Journal of Psychopathologyand BehavioralAssessment, Vol. 15, No.

1, 1993

Beliefs About Obsessional Thoughts

M a r k H . F r e e s t o n , 1,3 R o b e r t L a d o u c e u r , 1 F a b i e n G a g n o n , 2 a n d N i c o l e
Thibodeau 2
Accepted: November 1L 1992

Recent cognitive-behavioral formulations of obsessive-compulsive disorder

postulate that intrusive or obsessional thoughts are subject to appraisal.
Extreme beliefs about the occurrence and meaning of intrusive thoughts direct
appraisal, thus causing marked distress and subjective responsibility which may
lead to neutralizing activity. A brief self-re_port belief inventory was developed
from a 92-item pool to assess extreme beliefs concerning intrusive thoughts
and responsibility, the control o f such thoughts and their possible
consequences, and the appropriateness of guilt and neutralizing behavior as a
response. The inventory was developed sequentially on two nonclinical samples
(N = 125, N = 265) to distinguish between neutralizing and nonneutralizing
subjects. Initial psychometric data for the final instrument were obtained for
two further nonclinical samples (N = 61, N = 50) along with a sample of
OCD patients and a matched control group. The instrument showed
satisfactory reliability and evidence of criterion, convergent, discriminant, and
factorial validity. Finally, data from a heterogeneous outpatient medical sample
(N = 299) was used to test the relationship among obsessive-compulsive

Parts of this study were presented at the Annual Convention of the Canadian Psychological
Association, Calgary, Canada, June 1991.
This study was supported by a grant from le Fonds de ia Recherche en Sant6 du Qu6bec
and was completed while the first author was the holder of a studentship from the Medical
Research Council of Canada.
The authors thank two anonymous reviewers for comments on an earlier version of this
manuscript.
1Ecole de psychologic, Universit6 Laval, Cit6 Universitaire, Qu6bec, Canada G I K 7P4.
2D6partement de psychiatrie, Centre Hospitalier de l'Universite Laval, Qu6bec, Canada.
3To whom correspondence should be addressed.

1
0882-2689/93/0300-0001507.00/0 9 1993 Plenum Publishing Corporation
2 Freeston, Ladouceur, Gagnon, and Thibodeau

symptoms, mood state, and beliefs. The implications of these results for
contemporary models of obsessive-compulsive disorder are discussed.
KEY WORDS: obsessions; intrusive thoughts; beliefs; appraisal; validity.

INTRODUCTION
Recent advances in the treatment of obsessive-compulsive disorder
(OCD) with overt compulsions have not been paralleled for forms of the
disorder without overt compulsions (Emmelkamp, 1987; Foa, Steketee, &
Ozarow, 1985; Rachman, 1983; Salkovskis & Westbrook, 1989). Once con-
sidered rare (e.g., Black, 1974), recent epidemiological studies suggest
prevalence rates of 1.9 to 3.3% for OCD (Karno, Golding, Sorenson, &
Burnam, 1988). Up to 46.5% of these individuals may have no overt com-
pulsions (Karno et al., 1988). Some isolated reports suggest that exposure-
based treatment is promising for this population (e.g., Himle & Thyer,
1989; Salkovskis & Westbrook, 1989), but no systematic research has been
published. Cognitive-behavioral theoretical formulations of OCD (McFall
& Wollersheim, 1979; Rachman & Hodgson, 1980; Salkovskis, 1985, 1989a,
b) indicate possible treatment directions and emphasize the role of cogni-
tive factors such as beliefs in the maintenance of OCD.
A series of studies in nonclinical samples has shown that the majority
of people in the general population experience intrusive thoughts that are
in many ways similar to obsessional thoughts (e.g., Edwards & Dickerson,
1987; Freeston, Ladouceur, Thibodeau, & Gagnon, 1991; Rachman & de
Silva, 1978). The content may be quite similar; the difference lies in the
intensity of the experience (Freeston, Ladouceur, Letarte, Gagnon, & Thi-
bodeau, 1991; Rachman & de Silva, 1978), the degree of neutralization or
anxiety-reducing compulsions (Freeston, Ladouceur, Thibodeau, & Gag-
non, 1991; Salkovskis, 1985, 1989b), and the effect of these thoughts upon
the subject's life (Rachman & de Silva, 1978; Salkovskis, 1985). Current
models of OCD (Rachman, 1985; Salkovskis, 1989b) propose the existence
of a continuum between normal intrusive thoughts and clinical obsessions
which would enable the study of obsessive phenomena in nonclinical popu-
lations.
Although several reliable and valid self-report instruments for measuring
OC symptoms exist, few measure cognitive features adequately (see
Freeston, Ladouceur, Gagnon, & Thibodeau, 1991). Cognitive appraisal
of obsessional thoughts plays a key role in cognitive-behavioral models;
however, to date no standardized instruments have specifically attempted
to measure appraisal variables. Some existing measures of irrational beliefs,
such as the Irrational Beliefs Test (IBT; Jones, 1968), the Rational Beliefs
Beliefs About Obsessions 3

