Anxiety and mood (대한불안의학회지)

Korean Academy of Anxiety Disorders (대한불안의학회)
권호 표지
DOI QR코드

DOI QR Code

Relationships Among Experiential Avoidance, Cognitive Fusion and Obsessive-Compulsive Symptoms in Patients with Obsessive-Compulsive Disorder

강박장애 환자에서 체험회피, 인지융합 및 강박증상 간의 관계

  • Lee, Sang Won (Neuropsychiatry Center, Kyungpook National University Chilgok Hospital) ;
  • Choi, Mina (Department of Psychiatry, School of Medicine, Kyungpook National University) ;
  • Lee, Seung Jae (Institute of Biomedical Engineering Research, Kyungpook National University)
  • 이상원 (칠곡경북대학교병원 정신건강센터) ;
  • 최미나 (경북대학교 의공학연구소) ;
  • 이승재 (경북대학교 의과대학 정신건강의학교실)
  • Received : 2020.10.05
  • Accepted : 2020.12.15
  • Published : 2021.04.30
Download PDF
⟨ Previous Next ⟩

Abstract

Objective : Although cognitive-behavioral conceptualization of obsessive-compulsive disorder (OCD) has been well supported, cognitive constructs do not entirely explain the OCD symptoms. Based on the recently applied psychological model of acceptance-commitment therapy (ACT) in OCD, this study aimed to investigate the relationships among experiential avoidance, cognitive fusion, and OCD symptoms in patients with OCD. Methods : Seventy patients with OCD and 85 normal controls completed the Acceptance and Action Questionnaire-II (AAQ-II) for experiential avoidance, Cognitive Fusion Questionnaire (CFQ), and several symptom measures for OCD symptoms and depression. Results : AAQ-II and CFQ scores were higher in OCD patients than in normal controls, even after controlling for depression. Both AAQ-II and CFQ scores were significantly related to obsessing symptoms and responsibility to harm as well as unacceptable thoughts dimensions. Regression analyses showed that two variables of AAQ-II and CFQ accounted for over 25% of variances in these two symptom dimensions, with AAQ-II being the only significant predictor. Conclusion : These results suggest that two psychopathologies in ACT, termed, experiential avoidance and cognitive fusion are particularly important in explaining obsessing symptoms and its corresponding symptom dimensions such as unacceptable thoughts and responsibility to harm dimensions.

Keywords

Acknowledgement

이 논문은 2018년도 정부의 재원으로 한국연구재단의 지원을 받아 수행된 연구(NRF-2018R1A2B6007374)임.

