تفاوت ها و شباهت بین افکار مزاحم وسواسی در یک جمعیت غیر بالینی نگران: مطالعه 2

Differences between obsessions and worry have been clearly demonstrated on several variables [Langlois, F., Freeston, M. H., & Ladouceur, R. (2000). Differences and similarities between obsessive intrusive thoughts and worry in a non-clinical population: study 1. Behaviour Research and Therapy, 38, 157–173.]. Previous factor analysis of obsessions or worries have typically been used in developing measures for OCD and GAD symptoms. These studies generally support the distinctiveness of obsessions and worries but there have been no direct comparisons of the factor structure of obsession and worry on the same measure. This study aimed to compare the general structure of worry and obsessional intrusions. It also attempted to identify the relations between the respective factors identified in the appraisals of intrusions and the factor structures of coping strategies used in reaction to the thoughts. 254 students participated in the study. They first identified an obsession-like intrusion and a worry and then evaluated them with the Cognitive Intrusion Questionnaire. Different factor structures were obtained for worry and obsessive intrusive thoughts. However, the factor structure for the strategies used to counter the thoughts were highly similar for both types of thought. Furthermore, regression analysis identified interesting relationships between the strategies, the thought characteristics and appraisal. Thus, despite the ability to find differences between obsessive intrusive thoughts and worry, and even to accurately categorize them based on these differences, there may in fact exist common processes that are shared over much of a continuum. Sharp differences in the processes involved may only become clear in prototypical cases. The implications for models of cognitive intrusion are discussed.

Despite recent changes in the anxiety disorders in the DSM-IV (American Psychiatric Association, 1994), clinicians may be faced with an ambiguous situation where they have to make a differential diagnosis between Obsessive–Compulsive Disorder (OCD) when no overt compulsions are present and Generalized Anxiety Disorder (GAD). According to the literature, the belief system associated with the disorders may be an important distinction (Turner, Beidel & Stanley, 1992). However, in many cases, we cannot dichotomize obsessions and worry on this feature alone. Some obsessions can be reality based, for example fear of a house catching fire. Along the same lines, negative outcomes in worry may be associated to realistic events but overestimated in terms of probability (Borkovec, Robinson, Pruzinsky & DePree, 1983). Even though the DSM-IV states that obsessions do not concern worry about life circumstances, it is sometimes difficult, from a clinical point of view, to evaluate to what extent an intrusion has a basis in reality. Unfortunately, this is the principal distinction between obsession and worry proposed in the DSM-IV. These disorders are relatively easy to distinguish when overt compulsions are clearly present (Brown, Moras, Zinbarg & Barlow, 1993). Tallis and de Silva (1992) proposed that worry and obsessional symptoms can both occur in response to stress. Based on correlations between measures of worry and obsessive–compulsive symptoms, they suggested that worry and checking are functionally similar. They further proposed that Generalised Anxiety Disorder may represent a cognitive variant of obsessional checking. However, few studies have investigated the overlap and distinctions between obsession and worry. The first part of this study tested the presence of differences between obsessional intrusions and worries on several variables (appraisal variables, general descriptors and emotional reaction) in a non-clinical population. Both types of thoughts were presented as belonging to a family of disturbing thoughts that can be experienced by everybody. Differences between obsessions and worry were clearly demonstrated on most variables (Langlois, Freeston & Ladouceur, 2000). It was also possible to classify worries and obsessional intrusions with some accuracy using a discriminant function. Previous factor analyses of obsessions or worries have typically been used in developing measures for OCD and GAD symptoms Hodgson & Rachman, 1977, Sanavio, 1988 and Meyer, Miller, Metzger & Borkovec, 1990. Some studies have tested whether the factor structure can distinguish OCD and GAD. These studies generally support the distinctiveness of obsessions and worries (Gross & Eifert, 1990; Tallis & de Silva, 1992; Brown et al., 1993 and Freeston et al., 1994). However, there have been no direct comparisons of the factor structure of obsession and worry on the same measure. Worry and obsessions are both recurrent, repetitive and unwanted thoughts. A study by Parkinson and Rachman (1981) demonstrated that the factor structures of different forms of intrusions (thoughts, images, impulsions) share some similarities but differ in other respects. The factor structure for intrusions experienced as images was different to the factor structure of intrusions experienced as thoughts. As obsessions are postulated to occur more often as images, and worries more often in a verbal form (thoughts), this study may support the hypothesis of distinct constructs. Analogue studies have demonstrated that subjects use a range of coping strategies with their intrusive thoughts. These strategies are differentially associated to the appraisal of thoughts (Freeston, Ladouceur, Thibodeau & Gagnon, 1991; Freeston & Ladouceur, 1993). The choice of a strategy is not random; it is also determined by personal rules associated with discriminant stimuli (Freeston, Ladouceur, Provencher & Blais, 1995). Freeston et al. (1991) demonstrated that the use of strategies such as attentive thinking and escape/avoidance were associated with greater anxiety and more difficulty dismissing the intrusion. The use of escape/avoidance strategies was more strongly associated with sadness, worry, guilt and disapproval than non-effortful strategies (e.g. saying that the thought means nothing). Other variables may intervene in the choice of a coping strategy. In another study, probability of occurrence of the outcome and disapproval of the thought influenced the choice of strategy used (Freeston & Ladouceur, 1993). Situations that involve high disapproval and low probability were associated with escape/avoidance strategies, whereas high probability and low disapproval were associated with attentive thinking strategies. Thoughts with high disapproval and low probability ratings seem typical of obsessions, whereas low disapproval and high probability are more characteristic of worries. These results support the link between egodystonic obsessional intrusions and the escape/avoidance behaviors that were more frequently used with them. They also support the link between the egosyntonic nature of some thoughts and attention thinking strategies; a process that may resemble worry. The idea that obsessive thoughts and `morbid preoccupations' may be distinguished in terms of their egodystonic versus egosyntonic character was first proposed over 25 years ago by Rachman (1973). His description of morbid preoccupation that are ego-syntonic in nature and are more related to everyday events resembles more recent accounts of worry. Therefore, it seems important to test whether the egodystonic/egosyntonic dimension is central to the distinction of obsessional intrusions and worries. The first part of this study adopted a univariate approach, examining differences on a large number of items (Langlois et al., 2000). This study adopts a dimensional approach to understanding the global structure of obsessional intrusion and worry. Models of intrusive thinking propose that the intrusion is maintained due to the appraisal made by subjects and their reaction following the appraisal. Thus, it is important to identify the relations between the respective factors identified in the appraisals of obsessional intrusions and worry, and the factor structures of coping strategies used in reaction to the thoughts.