Assessing the Development of Inflated Responsibility Beliefs: The Pathways to Inflated Responsibility Beliefs Scale

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Behavior Therapy 39 (2008) 322–335 www.elsevier.com/locate/bt

Assessing the Development of Inflated Responsibility Beliefs: The Pathways to Inflated Responsibility Beliefs Scale Meredith E. Coles, Casey A. Schofield Binghamton University

Inflated responsibility beliefs are hypothesized to be a central feature of obsessive-compulsive disorder (OCD; Rachman, 1998, 2002; Salkovskis, 1985), but the etiology of these beliefs remains untested. Salkovskis and colleagues (1999) proposed 5 primary pathways to the development of inflated responsibility beliefs (e.g., heightened responsibility as a child, exposure to rigid and extreme codes of conduct as a child). The current paper presents 2 studies developing a self-report measure—the Pathways to Inflated Responsibility Beliefs Scale (PIRBS)—of these hypothesized pathways. In the first study, an initial version of the scale is developed and the number of items are reduced. In the second study, the revised scale is shown to provide a reasonable match to the proposed structure and to have good internal consistency, retest reliability, and convergent and divergent validity. These initial data suggest that the PIRBS may be useful for studying the etiology of inflated responsibility beliefs that are hypothesized to be central to the development of OCD. Limitations and future directions are discussed.

WHEN CONSIDERING THE NATURE of obsessive-compulsive disorder (OCD), few constructs have received more attention than inflated responsibility. Indeed, a search of PsycINFO using the terms “responsibility” and “OCD or obsessive” revealed nearly 663 articles addressing these two topics

Preliminary results of this study were presented at the annual meeting of the Anxiety Disorders Association of America, Miami, Florida, 2004. The authors would like to thank Betty Horng for her assistance with this project. Address correspondence to Meredith E. Coles, Department of Psychology, Binghamton University (SUNY), Binghamton, NY, 13902-6000; e-mail: [email protected]. 0005-7894/08/322−335$1.00/0 © 2008 Association for Behavioral and Cognitive Therapies. Published by Elsevier Ltd. All rights reserved.

(PsycINFO search conducted 8/16/07). Further, it is striking that over 100 articles were published on this topic within the past year. Much of this attention has been driven by cognitive-behavioral models of OCD emphasizing inflated responsibility beliefs in the development and maintenance of the disorder (see, for example, Rachman, 1998, 2002; Salkovskis, 1985). In early work on his cognitive-behavioral model of obsessional problems, Salkovskis (1985) argued that beliefs regarding responsibility for preventing harm or danger drive negative automatic thoughts that arise in response to intrusive thoughts and images. He proposed that intrusions would not cause distress unless they were interpreted as personally salient (i.e., high responsibility). In addition, Salkovskis (1985) proposed that attempts to neutralize these thoughts (i.e., compulsions) are efforts to reduce personal responsibility for potential harm to oneself or others. Similarly, Rachman (1998) emphasized that interpretations of intrusions related to responsibility for preventing harm are central to OCD, and that intrusions persist as long as such misinterpretations are exercised. Recently, Rachman (2002) proposed that although numerous factors determine the persistence of checking behavior (e.g., perceived responsibility, perceived probability of the negative outcome), perceived responsibility is the only essential factor in determining the frequency of checking. Finally, given the importance of responsibility in theories of OCD, the Obsessive Compulsive Cognitions Working Group (OCCWG) identified inflated responsibility beliefs as the first of six domains of OCrelated beliefs (OCCWG, 1997). In support of the theories discussed above, there is a wealth of data linking inflated responsibility and OCD. OCD patients demonstrate an excessive sense of responsibility (Salkovskis, 1989; van Oppen et al.,