Inventory (RBI; Shorkey & Whiteman, 1977), and the Belief Scale (BS;
Malouff & Schutte, 1986), are derived from general models of psychopa-
thology and are generally inappropriate for measuring specific beliefs about
obsessions (Emmelkamp, 1987). An alternative approach is to develop
measures for assessing specific content areas (Smith & Allred, 1986) such
as the Panic Belief Questionnaire (Greenberg, 1989), the Dysfunctional At-
titudes Scale for depression (Weissman & Beck, 1978), the Relationships
Belief Inventory for dyadic relationships (Eidelson & Epstein, 1982), and
the Type A Cognitive Questionnaire (TACQ) for Type A behavior (Wat-
kins, Ward, & Southard, 1986).
The object of the current article is to describe an instrument that was
constructed for the further development of cognitive models of obsessional
disorders and for a series of studies on the treatment of OCD without
overt compulsions. The criteria used during scale construction come from
studies of intrusive thoughts among nonclinical subjects using the Cognitive
Intrusions Questionnaire (CIQ; Freeston, Ladouceur, Letarte, Gagnon, &
Thibodeau, 1991). The CIQ identifies common intrusive thought themes
(illness, sex, accidents, aggression, etc.) that are then evaluated on a num-
ber of different dimensions (frequency, discomfort, guilt, controllability,
probability, disapproval, etc.). Subjects also indicate whether they use 10
different strategies when the intrusive thoughts occur.
The first study (Freeston, Ladouceur, Thibodeau, & Gagnon, 1991)
described strategies used by subjects when intrusive thoughts occur. Three
dominant response styles were identified, namely, minimal attention, con-
t i n u e d a t t e n t i o n , a n d e s c a p e / a v o i d a n c e . It is s u g g e s t e d t h a t
escape/avoidance strategies resemble obsessive-compulsive neutralization
strategies. Subjects using continued attention (e.g., thinking the problem
through) or escape/avoidance (e.g., a neutralizing thought or action,
thought replacement, thought stopping, etc.) were more anxious and re-
ported more difficulty removing intrusions than subjects who accorded
minimal attention to their thoughts. The group using escape/avoidance
strategies reported more sadness, worry, guilt, and disapproval than subjects
reporting minimal attention. Within-subject analyses supported the group
comparisons and showed that intrusions eliciting escape/avoidance strate-
gies were evaluated more disapprovingly than thoughts eliciting continued
attention. This result shows that more ego-dystonic thoughts are more likely
to be met with an avoidance response. We have since replicated this finding
(Freeston & Ladouceur, 1993).
A further study (Freeston, Ladouceur, Thibodeau, & Gagnon, 1992)
used factor analysis to identify structural dimensions of intrusive thought
experience. The first three factors, Distress, Evaluation/Responsibility, and
Control, were linked to measures of anxious, depressive, and compulsive
4 Freeston, Ladouceur, Gagnon, and Thlbodeau

symptoms. General Distress was a predictor of both depression and anxiety

scores. The Evaluation/Responsibility factor consisting of perceived respon-
sibility, disapproval, and guilt ratings was also associated with depression
and was the only significant predictor of compulsive symptoms. We have
since replicated the factor structure and the relationships with measures of
anxiety, depression, and obsessive-compulsive symptoms and extended the
results to clinical samples (e.g., Freeston, Ladouceur, Gagnon, & Thi-
bodeau, 1992). The research findings on intrusive thoughts in clinical and
nonclinical samples show the relevance of both the strategies and the factor
subscales to current understanding of OCD.
The scale development strategy involved an item pool that was gen-
erated from theoretical accounts of OCD and a two-step item selection
process using criteria from the intrusive thought research findings. The first
round of item selection used correlations with the CIQ factor scores,
whereas the second round used response strategies as the criterion. A se-
quential development model (see Anastasi, 1986) was chosen to build
validity into the scale during construction (at the possible cost of lower
internal consistency).
Examination of theoretical models of OCD identified nine themes as
being potentially pertinent to cognitive evaluation. These themes included
(1) direct or indirect responsibility for harming, possibly harming, or failing
to prevent harm to the self or another person (Salkovskis, 1985); (2) blame
and blame avoidance (Salkovskis, 1985, 1989b); (3) control of thoughts and
actions and the possible consequences of not controlling such thoughts
(Salkovskis, 1985); (4) thoughts as causing or provoking harm (Salkovskis,
1989b); (5) guilt as an appropriate response to thoughts (Niler & Beck,
1989; Rachman & Hodgson, 1980; Rosen, 1975); (6) the overestimation of
negative outcomes (Carr, 1974; Salkovskis & Warwick, 1988); (7) reaction
to danger (McFall & Wollersheim, 1979); (8) the neutralization rather than
confrontation of thoughts (McFall & WoUersheim, 1979); and (9) the in-
tolerability of uncertainty (McFall & Wollersheim, 1979). These nine
themes define the relevant domains studied and delineate the constructs
to be measured.
The current study consists of six experiments describing the develop-
ment and validation of a self-report questionnaire, the Inventory of Beliefs
Related to Obsessions (IBRO). The first experiment describes the genera-
tion of items, initial item selection among a first index sample of nonclinical
subjects, and content validity studies. The second experiment describes final
item selection and factorial validity studies on a second index sample. The
next three studies use validation samples. The third study provides reliabil-
ity, convergent validity, and discriminant validity data. The fourth study uses
a clinical sample, thus demonstrating criterion-related (known groups) va-
Beliefs About Obsessions

lidity. The fifth shows further evidence of criterion-related validity in a non-

clinical sample. Finally, the sixth study explores the relationships among
obsessive-compulsive symptoms, negative mood state, beliefs, and their in-
teractions.

