چرا خرس سفید بازگشت؟ علائم وسواس و خصیصه هایی برای سرکوب افکار ناموفق

The current study examined the nature and consequences of attributions about unsuccessful thought suppression. Undergraduate students with either high (n=67) or low (n=59) levels of obsessive–compulsive symptoms rated attributions to explain their unsuccessful thought suppression attempts. We expected that self-blaming attributions and attributions ascribing importance to unwanted thoughts would predict more distress and greater recurrence of thoughts during time spent monitoring or suppressing unwanted thoughts. Further, we expected that these attributions would mediate the relationship between obsessive–compulsive symptom levels and the negative thought suppression outcomes (distress and thought recurrence). Structural equation models largely confirmed the hypotheses, suggesting that attributions may be an important factor in explaining the consequences of thought suppression. Implications are discussed for cognitive theories of obsessive–compulsive disorder and thought suppression.

Current cognitive–behavioral theories of obsessive–compulsive disorder (OCD) suggest that obsessions arise from misinterpretations of the importance and personal significance of unwanted thoughts (Rachman, 1997; Salkovskis, 1998). The majority of the population experiences unwanted thoughts and images occasionally (i.e., thoughts of driving a car off the road or dropping one's baby), but dismisses these thoughts as being harmless anomalies (Rachman & de Silva, 1978). However, individuals at risk for developing OCD are believed to resist unwanted thoughts strongly, yet paradoxically find getting rid of these thoughts nearly impossible (Rachman & de Silva, 1978). Understandably, this experience can be distressing, and people make different attributions to explain why the thought returned. Some people may make benign attributions (“I’m just tired today”), while others make more negative attributions (“This thought must have special significance since it keeps returning!”). The current study investigated attributions that individuals at risk for OCD make about their unsuccessful attempts to resist unwanted thoughts, based on the hypothesis that certain negative attributions would predict distress and the recurrence of intrusive thoughts. Among the strategies people employ to resist unwanted thoughts, ‘thought suppression’ has received substantial attention in the literature (Wenzlaff & Wegner, 2000). During thought suppression, persons attempting to suppress thoughts sometimes ironically end up thinking more about those thoughts, particularly when encountering other simultaneous cognitive demands (for a review, see Wenzlaff & Wegner, 2000). Notably, individuals with OCD attempt thought suppression more frequently than non-anxious individuals do (Amir, Cashman, & Foa, 1997) and as a result may be more vulnerable to the unintended increases in frequency of unwanted thoughts and accompanying distress. Consistent with these suggestions, cognitive–behavioral theories of OCD have hypothesized that thought suppression is likely to be a frequently used—but maladaptive—approach, which contributes to the etiology and maintenance of the disorder (Rachman (1997) and Rachman (1998); Salkovskis (1985), Salkovskis (1989) and Salkovskis (1998)). Recently, several researchers have explored how thought suppression might have maladaptive effects in OCD (Purdon, 2004; Tolin, Abramowitz, Hamlin, Foa, & Synodi, 2002). They have proposed that the recurrence of unwanted thoughts despite suppression efforts could serve to enhance negative attributions (i.e., “This thought kept returning despite my suppression attempts; therefore, it must have been important.”) This approach contends that the return of a thought is not necessarily a problem by itself, but can become harmful due to the attributions individuals make. Therefore, certain attributions for unsuccessful suppression attempts are believed to enhance distress, obsessive beliefs and suppression effort. This proposal offers a plausible mechanism to explain why the findings for recurrence of thoughts after suppression are so divergent across studies and across suppression attempts by the same individual. In an innovative series of studies, Purdon and her colleagues examined interpretations1 of thought recurrences after suppression attempts (Markowitz & Purdon, 2004, as cited in Purdon (2001) and Purdon (2004); Purdon, Rowa, & Antony, 2005). They found that for both non-clinical participants (Purdon, 2001) and participants with OCD (Purdon et al., 2005) interpretations were important predictors of distress. Specifically, participants who endorsed interpretations that thought recurrences demonstrated undesirable personal characteristics or predicted future negative events reported more discomfort than those who did not report such interpretations. Moreover, Belloch, Morillo, and Gimenez (2004) and Markowitz and Purdon (2004, as cited in Purdon, 2004) have also found higher discomfort following negative interpretations of thought recurrences after suppression attempts. Taken together, these findings suggest that interpretations about suppression attempts can have serious consequences for distress after thought recurrences. The current study built on this exciting earlier work by focusing on attributions for unsuccessful thought suppression. Attributions are important to study because the perceived reason why a thought recurred (i.e., the attribution) may have additional consequences beyond those of the meaning given to a recurring thought (i.e., the interpretation). For example, a thought interpreted as signifying personal immorality may be downplayed if a person attributes its return as being due to an external factor (e.g., “My friend was just talking about that topic, no wonder the thought returned.”). We investigated three factors that we believe are important for understanding the attributions individuals make for unsuccessful thought suppression, and the emotional and cognitive consequences that follow these attributions. First, we examined whether the type of attributions made for unsuccessful thought suppression explains differences between individuals high versus low in OCD symptoms in their reactions to unwanted thoughts. Second, we evaluated whether the type of thought that is the target of suppression influences the type of attributions that are made. Finally, we tested whether the thought suppression instructions individuals receive (i.e., either to suppress or to monitor their thoughts) affect the attributions they make. Attributions may help explain why people with high levels of OCD symptoms have difficulties with the return of unwanted thoughts (Purdon, 2004). Purdon and Clark (1999) suggest that people with OCD symptoms