ارزیابی و کنترل افکار مزاحم جنسی و غیر جنسی در دانشجویان دانشگاه
|کد مقاله||سال انتشار||تعداد صفحات مقاله انگلیسی||ترجمه فارسی|
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Publisher : Elsevier - Science Direct (الزویر - ساینس دایرکت)
Journal : Behaviour Research and Therapy, Volume 38, Issue 5, May 2000, Pages 439–455
This study examined differences in the appraisal and thought control strategies associated with the perceived control of unwanted sexual and non-sexual intrusive thoughts. Eleven appraisal dimensions, subjective physiological arousal and 10 thought control strategies were measured in 171 university students who were administered the Revised Obsessive Intrusions Inventory-Sex Version, a self-report measure of unwanted intrusive thoughts. Thought-action fusion (TAF) likelihood was a significant unique predictor of the perceived controllability of respondents' most upsetting sexual and non-sexual intrusive thought. Moreover greater subjective physiological arousal was a significant predictor of reduced control over sexual intrusions, whereas worry that one might act on an intrusive thought and greater effort to control the intrusion were significant unique predictors of the control of non-sexual intrusive thoughts. Various thought control strategies were more often used in response to non-sexual than sexual cognitions. The results are discussed in terms of the differential role of various appraisal processes in the control of unwanted sexual and non-sexual thoughts.
Unwanted intrusive thoughts were first defined by Rachman (1981) as repetitive thoughts, images or impulses that are unacceptable, uncontrollable, have an internal origin and interrupt ongoing activity. Although they occur naturally in the general population (Rachman & de Silva, 1978, Parkinson & Rachman, 1981, Salkovskis & Harrison, 1984 and Clark & de Silva, 1985; Freeston, Ladoucer, Thibodeau & Gagnon, 1991; Freeston & Ladouceur, 1993 and Purdon & Clark, 1993), cognitive intrusions with ego-dystonic content, such as thoughts of situations or actions that involve personally revolting acts of sex, aggression, harm, dirt, disease and contamination, have been of particular interest to researchers of obsessive–compulsive disorders (OCD) because of their similarity to the content of clinical obsessions. Two recent cognitive theories of obsessions, one proposed by Salkovskis, 1985, Salkovskis, 1989, Salkovskis, 1996 and Salkovskis, Richards, and Forrester, 1995 and the other by Rachman, 1997 and Rachman, 1998, assert that clinical obsessions have their origin in the normal unwanted intrusive thoughts found in the general population. What distinguishes the unwanted cognitive intrusions of the non-clinical person from the clinical obsessions of the individual suffering from OCD is the meaning or appraisal associated with the intrusion. However the cognitive theories of Salkovskis, Rachman and others differ in which appraisal processes they consider central to the pathogenesis of obsessions (Clark & Purdon, 1993, Salkovskis, 1996, Obsessive Compulsive Cognitions Working Group, 1997, Rachman, 1993 and Rachman, 1997). Salkovskis (1996), for example, considers two processes to be critical in the escalation of normal intrusions into clinical obsessions; (a) the interpretation of intrusive thoughts as an indication of responsibility for harm or its prevention toward self or others and (b) the subsequent effort to neutralize this inflated sense of responsibility through direct thought control strategies. Rachman, 1997 and Rachman, 1998 views the catastrophic misinterpretation of the personal significance of unwanted intrusive thoughts as the appraisal process most likely to cause an increase in the range and threatening nature of the intrusion. A specific process that can inflate the significance of an intrusion, referred to as thought-action fusion (TAF), is a cognitive bias involving an interpretation of the unwanted thought as morally or realistically equivalent to its behavioral manifestation (Rachman, 1993; Shafran, Thordarson & Rachman, 1996). Previously we have argued that appraisals about the importance of controlling an unwanted intrusion and the perceived consequences of failing to exercise complete thought control are critical in the development of persistent intrusive thoughts and obsessions Clark, 1989 and Clark & Purdon, 1993. The Obsessive Compulsive Cognitions Working Group (1997) have described a number of other beliefs and appraisals that may be important in distinguishing obsessions including overimportance, overestimation of threat, intolerance of uncertainty, perfectionism and fixity of beliefs. A number of empirical studies have examined the relationship between the appraisal of unwanted intrusive thoughts and their frequency. One of the most consistent findings to emerge from this literature is that the less control individuals believe they have over an intrusive thought, the more frequent it intrudes into consciousness Parkinson & Rachman, 1981, Salkovskis & Harrison, 1984, Clark & de Silva, 1985, Niler & Beck, 1989 and Purdon & Clark, 1994a. Other appraisal dimensions found to be associated with an increased frequency and/or uncontrollability of unwanted intrusions include emotional intensity, unpleasantness, disapproval, guilt, unacceptability, belief that the intrusive thought might be acted upon in real life (TAF-Likelihood), worry that the intrusive thought might be acted upon (TAF-Worry), responsibility and belief that the intrusion may indicate something meaningful about one's personality (Parkinson & Rachman, 1981, Salkovskis & Harrison, 1984, Clark & de Silva, 1985 and Niler & Beck, 1989; Freeston, Ladouceur, Thibodeau & Gagnon, 1992; Purdon & Clark, 1994a, Purdon & Clark, 1994b and Clark & Claybourn, 1997). The importance of appraisals in the frequency and controllability of intrusion has also been replicated in samples of OCD patients (see Rachman & de Silva, 1978 and Calamari & Janeck, 1996). Salkovskis, 1985, Salkovskis, 1989 and Salkovskis, 1996 also implicated thought control strategies in the escalation of normal intrusions into clinical obsessions. Attempts to neutralize the sense of inflated responsibility or the distress associated