Results Preliminary Analysis One hundred and twenty-one participants (Male=33; Female=87; Other=1) were included in the analyses after the removal of incomplete data (n=107, 47%). This was in line with information outlined to participants in the information sheet, which interpreted of the survey as participants choosing to withdraw their data. These 107 cases were not included in the analysis. See Table 1 for demographic information for participants. For ethnicity, level of education and marital status, the highest two categories are presented. Table 1: Key demographic information for participants By condition Demographic variables All data Victim Perpetrator N 121 63 58 Gender M=33; F=87 M=13; F=50 M=20; F=37 Mean age in years (SD) 34.07 (11.69) 35.30 (12.24) 32.72 (11.01) Ethnicity White British 86% 84.1% 87.9% Asian or Asian British 6.6% 6.3% 6.9% Education Postgraduate degree 45.5% 41.3% 50% Undergraduate degree 25.6% 25.4% 25.9% Marital status Maa=41.3% Sb=52.1% Maa=41.3% Sb=50.8% Maa=41.4% Sb=53.4% N= number of participants; M=Male; F=Female; SD=Standard Deviation; Maa=Married; Sb=Single Table 1 shows that, when split by condition, the two groups were similar in their key demographic information. Overall the sample was largely White British and educated to an undergraduate or postgraduate degree level. Despite slight differences being observed in the gender ratio and Mean age of between groups, these were not significant. completion non-
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Table 1: Demographic variables of all studies Article Country % Sample Size Clinical/ nonclinical Population Mean Age Age range Herba & Rachman (2007) Canada 100% 120 Nonclinical Students 20.73 (SD= 4.73) Radomsky & Elliot (2009) Canada 100% 70 Nonclinical Students 23.30 (SD= 4.77) 18-43yrs Coughtrey, Shafran & Rachman (2014a) - 70% 40 Nonclinical Students 22.60 (SD= 5.33) 18-44yrs - 82% 60 Clinical (scores >10 on VOCI) Students 20.53 (SD= 4.30) 18-38yrs Coughtrey, Shafran & Rachman (2014b) - 82% 60 Nonclinical Students 20.53 (SD= 4.30) 18-38yrs Lee et al (2013) UK 83% 60 Nonclinical Students 22.25 (SD= 8.22) 18-57yrs Berman et al (2012) US 72% 265 Nonclinical Students 19.46 (SD= 2.75) - Coughtrey et al (2012a) UK 73% 177 Clinical (high OC symptoms) Community 34.40 (SD= 11.43) - UK 65% 54 Clinical (formal diagnosis using the ADIS-IV or structured interview) Community 33.39 (SD= 10.89) - Carraresi et al (2013) Italy 45% 83 Clinical (ADIS-IV) Community 32.6 (SD=9.6) -
2)40 3)40 4)40 2)20.63 (SD=2.93 3)21.53 (SD= 4.95) 4)22.75 (SD= 5.45) 2)18-36 3)19-43 4)17-52 Elliot & Radomsky (2009) Canada 100% 148 Nonclinical Students 22.86 (SD= 4.46) 17-48 Elliot & Radomsky (2012) Canada 100% 140 Nonclinical Students 22.70 (SD= 5.29) 18-55 Fairbrother & Rachman (2004) Canada 100% 50 Nonclinical (but who reported an unwanted sexual experience) Community 24.5 16-49 Ishikawa et al (2014) Japan 100% 48 Nonclinical Students 18.36 (SD= 2.31) 18-25 Elliot & Radomsky (2013) Canada 100% 50 Nonclinical Students 21.59 (SD= 4.01) 18-44 Coughtrey, Shafran & Lee (2013) UK 58% 12 Clinical (OCD of clinical severity, whose primary problem was mental contamination) Community 28.83 (SD= 8.54) - SD=Standard Deviation; VOCI= Vancouver Obsessional Compulsive Inventory; OC=Obsessive Compulsive; OCD=Obsessive Compulsive Disorder; DSM-IV=Diagnostic and Statistical Manual of Mental Disorders; ADIS-IV=Anxiety Disorder Interview Schedule; DOCS=Dimensional Obsessive-Compulsive Scale.
