Rationale for Current Study - Do Responsibility Beliefs Mediate the Relationship Between Attach

As previously discussed, various models have been proposed in order to account fo r the aetiology and psychopathology o f OCD. Despite the resulting advances made in ou r understanding o f OCD there remain several questions th a t have been poorly addressed. For example, how and w hy people w ith OCD develop the dysfunctional beliefs th a t m ight result in vulnerability to OCD? It has been proposed th a t an integration o f cognitive and

attachm ent th e o ry may be a helpful approach in order to address this question (Doron &

Kyrios, 2005)

From the theories and evidence reviewed in the present study th e re is evidence th a t responsibility appraisals are a key cognitive process th a t relate to OCD symptoms. W hat is not known is, o r there has been little evidence in the literature to suggest how, beliefs about inflated responsibility develop. Reviewing psychoanalytic th e o ry such as object relations theory, and more recent cognitive theory, such as Salkovskis and colleagues (1999) proposition o f several pathways to responsibility, it seems th a t a tte n tio n is turning tow ards relationships and particularly early relationships as crucial in understanding the developm ent o f beliefs th a t may influence OCD.

There is debate as to the extent to which attachm ent style is stable th ro u g h o u t the lifespan and some o f the studies reviewed found evidence those measures o f parental relationships and measures o f adult rom antic relationships do not correlate highly, suggesting th a t they may well be tapping into d iffe re n t aspects o f attachm ent as a construct. The present study seeks to replicate and extend the w ork o f Doron e t al. (2009) and Tim pano et al. (2010) and examine w h e th e r current attachm ent style in close adult relationships relates to responsibility beliefs and OCD symptoms. The novel aspect o f the current study is th a t a measure o f perceived parenting, to capture the perceptions o f care and overprotectio n, w ill be used and also examined to see how this may relate to responsibility and obsessive compulsive symptoms. As in Doron et al.'s (2009) study, it is also suggested th a t th e role o f responsibility beliefs may mediate the relationship between current a ttachm ent style/perceived parental relationship and OCD symptoms.

8. Hypotheses

It was hypothesised that:

1) Obsessive compulsive symptoms w ill be significantly associated w ith anxious

2) Obsessive com pulsive sym ptom s w ill be significantly associated w ith re sp o n sib ility/th re a t beliefs

3) R esponsibility/threat beliefs w ill be significantly associated w ith anxious attachm ent, avoidant attachm ent, low er levels o f perceived parental care and higher levels o f perceived parental overprotection.

4) R esponsibility/threat beliefs w ill m ediate th e relationship betw een: (i) anxious attachm ent, avoidant attachm ent, perceived parental care and perceived parental o verprotectio n, and (ii) Obsessive compulsive symptoms. This w ill remain tru e w hen controlling fo r current sym ptom s o f depression and anxiety.

METHOD

Participants

Participants fo r the present study w ere recruited from a population o f undergraduate and postgraduate students in the Faculty o f Arts and Human Sciences at university in the south o f England. 2863 potential participants w ere invited to participate in th e study via em ail, o f which 379 (13.24%) to o k part. O f this num ber 156 (41%) were excluded due to non

com pletion o f the full battery o f questionnaires. The to ta l sample size used in the analyses was 223, a response rate o f 7.81% fro m potential participants.

In the tw o previous sim ilar studies (Doron e t al. 2009; Tim pano e t al. 2010) large sample sizes were obtained through recruiting students, using an online m ode o f data collection.

This re cru itm e n t strategy has dem onstrated large sample sizes can be obtained and as such, a higher pow er level was adopted in the present study. An a p rio ri pow er calculation using the th ird version o f G *Pow er suggested th a t a sample size o f 191 w ou ld provide acceptable pow er (0.95) w ith alpha set at 0.5 fo r a m u ltiple regression analysis w ith fo u r p redictor variables and assuming a small to m edium effect size (Paul e t al., 2007).

The conservative assumption o f a small to m edium effect size was made given th e paucity o f previous studies to draw on.

Demographic Information

A sum m ary o f th e dem ographic info rm a tio n is presented in Table 3.