pathways to responsibility beliefs 1995), with both adults and children with OCD endorsing more responsibility beliefs than other anxious patients (Foa, Amir, Bogert, Molnar, & Przeworski, 2001) and matched controls (Barrett & Healy, 2003; Foa et al., 2001; Freeston, Ladouceur, Gagnon, & Thibodeau, 1993; Rheaume, Freeston, Dugas, Letarte, & Ladouceur, 1995). There is also support for the specificity of responsibility cognitions to OCD compared to other forms of psychopathology (Salkovskis et al., 2000; Smari, Gylfadottir, & Halldorsdottir, 2003). Further, studies have documented a link between responsibility beliefs and OCD symptoms in both clinical and nonclinical samples (e.g., Freeston & Ladouceur, 1993; Freeston et al., 1993; Salkovskis et al., 2000; Steketee & Frost, 1994). In addition, responsibility attitudes have been shown to mediate the relationship between intrusive thoughts and OCD symptoms (Smari & Holmsteinsson, 2001) supporting Salkovskis' (1985) proposition that interpretations of responsibility-related intrusions maintain OCD. Finally, experimentally manipulated levels of responsibility have been linked to ratings of the perceived severity of outcomes (Ladouceur et al., 1995), and experimentally increasing responsibility beliefs has been shown to increase checking behaviors (Bouchard, Rheaume, & Ladouceur, 1999; Ladouceur et al., 1995; Ladouceur, Rheaume, & Aublet, 1997). Given the substantial documentation linking heightened responsibility beliefs to OCD, it is striking that there is no research examining the etiology of these beliefs. Why do some individuals develop exaggerated beliefs regarding the personal need to prevent harm, while other individuals do not? Elucidating the origins of inflated responsibility beliefs (and ultimately other maladaptive OCD-related beliefs) may have significant implications for conceptualization, treatment, and prevention. Given the importance of this task, Salkovskis, Shafran, Rachman, and Freeston (1999) proposed five primary pathways to the development of inflated responsibility beliefs, as follows: 1

2) Rigid and extreme codes of conduct as a child: This pathway refers to early exposure to extreme or rigid teachings. In school and/or religious settings, children may be taught to follow strict behavioral codes and led to believe that failure to do so may result in blame, guilt, or punishment (either on earth or in the afterlife). For example, some religions teach that having a blasphemous or immoral thought is equivalent to performing the action. This may be a precursor to the development of moral thought-action fusion in which individuals believe that they commit a sin based solely on their thoughts of performing the act. 3) Overprotective and critical parenting leading to lack of experience with responsibility as a child: This pathway refers to childhood experiences manifest in a home environment characterized by anxiety and worry. Parents may convey a sense that danger is close at hand and that they doubt their child's ability to cope with danger. Attempts to protect the child from harm or danger may result in overprotective parenting. This parenting style may increase the child's sensitivity to responsibility as a result of limiting their experiences with personal responsibility. 4) Incidents in which one's actions/inactions caused a serious misfortune: This pathway refers to the rapid development of inflated responsibilty after a catastrophic event that affected the health or welfare of onself or others. With this type of event the individual believes that he or she played a vital role in causing the event or that they failed to prevent it. For example, Salkovskis et al. (1999) present a case example of a patient who forgot to turn her television off before going to bed, resulting in the television overheating and causing the house to burn down. Further, although the patient's husband typically worked the nightshift, the presence of his car in the driveway led 1

1) Heightened responsibility as a child: This pathway refers to children who have increased levels of responsibility when young. For example, they may be asked to perform chores or tasks that are typically performed by adults. In addition, these children may be given the message that they are responsible for preventing negative outcomes (e.g., via “scapegoating”). According to Salkovskis et al. (1999), these children are “trained” to have a broad sense of responsibility at an early age.

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Readers are encouraged to review the original Salkovskis et al. (1999) paper for additional information regarding the five primary hypothesized pathways and clinical examples for each. Of note, it is our understanding that the first and third pathways laid out by Salkovskis et al. (1999) are not intended to be opposite ends of a continuum (high and low responsibility). A mock case example may be useful in clarifying further. It is possible to imagine a child who is required to wash the dishes and dress a sibling at age 6 (reflecting the expectation that they perform tasks typically performed by older children/adults), but when they are confronted with new situations (e.g., going down a tall slide at the park, meeting a stranger, learning something new at school) the child's parent may doubt his ability to handle the situation and “do it” for them. This child would be high on heightened responsibility and overprotection.

