The Impact of Mood-State and Emotion Regulation on Negative Appraisal and Neutralising Motivations in Obsessive-Compulsive Disorder

Abstract

Cognitive appraisal models propose that obsessive-compulsive disorder (OCD) develops as a consequence of dysfunctional beliefs which give rise to distress-provoking, negative appraisals of intrusive thoughts (ITs), subsequently promoting compulsive neutralising behaviour. Increased awareness of the processes, conditions and contexts under which OCD-relevant beliefs and appraisals may operate differentially is important in moving forward our understanding of the disorder and its treatment. Teasdale’s (1983) associative networks model of cognition implies that mood may represent a condition under which different types of dysfunctional beliefs and negative appraisals of intrusive thoughts vary in their salience and function. The current research comprised two empirical studies and one clinical case series analysis designed to investigate the impact of mood-state and emotion regulation skills on negative appraisal and neutralising activity in obsessive-compulsive disorder. Study 1 examined the impact of induced anxious, dysphoric and neutral mood-states on negative appraisals and neutralising motivations in response to an induced obsession-like thought. This analogue study utilised a non-clinical sample (N=120) and employed an obsession-like thought provocation protocol to generate an obsession-like experience. Results revealed mood-state-dependent patterns in participants’ appraisals of the obsession-like thought and their neutralising motivations. These findings suggest that the prominence of particular types of dysfunctional appraisals is differentially affected by specific mood-states, and that mood-state-dependent appraisal patterns appear to subsequently exert unique influences on individuals’ motivations for engaging in neutralising behaviour. The primary implication of these findings is that enhanced capacity to manage or regulate negative affect may attenuate the impact of mood-state on negative appraisal and neutralising activity in obsessive-compulsive disorder. Study 2 was a replication and extension of Study 1. Study 2 investigated the impact of emotion regulation skills training (ERST) on mood-state-dependent patterns in 198 adult participants' negative appraisals and neutralising motivations in response to an induced obsession-like thought. Results replicated Study 1 findings of mood-state-dependent patterns in participants’ appraisals of an obsession-like thought and their subsequent motivations for neutralising. Study 2 additionally found that enhanced emotion regulation skills translated to an attenuation of mood-state-dependent patterns in negative appraisal and neutralising motivations. These findings identify mood-state as an important pathogenic process which appears to intersect with cognitive processes in the development and maintenance of OCD. A key implication of these findings is that OCD sufferers may benefit from an incorporation of emotion regulation skills training within traditional cognitive-behavioural therapy. Study 3 was a case series analysis assessing the impact of the addition of a 6-session emotion regulation skills training (ERST) program into a traditional course of CBT for OCD for four OCD patients. ERST was inserted between different phases of therapy creating a multiple baseline design. Visual analyses revealed that ERST was associated with obsessive-compulsive symptom reduction and reductions in negative appraisals for three of the four participants, suggesting that ERST may represent a valuable augmentation to CBT for some OCD sufferers. There was evidence of covariation in participants’ negative mood-states and negative appraisals, however, relationships appeared more generalised in the clinical study compared with the specific relationships observed in the analogue studies.