References

  1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders (5th ed). Arlington: American Psychiatric Association;2013.
  2. Schruers K, Koning K, Luermans J, Haack M, Griez E. Obsessive-compulsive disorder: a critical review of therapeutic perspectives. Acta Psychiatr Scand 2005;111:261-271. https://doi.org/10.1111/j.1600-0447.2004.00502.x
  3. Olatunji BO, Davis ML, Powers MB, Smits JA. Cognitive-behavioral therapy for obsessive-compulsive disorder: a meta-analysis of treatment outcome and moderators. J Psychiatr Res 2013;47:33-41. https://doi.org/10.1016/j.jpsychires.2012.08.020
  4. Sanchez-Meca J, Rosa-Alcazar AI, Iniesta-Sepulveda M, Rosa-Alcazar A. Differential efficacy of cognitive-behavioral therapy and pharmacological treatments for pediatric obsessive-compulsive disorder: a meta-analysis. J Anxiety Disord 2014;28:31-44. https://doi.org/10.1016/j.janxdis.2013.10.007
  5. Abramowitz JS, Blakey SM, Reuman L, Buchholz JL. New directions in the cognitive-behavioral treatment of OCD: theory, research, and practice. Behav Ther 2018;49:311-322. https://doi.org/10.1016/j.beth.2017.09.002
  6. Kim IJ, Shin MS. Evidence-based treatment of obsessive-compulsive disorder. Korean J Clin Psychol 2017;36:509-525. https://doi.org/10.15842/kjcp.2017.36.4.005
  7. Dehlin JP, Morrison KL, Twohig MP. Acceptance and commitment therapy as a treatment for scrupulosity in obsessive compulsive disorder. Behav Modif 2013;37:409-430. https://doi.org/10.1177/0145445512475134
  8. Twohig MP, Hayes SC, Masuda A. Increasing willingness to experience obsessions: acceptance and commitment therapy as a treatment for obsessive-compulsive disorder. Behav Ther 2006;37:3-13. https://doi.org/10.1016/j.beth.2005.02.001
  9. Twohig MP, Hayes SC, Plumb JC, Pruitt LD, Collins AB, Hazlett-Stevens H, et al. A randomized clinical trial of acceptance and commitment therapy versus progressive relaxation training for obsessive-compulsive disorder. J Consult Clin Psychol 2010;78:705-716. https://doi.org/10.1037/a0020508
  10. Hayes SC, Wilson KG. Acceptance and commitment therapy: Altering the verbal support for experiential avoidance. Behav Anal 1994; 17: 289-303. https://doi.org/10.1007/BF03392677
  11. Hayes SC, Luoma JB, Bond FW, Masuda A, Lillis J. Acceptance and commitment therapy: model, processes and outcomes. Behav Res Ther 2006;44:1-25. https://doi.org/10.1016/j.brat.2005.06.006
  12. Hayes SC, Strosahl KD, Wilson KG. Acceptance and commitment therapy: the process and practice of mindful change. Guilford Press, New York, 2011.
  13. Reuman L, Buchholz J, Abramowiz JS. Obsessive beliefs, experiential avoidance, and cognitive fusion as predictors of obsessive-compulsive disorder symptom dimensions. J Contextual Behav Sci 2018; 9:15-20. https://doi.org/10.1016/j.jcbs.2018.06.001
  14. Reuman L, Buchholz J, Blakey SM, Abramowitz JS. Uncertain and fused: cognitive fusion and thought-action fusion in the context of obsessive-compulsive symptom dimensions. J Cogn Psychother 2017;31: 191-203. https://doi.org/10.1891/0889-8391.31.3.191
  15. Reuman L, Jacoby RJ, Abramowitz JS. Cognitive fusion, experiential avoidance, and obsessive beliefs as predictors of obsessive-compulsive symptom dimensions. Int J Cogn Ther 2016;9:313-326. https://doi.org/10.1521/ijct_2016_09_13
  16. Manos RC, Cahill SP, Wetterneck CT, Conelea CA, Ross AR, Riemann BC. The impact of experiential avoidance and obsessive beliefs on obsessive-compulsive symptoms in a severe clinical sample. Anxiety Disord 2010;24:700-708. https://doi.org/10.1016/j.janxdis.2010.05.001
  17. Bluett EJ, Homan KJ, Morrison KL, Levin ME, Twohig MP. Acceptance and commitment therapy for anxiety and OCD spectrum disorders: an empirical review. J Anxiety Disord 2014;28:612-624. https://doi.org/10.1016/j.janxdis.2014.06.008
  18. Bond FW, Hayes SC, Baer RA, Carpenter KM, Guenole N, Orcutt HK, et al. Preliminary psychometric properties of the Acceptance and Action Questionnaire-II: a revised measure of psychological inflexibility and experiential avoidance. Behav Ther 2011;42:676-688. https://doi.org/10.1016/j.beth.2011.03.007