EXPERIMENT 1
Method
Subjects. Initial data were gathered during a study on the subjective
experience of intrusive thoughts using psychology students at Laval Uni-
versity (Freeston, Ladouceur, Thibodeau, & Gagnon, 1991). One hundred
twenty-five students (64% female, 36% male) participated on a volunteer
basis.
Item Generation. Existing tests were examined for items pertinent to
the nine themes outlined above. The tests included the Irrational Beliefs
Test (Jones, 1968), Rational Behavior Inventory (Shorkey & Whiteman,
1977), Reaction Interference Inventory (Evans & Kazarian, 1977), Obses-
sive Thoughts Checklist (Liste de pens6es obs6dantes; Bouvard, Mollard,
Cottraux, & Guerin, 1989), Thought Inventory (Steketee & Foa, 1985), and
Mosher Guilt Scales (Mosher, 1966). Only 15 relevant items were found,
so 77 additional items were written based on the nine themes listed above.
Both items keyed as rational and irrational were written. Examination of
the item pool led to the elimination of 16 items containing reference to
distress or affective response in order to maximize discriminant validity (see
Smith & Allred, 1986). The instructions and a 6-point scale were adapted
from the Relationships Belief Inventory (Eidelson & Epstein, 1982). The
scale ranged from 1, I firmly believe this statement is false, to 6, I firmly
believe this statement is true.
Content Analysis. A n analytical grid was developed based on the nine
themes previously described. 4 Seven graduate students rated the 76 items
using the scoring grid. Judges rated each theme as present or not. Items
were retained if six of seven judges agreed that at least one theme was
represented. Twenty-two items were eliminated. Eleven additional items
were generated to strengthen weaker content areas and the content of the
additional items was confirmed by three of the original judges.
Pilot Forms. The 65 items were assigned to two parallel forms. The
original random order was respected but items with the same content were
assigned alternately to the parallel forms. A further check confirmed that
4Details of the grid may be obtained from the first author.
6 Freeston, Ladouceur, Gagnon, and Thlbodeau

the two forms (32 and 33 items) were equivalent on the basis of major
content area, keying (rational-irrational), and phrasing (positive-negative).
Administration. Each subject received a single package of question-
naires containing the Cognitive Intrusion Questionnaire (CIQ; Freeston,
Ladouceur, Letarte, Gagnon, & Thibodeau, 1991) and three symptom
measures [see Freeston, Ladouceur, Thibodeau, & Gagnon (1991) for a
full description of the procedure]. After informed consent signatures were
obtained, the questionnaires were completed and returned to a central lo-
cation.

Results
Fifty-eight subjects (41 women, 17 men) received the 32-item form
and 67 (44 women, 23 men) received the 33-item form. Each item was
correlated with the first three factors on the CIQ (Distress, Evaluation,
and Control) related to intrusive thoughts (Freeston, Ladouceur, Thi-
bodeau, & Gagnon, 1992). Items that were significantly correlated with one
or more factors were retained. Eighteen items from the first form and 13
from the second were retained. These 31 items were combined in a single
questionnaire for further development.

EXPERIMENT 2
Method
Subjects. Two hundred sixty-five university students were recruited in
summer courses in various faculties. There were 146 women (M = 27.1
years, SD = 7.25) and 111 men (M = 25.9 years, SD = 6.4).
Procedure. The subjects completed two questionnaires after informed
consent signatures were obtained. The first was a shorter version of the
CIQ than the version used in Experiment 1 (see Freeston, Ladouceur, Le-
tarte, Gagnon, & Thibodeau, 1991). The second was the 31-item IBRO
retained from the first study.

Results and Discussion

The internal consistency (Cronbach's alpha) of the 31-item question-
naire was .76 and item-total correlations varied from .07 to .53. Scores
varied from 59 to 140.
Item Selection. Using the CIQ, no effortful response and escape/avoid-
ance groups were identified based on the type of strategies used against
intrusive thoughts. The minimal attention group comprised 44 subjects (15
Beliefs About Obsessions

Table I. Means, Standard Deviations, Item-Total Correlations and Factor Loadings for
the IBRO a
Factor
Item-total
Item M SD correlation 1 2 3

1 4.01 1.65 .20 .65

2 4.20 1.35 .13 .57
3 2.56 1.35 .46 .57
4 2.50 1.47 .39 .52
5 3.05 1.50 .35 .50
6 2.64 1.44 .23 .57
7 2.54 1.47 .42 .57
8 3.36 1.61 .46 .48 .46
9 2.19 1.19 .52 .69
10 4.14 1.30 .23 .64
11 4.18 1.39 .39 .30 .66
12 3.09 1.33 .20 .35 -.40
13 3.17 1.60 .20 .53
14 4.31 1.25 .24 .68
15 3.33 1.37 .38 .41 .40
16 4.27 1.50 .30 .52
17 1.93 1.13 .37 .55
18 3.47 1.30 .23 .58
19 4.87 1.08 .25 .63
20 2.86 1.22 .38 .42

an = 265.

