Evaluating the Use of Mindfulness Meditation Utilizing a Consumer-Grade EEG Biofeedback Device for Patients Awaiting Treatment for Obsessive Compulsive Disorder
Phase: NA
Conditions: Obsessive-Compulsive Disorder
Sponsor: Sunnybrook Health Sciences Centre

Study Protocol 
 
Study Protocol 
Title: Evaluating the Use of Mindfulness Meditation Utilizing a Consumer-Grade EEG Biofeedback Device for 
Patients Awaiting Treatment For Obsessive Compulsive Disorder 
Principal Investigator: Dr. Lance Hawley, C.Psych. 
Co-Investigators: Dr. Neil Rector, C.Psych., Dr. Peggy Richter 
Institution: Sunnybrook Health Sciences Centre 
Address: 2075 Bayview Avenue, Suite K3W46, Toronto, Ontario, Canada, M4N3M5 
Email: lance.hawley@sunnybrook.ca 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

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Abstract ........................................................................................................................................................................ 3 
1 
Specific Aims ........................................................................................................................................................ 3 
2 
Background and Significance ............................................................................................................................... 4 
2.1 
Background ..................................................................................................................................................... 4 
2.2 
Significance ..................................................................................................................................................... 4 
3 
Research Design and Methods .............................................................................................................................. 5 
3.1 
Research Design and Methods ........................................................................................................................ 5 
3.2 
Participant Information ................................................................................................................................... 6 
3.3 
Data Collection and Statistical Considerations ............................................................................................... 6 
4 
Study Measures and Materials .............................................................................................................................. 6 
5 
Human Subjects .................................................................................................................................................... 7 
5.1 
Characteristics of subject population............................................................................................................... 7 
5.2 
Inclusion .......................................................................................................................................................... 7 
5.3 
Exclusion ......................................................................................................................................................... 7 
5.4 
Consent Procedures .......................................................................................................................................... 7 
5.5 
Risks ................................................................................................................................................................ 7 
5.6 
Benefits ............................................................................................................................................................ 7 
6 
Intervention: .......................................................................................................................................................... 7 
7 
Costs and Payments .............................................................................................................................................. 7 
7.1 
Research study payments ................................................................................................................................ 8 
7.2 
Costs ................................................................................................................................................................ 8 
8 
Qualifications of Investigators .............................................................................................................................. 9 
8.1 
Principal Investigator: ..................................................................................................................................... 9 
8.2 
Co-Investigator: ............................................................................................................................................... 9 
9 
Instruments ......................................................................................................................................................... 10 
 
 
 
 
 
 
 
 

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Abstract 
 
The Frederick W. Thompson Anxiety Disorders Centre has experienced significant demand for services related 
to the treatment of Obsessive Compulsive Disorder (OCD), resulting in a significant wait time for service. 
Although Cognitive Behavior Therapy (CBT) is the most efficacious treatment intervention for OCD (McKay et 
al., 2015), there is a growing literature indicating the mindfulness based approaches can be beneficial in terms 
of managing acute mood and anxiety symptoms as well as reducing relapse risk following treatment (e.g., 
Huijbers et al., 2016). The National Institute for Health and Care Excellence (NICE) guidelines provide a 
framework for health professionals who provide integrated, comprehensive treatments for the management of 
mood and anxiety disorders. These guidelines suggest that clinicians provide clients with accessible, low 
intensity, low risk interventions as they await treatment. It may be that having clients engage in low intensity 
interventions while they wait for CBT treatment can prevent symptom exacerbation and improve their  
motivation to engage in subsequent hospital based treatments. Although past research has demonstrated the 
benefits of engaging in guided mindfulness meditation practice in terms of psychological symptom 
improvement, it is unclear whether self-guided meditation practice incorporating biofeedback could promote 
symptom alleviation for individuals experiencing OCD. The goal of this study is to examine the potential 
benefits of using a consumer grade EEG-based biofeedback device that allows clients to engage in home based 
mindfulness meditation practices while they are waiting to receive clinical services. Specifically, this study will 
investigate the effects of meditation home practice on symptom alleviation, as related to specific OCD related 
cognitive processes. Patients who are waiting to receive clinical services will engage in an initial clinical 
assessment prior to being offered service, which is standard clinical practice. Following a clinical assessment, 
the patient will be offered the opportunity to participate in the current study – regardless of their decision to 
participate, they will still receive treatment recommendations and be considered for an upcoming clinical 
treatment service as usual, as determined by the assessor. If they choose to be involved in this study, they will 
be randomized to one of two groups: either an eight week waitlist control condition, or an eight week 
mindfulness treatment condition. Participants in the mindfulness condition will receive a commercially 
available wireless EEG headset and a software package that provides guided meditation practices with auditory 
feedback. Participants will attend three sessions during the eight week protocol – each session involves 
completing a self-report questionnaire package (evaluating OCD symptoms, mindfulness and thought control 
strategies) and they will complete a brief open monitoring meditation practice using the Muse EEG headset. 
Participants in the meditation condition will engage in regular mindfulness practice during each week, and 
complete a brief online survey regarding their experience during the mindfulness practice, once per week.  
1 
Specific Aims 
 
This study will examine the potential benefits of engaging in mindfulness practices, for patients experiencing 
OCD who are waiting for clinical services to be offered. Patients will be offered a low intensity, low risk 
mindfulness intervention that is delivered by a consumer grade wireless EEG biofeedback device that provides 
guided mindfulness practices with biofeedback. Specifically, we will examine whether engaging in guided 
mindfulness meditation home practices can promote symptom alleviation, as related to variables which may 
influence treatment response (mindfulness, OCD beliefs, thought control strategies). If this intervention is 
found to be helpful, patients who are waiting for clinical services to be offered may experience symptom 
alleviation, which may, in turn, help them to optimally benefit from subsequent services offered by our clinic. 
If we determine that this intervention is efficacious, this approach could be further disseminated to other 
hospital based clinical programs, particularly those services in which wait times may be excessive.  
 
 

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2 
Background and Significance 
 
2.1 
Background   
Obsessive Compulsive Disorder (OCD) is a chronic and debilitating disorder known to have reported lifetime 
prevalence in the range of 2% (Kessler et al., 2005). OCD is most commonly treated with Cognitive Behavioral 
Therapy (CBT) and/or pharmacotherapy. Although Cognitive Behavior Therapy (CBT) is the most efficacious 
treatment intervention for OCD (McKay et al., 2015), there is often a substantial wait time for patients awaiting 
CBT services. The National Institute for Health and Care Excellence (NICE) guidelines provide a framework 
for health professionals who provide integrated, comprehensive treatments for the management of mood and 
anxiety disorders. These guidelines suggest that it can be beneficial for patients to be provided with easily 
accessible, low intensity, low risk interventions as they await treatment. It may be that engaging in low intensity 
interventions can prevent symptom exacerbation and improve patients’ motivation to engage in subsequent 
hospital based treatments.  
 
