Cognitive models of OCD propose that an exaggerated perception of personal responsibility for preventing or causing harm is a central contributing factor to the disorder (Salkovskis, 1985; Rachman, 1993).
Specifically, these models suggest that OCD patients frequently misinterpret intrusive thoughts, images, or impulses as indicating responsibility for preventing danger, which leads to substantial discomfort and subsequent urges to engage in checking compulsive behaviors as an attempt to reduce this distress and perceived responsibility (Salkovskis et al., 2000).
Thus, inflated responsibility appraisals are thought to directly elicit and maintain many of the core clinical features of OCD, such as obsessions and compulsions.
Parrish, C. L., & Radomsky, A. S. (2006). An experimental investigation of responsibility and reassurance: Relationships with compulsive checking. International Journal of Behavioral Consultation and Therapy, 2(2), 174–191. https://doi.org/10.1037/h0100775
Key Points
- Higher levels of perceived responsibility were associated with the maintenance of compulsive urges and performance-related doubt following an experimental task. Reductions in responsibility led to decreases in these phenomena.
- Manipulations of responsibility did not significantly impact anxiety levels or memory accuracy.
- The reassurance manipulation likely lacked ecological validity, so conclusions about its effects are limited.
- The study supports cognitive models emphasizing perceived responsibility in OCD. Future research should clarify the precise contribution of responsibility vs threat appraisals.
Rationale
Cognitive models propose that heightened perceptions of responsibility for harm are believed to play a fundamental role in OCD (Salkovskis, 1985; Rachman, 1993).
Specifically, OCD patients are thought to interpret their intrusive experiences as indicating personal responsibility for preventing danger, which elicits substantial anxiety and discomfort.
This distress then leads to urges to perform compulsions as an attempt to reduce perceived responsibility and risk (Salkovskis et al., 2000).
However, while some experimental studies have supported a link between inflated responsibility and OCD phenomena, findings have been mixed regarding the precise effects of manipulating responsibility on variables like anxiety, doubt, urges, and checking behaviors (Ladouceur et al., 1995; Lopatka & Rachman, 1995; Shafran, 1997).
Additionally, little research has examined how repeated reassurance interacts with perceived responsibility, despite reassurance seeking being a common compulsion in OCD.
This study aimed to clarify the impact of responsibility manipulations and examine whether repeated reassurance interacts with responsibility to exacerbate OCD phenomena.
Method
The study used a 2x2x2 mixed design with time (pre- and post-manipulation) as a within-subjects factor and responsibility condition (high vs low) and reassurance condition (high vs low) as between-subjects factors.
Dependent variables were subjective anxiety, urges to check/seek reassurance, confidence, and memory accuracy measured at baseline and post-manipulation.
Procedure
Participants performed a pill sorting task where they sorted pills into bottles according to predetermined combinations. They were instructed to sort as quickly and accurately as possible.
After the first three trials, participants received standardized feedback about their performance to increase uncertainty. Then, they provided baseline ratings of anxiety, urges to check/seek reassurance, and confidence, as well as a memory accuracy test.
The responsibility manipulation involved telling the high-responsibility group that their performance would help determine safe medication distribution procedures for a developing country. The low-responsibility group was told the study examined color perception, and their trials were just practice.
The reassurance manipulation occurred during trials 4-5. The high-reassurance group received positive feedback about their performance, while the low-reassurance group received no feedback.
After trial 5, participants again gave subjective ratings and completed the memory test. They also rated perceived responsibility as a manipulation check.
Sample
Nonclinical undergraduate sample, 73% female, mean age 22.57. Groups did not significantly differ demographically or in baseline OCD symptoms per self-report.
Statistical Analysis
2x2x2 mixed ANOVAs with planned contrasts examined effects of responsibility and reassurance on dependent variables.
Results
The study found that heightened perceived responsibility served to perpetuate urges to check and seek reassurance as well as self-doubt following the experimental task.
Conversely, reducing perceived responsibility led participants to experience significant decreases in doubts, checking urges, and urges to seek reassurance.
However, neither manipulating responsibility nor providing reassurance influenced participants’ subjective anxiety levels or memory accuracy.