men and 29 women) and the escape/avoidance group consisted of 110 sub-
jects (38 men and 72 women). Individual t tests were conducted on all
IBRO items. Items that distinguished the escape/avoidance group from the
minimal attention group were retained. Eighteen items were retained in
this way. An additional 2 items were retained on the basis of high item-
total correlations for a final version of 20 items. The final version consisted
of 16 positively and 4 negatively keyed items.
Psychometric Properties. The internal consistency (Cronbach's alpha)
of the final 20-item questionnaire was .76 and item-total correlations varied
from .13 to .52 (see Table I). Scores varied from 36 to 99, with a mean
score of 67.2 (SD = 10.9) for women and 66.0 (SD = 13.3) for men. An
analysis of variance (Group x Sex) on the index sample revealed a signifi-
cant group effect [F(3, 150) = 13.41, p < .001]. The minimal attention
group (M = 59.9, SD = 13.7) scored lower than the escape/avoidance
group (M = 68.0, SD = 11.6). The sex and interaction effects were not
significant.
Principal-component analysis of the 20-item questionnaire (Kaiser's
Measure of Sampling Adequacy = .76) followed by oblique (promax) ro-
8 Freeston, Ladouceur, Gagnon, and Thibodeau

tation revealed three factors using the scree plot and mineigen criteria.
The first factor consisted of 11 items, accounted for 19.6% of the variance
before rotation, and included items referring to responsibility, guilt, blame,
punishment, and loss. This may be interpreted as a general factor corre-
s p o n d i n g largely to S a l k o v s k i s ' s (1985) p r o p o s e d d y s f u n c t i o n a l
responsibility schema. The second factor consisted of 5 items, accounted
for 10.5% of the variance before rotation, and was interpreted as measuring
overestimation of threat, also consistent with Salkovskis's writings. Finally,
the third factor consisted of 4 items with primary loadings, accounted for
8.4% of the variance before rotation, and was interpreted as including in-
tolerance of uncertainty. This factor is consistent with part of McFall and
Wollersheim's (1979) model. All but five of the loadings were above .50
(Table I).
These results from the second index sample provide evidence of ac-
ceptable internal consistency and factorial validity.

EXPERIMENT 3
The aim of the present study was to study the reliability and conver-
gent and discriminant validity of the test using a validation sample. It was
hypothesized that the IBRO total score would be moderately correlated
with measures of obsessive symptoms and general irrational beliefs. It was
also expected that correlations would be observed with measures of anxiety
and depression because of the known correlations between irrational beliefs
and general negative affect or neuroticism (Smith & Allred, 1986). Finally,
it was expected that correlations with measures of social desirability would
be weak.

METHOD
Subjects. Sixty-one psychology students were recruited in an introduc-
tory psychology course. There were 48 women (M = 25.2 years, SD = 7.4
years) and 13 men (M = 22.6 years, SD = 3.4 years).
Procedure. The subjects completed a battery of seven questionnaires
after informed consent signatures were obtained. Four weeks later, 50 sub-
jects completed four of the same questionnaires. The questionnaires used
at both administrations were the IBRO, CIQ, Beck Anxiety Inventory
(BAI, Beck, Epstein, Brown, & Steer, 1988; translation: Freeston,
Ladouceur, Thibodeau, Gagnon, & Rhraume, 1993), Belief Scale (BS;
Malouff & Schutte, 1986; translation: Freeston et aI., 1991b). At the first
administration, the Balanced Inventory of Desirable Responding (Sabourin,
Bourgeois, Gendreau, & Morval, 1989), the abridged 13-item version of
Beliefs About Obsessions

the Beck Depression Inventory (BDI; Beck, Rush, Shaw, & Emery, 1979;
translation: Bourque & Beaudette, 1982), and the Obsessive Thoughts
Checklist (OTC; Liste de pens6es obs6dantes; LPO; Bouvard, Mollard,
Cottraux, & Guerin, 1989) were also included.
The questionnaires were administered in counterbalanced order. Sub-
jects were identified at retest by using the last four digits of their telephone
number, thereby assuring anonymity and reducing the risk of the subject
forgetting an experimenter-generated code.

Results and Discussion

Descriptive Data. The mean for the IBRO was 65.8 (SD = 11.11).
Scores varied from 35 to 90, with minimum and maximum possible scores
of 20 and 120, respectively.
Reliability. The value of coefficient alpha was .82 and the stability
(test-retest) was .70. These values are both acceptable and resemble those
obtained for the other belief measure, the Belief Scale (Malouff & Schutte,
1986), .77 and .74, respectively.
Validity. The correlations with the other measures are presented in
Table II. The highest correlation was obtained with the Belief Scale, an-
other belief measure; however as the correlation accounts for only 35% of
the common variance, the degree of overlap is not excessive. The correla-
tion with obsessive thoughts, accounting for 22% of the common variance,
indicates that irrational beliefs as measured by IBRO are associated with
obsessional thoughts as expected. The significant correlation between the
BAI and the IBRO, accounting for 16% of the variance, and the lack of
correlation between the abridged BDI and the IBRO suggest that such
beliefs are related to specific anxiety symptoms rather than to general nega-
tive affect. Finally, the absence of significant relationships with the BIDR
subscales indicates that social desirability is not a confounding factor, at
least not for volunteer subjects tested under anonymous conditions.
The results of this study indicate that the IBRO shows good reliability
and evidence of convergent and discriminant validity. In particular, the
moderate overlap with another measure of irrational beliefs and the lack
of influence of social desirability suggest good discriminant validity.