The existing research literature indicates that mindfulness based approaches can be beneficial in terms of 
managing mood and anxiety symptoms as well as reducing relapse risk following treatment (e.g., Huijbers et 
al., 2016). There is a substantial treatment efficacy literature indicating that engaging in mindfulness strategies 
can lead to psychological symptom alleviation (Segal et al., 2002; Brown & Ryan, 2003; Keng, Smoski & 
Robins, 2011) in a broad range of clinical populations (Baer, 2003; Chisea & Serretti, 2010; Strauss, Cavanagh, 
Oliver, & Pettman, 2014), as well as having a prophylactic effect in terms of reducing depression relapse risk 
following CBT treatment (e.g., Teasdale et al., 2000; Kuyken et al, 2016). For patients who have been 
diagnosed with an anxiety or mood disorder, mindfulness interventions are associated with effect sizes (Hedges’ 
g) of 0.97 and 0.95 for improving anxiety and mood symptoms, respectively (Hofmann, Sawyer, Witt & Oh, 
2010). Further, there is an emerging literature examining the potential benefits of utilizing mindfulness 
techniques for individuals experiencing OCD (e.g., Strauss, Rosten, Hayward, Lea, Forrester & Jones, 2015). 
These individuals experience difficulties with managing intrusive, disturbing, obsessive thoughts that produce 
considerable distress and anxiety (Abramowitz, Taylor & McKay, 2009). As a result, they engage in strategies 
that promote experiential avoidance, involving compulsive, problematic thought control strategies in order to 
neutralize their obsessive thoughts (e.g., Abramowitz et al., 2009). Essentially, these thought control strategies 
run counter to mindfulness strategies which promote experiential awareness. Considering this, there are several 
reasons why engaging in mindfulness strategies may promote OCD symptom alleviation. By cultivating 
improved experiential awareness, patients may become capable of adopting a more accepting approach to 
managing their problematic obsessive thoughts, feelings, and physical sensations, thereby developing a 
“decentered”, non-reactive attitude towards these experiences (Bieling et al., 2012). To date, there have been no 
studies that have examined whether engaging in weekly guided mindfulness meditation practices (using an EEG 
based biofeedback device) may be effective for individuals experiencing OCD. Therefore, this study sets out to 
examine the potential benefits of offering an easily accessible, low intensity intervention in order to promote 
OCD symptom alleviation, as related to OCD beliefs, mindfulness, mind wandering, motivation, and 
engagement in thought control strategies. 
 
2.2 
Significance   
As a result of an increasing demand for specialized mental health services, wait lists for treatment are more the 
norm than the exception. It is plausible to assume that providing clients with an EEG based biofeedback device 
that provides guided meditation practices will impact on symptom alleviation while clients are awaiting 
treatment. In addition, this research protocol has the potential to provide us with additional valuable information 
about the nature and course of OCD, providing insight into mechanisms underlying treatment response, thereby 
adding to our understanding of this disorder and its’ treatment. By learning more about factors that are involved 
in the disorders' presentations such as clients’ use of thought control strategies, OCD related beliefs, the quality 
of their mindfulness practice, and their motivation to engage in CBT in the future, we can improve our 

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understanding of the mechanisms underlying the disorder and help improve the quality of treatment for these 
individuals.   
 
It is hypothesized that clients participating in the meditation group (in comparison to the wait list control group) 
will see greater reductions in self-reported measures of symptom severity and improvement in their use of 
problematic thought control strategies, as well as their readiness to engage in subsequent treatment. If this study 
can demonstrate that engaging in eight sessions of guided mindfulness practice can provide benefits for those 
suffering with OCD, then it provides another route by which patients can experience symptom improvement 
while waiting for a more structured, evidence-based CBT treatment. If this intervention is found to be helpful, 
patients who are waiting for clinical services to be offered may experience symptom alleviation, which may, in 
turn, help them to optimally benefit from subsequent services offered by our clinic. Further, if we determine that 
this intervention is efficacious, this approach could be further disseminated to other hospital based clinical 
programs, particularly those services in which wait times may be excessive. 
3 
Research Design and Methods 
 
3.1 
Research Design and Methods   
Recruitment and Procedure 
Patients referred for consultation and treatment services at the Frederick W. Thomspon Anxiety Disorder 
Centre will be eligible for participation. Patients presenting with OCD who are currently awaiting services at 
the Centre will be recruited for participation in this study. However, those with active substance 
abuse/dependence, suspected organic pathology as listed on the referral form, recent suicide attempt/active 
suicideality, active bipolar disorder, psychotic disorder or post-traumatic stress disorder will be excluded from 
participation. 
 
Outcome measures will assess OCD symptom severity, OCD beliefs, the quality of their mindfulness practice, 
OCD thought control strategies, and whether they experience spontaneous or deliberate “Mind Wandering” 
during their mindfulness practice. OCD symptom measures will include the self-report Yale-Brown Obsessive 
Compulsive Scale (YBOCS), and the Obsessive Compulsive Inventory-Revised (OCI-R). OCD beliefs will be 
measured by the Obsessive Beliefs Questionnaire (OBQ-44). The Five Factor Mindfulness Questionnaire 
(FFMQ) will be used to measure the quality of participants’ mindfulness practice. The Acceptance and Action 
Questionnaire (AAQ-II) will be used to measure psychological flexibility. The Thought Control Questionnaire 
(TCQ) will measure participants’ tendency to engage in efforts to control intrusive thoughts. The 
Metacognitions Questionnaire (MCQ) will measure participants’ beliefs about their thinking. The Mind 
Wandering Scale (MW) will be used to determine the extent to which participants experienced spontaneous or 
deliberate mind wandering during their mindfulness practice. Motivation and readiness to engage in 
subsequent CBT treatment will be measured using the Readiness Ruler (RR). Daily practice data from the EEG 
headsets will be automatically uploaded to an encrypted server. 
 
At baseline, mid treatment (session 4), and post intervention, participants will complete the YBOCS, OCI, 
OBQ, FFMQ, TCQ, AAQ, MW and MCQ. Once per week, participants in the mindfulness condition will 
complete the YBOCS, TCQ, and MW. This weekly data will be collected online using the “Survey Monkey” 
web portal.  
 
Experimental Design 
The study will be a randomized trial where subjects (N=100 Total, N=50 assigned to Group 1 (Mindfulness 
condition) or Group 2 (Control condition) will be randomly assigned to receive either 1) an eight week 
meditation program involving use of an EEG-based biofeedback device, or 2) wait list as per usual. The 
experimental design is a 2 (treatment condition) by 3 (assessment phase: baseline (week 0), mid treatment 
(week 4), and post-treatment (week 8)) repeated measures factorial design. Randomization will be completed 

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by staff separate from the research team using numerical randomization for consecutive referrals.  
 
Data Analyses 
A repeated measures multivariate analysis of variance (MANOVA) will be conducted with the two groups 
(guided mindfulness meditation or control wait list group) as the between-group variable and OCD symptom 
scores as the dependent variables. A mediation analysis will examine whether obsessive beliefs, engagement in 
thought control strategies, psychological flexibility, and mind wandering mediates treatment related changes in 
OCD symptom scores (YBOCS, OCI). A Latent Difference Score (LDS) analysis will examine longitudinal 
temporal relationships between OCD symptoms and each of the above mentioned variables. Daily practice data 
from the EEG headsets will be automatically uploaded to an encrypted server. These data will be made 
anonymous from the start of the study; subjects will be identified using their subject I.D. EEG data will be 
preprocessed and analyzed using EEG Lab (Delorme & Makeig, 2004). Mean ERP amplitudes will be 
measured in latency windows selected according to prior research and determined from visual inspection of the 
waveforms. Analyses of variance (ANOVAs) will be computed on peak and mean amplitude using group as a 
between-subjects factor and session (pre or post), task condition, and electrode as within-subject factors. 
   