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her to (erroneously) believe that he was in the burning house. 5) Incidents in which it appears that one's actions/inactions/thoughts influenced a serious misfortune: The final pathway is similar in nature to the preceeding pathway in that the individual believes that his or her actions or failure to act contributed to serious misfortune to oneself or someone else. However, in this pathway, the events are coincidental, such as having a thought about something bad happening and the bad event occurring independently. For example, Salkovskis et al. (1999) present the case of a patient who had the thought that her father had died and learned shortly thereafter that he was indeed dead. The patient took this as evidence that her thought contributed to his death. In summary, Salkovskis et al. (1999) present a detailed model of the development of inflated responsibility beliefs, highlighting childhood experiences that may confer vulnerability to the development of these beliefs. However, this model has not yet been tested. Salkovskis et al. (1999, p. 1059) noted that “there are no systematically collected data on the origins of negative beliefs in obsessional problems.” Therefore, we sought to develop a psychometrically strong self-report measure of the specific etiological pathways to inflated responsibility beliefs proposed by Salkovskis and colleagues (1999). The current paper presents data from two initial studies toward this end. In Study 1, an initial version of the Pathways to Inflated Responsibility Scale (PIRBS) was developed and administered to a large unselected student sample. Data from that study were then used to shorten the measure (resulting in a 23-item version). In Study 2, the revised PIRBS was administered to a seperate unselected student sample in order to confirm the factor structure of the scale and examine the retest reliability and convergent and divergent validity of the scale.

Study 1 method Participants and Procedure. Participants for Study 1 were 562 undergraduate students who received course research credit for their involvement. The mean age for the sample was 18.53 (SD = 2.32), and the students reported an average of 12.52 years of education (SD = .99). Sixty-five percent were Caucasian, 23% Asian/Asian-American, 6% Latino/Latina, 3% African-American, 2% biracial, and 1% reported their ethnicity as “other.” Partici-

pants completed a battery of measures, including an initial 47-item version of the PIRBS. Measures. A pilot version of the PIRBS containing an initial item pool of 47 PIRBS items was administered in Study 1. The items for the PIRBS were developed by the first author (MEC) to assess pathways to heightened responsibility beliefs proposed by Salkovskis et al. (1999) via retrospective report of specific childhood experiences proposed to contribute to the development of such beliefs. The initial items were distributed as follows: 13 items each for the Heightened Responsibility, Rigid Rules, and Overprotection scales, and 4 items each for the Actions Caused and Actions Influenced scales. The items were not taken from, or based on, other existing scales, and the item format followed published guidelines for good items (Spector, 1992). Each item is rated on a 0-to-4 Likert-type scale, with higher scores indicating greater agreement. Items assessing the first three pathways were presented together in a random order and respondents were asked to report what things had been like for them as a child. Items for the final two pathways were presented in blocks (the 4 items assessing actions causing misfortune and then the 4 items assessing actions appearing to influence misfortune). To increase comprehension of the items for these two final pathways, brief instructions were given before each set of items. A complete version of the final PIRBS scale is presented in Appendix. The instructions were identical in both versions of the scale.

results An exploratory factor analysis was conducted on the original 47 items generated for the PIRBS in order to: (a) examine the factor structure of the items and (b) identify the strongest items for retention on the final scale. Principal components analysis with promax rotation was used given the anticipated correlations among the subscales and based on the precedent of previous efforts to examine the factor structure/reduce the number of items for OCD-related scales (cf. Foa et al., 2002). 2 2

In order to assess potential differences between participants that did and did not complete the 6-month retest assessmnt (n's = 420 and 38, respectively), independent samples t-tests were conducted comparing the two groups on the PIRBS total and all subscale scores. Interestingly, these analyses failed to reveal significant group differences for the PIRBS Total, Overprotection, Heightened Responsibility or Actions Influenced/Caused Misfortune scales (all t's b 1.00 and p's N .41). However, participants that completed the 6-month follow-up were found to have significantly higher scores on PIRBS Rigid Rules (report increased levels of exposure to childhood experiences with rigid rules) than participants that did not complete the follow-up (M = 11.97, SD = 3.96, and M = 10.47, SD = 4.21, t (454) = - 2.16, p = .03.

