Obsessive– Compulsive Disorder 465
the questionnaire and information- processing studies support the cognitive theory of
schematic threat activation in OCD but the specific characterization of this activation is
still a matter of considerable debate.
Hypothesis 3
Individuals with OCD are significantly more likely to engage in exaggerated appraisals that
obsession- related mental intrusions represent highly significant personal threats, whereas
individuals without OCD are more likely to interpret their intrusions with obsessive-like
content as insignificant or benign.
Questionnaires such as the Interpretation of Intrusions Inventory (III; OCCWG,
2001) or the Revised Obsessional Intrusions Inventory (ROII; Purdon & Clark, 1993,
1994a) were developed to assess appraisals of unwanted intrusive thoughts. Ratings of
hypothetical scenarios have also been used to assess appraisals relevant to OCD (e.g.,
Forrester, Wilson, & Salkovskis, 2002; Menzies, Harris, Cumming, & Einstein, 2000).
As predicted by the cognitive model, individuals with OCD are more likely to appraise
their obsessions in terms of overestimated threat (or distress), personal responsibility,
and importance/control (or perceived uncontrollability) compared to nonclinical indi-
viduals or when compared to the patient’s least upsetting intrusion (Calamari & Janeck,
1997; Morillo et al., 2007; OCCWG, 2001, 2003; Rachman & de Silva, 1978; Rowa
et al., 2005).
A number of faulty appraisals such as overestimated threat, inflated responsibil-
ity, TAF, and/or importance (or effort) of control have a significant association with
frequency of obsessive intrusive thoughts, anxiety or distress, and/or elevated level of
OC symptoms (e.g., Belloch, Morillo, Lucero, et al., 2004; Clark, Purdon, & Byers,
2000; Freeston et al., 1991; Menzies et al., 2000; Purdon & Clark, 1994b; Rowa &
Purdon, 2003). However, Lee and Kwon (2003) found that importance and control
appraisals were more relevant to intrusions that were autogenous in nature (spontane-
ous occurrence with no identifiable trigger), whereas responsibility appraisals were more
relevant for reactive intrusions (those evoked by an external stimulus). Forrester et al.
(2002) found that provision of a harm thought intrusion in OC-relevant hypothetical
scenarios significantly increased rated anxiety and distress as well as responsibility and
TAF—Likelihood appraisals in nonclinical and OCD samples. A greater tendency to
reflect on one’s cognitive processes, called cognitive self- consciousness, characterizes
OCD and may be a metacognitive process that contributes to an increased tendency to
negatively appraise intrusive thoughts in obsessional states (Cohen & Calamari, 2004;
Janeck, Calamari, Riemann, & Heffelfinger, 2003). Overall these studies support the
third hypothesis, which posits a close association between how an intrusive thought is
appraised (i.e., the meaning of the intrusion) and a person’s subjective experience of the
unwanted thought.
In order to validate the cognitive model, it is important to demonstrate cause-and-
effect relations between faulty appraisals and various parameters of unwanted intrusive
thoughts or obsessions. A number of experimental studies have shown that the manipu-
lation of responsibility or TAF causes the predicted increase in frequency and distress
of intrusions or other forms of negative thought as well as a greater tendency to engage
in neutralization such as checking. For example, individuals randomly assigned to a