Table 3. Summary of Demographic Information

Design

This study utilised a cross-sectional design. A selection o f validated self-report questionnaires was used to collect data on each o f the variables.

Measures

The fo llo w in g questionnaires were accessed via a website hosted on the university server and accessible only by the Principle Investigator and a Psychology Technician.

1. Background Inform ation

A questionnaire designed specifically fo r this study containing questions pertaining to age, education, ethnic background and o th e r relevant demographic inform ation.

2. Emotional W ellbeing

Depression, Anxiety and Stress Scale - short form (DASS - 21), (Lovibond & Lovibond, 1995a)

Doron e t al.'s (2009) original study used the second version o f the Beck's Depression Inventory (BDI-II) to measure depression in participants. Due to the cost im plication o f using the BDI-II, the DASS-21 was chosen as a freely available and suitably valid and reliable alternative. The depression scale on the DASS-21 has good concurrent validity w ith the BDI- II, w ith high correlations between the scales (Henry & Crawford, 2005) suggesting th a t the DASS-21 is a reasonable alternative to the BDI-II. The DASS-21 also has the advantage o f measuring anxiety and stress in addition to depression.

The DASS-21 is a measure th a t assesses three negative em otional states: Depression and Anxiety and Stress (Lovibond & Lovibond 1995a). There are 21 items (7 item s fo r each em otional state). The self-report fo rm a t consists o f statem ents referring to the past week.

Each item is scored on a 4-p o in t scale (0 = Did not apply to me at all, to 3 = Applied to me

valid measures o f negative affect (Henry & Crawford, 2005). In a recent study (Timpano et al., 2010), the DASS dem onstrated excellent internal consistency (Cronbach's alpha = .95).

In the current study good internal consistency was dem onstrated w ith alphas o f .91 fo r the depression scale and .78 fo r the anxiety scale.

3. OCD sym ptom ology

Padua Inventory - Revised (Pl-R) Burns et al., 1996

Obsessive compulsive symptoms were assessed w ith the Padua Inventory - Revised (Pl-R, Burns et al., 1996). The Pl-R is a 39-item inventory measuring the degree o f disturbance caused by a range o f intrusive thoughts and compulsive behaviours, across five subscales:

(a) obsessional thoughts o f harm to self o r others (7 items, e.g., "I imagine catastrophic consequences as a result if absent-mindedness or m inor errors th a t I make"); (b) obsessional impulses o f harm to self or others (9 items, e.g., "w hile driving I sometimes feel an impulse to drive the car into someone or som ething"); (c) contam ination obsessions and washing compulsions (10 items, e.g., "I find it d iffic u lt to touch an object when I know it has been touched by strangers or by certain people"); (d) checking compulsions (10 items, e.g.,

"I tend to keep on checking things more often than necessary"); and (e) dressing rituals (3 items, e.g., "Before going to sleep I have to do certain things in certain o rder").

The scale and its subscales have been found to have adequate internal consistency (as ranging from .77 to .88), te s t-re te s t stability over a 7-m onth interval [rs ranging fro m .61 to .84) and discrim inant validity (Burns et al.f 1996). In Doron et al.'s study (2009), Cronbach a was .94 fo r the to ta l scale, and as fo r the subscales ranged from .79 to .91. In the current study sample adequate internal consistency was dem onstrated w ith an alpha o f .73 fo r the to ta l scale.

4. Responsibility beliefs

Obsessive Beliefs Questionnaire-44 (OBQ-44), (OCCWG, 2005)

Responsibility beliefs were assessed using the Responsibility-Threat scale fro m the Obsessional Beliefs Questionnaire-Revised (OBQ, OCCWG, 2005). This scale is a 44-item

self-report measure o f cognitions associated w ith OCD. The instrum ent has three subscales:

(1) Responsibility/Threat Estimation, consisting o f 16 items about preventing harm from happening to oneself or others, the consequences o f inaction, and responsibility fo r bad things happening (e.g., "H arm ful events w ill happen unless I am very careful"); (2) Perfectionism /C ertainty, consisting o f 16 items reflecting high standards, rigidity, concern over mistakes and feelings o f uncertainty (e.g., "For me, things are not right if they are not perfect"); and (3) Im portance/C ontrol o f thoughts, w ith 12 items concerning the consequences o f having intrusive distressing thoughts and the need to rid oneself o f intrusive thoughts (e.g., "Having a bad th o u g h t is m orally no d iffe re n t than doing a bad deed"). Doron e t ol. (2009) reported good internal consistencies o f these scales th a t ranged from 0.85 to 0.91. The RT scale dem onstrated good internal consistency w ith the current study sample; an alpha o f .89 was calculated.

