Hoffman, West, & Sheets, 2002; Preacher & Hayes, 2004, 2008; Shrout & Bolger, 2002). In the current study, the Baron and Kenny (1986) criteria were not applied as these are considered to be overly conservative and require a very large sample size to achieve sufficient power (Preacher & Hayes, 2008). Furthermore, mediation results were not described as ‘full’ or ‘partial’ as per recent guidance (Rucker, Preacher, Tormala & Petty, 2011). Bootstrapping techniques were performed in line with recommendations by Preacher and Hayes (2008), with 5000 resamples and 95% bias-corrected and accelerated (BCa) confidence intervals (CI) used to evaluate indirect effects. BCa confidence intervals include corrections for median bias and skew (Efron & Tibshirani, 1993). The use of 95% confidence intervals is equivalent to testing for significance at the .05 level. Indirect effects were considered as significant when the BCa confidence interval did not include zero. Assumptions of the data were checked prior to completing the mediation analysis. Mediation effect sizes were calculated using Preacher and Kelley’s (2011) κ² method as this method is able to describe how large the indirect effect is compared to how large it could be. They argue it can be interpreted using Cohen’s effect size criterion whereby small, medium, and large effect sizes stand at .01, .09, and .25 respectively (Cohen, 1988). Figure 1: The mediation 3. Results 3.1. Sample Characteristics 3.1.1. Response Rate
Table 3. Zero-order correlations between all variables 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 1. OBQ-44- Responsibility -- 2. OCI- OC Symptoms .468** -- 3. PBI- Maternal Care -.154 -.171 -- 4. PBI- Maternal Overprotection .150 .076 -.469** -- 5. PBI- Paternal Care -.068 -.131 -.284** -.244* -- 6. PBI- Paternal Overprotection .298** .339** -.112 .397** -.333** -- 7. ECR-R- Attachment Anxiety .400** .369** -.274** .207* -.046 .184 -- 8. ECR-R- Attachment Avoidance .176 .186 -.392** .274** -.193* .113 .468** -- 9. DASS21- Depression .399** .391** -.266* .271* -.188 .264** .304* .123 -- 10. DASS21- Anxiety .509** .469** -.335** .221* -.143 .196* .336** .223* .463* -- ** Correlation is significant at the .01 level (2-tailed). * Correlation is significant at the .05 level (2-tailed).
related to OCD symptoms highlights the difference between these two constructs. It is possible that an avoidant attachment style does not lead to inflated personal responsibility, but an anxious attachment style does. This is supported by the finding that attachment anxiety is associated with relatively negative evaluations of competence across all life domains, but the self-views of avoidant individuals varies across domains (Mikulincer & Shaver, 2003). As such, it is possible that individuals with an avoidant attachment style may evaluate their competence during pregnancy positively, meaning they have lower responsibility beliefs at this time, compared to individuals with an anxious attachment style. Furthermore, an avoidant attachment style is associated with discomfort with closeness and preference for emotional distance and self-reliance (Mikulincer & Shaver, 2003). It is therefore possible that relationships are not deemed to be as important to a positive view of the self in individuals with an avoidant attachment style, meaning they do not activate attachment behaviours that ultimately might be expressed as symptoms of OCD. This is supported by the finding that around half of the peer reviewed studies into avoidant attachment and self-esteem found no evidence of self-esteem deficits in avoidant people, whereas almost all studies have shown that attachment anxiety is associated with lower (Mikulincer & Shaver, 2003). 4.3. Strengths and Limitations 4.3.1. Measurement Issues This study used valid and reliable measures of each of the variables; however these measures were all self-report scales. Self-report scales are a potential source of inaccuracy as participants can engage in socially desirable responding (Paulhus & Reid, 1991). However, there is no research into whether this is a particular problem with the sample used. To minimise this possible inaccuracy, the questionnaire responses were anonymous as