 
3.2 
Participant Information 
Participant information will be stored electronically within the FWT Anxiety Disorder Centre. To ensure 
anonymity, all documents containing participant names and/or contact information will be stored separately 
from the data. The data will be kept separately from any identifying info, anonymized and giving a coded ID 
number for matching purposes only.  
 
a) 
All electronic personal health information will be stored on an encrypted password protected USB key. 
All physical copies of the data will be stored in a secure area and access will be restricted to research 
investigators. 
 
b) 
Participant  information will be stored for a period of 10 years 
 
3.3 
Data Collection and Statistical Considerations   
Clinical data will be collected and entered into a computerized database.  Confidentiality of subjects will be 
protected by maintaining data in locked files in locked offices.  Data are maintained in computer files that are 
accessible only to FWT Anxiety Disorders Centre staff.  All data will be coded and subsequently stripped of 
personal identifiers.  Information linking the codes with subject identifiers will be maintained in a secure 
manner separate from the data.  Sunnybrook policy requires that research records be kept for a period of no 
less than 5 years.  
4 
Study Measures and Materials 
Participants will complete pre, mid and post-intervention self-report measures assessing OCD symptom 
severity, OCD beliefs, the quality of their mindfulness practice, engagement in OCD thought control strategies, 
and whether participants experience spontaneous or deliberate “Mind Wandering” during their mindfulness 
practice. OCD symptom measures will include the self-report Yale-Brown Obsessive Compulsive Scale 
(YBOCS), and the Obsessive Compulsive Inventory-Revised (OCI-R). OCD beliefs will be measured by the 
Obsessive Beliefs Questionnaire (OBQ-44). The Five Factor Mindfulness Questionnaire (FFMQ) and the 
Mindfulness Practice Questionnaire (MPQ) will be used to measure the quality of participants’ mindfulness 
practice. The Acceptance and Action Questionnaire (AAQ-II) will be used to measure psychological flexibility. 
The Thought Control Questionnaire (TCQ) will measure participants’ tendency to engage in efforts to control 
intrusive thoughts. The Metacognitions Questionnaire (MCQ) will measure participants’ beliefs about their 
thinking. The Mind Wandering Scale (MW) will be used to determine the extent to which participants 
experienced spontaneous or deliberate mind wandering during their mindfulness practice. Daily practice data 

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from the EEG headsets will be automatically uploaded to an encrypted server.   
 
 
 
5 
Human Subjects 
 
5.1 
Characteristics of subject population  
Patients included for participation are those with a referral for FWT Anxiety Disorder Centre services.   
 
5.2 
Inclusion 
All inclusion and exclusion criteria are consistent with the established guidelines for our service – there 
are no additional study specific criteria. Potential subjects are referred to the service with a query of OCD. 
Due to the nature of the assessment procedures, which include English-language self-report 
questionnaires and scales, the ability to communicate in written and spoken English is an inclusion 
criterion. 
 
5.3 
Exclusion 
a) those with active substance abuse/dependence  
b) suspected organic pathology 
c) recent suicide attempt/active suicidality 
d) active bipolar, psychotic disorder or post-traumatic stress disorder 
   
5.4 
Consent Procedures 
The FWT Clinic secretary will call patients to book their psychological assessment appointments. At the end of 
the assessment appointment, participants will be introduced to the study at that time and they will be asked if 
they are interested in participating. Participants interested in hearing a detailed study explanation will be 
contacted by the study co-ordinator who will review the study details with the participant. For eligible and 
interested participants, a mail out package including applicable measures will be sent out along with the consent 
form. Participants will be asked to bring the consent form unsigned with them to the first information session. 
Written consent will be obtained in person by the study co-ordinator at that time who will address any questions 
or concerns before the first session. 
 
5.5 
Risks 
There are no significant risks associated with the study. The only potential risk for participation is possible 
breach of confidentiality.  However, the Frederick W. Thompson Anxiety Disorders Centre's staff will take 
extensive precautions to maintain the participants' confidentiality.  Additionally, given that much of this 
information is already collected for clinical purposes, the risk to confidentiality should not be any greater than 
that of standard clinical care. There could also be a risk of some mild discomfort in answering some of the 
questionnaires. Again, this is not over and beyond the standard care and further, participants are explained that 
they may withdraw from the study at any time.  
 
5.6 
Benefits  
The benefit of participating in this study involves the likelihood of improving significantly in both symptom 
measures as well as measures demonstrated to underlie treatment response in OCD.   
6 
Intervention: 
MUSE Guided Meditation Practices:  The guided meditation intervention will be administered using 

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Interaxxon’s Muse device. Muse is a wireless EEG headset with an accompanying mobile device software 
application. The headset has 4 dry sensors (2 mastoid and 2 forehead sensors) and fits over the ears and 
extends at an angle over the middle of the forehead when properly fitted. Data are sampled at 220 Hz and 
referenced to Fpz channel. The data is communicated wirelessly to the mobile device application. 
Participants are asked to engage in a daily mindfulness practice, with each practice lasting for a minimum 
of 20 minutes, once per day. Participants may engage in additional practices if they feel motivated to do so. 
To provide high-fidelity neurofeedback during meditation practice, Interaxxon has established an algorithm 
that involves a combination of frequency bands that have been associated with meditative states (Kerr, 
Sacchet, Lazar, Moore, & Jones, 2013).  When the application determines that the participant’s “mind 
wandered”, biofeedback is provided in order to assist the participant with refocussing their attention on 
their meditation practice. The software application provides a guided pre-session calibration to customize 
neurofeedback to match participant experience prior to each training session. Calibration involves two brief 
exercises: in the first exercise, participants are asked to perform a word association task to simulate a 
period of mind-wandering. In the second exercise, participants are asked to relax and clear their minds as a 
brief induction of a focused attention state. These two calibration conditions are then entered into a 
machine learning algorithm to generate a session-specific signature of concentration and distraction 
customized to the participant. Calibration lasted 1 minute. Following calibration, guided meditation 
instructions were delivered through the paired smartphone/iPad, directing participants attention towards 
sensations of the breath, body, and/or cognition. Neurofeedback is delivered through auditory cues of wind 
and storm sounds, which increase in intensity with greater estimated distraction, and subsided towards calm 
with greater estimated stability of attention.  
7 
Costs and Payments  
 
7.1 
Research study payments   
At the end of the study, participants will receive a stipend of $40 for their involvement. 
 
7.2 
Costs  
Costs associated with the implementation and maintenance of the study shall be supported by the FWT 
Anxiety Disorder Centre.  

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APPENDICES  
 
8 
Qualifications of Investigators 
 
8.1 
Principal Investigator: 
 
Dr. Lance Hawley, PhD is a psychologist and Co-Director of Training for the Frederick W. Thompson 
Anxiety Disorders Centre at Sunnybrook Health Sciences Centre and an Assistant Professor in the 
Department of Psychiatry at the University of Toronto. He will oversee all aspects of the proposed study 
including data collection, analyses and dissemination of findings. 
 