may attribute unsuccessful control attempts to undesirable personality characteristics or threatening qualities of the thought, and Tolin et al. (2002) found that individuals with OCD endorsed relatively more internal (but not external) attributions after suppression when compared with non-anxious participants. Further, Purdon and others suggest that these attributions can lead to worsened mood and further preoccupation with thoughts, strengthening OCD symptoms and reinforcing the original attributions. Following these suggestions, the current study tests the role of attributions as a mediator of the relationship between level of OCD symptoms and future reactions to unwanted thoughts. We expected that participants with high levels of OCD symptoms would endorse more internal attributions and attributions ascribing importance to their thoughts, and that these attributions would help explain why these participants have increased distress and recurrence of unwanted thoughts. To enhance the generalizability of the study, we also wanted to pay special attention to the type of thought used with thought suppression. Previous studies have employed different types of thoughts (e.g., thinking of a white bear versus an ‘obsessional’ thought) to investigate how attributions relate to thought suppression. Results from these studies are complicated and suggest that the nature of the thought may influence the attributions that follow suppression attempts and their consequences (see Abramowitz, Tolin, & Street, 2001). Given the possibility that type of thought may be relevant to the attributions made following unsuccessful thought suppression, we included four types of thoughts differing in their negative valence, perceived immorality and personal relevance to participants. To adapt existing thought suppression methods for multiple thoughts, we introduced a novel thought-recording methodology that would not confine us to examining only one type of thought at a time. This study was the first we are aware of to use a suppression paradigm where multiple thoughts were to be suppressed and recorded simultaneously. Our examination of mean differences in attributions made after the different types of thoughts was somewhat exploratory. However, we hypothesized that the relationship between attributions and distress/recurrence of thoughts would be comparable across the different types of thoughts (e.g., a self-blaming attribution would predict distress regardless of the type of thought). An additional methodological challenge in the thought suppression literature concerns the comparison of suppression and control instructions. In particular, there tends to be a high degree of spontaneous active suppression in control groups that is nearly impossible to control in a laboratory setting (Purdon & Clark (2000) and Purdon & Clark (2001)); even researchers using explicit ‘do not suppress’ instructions have found that many participants suppress anyway. Therefore, we anticipated that the monitoring group would engage in some suppression attempts, so we compared monitoring instructions with traditional suppression instructions to see whether the type of instruction leads to different types of attributions. Like the hypotheses for thought type outlined above, we expected that the relationship between attributions and distress/recurrence of thoughts would be comparable across instructions. However, it seemed plausible that, at the mean level, individuals given suppression instructions may more easily attribute unsuccessful suppression to external factors (“I wasn’t directing this effort so it was someone else's fault that the thought came back.”). In contrast, people who initiate suppression by their own volition (i.e., the monitoring condition) may be more likely to endorse internal attributions. The current study tested the nature and consequences of attributions about unsuccessful thought suppression on subsequent distress and thought recurrence. To the best of our knowledge, this was the first study to explore the possible associations between type of attribution and future suppression outcomes, and to explore these associations following different types of unwanted thoughts. Participants high and low in OCD symptoms were randomly assigned to suppress or monitor four types of unwanted thoughts, and then indicate whether or not they had experienced any difficulty controlling the four different thoughts during the period. If they endorsed difficulty, participants then rated various attributions to explain why they were unable to keep that particular thought out of mind. To measure the consequences of these attributions, participants rated distress and recurrence of thoughts following both an initial suppression or monitoring period and again following a subsequent monitoring period. Our central hypothesis was that individuals who made self-blaming attributions or attributions ascribing importance to their unwanted thoughts would show more distress and greater thought recurrence when compared with individuals who did not endorse these attributions. Further, we expected that these self-blaming and importance attributions would mediate the relationship between OCD symptom level and the distress and thought recurrence outcomes. In contrast, given that previous research has shown that external (“The task was silly.”) and normative (“Thoughts aren’t controllable.”) attributions do not differ between people with OCD and non-anxious participants (Tolin et al., 2002), we did not expect these attributions to predict the distress and thought recurrence outcomes or to act as mediators. Finally, across the different types of to-be-suppressed thoughts and thought suppression instructions, we hypothesized that, while attributions might show mean differences, they would consistently predict distress and thought

Means and standard deviations for the measures of OCD symptoms and beliefs, depression and attributions for unsuccessful thought suppression are listed in Table 1. As expected, 2 (OCD group: high, low)×2 (instructions: suppression, monitoring) analyses of variance (ANOVAs) showed that the group with high OCD symptoms reported significantly more obsessive beliefs on the OBQ (F(1,122)=57.25, p<.001) and depressive symptoms on the BDI (F(1,122)=39.06, p<.001) than did the group with low OCD symptoms. The monitoring and suppression instruction groups did not differ on the OBQ (F(1,122)=1.37, p>.10) or BDI (F(1,122)=2.34, p>.10), indicating that randomization was successful. χ2 tests indicated that there were no differences between the OCD symptom groups for gender (χ2(1,n=126)=3.47, p=.063) or ethnicity (χ2(4,n=120)=1.62, p>.10), and no differences between the instruction groups for gender (χ2(1,n=126)=.03, p>.10) or ethnicity (χ2(4,n=120)=4.69, p>.10).