with the intrusion (Rachman, 1997 and Rachman, 1998) may inadvertently increase the salience and ultimately the frequency of the intrusion. A number of empirical studies have shown that certain thought control strategies, such as attentive focus on the intrusion, escape/avoidance, reassurance seeking and thought stopping, may be maladaptive approaches that lead to a significant increase in the frequency and emotional distress associated with the intrusion (Freeston et al., 1991, Freeston et al., 1992, Freeston & Ladouceur, 1993 and Purdon & Clark, 1994b). However Calamari & Janeck (1996) found no significant differences between OCD patients and non-clinical controls in whether they used `do nothing', `attentive thinking' or `escape/avoidance' in response to their unwanted intrusive thought or obsession. Overall, then, it is not clear what role thought control strategies play in the persistence and intensity of unwanted intrusive thoughts relative to the appraisal dimensions. One issue that has not been addressed in the literature on unwanted intrusive thoughts is whether the content of the thought might influence how it is appraised and the type of control response used to suppress the cognition. To date cognitive-clinical research on intrusive thoughts and obsessions have assumed non-specificity in the appraisal and control of intrusive thoughts regardless of their thematic content. In other words, it is assumed that the same appraisal processes and control strategies operate across diverse types of intrusive thoughts. However this assumption may not be tenable, especially when comparing ego-dystonic and ego-syntonic intrusive thoughts (Clark & Purdon, 1995). Recently Clark & Claybourn (1997) found that appraisals of personal significance uniquely predicted ego-dystonic intrusions, whereas a focus on the consequences of negative events and the intensity of one's distress were more characteristic of ego-syntonic intrusive thoughts. We also question whether the appraisal and control of intrusive thoughts dealing with unacceptable sexual themes may differ in important ways from the interpretation and control of non-sexual obsessive content dealing with aggression, dirt, disease and contamination. In a principal component analysis of the 13 symptom categories of the Yale-Brown Obsessive Compulsive Scale Symptom Checklist, Leckman et al. (1997) found that the aggressive, sexual and religious obsessions loaded together on the same factor and were distinct from symmetry, cleanliness and hoarding obsessions and compulsions. This suggests that distinct symptom dimensions may exist within OCD that could have different implications for the pathogenesis of the disorder (Leckman, 1998). At the very least these results indicate that sexual obsessions should be distinguished from dirt, contamination and disease obsessions. Not only may sexual obsessions and intrusive thoughts be distinct from other types of obsessions, but it is possible that individuals respond to this thought content differently than dirt, contamination, disease and aggression intrusions. For example, the symptoms of anxiety and of sexual arousal are very similar. If the emotional arousal associated with sexual intrusive thoughts is misinterpreted as a sign of sexual arousal rather than anxiety, this would reinforce individuals' concern that they might act on the thought, which might promote greater effort to suppress a sexual as opposed to a non-sexual intrusive thought. Second individuals have a longer history of having sexual fantasies that they then act upon than they do with intentional fantasies of dirt, contamination or aggression. If unwanted sexual intrusive thoughts are interpreted as closely linked to sexual fantasies, then individuals may have greater concerns that they will act on their sexual rather than non-sexual intrusions. Certainly the boundary between ego-syntonic and ego-dystonic sexual thoughts may be less distinct than with non-sexual obsessive-like intrusions. Gil (1990) found that 50% of a conservative Christian young adult sample rated their sexual fantasies as `morally flawed and unacceptable'. Child sexual abuse survivors report more sexual fantasies involving being forced to engage in sexual activity (Briere, Smiljanich & Henschel, 1994). In an initial paper based on a portion of the data set not included in the present article, Byers et al. (1998) found that men reported more unwanted, deviant sexual intrusive thoughts with aggressive themes and were more sexually aroused by these intrusions than were women. A more positive disposition towards sexuality and more frequent sexual daydreaming were associated with an increased frequency of unwanted sexual intrusive thoughts, although anxiety over sexuality was related to a more negative appraisal (i.e. guilt, disapproval, avoidance) of sexual intrusive thoughts. These findings, then, suggest that not all intrusions are the same and that unwanted intrusive thoughts of a sexual nature may be experienced differently from non-sexually related obsessive intrusions. The present study compared appraisal processes and control strategies used in response to individuals' most upsetting sexual and non-sexual intrusive thought. Three questions guided this research. Given the gender differences reported in our first analysis of the frequency of different types of unwanted sexual intrusive thoughts (Byers et al., 1998), do men and women differ in the appraisal and control of their most upsetting sexual and non-sexual intrusive thought? Are certain appraisal processes and control strategies uniquely characteristic of sexual versus non-sexual intrusive thoughts? Does a personality predisposition to respond positively to sexual cues influence how one appraises their sexual intrusive thoughts? Rachman (1998) has argued that the thought content that an individual finds most upsetting will be determined in part by what is most important in the individual's value system. It is unknown whether individuals who generally respond positively to sexual cues or those who have a more negative evaluative and affective response to sexual cues will be more or less upset by the intrusion of unacceptable, unwanted sexual thoughts and images.