It was decided to adm inister the whole questionnaire rather than to separate o u t the RT subscale as this m ight have affected the reliability and validity o f the findings. The RT subscale has been found to correlate well w ith o th e r measures o f Responsibility such as the RAS and the RAQ. (OCCWG, 2005b)

5. Recollected Parental Rearing Style

The Parental Bonding Index (PBI) (Parker, Tupling & Brown, 1979)

The Parental Bonding Instrum ent (PBI; Parker, Tupling & Brown, 1979) is a 25 item self- report measure o f an individual's recollection o f his o r her parent's childrearing practices up to the age o f 16. The measure is com pleted fo r each parent o r significant male and female caregiver. It contains a care subscale which consists o f 12 items and an overprotection subscale made up o f 13 items. Each item is rated on a fo u r-p o in t Likert scale ranging from 'very like' to 'very unlike'. Both subscales have been shown to possess a high internal consistency (split half reliability was .88 fo r the care scale and .74 fo r the protection subscale; (Parker, Tupling & Brown, 1979) and te st-re te st re lia b ility (care subscale =.75 and protection subscale =.68, W ilhelm & Parker, 1990). Participants' responses have been shown to be significantly correlated w ith the reports o f th e ir parents and siblings in both clinical and non-clinical populations (Parker, 1981; 1989) and to be

consistency was dem onstrated in the both the care scale (a = .94) and overprotection scale (a = .87).

6. A dult A ttachm ent Style

Experiences in Close Relationships Questionnaire (ECR) (Fraley, Waller, & Brennan, 2000)

A ttachm ent style in current relationships was assessed using the Experiences in Close Relationships inventory fECR; Brennan e t al., 1998). The ECR is a 36-item th a t measures individual variations along tw o dimensions o f attachm ent anxiety and attachm ent avoidance in current relationships. Participants rate the extent to which each item describes th e ir feelings in current close relationships on a 7-point scale ranging fro m 1 (not at all) to 7 (very much). Eighteen items assess attachm ent anxiety (e.g. "I w o rry about being abandoned") and eighteen assess avoidant attachm ent (e.g., "I prefer not to show a partner how I feel deep dow n").

The reliability and construct, convergent, discrim inant, and predictive validity o f the ECR subscales have been repeatedly dem onstrated in d iffe re n t nations and age groups, and in both non-clinical and clinical groups (Brennan e t al., 1998, and M ikulincer & Shaver, 2007).

T e st-re te st reliabilities (3-week interval) were .70 fo r each subscale (Brennan e t al., 1998).

In the Doron et al.'s study (2009) study, Cronbach a was .90 fo r the anxiety and .93 fo r the avoidance subscales. In the current study good internal consistency was also dem onstrated fo r the anxiety scale (a = .86) and the avoidance scale (a = .85).

Ethical Considerations

The study was granted ethical approval by the host university. All participants were provided w ith inform ation prior to participation which outlined w hat participating in the study involved and th e ir rights as a participant (Appendices 1 and 2). Participants w ere able to take as much tim e as they wished to read this info rm a tio n before deciding w h e th e r to participate. All participants com pleted a consent screen (Appendix 3) prior to participating and were made aware th a t they were free to w ith d ra w at any point. The investigators took in to consideration th a t answering questions relating to mood, obsessive-compulsive

symptoms, relationships and recollections o f th e ir childhood experience o f parents could have been potentia lly upsetting fo r some participants and th erefore all participants were provided w ith inform ation as to appropriate sources o f support at the end o f the study.