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Lovibond, P.F. & Lovibond, S.H. (1995). The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behaviour Research and Therapy, 33, 335-343 Maina, G., Albert, U., Bogetto, F., Vaschetto, P. & Ravizza, L. (1999). Recent life events and obsessive-compulsive disorder (OCD): The role of pregnancy/delivery. , 89(1), 49-58. Manassis , K. , Bradley , S. , Goldberg , S. , Hood , J. , & Swinson , R. P. (1994) . Attachment in mothers with anxiety disorders and children. Journal of the American Academy of Child and Adolescent Psychiatry, 33, 1106 – 1113 . Mancini, F., D'Olimpio, F., & Cieri, L. (2004). Manipulation of responsibility in non-clinical subjects: Does expectation of failure exacerbate obsessive-compulsive behaviors? Behaviour Research and Therapy, 42(4), 449-457. doi: 10.1016/S0005-7967(03)00153-0 McGuinness, M., Blissett, J. & . (2011). OCD in the Perinatal Period: Is Postpartum OCD (ppOCD) a Distinct Subtype? A Review of the Literature. Behavioural and Cognitive Psychotherapy, 39(3), 285-310. Mikulincer, M., & Shaver, P. R. (2007). Attachment in Adulthood: Structure, Dynamics, and Change. New York: The Guilford Press. MumsNet (n.d.). About Us. Retrieved 2nd August 2013 from National Childbirth Trust (n.d.). Our History. Retrieved 2nd August 2013 from NetMums (n.d.) About Us. Retrieved 2nd August 2013 from http://www.netmums.com/home/about-us
compulsions, not just checkers and so the relationship between responsibility and different subtypes of OCD is not clear from this study. The visuo-spatial memory task (used by Mancini et al., 2004) had high ecological validity as the experimenters gave no reassurance or feedback to participants and allowed participants to go back to check if desired. As such, the experiment was like most real life situations. The authors concluded that expectation of failure is an underestimation of coping abilities and so personal responsibility along with a perceived lack of coping abilities increases OCD symptoms more than personal responsibility alone. This supports Ladouceur et al.’s (1997) findings and fits with Salkovskis’ theory (1985, 1989) that excessive responsibility produces negative automatic thoughts, and discomfort arises, as perceived lack of coping would intensify and add to the negative automatic thoughts and feeling of discomfort. However, Mancini et al. did not include an expectation of failure alone condition (without perceived responsibility), and so this conclusion is limited as it is unclear what effect perceived lack of coping without excessive responsibility would have had on participants’ behaviour. The experimental vignette method of manipulation (used by Parrish & Radomsky, 2011) manipulated responsibility successfully. However, higher responsibility did not lead to higher to seek reassurance. This may be because if a person is more responsible they may prioritise checking than seeking reassurance as personally checking may be seen as more reliable evidence than relying on someone else. Alternatively, people may only seek reassurance if checking fails or is impossible, but this was not the case in the study. It is also possible that the responsibility manipulation was not as effective as the threat or ambiguity of feedback manipulations thus limiting statistical power to detect an effect. Indeed there was a medium-large effect size of the manipulation of responsibility (r=0.47) compared to larger effect sizes of the manipulation of threat (r=0.57) and manipulation of ambiguity of feedback
Treatment. Amsterdam Netherlands: Pergamon/Elsevier Science, pp. 45-61. doi: 10.1016/B978-008043410-0/50005-2 Salkovskis, P. M., Wroe, A. L., Gledhill, A., Morrison, N., Forrester, E., Richards, C., Reynolds, M. & Thorpe, S. (2000). Responsibility attitudes and interpretations are characteristic of obsessive compulsive disorder. Behaviour Research and Therapy, 38(4), 347-372. doi: Salkovskis, P. M., Rachman, S., Ladouceur, R., & Freeston, M. (1992). The definition of ‘responsibility’. Proceedings of the Toronto Cafeteria. In Salkovskis, P. M., Richards, H. C., & Forrester, E. (1995). The relationship between obsessional problems and intrusive thoughts. Behavioural and Cognitive Psychotherapy, 23(3), 281-299. doi: 10.1017/S1352465800015885 Shafran, R. (1997). The manipulation of responsibility in obsessive-compulsive disorder. British Journal of Clinical Psychology, 36(3), 397-407. doi: Taylor, S., & Jang, K. L. (2011). Biopsychosocial etiology of obsessions and compulsions: An integrated behavioral–genetic and cognitive–behavioral analysis. Journal of Abnormal Psychology, 120(1), 174-186. doi: 10.1037/a0021403 Van Oppen, P., & Arntz, A. (1994). Cognitive therapy for obsessive-compulsive disorder. Behaviour Research and Therapy, 32(1), 79-87. doi: 10.1016/0005-7967(94)90086-8 Van Oppen, P., De Haan, E., Van Balkom, A. J. L. M., Spinhoven, P., Hoogduin, K., & Van Dyck, R. (1995). Cognitive therapy and exposure in vivo in the treatment of obsessive compulsive disorder. Behaviour Research and Therapy, 33, 379-390.
