Reduced fear‐of‐self is associated with improvement in concerns related to repugnant obsessions in obsessive–compulsive disorder

Abstract

Objective. The potential causal and maintaining role of vulnerable self-themes and beliefs about the self in obsessive-compulsive disorder (OCD) have received increasing attention from cognitive-behavioural theorists. This interest was translated into the development of a self-report measurement of the feared self (the fear of who one might be or become), a construct theoretically and empirically pertinent to unwanted thoughts and impulses in OCD (i.e., repugnant obsessions).Method. The current study aimed to provide converging evidence on the relevance of the feared self in OCD, by examining whether improvements in symptoms associated with repugnant obsessions (measured on the Vancouver Obsessional Compulsive Inventory [VOCI] obsessions subscale) would be predicted by reduced feared selfperceptions (measured on the Fear-of-Self Questionnaire [FSQ]) in a sample of 93 patients receiving psychotherapy for OCD.Results. Using a series of hierarchical linear regression models, we found that treatment-related reductions on the FSQ significantly and uniquely predicted reductions on the VOCI obsessions subscale and the contamination subscale.Conclusions. The current study thus replicated previous research suggesting the relevance of the feared possible self in psychological disorders such as OCD, where negative self-perception is a dominant theme. Practitioner pointsCurrent results suggest that changes in feared self-perceptions may be the mechanism through which OCD symptoms improve via therapy.

What is the relationship between fear of self, self‐ambivalence, and obsessive–compulsive symptomatology? A systematic literature review

“…In summary, there is strong evidence that both fear of self and self-ambivalence are significant predictors of OCD symptomatology in general. This was a consistent finding across all but one (Aardema et al, 2018) of the studies included for review. This study looked at change in symptoms before and after treatment.…”

“…The evidence supporting the ability of self-ambivalence to predict obsessional thoughts was more varied. Of the two papers investigating this, one paper showed a strong significant predictive effect (Aardema et al, 2013) and another, by the same first author (Aardema et al, 2018) As the MA subscale of the SAM was found to be a significant predictor of importance of thoughts and responsibility, but not contamination , it would be interesting for future research to assess the extent to which this concept could predict mental contamination, as opposed to the physical contamination fears that are perhaps better represented by the VOCI subscale. The contamination subscale on the VOCI has items such as "I am excessively concerned about germs or disease" and "I feel very contaminated if I touch an animal," which may be less relevant to those people who experience mental contamination.…”

“…Ten of the 11 studies utilized a cross-sectional research design. The other (Aardema, Wong, Audet, Melli, & Baraby, 2018) utilized a longitudinal, within-participants design, assessing the same participants before and after treatment to look at changes in symptoms and fear of self-beliefs within participants.…”

“…This was a strength of these studies as it allowed for comparisons and examination of the relationship between self-doubt beliefs and OCD across the spectrum of symptom severity. One study would have benefitted from further clarity around participant selection (Aardema et al, 2018) as it was not clear from the write up whether the same participants had been used in previous research (Aardema, Doron, et al, 2017), as both papers appeared to recruit from the same source. This paper was therefore marked down on this criterion as sample selection was deemed to not be reported in sufficient detail.…”

“…Only one of the 11 studies (Aardema et al, 2018) looked specifically at the ability of the FSQ and SAM to predict contamination fears.…”