EXPERIMENT 4
The aim of the fourth study was to demonstrate criterion-related
(known groups) validity. It was hypothesized that the IBRO total score
would be higher in a group of OCD patients than in a matched group of
normal controls.
10 Freeston, Ladouceur, Gagnon, and Thibodeau

Table II. Means, Standard Deviations, and Correlations with IBRO for Six Self-Report
Measuresa
Instrument M SD r

Beck Anxiety 11.20 8.30 .40*

Beck Depression (abridged) 4.40 3.80 .15
Belief Scale 59.30 10.20 .59**
Obsessive Thoughts 20.80 12.10 .47*
Self Deception 87.80 12.40 .04
Impression Management 86.40 15.20 -.05
an = 6 1 .
*p < .01.
**p < .001.

Method

Subjects. Fourteen patients currently receiving therapy from a univer-

sity teaching hospital or university psychological counseling service (eight
men and six women) participated in the study. All met DSM-IIIR (Ameri-
can P s y c h i a t r i c A s s o c i a t i o n , 1987) c r i t e r i a f o r c u r r e n t
Obsessive-Compulsive Disorder, although other Axis I and Axis II disorders
were present. These patients were matched with volunteer controls on gen-
der, age, and educational status. Controls had completed the questionnaires
as part of another study. The mean age was 34.3 years (SD = 10.0 years)
in the clinical group and 33.4 years (SD = 9.7 years) in the control group.
Procedure. All subjects received an envelope containing a consent
form, an instruction sheet, the CIQ, and the IBRO. The clinical group re-
ceived the envelope from their psychiatrist or therapist and returned it to
a research assistant before completing a battery of tests the following week.
The nonclinical group received the envelope from a research assistant and
returned it several days later to the same research assistant. All subjects
provided informed consent signatures.

Results and Discussion

A t test conducted on the IBRO scores revealed a significant differ-
ence (t = 4.11, p < .0005). The means were 75.59 (SD = 10.82) in the
clinical group and 59.20 (SD = 10.27) in the control group. The signifi-
cantly higher score in the clinical group supports the criterion-related
validity of the inventory.
Beliefs About Obsessions 11

EXPERIMENT 5
The aim of the fifth study was to demonstrate further criterion-related
(known groups) validity in normal subjects with a dominant cognitive style
of responding to intrusive thoughts. This study in fact compares the same
type of groups used for item selection in Experiment 2. It was hypothesized
that the IBRO total score would be higher in a group of normal subjects
selected for escape/avoidance strategies than in another group of normal
subjects selected for minimal attention strategies. In addition, the two
groups were characterized according to anxious, depressive, and obsessive-
compulsive symptoms and the severity of the intrusive thoughts as defined
by the CIQ factor scores (see Introduction).

Method
Subjects. Twenty-three subjects were retained from an initial group
of 50 subjects who participated in a study on nonclinical intrusive thoughts.
The subjects, university students, received $7 for an individual testing ses-
sion lasting about an hour. The minimal attention group (M = 24.4 years,
SD = 5.1 years) consisted of three men and seven women and the es-
cape/avoidance (M = 23.5 years, SD = 3.5 years) consisted of four men
and nine women.
Procedure. The subjects had indicated their willingness to participate
in an individual testing session when they completed the CIQ during mass
administrations in music appreciation courses frequented by students from
all faculties. All subjects provided informed consent signatures. Of the 327
subjects (51% male) who completed the questionnaire, 33% indicated that
they would participate at the second session. If the subject's dominant re-
sponse style could be identified, a research assistant who was unaware of
the style contacted the subject. The subjects completed two cognitive tasks
and then completed five questionnaires in counterbalanced order. Subjects
were retained if they indicated the same dominant response style at both
administrations of the CIQ using stringent criteria. The questionnaires were
the IBRO, BAI, and BDI (abridged), the first part of the CIQ, and the
Padua Inventory (PI, Sanavio, 1988; translation: Freeston et al., 1991a). The
Padua Inventory is a 60-item questionnaire which covers a wide range of
OCD behavior, namely, Checking, Contamination, Mental Control, and Im-
pulses. Reliability is excellent and the factor structure has been replicated
in Italy, the western United States and in Quebec (Sanavio, 1988; Stern-
berger & Bums, 1990, 1991; Freeston et al., 1991a; Ladouceur et al., 1992).
These studies have also shown convergent and criterion-related (known
groups) validity.
12 Freeston, Ladouceur, Gagnon, a n d Thibodeau

Table III. M e a n s and Standard Deviations for No Effortful R e s p o n s e and

Escape/Avoidance G r o u p s on Five Self-Report M e a s u r e s
Minimal attention a Escape/avoidance b

Instrument M SD M SD t

IBRO 63.20 7.89 73.38 10.91 2.79**

Padua 37.90 20.13 63.39 25.99 2.56**
Beck Anxiety 9.10 5.92 7.94 3.67 .16
Beck Depression (abr.) 2.40 2.59 7.69 5.41 3.09*
CIQ c
Distress -.64 .87 .95 .84 4.41"**
Evaluation/responsibility -.45 .88 .40 1.05 2.05 * *
Control -.39 .83 - . 11 .79 .83
C u r r e n t concerns -.50 .71 .40 1.16 2.14"*

an=lO.
bn = 13.
CStandardized factor scores.
9t, < .05.
9 *p < .01.
9 **p < .001.