8.2 
Co-Investigator: 
 
Dr. Neil Rector, PhD is a psychologist and senior research scientist at the Sunnybrook Research Institute 
(SRI) and Director of Research for the Frederick W. Thompson Anxiety Disorders Centre at Sunnybrook 
HSC.  He is also a Full Professor in the Departments of Psychiatry and Psychological Clinical Science at 
the University of Toronto. He has participated in the conceptual design of the current study and will be 
actively involved in data collection, study monitoring, data analyses, and preparation of findings for 
dissemination. 
 
Dr. Peggy Richter, M.D. is a psychiatrist with clinical and research expertise in the study and treatment of 
adults with anxiety disorders with particular emphasis on Obsessive Compulsive Disorder.  She is head of 
the Frederick W. Thompson Anxiety Disorders Centre at Sunnybrook HSC and is an Associate Professor 
at the University of Toronto.  She will participate in data collection, analyses and dissemination of 
findings. 

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9 
Instruments 
 
Please see attached for all instruments including: 
1) Yale Brown Obsessive Compulsive Disorder Scale Self-Report (Y-BOCS-SR; Baer, Brown-Beasley, 
Sorce & Henriques, 1993) 
2) Mindfulness Practice Questionnaire (MPQ; Hawley, Rector, Richter, 2015) 
3) Obsessive-Compulsive Inventory-Revised (OCI-R; Foa et al., 2002) 
4) Obsessive Beliefs Questionnaire (OBQ-44; OCCWG, 2005) 
5) Five Factor Mindfulness Questionnaire (FFMQ; Baer, Smith, Hopkins, Krietemeyer & Toney, 2006) 
6) Thought Control Questionnaire (TCQ; Wells & Davies, 1994) 
7) Mind Wandering Scale (MW (Carriere et al., 2013) 
8) Acceptance and Action Questionnaire (AAQ-II; Bond et al., 2011) 
9) Readiness Ruler (RR; Rollnick, 2002) 
10) Metacognitions Questionnaire (MCQ; Wells, 1997) 

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Y-BOCS Part 2 
 
Thank you for completing the Y-BOCS checklist. Please make sure that you circled the 2 most 
upsetting obsessions that you currently experience, and the 2 compulsions that cause you the most difficulty. 
Please enter them here: 
 
2 most upsetting obsessions (thoughts or images): 
 
 
 
 
 
 
 
2 most upsetting compulsive behaviors: 
 
 
 
 
 
 
 
Remember the definitions of obsessions and compulsions and the examples of each that you may 
have noted on the checklist. Please place a check mark by the appropriate number from 0-4 beside each 
question below. If you are not currently experiencing any obsessions or compulsions, you may simply enter 
zeros for those questions, then continue to the next question. 
 
OBSESSIVE THOUGHTS: Review the obsessions you checked on the Y-BOCS Symptom Checklist to help 
you answer the first five questions. Please think about the last seven days (including today), and check one 
answer for each question. 
 
1. TIME OCCUPIED BY OBSESSIVE THOUGHTS: How much of your time was occupied by obsessive 
thoughts? How frequently did these obsessive thoughts occur? 
 
 
0 = None 
 
 
 
1 = Less than 1 hour per day, or occasional intrusions (occur no more than 8 times a day) 
 
 
 
2 = 1-3 hours per day, or frequent intrusions (most of the day are free of obsessions) 
 
 
 
3 = More than 3 hours and up to 8 hours per day, or very frequent intrusions. 
 
 
 
4 = More than 8 hours per day, or near-constant intrusions. 
 
 

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2. INTERFERENCE DUE TO OBSESSIVE THOUGHTS: How much did these thoughts interfere with 
your social or work functioning? Is there anything that you didn’t do because of them? 
 
 
0 = No interference 
 
 
 
 
1 = Mild, slight interference with social or occupational performance, but still performance not impaired. 
 
 
 
 
2 = Moderate, definite interference with social or occupational performance, but still manageable. 
 
 
 
3 = Severe interference, causes substantial impairment in social or occupational performance. 
 
 
 
4 = Extreme, incapacitating interference. 
 
 
3. DISTRESS ASSOCIATED WITH OBSESSIVE THOUGHTS: How much distress did your 
obsessive thoughts cause you? 
 
 
0 = None 
 
 
 
1 = Mild, infrequent, and not too disturbing distress. 
 
 
 
2 = Moderate, frequent, and disturbing distress, but still manageable. 
 
 
 
3 = Severe, very frequent and very disturbing distress. 
 
 
 
4 = Extreme, near-constant, and disabling distress. 
 
4. RESISTANCE AGAINST OBSESSIONS: How much effort did you make to resist the obsessive 
thought? How often did you try to disregard or turn your attention away from those thoughts as they 
entered your mind? 
 
 
 
0 = I made an effort to always resist (or the obsessions are so minimal that there is no need to actively 
resist them). 
 
 
 
1 = I tried to resist most of the time (e.g., more than half of the time I tried to resist). 
 
 
 
2 = I made some effort to resist. 
 
 
 
 
3 = I allowed all obsessions to fill my mind without attempting to control them, but I did so with some 
reluctance. 
 
 
 
4 = I completely and willingly gave in to all obsessions. 

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5. DEGREE OF CONTROL OVER OBSESSIVE THOUGHTS: How much control did you have over 
your obsessive thoughts? How successful were you in stopping or diverting your obsessive thinking? 
 
 
0 = Complete control 
 
 
 
 
1 = Much control; usually I could stop or divert obsessions with some effort and concentration. 
 
 
 
 
2 = Moderate control; sometimes I could stop or divert obsessions. 
 
 
 
 
3 = Little control; I was rarely successful in stopping obsessions and could only divert attention with 
great difficulty. 
 
 
 
4 = No control; I was rarely able to even momentarily ignore the obsessions. 
 
OBSESSION SUBTOTAL (Add items 1-5)   
 
 
 
COMPULSIONS: Review the compulsions you checked on the Y-BOCS Symptom Checklist to help 
you answer these five questions. Please think about the last seven days (including today), and check 
one answer for each question. 
 
6. TIME SPENT PERFORMING COMPULSIVE BEHAVIORS: How much time did you spend 
performing compulsive behaviors? How frequently did you perform compulsions? 
 
 
0 = None 
 
 
 
 
1 = Less than 1 hour per day was spent performing compulsions, or occasional performance of 
compulsive behaviors (no more than 8 hours per day). 
 
 
 
 
2 = 1-3 hour per day was spent performing compulsions, or frequent performance of compulsive 
behaviors (most hours were free of compulsions). 
 
 
 
 
3 = More than 3 hours and up to 8 hours per day were spent performing compulsions, or very frequent 
performance of compulsive behaviors (during most hours of the day). 
 
 
 
 
4 = More than 8 hours were spent performing compulsions, or near-constant performance of compulsive 
behaviors (hour rarely passes without several compulsions being performed). 
 

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7. INTERFERENCE DUE TO COMPULSIVE BEHAVIOR: How much did your compulsive behaviors 
interfere with your social or work functioning? 
 
 
0 = No interference. 
 
 
 
 
1 = Mild, slight interference with social or occupational activities, but overall performance not impaired. 
 
 
 
 
2 = Moderate, definite interference with social or occupational performance, but still manageable. 
 
 
 
 
3 = Severe interference, substantial impairment in social or occupational performance. 
 
 
 
4 = Extreme, incapacitation interference. 
 
8. DISTRESS ASSOCIATED WITH COMPULSIVE BEHAVIOR: How would you have felt if you were 
prevented from performing your compulsion(s)? How anxious would you have become?  
 