All data was used and stored in accordance w ith the Data Protection Act.

The study was reviewed by the University o f Surrey Faculty o f Arts and Human Sciences Research Ethics C om m ittee and received a favourable ethical opinion (Appendix 5).

Procedure

Recruitm ent o f Participants

Participants fo r the present study were recruited fro m a population o f 2863 undergraduate and postgraduate students in the Faculty o f Arts and Human Sciences at the University o f Surrey. Potential participants were approached via an email (See Appendix 1) outlin in g the details o f the study and inviting them to take part. This recruitm ent procedure was used in order to address one o f lim itations identified by Doron et al. (2009) whose study recruited solely psychology undergraduates w ho may not have been naive to the research area. The recruitm ent o f undergraduate and post graduate students was chosen to provide a sample th a t could hopefully be m ore heterogeneous than most undergraduate psychology cohorts and provide access to a larger num ber o f participants in order to give the study sufficient power. Previous research has suggested, (Doron e t al., 2009), th a t OCD sym ptom s are best conceptualised as dim ensional which supports the appropriateness o f studying OCD related phenomena in non-clinical subjects.

Participants th a t were interested in taking part in the study were directed via a link in the recruitm ent email to a purpose built website (Appendix 1). This website provided participants w ith an inform ation screen (Appendix 2) which also gave participants inform ation on the prize draw and how to enter this on com pletion o f the study. This was follow ed by a screen containing the consent form (Appendix 3) which had to be com pleted

required participants to check boxes. The questionnaires were com pleted in the order outlined above.

Following com pletion o f th e questionnaires, participants were provided w ith a debrief screen (Appendix 10) providing contact details fo r any participants w ho may have experienced distress in com pleting the questions and contact detail fo r the researcher fo r participants w ho wished to be entered in the prize draw a n d /o r received a sum m ary o f findings upon the study's com pletion.

Planned Statistical Analyses

Statistical analyses were perform ed using SPSS version 18.0 fo r W indows.

Data Screening

Firstly, it was planned to screen data fo r missing values, errors and outliers. Due to the online requirem ent to respond to each item in order to proceed to the end o f the end o f the questionnaire, there were no missing values. It was planned to assess the distrib u tio n o f data fo r each variable using a) histograms, b) skewness and kurtosis values and c) Kolmogorov-Smirnov tests.

Correlations

Pearson's correlation analyses were planned unless data violated th e assumption o f fittin g the norm al distribution, in which case the non-param etric Spearman's correlation analyses were planned.

M ediation Analyses

M ediation analyses were planned to fu rth e r investigate the relationships betw een th e main variables o f this study (hypothesis 4). M ediation occurs when a variable increases or

decreases the effect o f a predictor variable on a dependent variable. The role o f responsibility beliefs in this study to m ediate the relationship between parental bonding and attachm ent experiences, and OCD symptoms was investigated using Baron and Kenny's (1986) causal steps. Figure 1 shows an illustration o f the process o f m ediation as described by Baron and Kenny (1986) w ith the variables included in this study.

Figure 1. Responsibility beliefs as a mediator of parental bonding experience, attachment style and obsessional behaviour.

M ediator variable Responsibility

beliefs Independent variable

A ttachm ent style

Independent variable Attachm ent style Independent variable

Parental bonding experience

Dependant variable Obsessional

behaviour

Independent variable Parental bonding

experience

Dependant variable Obsessional

behaviour

Baron and Kenny's (1986) criteria fo r perfect m ediation specifies th a t the independent

has reduced but is n o t zero. Baron and Kenny's casual steps however, do not test the significance o f the indirect pathway. Therefore, tw o fu rth e r tests w ere planned. The Sobel te s t was selected as it provides a one step te st o f significance. In addition, Bootstrap Confidence Intervals (Cl) w ere planned to be calculated if the dependent variable was not norm ally distributed. The Sobel and Bootstrap CIs w ere planned using an SPSS macro developed by Preacher and Hayes (2004) and 1000 bootstraps were used.