Results and Discussion

The groups were first compared on the symptom measures and CIQ
factor scores (MANOVA). A significant multivariate effect was obtained
[F(8, 14) = 2.80, p < .05]. The t tests on each of the dependent variables
showed significant group effects for the Padua Inventory (t = 2.56, p <
.05), BDI, (t = 3.09, p < .01), and three CIQ factor scores: Severity (t =
4.41, p < .001), Evaluation-Responsibility (t = 2.05, p < .05), and Current
concerns (t = 2.14, p < .05). For the key variable in this study, IBRO, the
effect was also significant (t = 2.79, p < .05; see Table III). The significant
difference supports the criterion-related validity of the inventory in that it
distinguishes between normal subjects who report different responses to
intrusive thoughts. Those who use escape/avoidance strategies also report
greater distress, higher evaluation/responsibility, more current concerns re-
l a t e d to i n t r u s i v e t h o u g h t s , a n d g r e a t e r levels of d e p r e s s i v e a n d
obsessive-compulsive symptoms. These subjects who are more disturbed by
their thoughts also endorse more irrational beliefs associated with intrusive
thoughts.

EXPERIMENT 6
The aim of this final study was to explore further the link between
beliefs related to obsessional thoughts and obsessive-compulsive symptoms.
The first objective was to provide a rigorous test of the relationship by first
Beliefs About Obsessions 13

partialling out current mood state, because some authors (e.g., Smith &
Allred, 1986) have pointed out weak convergent validity in other belief
scales. The second objective was to examine the relationship between the
beliefs and different obsessive compulsive phenomena such as obsessive
cleaning and checking, rumination thoughts and doubts, and impulses iden-
tified in earlier work (e.g., Bouvard et al., 1989; Rachman & Hodgson, 1980;
Sanavio, 1988). The third objective was to provide an initial test of recent
cognitive theory which suggests that beliefs are not stable and omnipresent.
For example, Salkovskis (1985) postulates that mood state acts as a modu-
lating influence in obsessive-compulsive disorder, and one site of this
influence is in the activation of dysfunctional schemata. Miranda, Persons,
and Byers (1990), based on their work on dysfunctional attitudes in de-
pression, predict, "We expect that reporting of dysfunctional beliefs that
predispose persons to anxiety and anxiety disorders is facilitated by the
presence of an anxious mood state" (p. 239). This prediction may be tested
by adding an interaction term (Negative mood state • Belief score) to a
regression equation.
In a nonclinical population the BDI and BAI both seem to measure
primarily a large cognitive-affective component that is probably best de-
scribed as general negative affect (see Freeston, Ladouceur, Thibodeau,
Gagnon, & Rh6aume, 1991). Together they constitute a measure of nega-
tive affect appropriate for studying obsessive-compulsive symptomatology
which is frequently associated with both anxiety and depression (e.g., Black,
1974; Rachman & Hodgson, 1980; Salkovskis, 1985). It was predicted in a
series of hierarchical regression analyses that (1) belief scores would explain
a significant proportion of the variance in obsessive-compulsive symptom
scores once the BAI and BDI scores had been partialled out, (2) belief
scores would be less strongly related to subscales measuring overt compul-
sions than cognitive phenomena, and (3) the interaction term would reach
significance even after mood and belief scores had been partialled out.

Method
Subjects. Five hundred seventy-seven volunteer adult participants were
recruited in the waiting rooms of family medicine and blood sampling units
at a large urban university teaching hospital. Due to random allocation of
questionnaire combinations, 299 subjects received the Inventory of Beliefs
Related to Obsessions. The subjects were 64% female, 69% were patients,
and 96% were Canadian born. The educational level was varied: 39% sec-
ondary, 26% junior college, and 33% some university. The men had
completed a higher educational level than the women (Zz = 19.8,p < .001).
Only 10% were currently consulting a mental health professional, whereas
14 Freeston, Ladouceur, Gagnon, and Thibodeau

22% had previously consulted a mental-health professional. The mean age

was 37.5 years (SD = 12.6) for women and 37.8 years (SD = 12.4) for
men. Apart from a significant relationship between age and educational
level completed (Z2 = 38.47, p < .003), no other significant combinations
of sociodemographic variables were found.
Procedure. People arriving at the waiting rooms were invited by a re-
search assistant 5 to participate in a study examining thoughts and actions.
The goal, procedure, and voluntary nature of participation were explained
verbally and in writing. Subjects willing to participate were given an enve-
lope containing a randomly ordered combination of two of the following
three questionnaires: the Cognitive Intrusions Questionnaire, the Padua In-
ventory (see Experiment 5), and a block containing the Beck Anxiety and
Depression Inventories and the IBRO (All the instruments have been de-
scribed earlier). The subject filled out the questionnaire while waiting,
sealed it in an envelope, and returned it to the research assistant when
complete or when called by the doctor or nurse. This procedure resulted
in complete data for 129 subjects for the IBRO, BAI, BDI (abridged), and
Padua Inventory. The Padua Inventory has a total symptom score (tx =.94)
and four subscales based on factor analyses of three large samples
(Freeston et al., 1991a; Sanavio, 1988; Sternberg & Burns, 1990). The four
scales used were based on items common to both analyses and were, re-
spectively, mental control (14 items; tx =.89), contamination (10 items; t~
=.84), checking (8 items; 0t =.90), and impulses (6 items; =tx .77).