 
0 = Not at all anxious. 
 
 
 
 
1 = Only slightly anxious if compulsions prevented. 
 
 
 
 
2 = Anxiety would mount but remain manageable if compulsions prevented. 
 
 
 
 
3 = Prominent and very disturbing increase in anxiety if compulsions interrupted. 
 
 
 
4 = Extreme, incapacitating anxiety from any intervention aimed at reducing the compulsions. 
 
9. RESISTANCE:  How much effort did you make to resist the compulsions? Or, how often did you try 
to stop the compulsions? 
 
 
 
0 = I made the effort to always resist (or the symptoms were so minimal that there was no need to 
actively resist them). 
 
 
 
 
1 = I tried to resist most of the time. 
 
 
 
 
2 = I made some effort to resist 
 
 
 
 
3 = I yielded to almost all compulsions without attempting to control them, but I did so with some 
reluctance. 
 
 
 
4 = I completely and willingly yielded to all compulsions. 

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10. DEGREE OF CONTROL OVER COMPULSIVE BEHAVIOR: How much control did you have 
over the compulsive behavior? How successful were you in stopping the ritual(s)? 
 
 
0 = I had complete control. 
 
 
 
 
1 = Usually I could stop compulsions or rituals with some effort and willpower. 
 
 
 
 
2 = Sometimes I could stop compulsive behavior but only with difficulty. 
 
 
 
 
3 = I could only delay the compulsive behavior, but eventually it had to be carried out to completion. 
 
 
 
4 = I was rarely able to even momentarily delay performing the compulsive behavior. 
 
COMPULSIVE SUBTOTAL (Add items 6-10)   
 
 

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Mindfulness Practice Questionnaire 
 
This questionnaire is to be completed based on the mindfulness practices you completed during the past week 
 
How many separate, planned mindfulness practices did you complete over the last seven days (last week)? 
 
Describe the most important obsessive thought or image that you experience during these practices: 
 
Describe the most important ritual that you resisted engaging in during these practices: 
 
Section 1: Please rate each of the following statements using the scale provided.  Write the number in the blank space beside 
each question that best describes your own opinion of what is generally true for you, considering all of the mindfulness 
practices you completed during the past week.  
 
1 
2 
3 
4 
5 
Never or very 
rarely true 
Rarely true 
Sometimes true 
Often true 
Very often or 
always true 
 
1. I noticed that when I repeat the same mindfulness practice, the “peak” level of anxiety           
(the highest level of anxiety overall) I experienced decreased with each repetition. 
 
 
2. I was aware of physical sensations in my body and how thoughts and emotions are 
connected to my physical sensations. 
 
3. I learned something new about the connection between having obsessive thoughts and 
engaging in rituals. 
 
4. The mindfulness practices were completed without engaging in rituals                                     
(e.g., checking, washing, counting, cleaning, repeating, mental rituals). 
 
5. I was able to pay attention to new information that I wasn’t previously aware of. 
 
 
6. I learned that I need to engage in rituals or safety behaviours in order to experience 
symptom relief. 
 
7. I was able to re-evaluate my appraisal (or interpretation) of the obsessive thought or image 
during each mindfulness practice. 
 
 
8. The mindfulness practices were completed without engaging in safety behaviours                   
(e.g., checking, reassurance seeking, distraction, mental avoidance, using medications). 
 
 
9. I was not aware of distressing obsessive thoughts or images that I experienced during my 
mindfulness practices. 
 
 
10. I learned something new – the outcome of my mindfulness practices were worse than 
what I had expected. 
 
11. I learned that if I pay attention to my experience in the present moment, my anxiety will 
gradually decrease. 
 
 
12. Whenever my mind wandered, I was aware of how I felt about this and how I reacted to 
this experience 
 
13. I carefully planned to complete a formal, structured mindfulness practice that I decided on 
in advance. 
 
14. I considered how my experience during the mindfulness practice may apply to my 
everyday experiences 
 
15. I was able to generate an alternative understanding of my interpretation of the obsessive 
thought. 
 
 
Hawley, Rector & Richter (2015).  Please do not use, copy or distribute without permission from one of the authors. 
 

Study Protocol 
OCI-R 
The following statements refer to experiences that many people have in their everyday 
lives. Circle the number that best describes HOW MUCH that experience has 
DISTRESSED or BOTHERED you during the PAST MONTH. The numbers refer to the 
following labels: 
 
0 
Not at all 
1 
A little 
2 
Moderately 
3 
A lot 
4 
Extremely 
 
1. I have saved up so many things that they get in the way 
0 1 2 3 4 
2. I check things more often than necessary. 
0 1 2 3 4 
3. I get upset if objects are not arranged properly. 
0 1 2 3 4 
4. I feel compelled to count while I am doing things. 
0 1 2 3 4 
5. I find it difficult to touch an object when I know it has been touched by 
strangers or certain people. 
0 1 2 3 4 
6. I find it difficult to control my own thoughts. 
0 1 2 3 4 
7. I collect things I don’t need. 
0 1 2 3 4 
8. I repeatedly check doors, windows, drawers, etc. 
0 1 2 3 4 
9. I get upset if others change the way I have arranged things. 
0 1 2 3 4 
10. I feel I have to repeat certain numbers. 
0 1 2 3 4 
11. I sometimes have to wash or clean myself simply because I feel 
contaminated. 
0 1 2 3 4 
12. I am upset by unpleasant thoughts that come into my mind against my 
will. 
0 1 2 3 4 
13. I avoid throwing things away because I am afraid I might need them later. 
0 1 2 3 4 
14. I repeatedly check gas and water taps and light switches after turning 
them off. 
0 1 2 3 4 
15. I need things to be arranged in a particular way. 
0 1 2 3 4 
16. I feel that there are good and bad numbers. 
0 1 2 3 4 
17. I wash my hands more often and longer than necessary. 
0 1 2 3 4 
18. I frequently get nasty thoughts and have difficulty in getting rid of them. 
0 1 2 3 4 

Version 2 Updated Friday, September 01, 2017 
2
(OBQ-44) 
 
This inventory lists different attitudes or beliefs that people sometimes hold. Read each statement carefully 
and decide how much you agree or disagree with it.  
For each of the statements, choose the number matching the answer that best describes how you think. 
Because people are different, there are no right or wrong answers.  
To decide whether a given statement is typical of your way of looking at things, simply keep in mind what 
you are like most of the time. 
 
Use the following scale: 
1 
2 
3 
4 
5 
6 
7 
Disagree very 
much 
Disagree 
moderately 
Disagree a 
little 
Neither agree 
or disagree 
Agree a little 
Agree 
moderately 
Agree very 
much 
 
In making your ratings, try to avoid using the middle point of the scale (4), but rather indicate whether you 
usually disagree or agree with the statements about your own beliefs and attitudes. 
 
