468 TREATMENT OF SPECIFIC ANXIETY DISORDERS
because failure to control will be appraised negatively and this can lead to further reduc-
tions in mental control and increased negative mood. Together these findings are con-
sistent with Hypothesis 5 that faulty appraisals of failed mental control contribute to
increased salience of the obsession for individuals with OCD.
Cognitive Vulnerability to OCD
Theory and research on cognitive vulnerability for OCD has lagged far behind develop-
ment of the descriptive model and cognitive treatment for obsessions and compulsions.
A number of possible vulnerability pathways have been described (see Rachman et
al., 2006, for discussion). Salkovskis and colleagues argued that inflated responsibil-
ity beliefs might constitute an enduring vulnerability for the etiology of obsessions
( Salkovskis, Shafran, et al., 1999). They speculated that five different developmen-
tal learning pathways could result in the adoption of general inflated responsibility
assumptions. A critical incident involving real or perceived blame (i.e., personal respon-
sibility) for causing harm could interact with prior developmental learning history to
intensify an inflated sense of personal responsibility. A preexisting generalized sense of
inflated responsibility might lead to misinterpretations of certain intrusive thoughts,
especially if they are associated with a critical incident of perceived harm (see Shafran,
2005).
Other cognitive constructs have been proposed as possible vulnerability factors in
OCD. Rachman (2003) argued that TAF beliefs or proneness to interpret one’s value-
laden thoughts as highly significant may increase vulnerability to obsessions. High cog-
nitive self- consciousness has also been promoted as a possible cognitive vulnerability for
obsessions (Janeck et al., 2003) and the six belief domains proposed by the OCCWG
are considered enduring constructs that might predispose to OCD (OCCWG, 1997).
Sookman, Pinard, and Beck (2001) described a cognitive vulnerability model of OCD
that consisted of enduring beliefs about personal vulnerability, unpredictability, strong
affect, and need for control. In his cognitive control model of obsessions, D. A. Clark
(2004) suggested that high trait negative affectivity, an ambivalent self- evaluation, and
preexisting metacognitive beliefs about the importance and control of thoughts might
constitute a vulnerability for obsessions. Finally, Doron and Kyrios (2005) have pro-
posed a most interesting perspective in which vulnerability to OCD is viewed in terms
of cognitive- affective structures involving an internal representation of the self that is
limited to a few “sensitive” self- domains as well as a representation of the world as
dangerous but controllable. Thought intrusions representing failures in these highly val-
ued or sensitive domains of the self (e.g., morality, worthiness, acceptance by others)
will be interpreted as highly significant because they involve a threat to the individual’s
self-worth. The authors trace the origins of these cognitive- affective representations of
self and world to certain developmental and early attachment experiences. Doron and
Kyrios noted connections between their conceptualization and Bhar and Kyrios’s (2000)
view that an ambivalent sense of self (i.e., degree of uncertainty about one’s self-worth)
may be a vulnerability factor in OCD.
Until very recently there was practically no prospective research on cognitive fac-
tors in OCD and so the empirical support for cognitive vulnerability was nonexistent.
Fortunately, a few studies have begun to appear that address this critical gap in the cog-