Results and Discussion

Mean scores for the IBRO were 65.8 (SD = 11.8) and 62.3 (SD =
13.1) for women and men, respectively. The difference was small but sig-
nificant [t(303) = 2.44, p < .05]. The internal consistency was acceptable
(.77) for a sample varied in age and educational status.
The intercorrelations between the symptom and the belief scores are
presented in Table IV. Note that after Bonferroni adjustment, the belief
score was moderately correlated with the total OC score and mental control
score and weakly correlated with the contamination, checking, and impulse
scores. Note that the intercorrelations between the Padua subscale scores
vary from .12 to .62, suggesting that separate aspects of OC symptomatol-
ogy are being measured.
5The authors thank the administration and staff at le Centre Hospitalier de l'Universit6 Laval
for their assistance. We also thank H61~ne Letarte and Jos~e Rh~aume, who collected the
data and aided in the data analysis.
Beliefs About Obsessions 15

Table IV. Intercorrelation Matrix for Scale Totals for a General Hospital Outpatient
Sample a,~
Con-
Padua tamination Control Checking Impulsion BAI BDI

IBRO .39 .28 .35 .28 .26 .29 .22

Padua (total) .66 .90 .78 .54 .65 .59
Contamination .43 .46 .12 .33 .33
Control .62 .50 .69 .65
Checking .28 .41 .32
Impulsion .50 .47
BAI .57
*Values > .25 are significant at p < .0018, which represents a Bonferroni adjustment for an
overall alpha = .05 for the table.
aN = 135.

A series of hierarchical regression analyses was conducted predicting

Padua total and subscale scores. The BAI and BDIa scores were entered
first in all cases, the IBRO score was entered second, and the BAI x IBRO
and BDI x IBRO scores were entered in the third and final step.
The results are presented in Table V. Negative mood accounted for
52% of the total OC score and for between 18% and 57% of the subscale
scores. IBRO scores were significant predictors of total OC, mental control,
checking, and contamination scores and accounted for 5% of the total OC
score and 3% for each of the subscale scores. The interaction set reached
significance for the contamination and impulse subscale. However, the in-
dividual terms reached significance only once for the impulse scale, where
the BAI x Belief interaction accounted for 8% of the variance. Note that
the full models accounted for between 25% (contamination) and 60%
(mental control) of the variance. Shrinkage was never greater than 3%.
These results show that in a conservative test of the relationship be-
tween beliefs about obsessions and OC symptomatology, the IBRO total
score remained a significant predictor even when a large cognitive-affective
negative mood state effect was partialled out. Note that if the order had
been reversed, the irrational belief score would have explained between
9% and 17% of the variance when entered first.
Further, although the zero order correlations with the overt compul-
sion subscales were somewhat lower than with the mental control subscate,
the belief score was still a significant predictor of these scores. The same
issues of responsibility, guilt, intolerance of uncertainty, and overestimation
of the implication of intrusive thoughts were seemingly related to overt
compulsive behavior.
Finally, some support for the Negative Mood State x Belief interac-
tion hypothesis was found in this sample of nonclinical subjects. In
16 Freeston, Ladouceur, Gagnon, and Thibodeau

Table V. Hierarchical Regression Analyses Predicting Padua Inventory Total and Subscale
Scores from Negative Mood State, Beliefs, and Their Interaction
Set F t ~ sR2 (%)

Padua--total
Mood Statea 68.69****
BAI 5.81"*** .45 44
BDIa 4.53**** .35 8
Beliefsb 6.85"* .22 5
Interactionc 0.82
BAI • Beliefs
BDI X Beliefs
Contamination
Mood State 14.60"***
BAI 2.12' .16 14
BDIa 2.59* .26 4
Beliefs 4.61" .18 3
Interaction 3.15 *
BAI X Beliefs 0.74 -.46 3
BDI X Beliefs 0.82 -.60 0
Mental Control
Mood State 83.67****
BAI 6.01"*** .44 47
BDIa 5.33**** .40 10
Beliefs 8.19"* .17 3
Interaction 0.11
BAI X Beliefs
BDI X Beliefs
Checking
Mood State 15.80'***
BAI 3.57*** .36 18
BDIa 1.24 .12 1
Beliefs 5.21" .19 3
Interaction 2.40
BAI X Beliefs
BDI X Beliefs
Impulses
Mood State 36.47****
BAI 3.93**** .35 31
BDIa 3.53**** .32 6
Beliefs 1.23
Interaction 9.16"*
BAI • Beliefs 2.60* 1.41 8
BDI X Beliefs 0.11 0.07 0
aF(2, 126).
bF(1, 125).
CF(2, 123).
*p < .05.
**p < .01.
***p < .001.
****p < .0001.
Beliefs About Obsessions 17