1. I often think things around me are unsafe. 
1 
2 
3 
4 
5 
6 
7 
2. If I’m not absolutely sure of something, I’m bound to 
make a mistake 
1 
2 
3 
4 
5 
6 
7 
3. Things should be perfect according to my own 
standards. 
1 
2 
3 
4 
5 
6 
7 
4. In order to be a worthwhile person, I must be perfect 
at everything I do. 
1 
2 
3 
4 
5 
6 
7 
5. When I see any opportunity to do so, I must act to 
prevent bad things from happening. 
1 
2 
3 
4 
5 
6 
7 
6. Even if harm is very unlikely, I should try to prevent 
it at any cost. 
1 
2 
3 
4 
5 
6 
7 
7. For me, having bad urges is as bad as actually 
carrying them out. 
1 
2 
3 
4 
5 
6 
7 
8. If I don’t act when I foresee danger, then I am to 
blame for any consequences. 
1 
2 
3 
4 
5 
6 
7 
9. If I can’t do something perfectly, I shouldn’t do it at 
all. 
1 
2 
3 
4 
5 
6 
7 
 

Version 2 Updated Friday, September 01, 2017 
3
 
 
1 
2 
3 
4 
5 
6 
7 
Disagree very 
much 
Disagree 
moderately 
Disagree a 
little 
Neither agree 
or disagree 
Agree a little 
Agree 
moderately 
Agree very 
much 
10. I must work to my full potential at all times. 
1 
2 
3 
4 
5 
6 
7 
11. It is essential for me to consider all possible 
outcomes of a situation. 
1 
2 
3 
4 
5 
6 
7 
12. Even minor mistakes mean a job is not complete. 
1 
2 
3 
4 
5 
6 
7 
13. If I have aggressive thoughts or impulses about my 
loved ones, this means I may secretly want to hurt 
them. 
1 
2 
3 
4 
5 
6 
7 
14. I must be certain of my decisions. 
1 
2 
3 
4 
5 
6 
7 
15. In all kinds of daily situations, failing to prevent 
harm is just as bad as deliberately causing harm. 
1 
2 
3 
4 
5 
6 
7 
16. Avoiding serious problems (for example, illness or 
accidents) requires constant effort on my part. 
1 
2 
3 
4 
5 
6 
7 
17. For me, not preventing harm is as bad as causing 
harm. 
1 
2 
3 
4 
5 
6 
7 
18. I should be upset if I make a mistake. 
1 
2 
3 
4 
5 
6 
7 
19. I should make sure others are protected from any 
negative consequences of my decisions or actions 
1 
2 
3 
4 
5 
6 
7 
20. For me, things are not right if they are not perfect. 
1 
2 
3 
4 
5 
6 
7 
21. Having nasty thoughts means I am a terrible person. 
1 
2 
3 
4 
5 
6 
7 
22. If I do not take extra precautions, I am more likely 
than others to have or cause a serious disaster. 
1 
2 
3 
4 
5 
6 
7 
23. In order to feel safe, I have to be as prepared as 
possible for anything that could go wrong. 
1 
2 
3 
4 
5 
6 
7 
24. I should not have bizarre or disgusting thoughts. 
1 
2 
3 
4 
5 
6 
7 
25. For me, making a mistake is as bad as failing 
completely. 
1 
2 
3 
4 
5 
6 
7 
26. It is essential for everything to be clear cut, even in 
minor matters. 
1 
2 
3 
4 
5 
6 
7 
27. Having a blasphemous thought is as sinful as 
committing a sacrilegious act. 
1 
2 
3 
4 
5 
6 
7 

Version 2 Updated Friday, September 01, 2017 
4
 
1 
2 
3 
4 
5 
6 
7 
Disagree very 
much 
Disagree 
moderately 
Disagree a 
little 
Neither agree 
or disagree 
Agree a little 
Agree 
moderately 
Agree very 
much 
28. I should be able to rid my mind of unwanted 
thoughts. 
1 
2 
3 
4 
5 
6 
7 
29. I am more likely than other people to accidentally 
cause harm to myself or to others. 
1 
2 
3 
4 
5 
6 
7 
30. Having bad thoughts means I am weird or abnormal. 
1 
2 
3 
4 
5 
6 
7 
31. I must be the best at things that are important to me. 
1 
2 
3 
4 
5 
6 
7 
32. Having an unwanted sexual thought or image means I 
really want to do it. 
1 
2 
3 
4 
5 
6 
7 
33. If my actions could have even a small effect on a 
potential misfortune, I am responsible for the 
outcome. 
1 
2 
3 
4 
5 
6 
7 
34. Even when I am careful, I often think that bad things 
will happen. 
1 
2 
3 
4 
5 
6 
7 
35. Having intrusive thoughts means I'm out of control. 
1 
2 
3 
4 
5 
6 
7 
36. Harmful events will happen unless I am very careful. 
1 
2 
3 
4 
5 
6 
7 
37. I must keep working at something until it's done 
exactly right. 
1 
2 
3 
4 
5 
6 
7 
38. Having violent thoughts means I will lose control and 
become violent. 
1 
2 
3 
4 
5 
6 
7 
39. To me, failing to prevent a disaster is as bad as 
causing it. 
1 
2 
3 
4 
5 
6 
7 
40. If I don’t do a job perfectly, people won’t respect me. 
1 
2 
3 
4 
5 
6 
7 
41. Even ordinary experiences in my life are full of risk. 
1 
2 
3 
4 
5 
6 
7 
42. Having a bad thought is morally no different than 
doing a bad deed. 
1 
2 
3 
4 
5 
6 
7 
43. No matter what I do, it won’t be good enough. 
1 
2 
3 
4 
5 
6 
7 
44. If I don't control my thoughts, I'll be punished. 
1 
2 
3 
4 
5 
6 
7 
 
 
 
 

Version 2 Updated Friday, September 01, 2017 
5
 
5-FACET M QUESTIONNAIRE 
 
Please rate each of the following statements using the scale provided.  Write the number in 
the blank that best describes your own opinion of what is generally true for you. 
 
1 
2 
3 
4 
5 
never or very 
rarely true 
rarely 
true 
sometimes 
true 
often 
true 
very often or 
always true 
 
_____ 1.  When I’m walking, I deliberately notice the sensations of my body moving. 
_____ 2.  I’m good at finding words to describe my feelings. 
_____ 3.  I criticize myself for having irrational or inappropriate emotions. 
_____ 4.  I perceive my feelings and emotions without having to react to them. 
_____ 5.  When I do things, my mind wanders off and I’m easily distracted. 
_____ 6.  When I take a shower or bath, I stay alert to the sensations of water on my body. 
_____ 7.  I can easily put my beliefs, opinions, and expectations into words. 
_____ 8.  I don’t pay attention to what I’m doing because I’m daydreaming, worrying, or 
 
otherwise distracted. 
_____ 9.  I watch my feelings without getting lost in them. 
_____ 10. I tell myself I shouldn’t be feeling the way I’m feeling. 
_____ 11. I notice how foods and drinks affect my thoughts, bodily sensations, and emotions. 
_____ 12. It’s hard for me to find the words to describe what I’m thinking. 
_____ 13. I am easily distracted. 
_____ 14. I believe some of my thoughts are abnormal or bad and I shouldn’t think that way. 
_____ 15. I pay attention to sensations, such as the wind in my hair or sun on my face. 
_____ 16. I have trouble thinking of the right words to express how I feel about things 
_____ 17. I make judgments about whether my thoughts are good or bad. 
_____ 18. I find it difficult to stay focused on what’s happening in the present. 
_____ 19. When I have distressing thoughts or images, I “step back” and am aware of the  
 
thought or image without getting taken over by it. 
_____ 20. I pay attention to sounds, such as clocks ticking, birds chirping, or cars passing. 
_____ 21. In difficult situations, I can pause without immediately reacting. 
_____ 22. When I have a sensation in my body, it’s difficult for me to describe it because I can’t 
 
find the right words. 
 


