Symptom-Specific Threat Perception Mediates the Relationship Between Obsessive Beliefs and OCD Symptoms

  • Noah Chase BermanEmail author
  • Hilary Weingarden
  • Sabine Wilhelm
Brief Report


Cognitive theories of obsessive compulsive disorder (OCD) propose that obsessive beliefs bias individuals’ perception of OC-relevant threats, which in turn maintain OCD symptoms. However, no prior research has directly tested this mediational model in a clinical sample. The current study bridges this gap in the literature. Sixty adults with OCD completed a diagnostic interview, self-report questionnaires and a threat perception task. More specifically, participants rated the perceived threat associated with (a) OC-specific stimuli (e.g., toilet) that matched their most interfering symptom dimension (e.g., contamination) and (b) generally negative terms (e.g., pain). Results supported hypotheses, in that the threat associated with OC-specific—but not generally negative—terms significantly mediated the relationship between obsessive beliefs and the severity of participants’ most interfering OCD symptom dimension. Findings underscore the importance of targeting inflated perceptions of OC-specific threats in the treatment of OCD. Limitations and future directions are discussed.


Cognitive model OCD Threat perception Obsessive beliefs 



This study was funded by the Kaplen Fellowship on Depression at Harvard Medical School, the Charles A. King Postdoctoral Fellowship (Harold Whitworth Pierce Charitable Trust) and the David Judah Fund.

Compliance with Ethical Standards

Conflict of interest

Drs. Berman, Weingarden and Wilhelm declare that they have no conflict of interest.

Ethical Approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Animal Rights

No animal studies were carried out by the authors for this article.