pathways to responsibility beliefs Results showed 7 factors with eigenvalues greater than 1, accounting for a combination of 61% of the variance. However, given that Monte-Carlo studies have shown that use of the Kaiser Criterion (i.e., retaining factors with eigenvalues N 1; see Floyd & Widaman, 1995) results in frequent overestimation of the number of factors, Floyd and Widaman (1995) recommended use of the scree test. Examination of the scree plot suggested retention of 4 to 5 factors. Therefore, subsequent analyses were conducted forcing four and five factors. Examination of the five-factor solution yielded a factor with only three items; therefore the four-factor solution was preferred. The four-factor solution produced interpretable factors accounting for a total of 53% of the variance. Examination of the item loadings revealed that all items loaded meaningfully (see Table 1) and that the empirically derived factors were notably consistent with the intended domains. All items intended to assess Rigid Rules loaded onto Factor 1, all items intended to assess Heightened Responsibility loaded on Factor 2, all items intended to assess Actions Caused and Actions Influenced loaded onto Factor 3, and all items intended to assess Overprotection loaded onto Factor 4. Next, the strongest items were identified for retention on the final scale. Results of the factor analysis were used to reduce the number of items on the Heightened Responsibility, Rigid Rules, and Overprotection scales. Given that the items within the Actions Caused and Actions Influenced scales were each theoretically distinct, and that they all showed strong loadings, all 8 of these items were retained. However, based on the results of the exploratory factor analysis, they were combined into one subscale (Actions Caused/Influenced). Items for the other scales were selected for retention based on their factor loadings on the respective factor (cf. Foa et al., 2002) in order to develop subscales with 5 items each. First, items that substantially loaded onto more than factor (≥.40) were excluded. Then, the remaining items with the highest loadings were retained. This produced a 23-item version of the PIRBS.

discussion In Study 1, an item pool of 47 items was developed assessing the five hypothesized pathways to inflated responsibility beliefs (see description above). Data from a large unselected undergraduate sample were used to test the structure of the initial 47 items and identify the strongest items for inclusion on the final scale. This yielded a 23-item version comprised of four factors: (1) Heightened Responsibility as a Child, (2) Overprotection as a Child, (3) Exposure to Rigid and Extreme Codes of Conduct and Duty During

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Childhood, and (4) Incidents in Which One's Actions/Inactions Caused or Influenced Misfortune. The observed factor structure was notably similar to the hypothesized structure, based on the model of Salkovskis et al. (1999), with one exception: The results suggested collapsing items assessing Actions That Caused Misfortune and Actions That Influenced Misfortune into one subscale. One possible explanation is that respondents may not be able to make this subtle distinction between incidents in which they know that they influenced an outcome versus incidents in which they believe they influenced an outcome. Further, the current findings may be viewed as consistent with the phenomenon of thought-action fusion that has been frequently associated with OCD symptoms. To the extent that respondents are characterized by thoughtaction fusion, distinguishing between actions that influenced, versus caused, misfortune, may become increasingly difficult. Given that scales can perform differently when items are scored from responses embedded within the context of other items, versus when they are administered alone, the revised 23-item version of the PIRBS was administered to an independent sample in order to test the psychometric properties of the scale.

Study 2 method Participants and Procedure. Participants in Study 2 completed the revised, 23-item version of the PIRBS (see Appendix) along with other measures of OCD-related beliefs, parenting style, childhood level of responsibility, and OCD symptoms that were utilized to assess the convergent and divergent validity of the PIRBS. Participants for Study 2 were drawn from two studies of unselected undergraduates: (a) a prospective study of cognitive vulnerability to OCD (N = 458), and (b) a cross-sectional study of hoarding behaviors (N = 170). Data collection for these two projects was conducted during the same time period at the same university, and including both samples allowed for increased sample size, a wider range of ages, and inclusion of both students enrolled in psychology courses and students recruited from the general student body (not based on enrollment in psychology courses). Participants in the longitudinal study were paid for their participation and participants in the crosssectional study received course research credit. The prospective design of the longitudinal study allowed for collection of re-test data on the PIRBS at the 6-month follow-up. Specifically, 420 of the