particular, a stronger endorsement of irrational beliefs at higher levels of

anxiety was a good predictor of the impulse subscale score, whereas the
belief score alone did not add to the prediction.
This experiment provided a rigorous test of the convergent validity
of the scale and showed significant relations between OC symptoms and
beliefs about obsessions over and above the common link to negative mood.
Furthermore, some support was found for Miranda and co-workers' (1990)
prediction of the interaction between mood state and irrational beliefs in
predicting cognitive and behavioral concomitants of anxiety disorders. Fi-
nally, the results also support Salkovskis's (1985) model of OCD. Beliefs
predicted by the model were related to obsessive-compulsive symptoms
even when negative mood was partialled out. Negative mood state acted
as a modulating influence in the association between beliefs and the im-
pulse scale, as predicted by the model.

GENERAL DISCUSSION
Based upon theoretical models of OCD and empirical work on in-
trusive thoughts in normal subjects, a questionnaire was developed to
distinguish between groups of normal subjects who differed in their expe-
rience of intrusive thoughts. Irrational beliefs about the occurrence and
meaning of intrusive thoughts and responsibility, the control of such
thoughts and their consequences, the appropriateness of guilt and neutral-
izing behavior as a response, and uncertainty were retained. These beliefs
distinguished subjects in the index sample using escape/avoidance from oth-
ers according minimal attention to their intrusions. The beliefs also
distinguished the same two groups in a validation sample where the psy-
chometrically defined escape/avoidance group also reported more troubling
intrusive thoughts and depressive and obsessive-compulsive symptoms.
These same beliefs also distinguished clinical OCD patients from matched
normal control subjects. These results, together with the reliability data and
evidence of convergent and discriminant validity, suggest that the instru-
ment has satisfactory psychometric properties. In Experiment 6, subjects of
varied age and educational status successfully completed the questionnaire,
suggesting that further use is appropriate.
What are the implications of these preliminary studies for contemporary
models of obsessive-compulsive disorder? Inasmuch as escape/avoidance
strategies are related to neutralization strategies in clinical obsessives, cer-
tain inferences may be drawn. First, the fact that more extreme beliefs are
associated with escape/avoidance strategies is coherent with the position
that cognitive appraisal of intrusive thoughts plays a key role in the devel-
18 Freeston, Ladouceur, Gagnon, and Thibodeau

opment of obsessional disorders (McFall & Wollersheim, 1979; Salkovskis,

1985, 1989a, b). Second, the factor analysis on the index sample provides
support for work by Salkovskis. Responsibility and guilt figure strongly in
the first factor of the present study, supporting Salkovskis's (1985) theory
where appraisal of intrusive thoughts in terms of responsibility leads to neu-
tralizing activity. The association between responsibility and guilt is both
intuitive and empirically established in other work on intrusive thoughts
(Freeston, Ladouceur, Thibodeau, & Gagnon, 1991, 1992). Likewise, the
second factor supports Salkovskis's (1985, 1989b) view that beliefs about
the dangerous nature of intrusive thoughts and their possible consequences
can increase the salience of intrusive thoughts, thereby increasing the pos-
sibility of action to reduce responsibility (Salkovskis, 1985) and/or guilt
(Rosen, 1975). Third, the intolerance of uncertainty factor supports McFall
and Wollersheim's (1979) position that neutralization behavior may be seen
as an uncertainty reduction device.
Further support for Salkovskis' model comes from Experiment 6,
where beliefs still accounted for variance in obsessive and compulsive
symptoms when negative mood had been partialled out. The role of
mood as a modulating influence on the role of beliefs was shown by an
important interaction term in predicting impulses. It is possible that the
type of impulses described in the scale are further along the continuum
from normal to abnormal behavior than the checking, contamination,
and mental control symptoms found in nonclinical samples (see also Pur-
don & Clark, 1992). For example, compulsive checking has been shown
in nonclinical samples (Frost, Sher, & Geen, 1986), and in fact the Ley-
ton Obsessions Inventory (Cooper, 1970), long used in studies of OCD,
was originally developed to study house-proud housewives and their
cleaning and contamination preoccupations and activities. The mental
control subscale may also show a strong relationship to the phenomenon
of worry due to a limited number of highly overlapping items and so
may not be specific to OCD in nonclinical samples (see also Ladouceur
et al., 1992). Although impulses are commonly reported in nonclinical
samples (e.g., Freeston, Ladouceur, Thibodeau, & Gagnon, 1991; Niler
& Beck, 1990; Rachman & de Silva, 1978; Salkovskis & Harrison, 1984),
some evidence suggests that they are considered more severe than
thoughts (Niler & Beck, 1990).
These results provide an initial response to Emmelkamp's (1987) call
for belief measures specifically related to obsessions. Further studies with
additional clinical samples will provide a clearer idea of how universally
experienced intrusive thoughts may develop into full-fledged obsessions in
a small but significant minority.
Beliefs About Obsessions 19

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