Appendices for the Literature Review Appendix A: Table A1- Overview of the literature examining the causal connection between inflated responsibility and OCD symptoms Studies where behavioural OCD symptoms were not directly observed. Author(s) Sample Conditions Measures used Method of manipulation used Outcomes Effect sizes Fritzler et al. (2008) Non clinical adults n=100 (25 per condition) Responsible, not responsible, thought suppression, no thought suppression. Phobia Questionnaire, BAI, BDI, POMS, MOCI P’s were asked to close door to snake cage or experimenter closed the door P's for whom the was a salient stimulus and who felt responsible for snake’s escape had highest frequency of snake thoughts and anxiety. Significant difference between intrusive thought frequency in responsible vs. not responsible conditions. RM: 2.75 OCDS: 0.52 Mancini and Gangemi (2006) Non clinical adults n= 236 (each condition had 84, 77 and 75, respectively) Perceived responsibility, no responsibility, perceived responsibility + fear of guilt. Manipulation check questionnaire Decision making vignette. In perceived responsibility condition-P’s tested danger hypothesis (rather than control) and chose to continue with testing. Fear of guilt had a significant additive effect. RM: NA OCDS: NA Menzies et al. (2000) Non-clinical adults n=70 (38 and 32 in each condition) Personally responsible and other responsible The outcome questionnaire, visual analogue Questionnaire In the personally responsible group they rated severity of potential outcome higher than in other responsible group but RM: NA OCDS: likelihood: 0.17/0.18
no difference in likelihood of outcome. severity: 0.62/0.78 Studies where behavioural OCD symptoms were directly observed. Author (s) Sample Conditions Measures used Method of manipulation used Outcomes Effect Lopatka and Rachman (1995) Adults with OCD n=30 High responsibility, low responsibility, 2 control conditions ADIS-R, MOCI, Verbal analogue scales. BAT task. Decreased responsibility- significant decreases in perceived discomfort, urge to probability of anticipated harm, severity of anticipated harm, estimated length of time needed to finish checking, perceived panic, likelihood of anticipated criticism, timing of anticipated criticism and severity of anticipated criticism. RM: 0.28 OCDS: 0.22 Ladouceur et al. (1995) clinical adults n= 60 (30 in each condition) High and low responsibility Computerised Sound recognition task, a retrospective questionnaire (measured effect of manipulation), BDI, BAI, Padua Inventory. 1- sound recognition task Study 2-pill sorting task Study 1- no significant differences between conditions for OCD symptoms. Study 2- subjects in high responsibility group checked significantly more and had more anxiety and with errors. Study 1: RM: 0.64 OCDS: 0.12 Study 2: RM: 1.14 OCDS: 0.89
Ladouceur et al. (1997) clinical adults n=77 Personal influence, negative consequence, combined and control. Experimenter observations of behaviours, retrospective questionnaire. Pill sorting task Perceived influence was a better predictor of responsibility. Increasing either produces more hesitation, increasing just negative consequences or both increases checking, increasing both produces modifications. RM: NA OCDS: NA Shafran (1997) Adults with OCD n=40 (21 and 19 in each condition) High and low responsibility Diagnostic Interview Schedule, MOCI, Verbal analogue Scale. Experimenter present or not In high responsibility condition- urge to neutralise, discomfort and estimations of the probability of threat were all significantly higher. RM: 0.43 OCDS: 0.35 Bouchard et al. (1999) Non-clinical adults n=41 (24 classed as moderately perfectionistic [MP], 27 as highly perfectionistic [HP]) High and low responsibility The perfectionism questionnaire, a retrospective questionnaire. Pill sorting task In both groups- significantly more checking behaviours in the high responsibility condition. High perfectionism meant higher responsibility for negative events and more influence over negative events compared to moderate perfectionism. RM: NA OCDS: MP:0.44 HP:0.19 Mancini et al. (2004) Non clinical adults n-47 (~15 in each condition) Personal influence (PI), PI + expectation of failure (EF), control. Self report questionnaire, retrospective questionnaire. Visuo-spacial memory task In the PI and PI+EF conditions, P’s had significantly more checking behaviours, doubts performance, and took longer than control. PI+EF had more RM: 0.81 OCDS: 0.81
People with Learning Disabilities/Child and Family/Older People – Case Report Neuropsychological Assessment of a Teenage Girl Presenting with Challenging Behaviour and Disinhibition. Personal and Professional Learning Discussion Groups – Process Account PPLDG Process Account People with Learning Disabilities/Child and Family/Older People – Oral Presentation of Clinical Activity Developing skills in working with systems in the context of completing a Positive Behaviour Support assessment and intervention with a man with a learning disability. Year III Assessments Programme Component assessment title Research - SRRP Evaluation of Staff Perception of a New Single Point of Access Referral System for a Child and Adolescent Mental Health Service (CAMHS) Research – MRP Portfolio Do Responsibility Beliefs Mediate the Relationship Between Attachment and Parenting Styles, and Obsessive Compulsive Symptoms In Pregnant Women? Personal and Professional Learning – Final Reflective Account On becoming a clinical psychologist: A retrospective, developmental, reflective account of the experience of training. and Family/People with Learning Disabilities/ Older People/Specialist – Case Report A Systemic Assessment, Formulation and Intervention with a couple in their Eighties.