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458 Time 1 participants (92%) completed the retest assessment.3 The mean age for the sample was 18.38 (SD = 1.02), and the students reported an average of 12.30 years of education (SD = .78). Sixty-five percent were Caucasian, 18% Asian/ Asian-American, 7% Latino/Latina, 5% AfricanAmerican, 2% Biracial, and 3% reported their ethnicity as “other.” Measures. The 23-item version of the PIRBS developed in Study 1 was used in the current study and were distributed as follows: Heightened Responsibility = 5 items, Rigid Rules = 5 items, Overprotection = 5 items, and 8 items for the Actions Caused/ Influenced scale. The Obsessive Beliefs Questionnaire-44 (OBQ-44; Obsessive Compulsive Cognitions Working Group [OCCWG], 2005) is a 44-item self-report measure of beliefs considered characteristic of obsessive thinking (OCCWG, 1997, 2001) and was included in the current study to examine the convergent validity of PIRBS scores with beliefs regarding inflated responsibility. Responses to a series of belief statements yield scores in three empirically derived belief domains: (1) responsibility and threat estimation, (2) perfectionism and intolerance for uncertainty, and (3) importance and control of thoughts. Given the aims of the current study, the OBQ-44 Responsibility and Threat Estimation Scale is of particular interest herein. The OBQ-44 has good internal consistency (r's = .89 to .95; OCCWQ, 2005). Further, OBQ-44 scores are significantly correlated with OCD symptoms, and individuals with OCD have significantly higher OBQ-44 scores on all three subscales than community and student controls (OCCWG, 2005). The modified Parental Bonding Instrument (PBI-K; Kendler, 1996) was included in the current study in order to assess the convergent validity of the PIRBS Overprotection subscale. It was predicted that PIRBS Overprotection scores would show moderate to strong correlations with ratings of protectiveness and authoritarianism on the PBI-K but that they would be only weakly correlated with ratings of parental warmth. The PBI-K is a 16-item self-report measure of parenting, including parental warmth, protectiveness, and authoritarianism (with the latter two subscales representing domains of overprotection). Each item is rated on a 0 to 3 Likert-type scale with respondents recalling their parent over their first 16 years. The PBI subscales have high internal consistency and strong retest reliability (Parker, 1989). The PBI-K differs from the PIRBS in that it

3 Of note, results using common factor analysis with Orthogonal (varimax) rotation produced a nearly identical solution.

assesses broad childhood experiences, not the hypothesized pathways to inflated responsibility. The PBI-K was completed separately for one's mother and father. Ratings of Childhood Level of Responsibility were included to assess the convergent validity of the PIRBS Heightened Responsibility scale. Review of the literature failed to reveal an existing measure of childhood levels of responsibility. Therefore, ratings were developed for this project. Specifically, participants were asked to report the number of chores they were responsible for in an average week as a child and what percentage of those chores were tasks typically done by adults (e.g., preparing meals, etc.) in contrast to more typical childhood chores (e.g., making bed, etc.). It was hypothesized that PIRBS Heightened Responsibility scores would be moderately correlated with the percentage of chores done in childhood that resembled typical adult chores. The Obsessive-Compulsive Inventory (OCI; Foa, Kozak, Salkovskis, Coles, & Amir, 1998) was included in the current study to assess symptoms of OCD. Given that the primary interest in the etiology of inflated responsibility beliefs stems from models of OCD, we tested the hypothesis that PIRBS scores would be moderately correlated with OCD symptoms. The OCI is a 42-item self-report measure of OC symptoms across multiple common symptom domains (e.g., washing, checking, doubting). The OCI can be scored to yield total scores representing both the frequency of OCD symptoms and the distress associated with them. Higher scores are indicative of increased symptom severity. The OCI total scores have been shown to have good convergent and divergent validity in both clinical OCD and control samples, strong internal consistency, and good retest reliability (Foa et al., 1998). Simonds, Thorpe, and Elliott (2000) provided additional support for use of the OCI in undergraduate samples.

results Confirmatory Factor Analysis. A confirmatory factor analysis with maximum likelihood estimation using AMOS 7.0 (Arbuckle, 2006) was used to test the fit beteween the hypothesized structure of the 23 PIRBS items and the data. The model was specified including four latent factors: Rigid Rules (4 items), Heightened Responsibility (4 items), Overprotection (4 items), and Actions Caused/Influenced (8 items). The structural model and results of the confirmatory factor analysis (stanadardized beta weights) are shown in Fig. 1.