  1. Abramowitz, J. S., Deacon, B. J., Olatunji, B. O., Wheaton, M. G., Berman, N. C., Losardo, D., … Hale, L. R. (2010). Assessment of obsessive-compulsive symptom dimensions: Development and evaluation of the Dimensional Obsessive-Compulsive Scale. Psychological Assessment, 22, 180–198. Scholar
  2. Abramowitz, J. S., Fabricant, L. E., Taylor, S., Deacon, B. J., McKay, D., & Storch, E. A. (2014). The relevance of analogue studies for understanding obsessions and compulsions. Clinical Psychology Review, 34, 206–217. Scholar
  3. Alcolado, G. M., & Radomsky, A. S. (2011). Believe in yourself: Manipulating beliefs about memory causes checking. Behaviour Research and Therapy, 49, 42–49.CrossRefGoogle Scholar
  4. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Association.CrossRefGoogle Scholar
  5. Angst, J., Gamma, A., Endrass, J., Goodwin, R., Ajdacic, V., Eich, D., & Rössler, W. (2004). Obsessive-compulsive severity spectrum in the community: Prevalence, comorbidity, and course. European Archives of Psychiatry and Clinical Neuroscience, 254, 156–164.Google Scholar
  6. Beck, A. T., & Haigh, E. A. (2014). Advances in cognitive theory and therapy: The generic cognitive model. Annual Review of Clinical Psychology, 10, 1–24.CrossRefGoogle Scholar
  7. Berman, N. C., Fang, A., Hansen, N., & Wilhelm, S. (2015). Cognitive-based therapy for OCD: Role of behavior experiments and exposure processes. Journal of Obsessive-Compulsive and Related Disorders, 6, 158–166. Scholar
  8. Berman, N. C., Wheaton, M. G., & Abramowitz, J. S. (2012). The “Arnold Schwarzenegger Effect”: Is strength of the “victim” related to misinterpretations of harm intrusions? Behaviour Research and Therapy, 50, 761–766.CrossRefGoogle Scholar
  9. Berman, N. C., Wheaton, M. G., Fabricant, L. E., Jacobson, S. R., & Abramowitz, J. S. (2011). The effects of familiarity on thought-action fusion. Behaviour Research and Therapy, 49, 695–699. Scholar
  10. Calkins, A. W., Berman, N. C., & Wilhelm, S. (2013). Recent advances in research on cognition and emotion in OCD: A review. Current Psychiatry Reports, 15, 357.CrossRefGoogle Scholar
  11. Clerkin, E. M., & Teachman, B. A. (2011). Training interpretation biases among individuals with symptoms of obsessive compulsive disorder. Journal of Behavior Therapy and Experimental Psychiatry, 42, 337–343. Scholar
  12. Eisen, J. L., Mancebo, M. A., Pinto, A., Coles, M. E., Pagano, M. E., Stout, R., & Rasmussen, S. A. (2006). Impact of obsessive-compulsive disorder on quality of life. Comprehensive Psychiatry, 47, 270–275. Scholar
  13. Goodman, W. K., Price, L. H., Rasmussen, S. A., Mazure, C., Delgado, P., Heninger, G. R., & Charney, D. S. (1989a). The Yale-Brown Obsessive Compulsive Scale. II. Validity. Archives of General Psychiatry, 46(11), 1012–1016.CrossRefGoogle Scholar
  14. Goodman, W. K., Price, L. H., Rasmussen, S. A., Mazure, C., Fleischmann, R. L., Hill, C. L., … Charney, D. S. (1989b). The Yale-Brown Obsessive Compulsive Scale. I. Development, use, and reliability. Archives of General Psychiatry, 46(11), 1006–1011.CrossRefGoogle Scholar
  15. Harris, P. A., Taylor, R., Thielke, R., Payne, J., Gonzalez, N. L., & Conde, J. G. (2009). Research electronic data capture (REDCap): A metadata-driven methodology and workflow process for providing translational research informatics support. Journal of Biomedical Informatics, 42(2), 377–381. Scholar
  16. IBM Corp. (2016). IBM SPSS Statistics for Windows, Version 24.0. Armonk. New York: IBM Corp.Google Scholar
  17. Lavy, E. H., van Oppen, P., & van den Hout, M. A. (1994). Selective processing of emotional information in obsessive compulsive disorder. Behaviour Research and Therapy, 32, 243–246. Scholar
  18. Lecrubier, Y., Sheehan, D. V., Weiller, E., Amorim, P., Bonora, I., Harnett Sheehan, K., … Dunbar, G. C. (1997). The mini international neuropsychiatric interview (MINI). A short diagnostic structured interview: Reliability and validity according to the CIDI. European Psychiatry, 12(5), 224–231.CrossRefGoogle Scholar
  19. Mataix-Cols, D., Rosario-Campos, M. C., & Leckman, J. F. (2005). A multidimensional model of obsessive-compulsive disorder. American Journal of Psychiatry, 162, 228–238. Scholar
  20. Obsessive Compulsive Cognitions Working Group. (2005). Psychometric validation of the obsessive belief questionnaire and interpretation of intrusions inventory–Part 2: Factor analyses and testing of a brief version. Behavior Research and Therapy, 43(11), 1527–1542.CrossRefGoogle Scholar
  21. Preacher, K. J., & Hayes, A. F. (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods, 40(3), 879–891.CrossRefGoogle Scholar
  22. Rachman, S. (1997). A cognitive theory of obsessions. Behaviour Research and Therapy, 35, 793–802.CrossRefGoogle Scholar
  23. Rachman, S., & de Silva, P. (1978). Abnormal and normal obsessions. Behaviour Research and Therapy, 16, 233–248.CrossRefGoogle Scholar
  24. Ruscio, A. M., Stein, D. J., Chiu, W. T., & Kessler, R. C. (2010). The epidemiology of obsessive-compulsive disorder in the National Comorbidity Survey Replication. Molecular Psychiatry, 15, 53–63. Scholar
  25. Rush, A. J., Trivedi, M. H., Ibrahim, H. M., Carmody, T. J., Arnow, B., Klein, D. N., … Keller, M. B. (2003). The 16-Item quick inventory of depressive symptomatology (QIDS), clinician rating (QIDS-C), and self-report (QIDS-SR): A psychometric evaluation in patients with chronic major depression. Biological Psychiatry, 54(5), 573–583.CrossRefGoogle Scholar
  26. Salkovskis, P. M. (1985). Obsessional-compulsive problems: A cognitive-behavioural analysis. Behaviour Research and Therapy, 23, 571–583. Scholar
  27. Sheehan, D. V., Lecrubier, Y., Sheehan, K. H., Amorim, P., Janavs, J., Weiller, E., … Dunbar, G. C. (1998). The mini-international neuropsychiatric interview (M.I.N.I.): The development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry, 59(Suppl 20), 22–33.Google Scholar
  28. Sica, C., Coradeschi, D., Sanavio, E., Dorz, S., Manchisi, D., & Novara, C. (2004). A study of the psychometric properties of the obsessive beliefs inventory and interpretations of intrusions inventory on clinical italian individuals. Journal of Anxiety Disorders, 18, 291–307. Scholar
  29. Tata, P. R., Leibowitz, J. A., Prunty, M. J., Cameron, M., & Pickering, A. (1996). Attentional bias in obsessional compulsive disorder. Behaviour Research and Therapy, 34, 53–60. Scholar
  30. Taylor, S., Coles, M. E., Abramowitz, J. S., Wu, K. D., Olatunji, B. O., Timpano, K. R., … Tolin, D. F. (2010). How are dysfunctional beliefs related to obsessive-compulsive symptoms? Journal of Cognitive Psychotherapy, 24, 165–176.CrossRefGoogle Scholar
  31. Tolin, D. F., Woods, C. M., & Abramowitz, J. S. (2003). Relationship between obsessive beliefs and obsessive-compulsive symptoms. Cognitive Therapy and Research, 27, 657–669.CrossRefGoogle Scholar
  32. Trivedi, M., Rush, A. J., Ibrahim, H. M., Carmody, T. J., Biggs, M. M., Suppes, T., … Kashner, T. M. (2004). The inventory of depressive symptomatology, clinician rating (IDS-C) and self-report (IDS-SR), and the quick inventory of depressive symptomatology, clinician rating (QIDS-C) and self-report (QIDS-SR) in public sector patients with mood disorders: A psychometric evaluation. Psychological Medicine, 34(1), 73–82.CrossRefGoogle Scholar
  33. Wheaton, M. G., Abramowitz, J. S., Berman, N. C., Reimann, B. C., & Hale, L. R. (2010). The relationship between obsessive beliefs and symptom dimensions in obsessive-compulsive disorder. Behaviour Research and Therapy, 48, 949–954.CrossRefGoogle Scholar
  34. Wilhelm, S., Berman, N. C., Keshaviah, A., Schwartz, R. A., & Steketee, G. (2015). Mechanisms of change in cognitive therapy for obsessive compulsive disorder: Role of maladaptive beliefs and schemas. Behaviour Research and Therapy, 65, 5–10.CrossRefGoogle Scholar
  35. Williams, A. D., & Grisham, J. R. (2013). Cognitive bias modification (CBM) of obsessive compulsive beliefs. BMC Psychiatry, 13, 256. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Noah Chase Berman
    • 1
    • 2
    Email author
  • Hilary Weingarden
    • 1
  • Sabine Wilhelm
    • 1
  1. 1.Department of PsychiatryMassachusetts General Hospital/Harvard Medical SchoolBostonUSA
  2. 2.Psychology DepartmentCollege of the Holy CrossWorcesterUSA

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