Therefore, inflated responsibility appraisals seem capable of specifically maintaining compulsive phenomena, distinct from broader anxiety.
Additionally, the failure to detect the effects of repeated reassurance in this analog highlights the need for improved methodologies to examine this compulsive behavior.
Insight
The results provide support for cognitive models of OCD, proposing that inflated perceptions of responsibility contribute to obsessional thinking by perpetuating doubt and compulsive behaviors like repeated checking.
However, the limited effects on anxiety suggest that compulsions may serve functions beyond merely reducing anxiety for some patients.
Therefore, while lending evidence to dominant cognitive theories emphasizing the role of inflated responsibility in the maintenance of OCD (Salkovskis, 1985; Rachman, 1993), the findings indicate complex relationships between responsibility, threat perception, anxiety, and compulsions that need further clarification through additional experimental and treatment outcome research (Rachman, 2002).
Future investigations should also focus on enhanced methodologies for studying reassurance seeking and its potential to exacerbate OCD symptoms when responsibility perceptions are heightened.
Strengths
- Manipulated responsibility directly
- Used multifaceted responsibility manipulation
- Examined reassurance-seeking
- Included multiple relevant dependent variables
Limitations
- Potential issues with reassurance ecological validity
- Responsibility measure limitations,
- No clinical sample
- Experimenter present during task
Implications
Results support targeting inflated responsibility in OCD treatment. They suggest variability in OCD that should inform case conceptualization. Reassurance-seeking requires difficult but needed research.
Future investigations aimed at clarifying the precise relationships between inflated responsibility and checking compulsions would benefit from efforts to determine whether OCD patients show fundamental impairments in their ability to integrate and process information that contradicts their perceived obligations and duties.
For instance, experimental tasks could be designed that assess the capacity to update responsibility appraisals when external evidence clearly refutes the accuracy of current beliefs. Comparing results to nonclinical controls would delineate if underlying cognitive biases exist.
Additionally, because perceptions of responsibility and threat estimation often coincide in OCD, teasing apart their individual causal contributions poses a challenge.
However, through carefully crafted manipulations that explicitly heighten perceived responsibility via methods like responsibility contracts, while independently varying contextually induced threat levels, researchers may achieve better conceptual precision.
The separate and combined effects on key outcomes like urges, doubt, and checking frequencies could have theoretical and clinical implications.
If compulsions persist irrespective of danger so long as self-imposed responsibilities dominate, this would further implicate inflated responsibility attributions in the maintenance of OCD.
References
Primary reference
Parrish, C. L., & Radomsky, A. S. (2006). An experimental investigation of responsibility and reassurance: Relationships with compulsive checking. International Journal of Behavioral Consultation and Therapy, 2(2), 174–191. https://doi.org/10.1037/h0100775
Other references
Ladouceur, R., Rheaume, J., Freeston, M.H., Aublet, F., Jean, K., Lachance, S., Langlois, F., & de Pokomandy-Morin, K. (1995). Experimental manipulations of responsibility: an analogue test for models of obsessive-compulsive disorder. Behaviour Research and Therapy, 33(8), 937-946.
Lopatka, C., & Rachman, S. (1995). Perceived responsibility and compulsive checking: an experimental analysis. Behaviour Research and Therapy, 33(6), 673-684.
Rachman, S. (1993). Obsessions, responsibility, and guilt. Behaviour Research and Therapy, 31(2), 149-154.
Rachman, S. (2002). A cognitive theory of compulsive checking. Behaviour Research and Therapy, 40, 625-639.
Salkovskis, P.M. (1985). Obsessional-compulsive problems: A cognitive-behavioural analysis. Behaviour Research and Therapy, 23(5), 571-583.
Shafran, R. (1997). The manipulation of responsibility in obsessive-compulsive disorder. British Journal of Clinical Psychology, 36(3), 397-407.
Keep Learning
- What factors might lead some OCD patients to seek reassurance excessively and others to engage primarily in checking compulsions?
- How might we design more ecologically valid reassurance-seeking analogues?
- What treatment implications arise from the finding that reduced responsibility lessens compulsive urges?