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pathways to responsibility beliefs Table 1 Initial item pool for the PIRBS and results of exploratory factor analysis (Study 1)

Factor 1: Factor 2: Factor 3: Actions Factor 4: Rigid Heightened caused/ Actions OverRules Responsibility influenced protection Original items grouped according to intended scale RIGID RULES: As a child my family cared a lot about following rules As a child my parents strongly valued obedience As a child adults around me strictly enforced rules As a child I was taught to follow a precise set of rules As a child I was taught that rules were to be obeyed without discussion As a child I was taught that I would be punished for not following rules As a child my family had strict rules to be followed As a child my family cared a lot about following rules (e.g., religious rules, moral codes, etc.) As a child I learned that I would be blamed for not following rules ⁎ As a child I was taught to not question rules or authority As a child I got in more trouble than most kids if I broke rules ⁎ As a child I was taught to feel guilty for not behaving as I was supposed to As a child my school(s) had rigid codes of conduct HEIGHTENED RESPONSIBILITY: As a child I was responsible for keeping our house functioning smoothly As a child I had more responsibility for taking care of myself than most kids my age As a child I was more like a parent than most kids my age As a child I was responsible for the cooking As a child I was responsible for protecting a family member/ family members As a child I was responsible for doing errands As a child I was responsible for keeping everyone happy As a child I was responsible for taking care of my parent(s) As a child I was responsible for cleaning our house As a child I was responsible for taking care of my sibling(s) As a child I had more responsibility than most kids my age As a child I was held responsible for things that went wrong ⁎ As a child I missed out on things (e.g., playing sports, spending time with friends, etc) because of my responsibilities at home ACTIONS CAUSED/INFLUENCED MISFORTUNE: I believe that something I did or did not do may have contributed to me experiencing a serious misfortune I am confident that something I did resulted in me experiencing a serious misfortune I believe that something I did or did not do may have contributed to someone else experiencing a serious misfortune I am confident that something I did resulted in someone else experiencing a serious misfortune I am confident that something I did not do resulted in me experiencing a serious misfortune I believe that my thoughts may have contributed to me experiencing a serious misfortune I am confident that something I did not do resulted in someone else experiencing a serious misfortune I believe that my thoughts may have contributed to someone else experiencing a serious misfortune OVERPROTECTION: As a child my parent(s) did many things to protect me As a child my parent(s) thought that I was unable to deal with danger As a child my parent(s) thought that I couldn't protect myself As a child my parent(s) thought that I couldn't handle things As a child my parent(s) frequently preferred to do things for me rather than have me do them myself

0.84 0.80 0.80 0.78 0.77 0.77 0.77 0.75

0.28 0.34 0.38 0.36 0.35 0.29 0.37 0.21

0.08 0.17 0.19 0.15 0.16 0.17 0.15 0.06

0.40 0.40 0.40 0.39 0.38 0.37 0.37 0.39

0.69

0.39

0.17

0.43

0.67 0.62 0.56 0.53

0.36 0.46 0.47 0.32

0.19 0.28 0.33 0.18

0.38 0.31 0.35 0.35

0.32 0.34

0.82 0.76

0.28 0.30

0.16 0.07

0.27 0.28 0.34 0.43 0.24 0.16 0.50 0.23 0.38 0.50 0.40

0.73 0.72 0.71 0.71 0.71 0.68 0.68 0.68 0.67 0.65 0.63

0.28 0.16 0.28 0.22 0.33 0.29 0.18 0.20 0.21 0.32 0.36

0.12 0.10 0.21 0.20 0.29 0.18 0.17 0.14 0.10 0.26 0.30

0.20

0.25

0.85

0.21

0.20

0.28

0.81

0.28

0.17

0.28

0.81

0.17

0.19

0.35

0.79

0.22

0.12

0.22

0.79

0.24

0.19

0.33

0.77

0.20

0.11

0.32

0.73

0.20

0.16

0.32

0.69

0.26

0.46 0.33 0.30 0.28 0.16

0.07 0.31 0.28 0.31 0.02

0.10 0.30 0.30 0.32 0.18

0.72 0.71 0.68 0.61 0.60

(continued on next page)

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Table 1 (continued) Factor 1: Factor 2: Factor 3: Actions Factor 4: Rigid Heightened caused/ Actions OverRules Responsibility influenced protection As a child my parent(s) protected me more than most kids my age ⁎ As a child my family did many things to prevent danger or harm ⁎ As a child if something was potentially dangerous my parents would not let me do it⁎ As a child my parent(s) always watched for things that might go wrong ⁎ As a child my family believed that it is better to be safe than sorry ⁎ As a child my parent(s) frequently worried ⁎ As a child I was taught to be alert for possible danger ⁎ As a child my parent(s) often took care of my problems for me

0.59 0.63 0.51

0.27 0.23 0.19

0.13 0.13 0.02

0.71 0.69 0.63

0.56 0.49 0.50 0.50 0.16

0.20 0.14 0.30 0.25 - 0.08

0.11 0.04 0.24 0.12 0.14

0.63 0.62 0.61 0.50 0.55

Note: Items shown in bold were retained for the final version of the PIRBS. Items marked with a ⁎ were eliminated due to notable crossloadings on multiple factors.