throughout the process. However, overall, the paper was deemed appropriate for inclusion in this review. Description of the Results Measures. Forty-nine different measures were used across all studies, with 10 of those specifically measuring mental contamination (Mental Contamination Report (MCR) Cronbach’s α=.41to .88 (Elliott & Radomsky, 2009); Mental Contamination Interview (α not reported) (Rachman, 2006); Mental Pollution Questionnaire (MPQ) α=.86 for the washing subscale and α=.85 for inward contamination subscale (Cougle et al. 2008); the Vancouver Obsessional Compulsive Inventory – Mental Contamination Scale (VOCI-MC) α=.94 (Rachman, 2006); Thought-Action Fusion- Mental Contamination Scale (TAF-MC) α=.92 (Rachman, 2006); Sexual Assault and Rape Appraisals (SARA) α=.80 (Fairbrother & Rachman, 2004); Obsessive Compulsive Inventory – Short Version (OCI-R) α=.57 to .93 (Foa et al., 2002); Contamination Sensitivity Scale (CSS) α not reported (Rachman, 2005b); Contamination Thought-Action Fusion Scale (CTAF) α not reported (Rachman, 2005c); and the Unwanted Sexual Experiences Study Questionnaire (USES) α not reported (Fairbrother, Newth & Rachman, 2005), which includes questions specific to mental contamination). Some of these measures were adapted from other OCD and contamination specific measures to include explicit questions on mental contamination. Not all of the studies reported the internal consistency or reliability data for the measures used. It is therefore difficult to be confident that they are all reliable and valid measures of mental contamination. Whilst the majority of those that did state Cronbach’s alpha (α) figures report good to excellent amounts of internal consistency within the measures, the OCI-R and MCR reported ranges of internal consistency with the lowest point showing poor to unacceptable levels. As well as these standardised measures used to measure mental contamination, Visual analogue
Likewise, focusing clinical work on appraisals specifically, could be an important future direction to take due to this seeming to be a theme across the studies that this paper reviewed. Studies have found that an adapted CBT focusing on directly addressing mental contamination was more effective for some participants (Coughtrey, Shafran & Lee, 2013) and that appraisals played a key role in this. This therefore highlights the importance of investigating the role of appraisals further as research is beginning to demonstrate that they seem to have a significant impact upon mental contamination, which could have important clinical implications. Conclusions This synthesis has systematically and critically evaluated the research to date in the field of mental contamination. It has found that the majority of the research has focused, in some part, on adding to the evidence base that mental contamination is a separate construct from contact contamination. Now that a consensus has been reached on this point, the field has begun to move in different directions in an aim to further explore and understand the construct. Whilst this is promising in terms of widening the knowledge base, it has led to a confusing picture in the literature as there is less reliability between studies because of the lack of replication of findings. This therefore means that it is difficult to make any clear assertions about the relationship between mental contamination and psychological distress in a more specific manner. There does however, seem to be some promising findings emerging from the research into mental contamination and morality and associated negative emotions (such as shame and guilt). Whilst the research in this area remains in its infancy, replicable results across studies are being found, therefore warranting further investigation. Research in this area also has potential important clinical implications for the treatment of patients presenting with OCD as understanding how these associated negative emotions interact with mental contamination could help to identify specific vulnerabilities to the construct in the
between ‘victims’ and ‘perpetrators’ of moral transgressions? Personal and Professional Learning – Final Reflective Account On becoming a clinical psychologist: A retrospective, developmental, reflective account of the experience of training Specialist – Case Report An integrative formulation and intervention of girl in early adolescence with an acquired brain injury in the context of a neurorehabilitation service.