005).
If overestimated threat, inflated responsibility, importance/control of thoughts,
perfectionism, intolerance of uncertainty, and TAF schemas are activated in OCD, an
information- processing bias should be apparent. In this regard Radomsky and Rachman
(1999) found enhanced memory for contaminated (threat) objects in OCD patients, and
in a later study Radomsky et al. (2001) determined that this effect was mediated by
presence of high perceived responsibility. Muller and Roberts (2005) concluded in their
review that several OCD studies have shown selective attentional bias for threat, espe-
cially for information relevant to the patients’ primary OCD concerns. Overall, then,