Review of the output showed significant regression weights for all items of the PIRBS (all p's b .001), and fit indices suggested a reasonable fit between the data and the model: χ2 (224) = 1109.19, CMIN/df = 4.95, Stieger-Lind Root Mean Square Error of Approximation, RMSEA, = .08, the Bentler Comparative Fit Index, CFI, = .86, and the Standardized Root Mean Square Residual, SRMR = .07 (cf. Kline, 2005).4 Therefore, these analyses supported used of the 23 items of the PIRBS and computation of the 4 subscales derived in Study 1. Internal Consistency. Alpha coefficients for the PIRBS total score and subscale scores were calculated and revealed that all PIRBS scales had strong internal consistency (α N .78; see Table 2). Scale Intercorrelations. Zero-order correlations among the PIRBS scales are presented in Table 3. Results showed that the PIRBS scales were moderately correlated with PIRBS Total scores (removing the items for the subscale being tested so as to not falsely inflate the magnitude of the correlations). Results for the subscale intercorrelations were consistent with expectations, revealing variability in the strength of relationships among the PIRBS subscales. For example, PIRBS Rigid Rules and Overprotection scores were moderately positively correlated, whereas Heightened Responsibility and Overprotection scores showed a small negative correlation.

4 Values for fit indices recommended by Kline (2005) are presented herein to facilitate assessment of the model fit. However, it is noteworthy that there is increasing discussion of the dangers of reifying “golden rules” for assessing model fit using prespecified cutoffs on various measures of fit (Marsh, Hau, & Grayson, 2005; Marsh, Hau, & Wen, 2004; Tomarken & Waller, 2005) and recognition that some published recommendations for cutoff values are arguably overly conservative (see Marsh et al., 2004).

Retest Reliability. The temporal stability of the PIRBS over 6 months was examined for participants who completed the measure on two ocassions (N = 420). Using a standard of r ≥ .70 as an indicator of acceptable retest reliability (cf. Spector, 1992), results showed that the PIRBS Total, Heightened Responsibility, and Rigid Rules subscales all had strong retest reliabilty over the 6-month follow-up (r's = .71, .79, .71, respectively). The retest reliability of the Overprotection and Actions Caused/Influenced subscales fell below the targeted .70 criterion (r's = .67 and .58, respectively). Correlations of PIRBS with beliefs regarding inflated responsibility and threat. As would be hypothesized, PIRBS Total scores and all subscales were significantly correlated with beliefs regarding inflated responsibility and overestimation of threat (see Table 2). The PIRBS total scores, Heightened Responsibility, and Actions Caused/Influenced scores were moderately correlated with beliefs regarding inflated responsibility and overestimation of threat, whereas these specific OCD-related beliefs showed small correlations with PIRBS Rigid Rules and Overprotection scores. Specificity of PIRBS to beliefs regarding inflated responsibility and threat versus other domains of OCD-related beliefs. Given that the PIRBS was developed based on a theory of the etiology of inflated responsibility beliefs in particular, tests of dependent correlations were used to examine whether PIRBS scores were significantly more strongly correlated with inflated responsibility and threat beliefs than with other OCD-related beliefs (perfectionism/certainty beliefs or beliefs regarding the importance and control of thoughts). This provided a stringent test of the discriminant validity of the PIRBS given that the OBQ-44 subscale scores were strongly related in

pathways to responsibility beliefs

FIGURE 1

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Results of confirmatory factor analysis of PIRBS items (Study Two).

the current sample (RT and ICT r = .68, RT and PC r = .72, ICT and PC r = .61). In support of the discriminant validity of the PIRBS, PIRBS Total scores, Heightened Responsibility, Over-

protection, and Actions Caused/Influenced scores were significantly more strongly correlated with responsibility/threat estimation beliefs than with perfectionism/certainty beliefs: Z(614) = 2.23,