Version 2 Updated Friday, September 01, 2017 
6
 
1 
2 
3 
4 
5 
never or very 
rarely true 
rarely 
true 
sometimes 
true 
often 
true 
very often or 
always true 
 
_____ 23. It seems I am “running on automatic” without much awareness of what I’m doing. 
 _____24. When I have distressing thoughts or images, I feel calm soon after. 
_____ 25. I tell myself that I shouldn’t be thinking the way I’m thinking. 
_____ 26. I notice the smells and aromas of things. 
_____ 27. Even when I’m feeling terribly upset, I can find a way to put it into words. 
_____ 28. I rush through activities without being really attentive to them. 
_____ 29. When I have distressing thoughts or images I am able just to notice them without 
 
reacting. 
_____ 30. I think some of my emotions are bad or inappropriate and I shouldn’t feel them. 
_____ 31. I notice visual elements in art or nature, such as colors, shapes, textures, or patterns of 
 
light and shadow. 
_____ 32. My natural tendency is to put my experiences into words. 
_____ 33. When I have distressing thoughts or images, I just notice them and let them go. 
_____ 34. I do jobs or tasks automatically without being aware of what I’m doing. 
_____ 35. When I have distressing thoughts or images, I judge myself as good or bad, depending 
 
what the thought/image is about. 
_____ 36. I pay attention to how my emotions affect my thoughts and behavior. 
_____ 37. I can usually describe how I feel at the moment in considerable detail. 
_____ 38. I find myself doing things without paying attention. 
_____ 39. I disapprove of myself when I have irrational ideas. 

Study Protocol 
THOUGHT CONTROL QUESTIONNAIRE (TCQ) 
Most people experience unpleasant and/or unwanted thoughts (in verbal and/or picture form) 
which can be difficult to control. We are interested in the techniques that you generally use to 
control such thoughts. Below are a number of things that people do to control these thoughts. 
Please read each statement carefully, and indicate how often you use each technique by circling 
the appropriate number. There are no right or wrong answers to these questions. Do not spend 
too much time thinking about each one. 
When I experience an unpleasant / unwanted thought: 
 
Never 
Sometimes 
Often 
Almost 
always 
I call to mind positive images instead 
1 
2 
3 
4 
I tell myself not to be so stupid 
1 
2 
3 
4 
I focus on the thought 
1 
2 
3 
4 
I replace the thought with a more trivial bad thought 
1 
2 
3 
4 
I don’t talk about the thought to anyone 
1 
2 
3 
4 
I punish myself for thinking the thought 
1 
2 
3 
4 
I dwell on other worries 
1 
2 
3 
4 
I occupy myself with work instead 
1 
2 
3 
4 
I challenge the thought’s validity 
1 
2 
3 
4 
I get angry at myself for having the thought 
1 
2 
3 
4 
I avoid discussing the thought 
1 
2 
3 
4 
I shout at myself for having the thought 
1 
2 
3 
4 
I analyze the thought rationally 
1 
2 
3 
4 
I slap or pinch myself to stop the thought 
1 
2 
3 
4 
I think pleasant thoughts instead 
1 
2 
3 
4 
I find out how my friends deal with these thoughts 
1 
2 
3 
4 
I worry about more minor things instead 
1 
2 
3 
4 
I do something that I enjoy 
1 
2 
3 
4 
I try to reinterpret the thought 
1 
2 
3 
4 
I think about something else 
1 
2 
3 
4 
I think about the more minor problems I have 
1 
2 
3 
4 
I try a different way of thinking about it 
1 
2 
3 
4 
I think about past worries instead 
1 
2 
3 
4 
I ask my friends if they have similar thoughts 
1 
2 
3 
4 
I focus on different negative thoughts 
1 
2 
3 
4 
I question the reasons for having the thought 
1 
2 
3 
4 
I tell myself that something bad will happen if I think the 
thought 
1 
2 
3 
4 
I talk to a friend about the thought 
1 
2 
3 
4 
I keep myself busy 
1 
2 
3 
4 

Version 2 Updated Friday, September 01, 2017 
2
Mind Wandering: Deliberate 
 
For the following statements please select the answer that most accurately reflects your 
everyday mind wandering. 
1. I allow my thoughts to wander on purpose. 
Rarely 
A Lot 
1 
2 
3 
4 
5 
6 
7 
2. I enjoy mind-wandering. 
Rarely 
A Lot 
1 
2 
3 
4 
5 
6 
7 
3. I find mind-wandering is a good way to cope with boredom. 
Not At All 
True 
 
 
 
 
 
Very True 
1 
2 
3 
4 
5 
6 
7 
4. I allow myself to get absorbed in pleasant fantasy. 
Rarely 
A Lot 
1 
2 
3 
4 
5 
6 
7 

Version 2 Updated Friday, September 01, 2017 
3
 
Mind Wandering: Spontaneous 
 
For the following statements please select the answer that most accurately reflects your 
everyday mind wandering. 
1. I find my thoughts wandering spontaneously. 
Rarely 
A Lot 
1 
2 
3 
4 
5 
6 
7 
2. When I mind-wander my thoughts tend to be pulled from topic to topic. 
Rarely 
A Lot 
1 
2 
3 
4 
5 
6 
7 
3. It feels like I don't have control over when my mind wanders. 
Almost 
Never 
 
 
 
 
 
Almost 
Always 
1 
2 
3 
4 
5 
6 
7 
4. I mind-wander even when I'm supposed to be doing something else. 
Rarely 
A Lot 
1 
2 
3 
4 
5 
6 
7 

Study Protocol 
AAQ-II 
 
Below you will find a list of statements. Please rate how true each statement is for you by circling a number 
next to it. Use the scale below to make your choice. 
 
 
 
1. It’s OK if I remember something unpleasant 
1        2        3        4        5       6         7 
2. My painful experiences and memories make it difficult for me to 
live a life that I would value. 
 
1       2       3       4       5       6       7 
3. I'm afraid of my feelings. 
 
1       2       3       4       5       6       7 
4. I worry about not being able to control my worries and feelings. 
 
1       2       3       4       5       6       7 
5. My painful memories prevent me from having a fulfilling life. 
 
1       2       3       4       5       6       7 
6. I am in control of my life 
1       2       3       4       5       6       7 
7. Emotions cause problems in my life. 
 
1       2       3       4       5       6       7 
8. It seems like most people are handling their lives better than I am. 
 
1       2       3       4       5       6       7 
9. Worries get in the way of my success. 
 
1       2       3       4       5       6       7 
10. My thoughts and feelings do not get in the way of how I want to 
live my life 
1       2       3       4       5       6       7 
 
 
 
 
 
 
 
Never true 
Very seldom true 
Seldom true 
Sometimes true 
Frequently true 
Almost always true 
Always true 
1 
2 
3 
4 
5 
6 
7 

Version 2 Updated Friday, September 01, 2017 
2
RR 
Instructions: Please circle the line on the ruler below that you feel appropriately captures your desire to 
change and your feelings about being capable of change: 
 
1. On a scale from 1 to 10, how important is it to you to improve your obsessive/compulsive 
symptoms? 
 
  Not at all 
Important 
Somewhat 
Important 
Extremely 
Important 
 
  
      |IIIIIIIII|IIIIIIIII|IIIIIIIII|IIIIIIIII|IIIIIIIII|IIIIIIIII|IIIIIIIII|IIIIIIIII|IIIIIIIII| 
       1          2           3            4           5 
       6           7            8           9           10 
 
2. On a scale from 1 to 10, how confident do you feel that you can succeed in improving your 
obsessive/compulsive symptoms?  
 
