Impact of Religiosity on Coping with Intrusive Thoughts A thesis presented to the faculty of the College of Arts and Sciences of Ohio University In partial fulfillment of the requirements for the degree Master of Science Allison J. Petrarca May 2013 © 2013 Allison J. Petrarca. All Rights Reserved. 2 This thesis titled Impact of Religiosity on Coping with Intrusive Thoughts by ALLISON J. PETRARCA has been approved for the Department of Psychology and the College of Arts and Sciences by Brook A. Marcks Special Adjunct Professor of Psychology – University of Memphis Robert Frank Dean, College of Arts and Sciences 3 Abstract PETRARCA, ALLISON J., M.S., May 2013, Psychology Impact of Religiosity on Coping with Intrusive Thoughts Director ofThesis: Brook A. Marcks Intrusive thoughts are unwanted, distressing thoughts that are experienced by the majority of individuals, and are one of the key features of obsessive-compulsive disorder (OCD). It is theorized that maladaptive beliefs about intrusive thoughts, such as thought- action fusion (TAF) beliefs, as well as the use of avoidant coping strategies, such as thought suppression, in response to intrusive thoughts may cause them to escalate into obsessions. Religiosity may be another factor that influences the way an individual responds to intrusive thoughts. Previous studies have found that religiosity is related to TAF and the tendency to suppress unwanted thoughts. However, it is unclear whether religiosity impacts the effectiveness of thought suppression. Therefore, the purpose of this study was to compare the effects of different coping strategies (thought suppression, acceptance-based approach, and monitor-only control) to manage an intrusive thought on distress and thought frequency, while also taking into consideration levels of religiosity. This study also aimed to test a model in which the relationship between TAF beliefs, thought suppression, and OC symptoms is moderated by religiosity. The results suggest that religiosity does not account for a significant amount of the variance in intrusive thought frequency, anxiety, negative appraisals, or changes in intrusive thought frequency and anxiety over time. Religiosity was also not found to moderate the relationship between TAF beliefs, thought suppression, and OC symptoms. Limitations 4 of the experimental manipulation make interpreting the results from the experimental portion difficult. However, additional exploratory analyses provided evidence showing that thought suppression is related to increased intrusions, higher levels of anxiety, and negative appraisal ratings. The limitations of the current study and directions for future research are discussed. 5 Table of Contents Page Abstract ............................................................................................................................... 3 List of Tables ...................................................................................................................... 7 Introduction ......................................................................................................................... 8 Intrusive Thoughts .......................................................................................................... 9 Coping Strategies .......................................................................................................... 10 Cognitive-Behavioral Model of Obsessive-Compulsive Disorder ............................... 15 Scrupulosity .................................................................................................................. 18 Current Study ................................................................................................................ 21 Hypotheses .................................................................................................................... 22 Method .............................................................................................................................. 25 Participants .................................................................................................................... 25 Materials ....................................................................................................................... 26 Procedure ...................................................................................................................... 34 Results ............................................................................................................................... 39 Thought-Action Fusion Induction Check ..................................................................... 39 Experimental Manipulation Check ............................................................................... 39 Experimental Hypotheses ............................................................................................. 40 Exploratory Analyses .................................................................................................... 47 Discussion ......................................................................................................................... 50 References ......................................................................................................................... 64 Appendix A: Demographics Questionnaire ...................................................................... 92 Appendix B: SCSRFQ ...................................................................................................... 94 Appendix C: DRI .............................................................................................................. 95 Appendix D: TAFS ........................................................................................................... 97 Appendix E: WBSI ........................................................................................................... 98 Appendix F: AAQ-II ......................................................................................................... 99 Appendix G: PI-WSUR .................................................................................................. 100 Appendix H: PIOS .......................................................................................................... 102 Appendix I: PANAS ....................................................................................................... 103 6 Appendix J: Appraisal Ratings ....................................................................................... 104 Appendix K: Intrusive Thought Induction Check .......................................................... 105 Appendix L: Coping Strategy Manipulation Check ....................................................... 106 Appendix M: Selection of Target Individual Form ........................................................ 107 Appendix N: Sentence Copy Form ................................................................................. 108 7 List of Tables Page Table 1: Descriptive Statistics for Demographic Variables by Group ...........................83 Table 2: Percentages of Participants’ Religious Affiliation by Group…………………84 Table 3: Descriptive Statistics for Religiosity Measures ................................................85 Table 4: Descriptive Statistics for Coping Strategy Affect Measures ............................86 Table 5: Descriptive Statistics for OC Related Beliefs and Symptoms Measures .........87 Table 6: Descriptive Statistics for TAF Induction Check and Appraisal Ratings…….. 88 Table 7: Descriptive Statistics for Appraisal Ratings Across Time Periods 1 and 2 By Group ..................................................................................................................89 Table 8: Hierarchical Multiple Regression Analysis for the Interactions of Religiosity and OC Beliefs in Predicting Obsessive-Compulsive Symptoms .............................90 Table 9: Unique Predictor of OC Experiences: Effort Suppressing Intrusive Thought .91 8 Introduction Intrusive thoughts play an important role in the development and maintenance of a number of psychological disorders (Ladouceur et al., 2000). Repetitive and persistent thoughts, images, and/or impulses are included in the definition of obsessive-compulsive disorder (OCD) (American Psychiatric Association, 2000). Indeed, beliefs about, appraisals of, and strategies used to cope with such thoughts are hypothesized to be involved in the escalation of intrusive thoughts into obsessions in OCD (Clark & Purdon, 1993; Ehlers & Steil, 1995; Freeston & Ladouceur, 1993; Rachman 1997; Salkovskis, 1985). Religion may also be a factor in the development of the disorder, in that individuals higher in religiosity may have more negative beliefs about intrusive thoughts, due to religious doctrine, and may in turn use thought suppression more often (Abramowitz, Deacon, Woods, & Tolin, 2004; Yorulmaz, Gençöz, & Woody, 2009). This may explain why some individuals with OCD experience religiously themed obsessions and compulsions, which is a presentation of the disorder called 'scrupulosity' (Abramowitz, Huppert, Cohen, Tolin, & Cahill, 2002; Fallon et al., 1990; Miller & Hedges, 2008). Indeed, research suggests that individuals who are devoutly religious and suffer from OCD report more religious obsessions and compulsions than other OCD symptoms (Steketee, Quay, & White, 1991). Other researchers have found that in individuals with OCD, their specific cultural and religious behaviors are often a part of their symptoms (Okasha, Saad, Khalil,