  19. Heo JH, Choi MS, Jin HJ. Study on the reliability and validity of Korean translated Acceptance-Action Questionnaire-II. Korean J Counsel Psychotherapy 2009;21:861-878.
  20. Gillanders DT, Bolderston H, Bond FW, Dempster M, Flaxman PE, Campbell L, et al. The development and initial validation of the cognitive fusion questionnaire. Behav Ther 2014;45:83-101. https://doi.org/10.1016/j.beth.2013.09.001
  21. Kim BO, Cho SK. Psychometric properties of a Korean version of the Cognitive Fusion Questionnaire. J Soc Behav Pers 2015;43:1715-1723. https://doi.org/10.2224/sbp.2015.43.10.1715
  22. Abramowitz JS, Deacon BJ, Olatunji BO, Wheaton MG, Berman NC, Losardo D, et al. Assessment of obsessive-compulsive symptom dimensions: development and evaluation of the Dimensional Obsessive-Compulsive Scale. Psychol Assess 2010;22:180-198. https://doi.org/10.1037/a0018260
  23. Kim HW, Kang JI, Kim SJ, Jhung K, Kim EJ, Kim SJ. A validation study of the Korean-version of the Dimensional Obsessive-Compulsive Scale. J Korean Neuropsychiatr Assoc 2013;52:130-142. https://doi.org/10.4306/jknpa.2013.52.3.130
  24. Foa EB, Kozak MJ, Salkovskis PM, Coles ME, Amir N. The validation of a new obsessive-compulsive disorder scale: The Obsessive-Compulsive Inventory. Psychol Assess 1998;10:206. https://doi.org/10.1037/1040-3590.10.3.206
  25. Foa EB, Huppert JD, Leiberg S, Langner R, Kichic R, Hajcak G, et al. The Obsessive-Compulsive Inventory: development and validation of a short version. Psychol Assess 2002;14:485. https://doi.org/10.1037/1040-3590.14.4.485
  26. Woo CW, Kwon SM, Lim YJ, Shin MS. The Obsessive-Compulsive Inventory-Revised (OCI-R): psychometric properties of the Korean version and the order, gender, and cultural effects. J Behav Ther Exp Psychiatry 2010;41:220-227. https://doi.org/10.1016/j.jbtep.2010.01.006
  27. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry 1961;4:561-571. https://doi.org/10.1001/archpsyc.1961.01710120031004
  28. Lee YH, Song JY. A study of the reliability and the validity of the BDI, SDS, and MMPI-D scales. Kor J Clin Psychol 1991;10:98-113.
  29. Rui FJ, Suarez-Falcon JC, Riano-Hernandez D, Gilanders DT. Psychometric properties of the Cognitive Fusion Questionnaire in Colombia. Rev Latinoam Psicol 2017;49:80-87. https://doi.org/10.1016/j.rlp.2016.09.006
  30. Chian C, Hansen LB, Gillanders DT, Benninghoven D. Concept and validation of the German version of the Cognitive Fusion Questionnaire (CFQ-D). J Contextual Behav Sci 2018;9:30-35. https://doi.org/10.1016/j.jcbs.2018.06.003
  31. Lee HJ, Kwon SM. Two different types of obsession: autogenous obsessions and reactive obsessions. Behav Res Ther 2003;41:11-29. https://doi.org/10.1016/S0005-7967(01)00101-2
  32. Keles Altun I, Uysal E, Ozkorumak Karaguzel E. Differences between autogenous and reactive obsessions in terms of metacognitions and automatic thoughts. Neuropsychiatr Dis Treat 2017;13:2977-2985. https://doi.org/10.2147/NDT.S151083
  33. Lee SW, Lee KU, Choi MN, Lee SJ. Conceptual understanding of thought-action fusion and cognitive fusion: focus on obsessive-compulsive symptoms. Anxiety and Mood 2019;15:1-12. https://doi.org/10.24986/ANXMOD.2019.15.1.001
  34. Chawla N, Ostafin B. Experiential avoidance as a functional dimensional approach to psychopathology: an empirical review. J Clin Psychol 2007;63:871-890. https://doi.org/10.1002/jclp.20400
  35. Jacoby RJ, Abramowitz JS, Buchholz JL, Reuman L. Experiential avoidance in the context of obsessions: development and validation of the acceptance and action questionnaire for obsessions and compulsions. J Obsessive Compuls Relat Disord 2018;19:34-43. https://doi.org/10.1016/j.jocrd.2018.07.003
  36. Hwang SS, Roh D, Kim CH. The significance of affective problems in obsessive-compulsive disorder. Anxiety Mood 2010;6:10-16.
  37. Goodwin GM. The overlap between anxiety, depression, and obsessive-compulsive disorder. Dialogues Clin Neurosci 2015;17:249-260. https://doi.org/10.31887/DCNS.2015.17.3/ggoodwin