 
 
    
 Not at all 
Confident 
Somewhat 
Confident 
Extremely 
Confident 
      |IIIIIIIII|IIIIIIIII|IIIIIIIII|IIIIIIIII|IIIIIIIII|IIIIIIIII|IIIIIIIII|IIIIIIIII|IIIIIIIII| 
       1          2           3            4           5 
       6           7            8           9           10 
 
3. On a scale from 1 to 10, how ready are you to make changes in your life in order to 
improve your obsessive/compulsive symptoms? 
 
 
     Not at all 
Ready to change 
Somewhat 
Ready to change 
                  Extremely 
  Ready to change 
      |IIIIIIIII|IIIIIIIII|IIIIIIIII|IIIIIIIII|IIIIIIIII|IIIIIIIII|IIIIIIIII|IIIIIIIII|IIIIIIIII| 
       1          2           3            4           5 
       6           7            8           9           10 
 
 
3. On a scale from 1 to 10, how motivated are you to engage in upcoming weekly Cognitive 
Behavior Therapy sessions for Obsessive Compulsive Disorder? 
 
 
Not at all 
Motivated 
Somewhat 
Motivated 
Extremely 
Motivated 
      |IIIIIIIII|IIIIIIIII|IIIIIIIII|IIIIIIIII|IIIIIIIII|IIIIIIIII|IIIIIIIII|IIIIIIIII|IIIIIIIII| 
       1          2           3            4           5 
       6           7            8           9           10

Study Protocol 
Metacognitions Questionnaire (MCQ) 
 
This questionnaire is concerned with beliefs people have about their thinking. Listed 
below are a number of beliefs that people have expressed. Please read each item and 
say how much you generally agree with it by circling the appropriate number. Please 
respond to all the items; there are no right or wrong answers. 
 
Do not 
agree 
Agree 
slightly 
Agree 
moderately 
Agree 
very much 
1. Worrying helps me to avoid problems in the future 
1 
2 
3 
4 
2. My worrying is dangerous for me. 
1 
2 
3 
4 
3. I have difficulty knowing if I have actually done something, or 
just imagined it. 
1 
2 
3 
4 
4. I think a lot about my thoughts. 
1 
2 
3 
4 
5. I could make myself sick with worrying. 
1 
2 
3 
4 
6. I am aware of the way my mind works when I am thinking 
through a problem 
1 
2 
3 
4 
7. If I did not control a worrying thought, and then it happened, it 
would be my fault. 
1 
2 
3 
4 
8. If I let my worrying thoughts get out of control, they will end up 
controlling me. 
1 
2 
3 
4 
9. I need to worry in order to remain organized. 
1 
2 
3 
4 
10. I have little confidence in my memory for words and names. 
1 
2 
3 
4 
11. My worrying thoughts persist, no matter how I try to stop them. 
1 
2 
3 
4 
12. Worrying helps me to get things sorted out in my mind. 
1 
2 
3 
4 
13. I cannot ignore my worrying thoughts. 
1 
2 
3 
4 
14. I monitor my thoughts. 
1 
2 
3 
4 
15. I should be in control of my thoughts all of the time. 
1 
2 
3 
4 
16. My memory can mislead me at times. 
1 
2 
3 
4 
17. I could be punished for not having certain thoughts. 
1 
2 
3 
4 
18. My worrying could make me go mad. 
1 
2 
3 
4 
19. If I do not stop worrying thoughts, they could come true. 
1 
2 
3 
4 
20. I rarely question my thoughts. 
1 
2 
3 
4 
21. Worrying puts my body under a lot of stress. 
1 
2 
3 
4 
22. Worrying helps me to avoid disastrous situations. 
1 
2 
3 
4 
23. I am constantly aware of my thinking. 
1 
2 
3 
4 
24. I have a poor memory. 
1 
2 
3 
4 
25. I pay close attention to the way my mind works. 
1 
2 
3 
4 
26. People who do not worry have no depth. 
1 
2 
3 
4 
27. Worrying helps me cope. 
1 
2 
3 
4 
 

Version 2 Updated Friday, September 01, 2017 
2
 
Do not 
agree 
Agree 
slightly 
Agree 
moderately 
Agree 
very much 
28. I imagine having not done things and then doubt my memory 
for doing them. 
1 
2 
3 
4 
29. Not being able to control my thoughts is a sign of weakness. 
1 
2 
3 
4 
30. If I did not worry, I would make more mistakes. 
1 
2 
3 
4 
31. I find it difficult to control my thoughts. 
1 
2 
3 
4 
32. Worrying is a sign of a good person. 
1 
2 
3 
4 
33. Worrying thoughts enter my head against my will. 
1 
2 
3 
4 
34. If I could not control my thoughts I would go crazy. 
1 
2 
3 
4 
35. I will lose out in life if I do not worry. 
1 
2 
3 
4 
36. When I start worrying, I cannot stop. 
1 
2 
3 
4 
37. Some thoughts will always need to be controlled. 
1 
2 
3 
4 
38. I need to worry in order to get things done. 
1 
2 
3 
4 
39. I will be punished for not controlling certain thoughts. 
1 
2 
3 
4 
40. My thoughts interfere with my concentration. 
1 
2 
3 
4 
41. It is alright to let my thoughts roam free. 
1 
2 
3 
4 
42. I worry about my thoughts. 
1 
2 
3 
4 
43. I am easily distracted. 
1 
2 
3 
4 
44. My worrying thoughts are not productive. 
1 
2 
3 
4 
45. Worry can stop me from seeing a situation clearly. 
1 
2 
3 
4 
46. Worrying helps me to solve problems. 
1 
2 
3 
4 
47. I have little confidence in my memories for places. 
1 
2 
3 
4 
48. My worrying thoughts are uncontrollable. 
1 
2 
3 
4 
49. It is bad to think certain thoughts. 
1 
2 
3 
4 
50. If I do not control my thoughts, I may end up embarrassing 
myself. 
1 
2 
3 
4 
51. I do not trust my memory. 
1 
2 
3 
4 
52. I do my clearest thinking when I am worrying. 
1 
2 
3 
4 
53. My worrying thoughts appear automatically. 
1 
2 
3 
4 
54. I would be selfish if I never worried. 
1 
2 
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55. If I could not control my thoughts, I would not be able to 
function. 
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56. I need to worry, in order to work well. 
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57. I have little confidence in my memory for actions. 
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58. I have difficulty keeping my mind focused on one thing for a 
long time. 
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Version 2 Updated Friday, September 01, 2017 
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Do not 
agree 
Agree 
slightly 
Agree 
moderately 
Agree 
very much 
59. If a bad thing happens which I have not worried about, I feel 
responsible. 
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4 
60. It would not be normal if I did not worry. 
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61. I constantly examine my thoughts. 
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62. If I stopped worrying, I would become glib, arrogant and 
offensive. 
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63. Worrying helps me to plan the future more effectively. 
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64. I would be a stronger person if I could worry less. 
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65. I would be stupid and complacent not to worry. 
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