It was planned to check the assumptions fo r m ultiple regression analysis, including no perfect m u lticollinearity, hom oscedasticity and independent errors (Field, 2005). Unless otherw ise stated, it can be assumed th a t th e assumptions fo r conducting m ultiple regression analysis w ere met.

C ontrolling fo r Depression and Anxiety

Finally, it was planned to repeat the m ediation analyses controlling fo r cu rre n t sym ptom s o f anxiety and depression. The SPSS macro developed by Preacher & Hayes (2008) was used to control fo r anxiety and depression scores before repeating th e m ediation analyses described above.

RESULTS

Data Screening

The data were firstly screened to check fo r missing values. Due to the online requirem ent to respond to each item in order to proceed to the end o f the end o f the questionnaire, there were no missing values. Those participants w ho did not com plete all tests in the battery were not removed from the datasheet and were not included in the analysis, giving a to ta l o f 223 participants w ho com pleted all the measures.

The data were also screened to check if they m et the assumption o f fittin g the normal distrib u tio n fo r all m ajor variables. Histograms were produced and visually checked fo r each variable. Each variable was examined fo r outliers th a t were m ore than 3 standard deviations from the mean to see if they exerted an undue influence on analysis. Using z scores to id e n tify outliers, Field (2005) suggests th a t we w ould expect to see 95% o f cases w ith an absolute value o f less than 1.96, 5% (or less) w ith an absolute value o f greater than 1.96, and 1% (or less) w ith an absolute value greater than 2.58, and no cases above 3.29. A small num ber o f outliers fo r each variable were identified. These were le ft in as they did not significantly affect the final m ultiple regression model.

As part o f the m ultiple regression analyses, residuals w ere also examined to determ ine the erro r present in the m ultiple regression model. 3 cases were identified as having large residuals these were fu rth e r examined and it was found th a t they did not have a disproportionate effect on the final m ultiple regression model.

As param etric analyses were planned, tests o f skewness and kurtosis and Kolm ogorov- Smirnov tests were conducted on each o f the variables dem onstrating th a t all except tw o variables (Appendix 7) were significantly d iffe re n t from the normal distrib u tio n . Only ECR-R - anxious attachm ent, 0(223) =.051, p <.05 and OBQ- responsibility-threat beliefs, 0(223)

=.056, p <.05, did not d iffe r significantly from the norm al distribution. Natural log and square route transform ations were perform ed on all non-norm ally distributed variables.

However this made little difference w hen fu rth e r skewness, kurtosis and Kolm ogorov- Smirnov tests were conducted, w ith the data still not fittin g the normal d istrib u tio n . Field

overestim ate skewness and kurtosis and th a t the Kolmogorov-Smirnov te st is also less reliable fo r large samples. However, it was decided w here possible to conduct non- param etric analyses o r analyses th a t did n o t depend on the data being norm ally distributed. Assumptions fo r specific analyses w ill be reported later.

VariablesPI-WSURFBI FBI FBI FBI father ECR-RECR-ROBQ-44DASS-21DASS-21 total mothermother father protect anxietyavoidResp depressanxiety careprotect care______________________________________________________________________________ PI-WSUR1 -.243**.259**-.045.005.402**.110.552**.425**.451** total

Table 4: Correlations for all variables

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Table 5. Means and standard deviations for all variables

PI-WSUR = Padua Inventory (Washington State University Revision); PBI = Parental Bonding Instrument; ECR-R = Emotions in Close Relationships (Revised scale); OBQ-44 = Obsessive Beliefs Questionnaire (Responsibility/Threat Scale); DASS-21 = Depression, Anxiety and Stress Scale.

The low mean and large standard deviation on the PI-WSUR scores and o th e r variables are indicative o f the positively skewed distributions found during data inspection. The results o f PI-WSUR in particular dem onstrate th a t the m ajority o f the nonclinical population were scoring well below the actual scale mean, indicating low er levels o f reported sym ptom s of OCD. In comparing participants' scores in this study w ith those from Doron et ol.'s (2009)

In document Do Responsibility Beliefs Mediate the Relationship Between Attachment and Parenting Styles and Obsessive Compulsive Symptons? (Page 35-61)