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Table 2 Psychometric Properties of the PIRBS (Study 2)

PIRBS Total Heightened Responsibility Rigid Rules Overprotection Actions influenced/ caused misfortune

# of items

Mean (SD)

23 5 5 5 8

34.59 (12.24) 6.09 (4.39) 11.64 (4.12) 8.17 (4.10) 8.76 (6.17)

Alpha

.86 .78 .84 .79 .90

6-month retest

Correlation with OBQ-RT

OBQ-PC

OBQ-ICT

.71 .79 .71 .67 .58

.46 .32 .20 .24 .41

.40 .26 .24 .17 .33

.35 .22 .16 .23 .30

Note. PIRBS = Pathways to Inflated Responsibility Scale; OBQ = Obsessive Beliefs Questionnaire; RT = Responsibility/Threat; PC = Perfectionism/Certainty; ICT = Importance/ Control of Thoughts. All correlations significant at p ≤ .001.

p b .05; Z(614)= 2.08, p b .05; Z(614) = 2.37, p b .05; andZ (614) = 2.88, p b .01, respectively. Only PIRBS Rigid Rules scores were found to be similarly correlated with responsibility/threat estimation beliefs and perfectionism/certainty beliefs, Z(614) = -1.36, p = .17. Turning to comparisons of the relationships with responsibility beliefs versus beliefs regarding the importance and control of thoughts, PIRBS Total scores, Heightened Responsibility, and Actions Caused/Influenced Misfortune scores were significantly more strongly correlated with responsibility and threat estimation beliefs than with beliefs regarding the importance and control of thoughts: Z(614) = 3.78, p b .001; Z(614) = 3.23, p = .001; Z(614) = 3.68, p b .001 respectively. However, PIRBS Rigid Rules and Overprotection scores were similarly correlated with responsibility/threat estimation beliefs and beliefs regarding the importance and control of thoughts: Z(614) = 1.26, p = .21; Z(614) = .32, p = .75. Correlations of PIRBS overprotection scores with parental control. To further test the construct validity of the PIRBS, PIRBS Overprotection scores were correlated with parenting variables. It was hypothesized that the PIRBS Overprotection scale would be positively correlated with parental control (PBI protectiveness and PBI authoritarianism) and negatively (but more modestly) correlated with parental warmth (PBI warmth). As hypothesized, PIRBS Overprotection scores were

significantly correlated with reports of both maternal and paternal protectiveness (r's = .51 and .38, p's b .001, respectively), and maternal and paternal authoritarianism (r's = .45 and .34, p's b .001, respectively). Further, these correlations were moderate to strong in magnitude. As was expected, PIRBS Overprotection scores were negatively (and more modestly) correlated with reports of maternal and paternal warmth (r's = - .17 and - .14 respectively). In addition, there was support for specificity of the relationship between the PIRBS Overprotection scale in particular with both maternal and paternal overprotection (PBI protectiveness scores) in contrast to the other PIRBS subscales. Specifically, although maternal overprotection was strongly correlated with PIRBS Overprotection scores (r = .51), it showed small correlations with the other PIRBS subscales (.03 with Heightened Responsibility, .22 with Rigid Rules, and .19 with Actions Caused/Influenced). Scores for fathers showed a similar pattern, with paternal overprotection scores being moderately correlated with PIRBS Overprotection scores (r = .38), but showing more modest correlations with the other PIRBS subscales (.11 with Heightened Responsibility, .16 with Rigid Rules, and .23 with Actions Caused/Influenced Misfortune). Supporting the specificity of these relationships, Z-tests of dependent correlations showed that maternal and paternal protectiveness were significantly more strongly correlated with PIRBS Overprotection

Table 3 Intercorrelations among the PIRBS scales (Study 2)

Heightened Responsibility Rigid Rules Overprotection Actions influenced/ caused misfortune

PIRBS Total

Heightened Responsibility

Rigid Rules

.27 .31 .31 .37

— .19 .02 ns .33

— .38 .12

Over-protection

— .28

Actions influenced/ caused misfortune

—

Note. PIRBS Total scores were calculated without the items of the relevant subscale. All correlations significant at p b .001 except those labeled ns for nonsignificant.

pathways to responsibility beliefs scores than each of the other PIRBS subscale scores (all p's b .001).5 Correlations of PIRBS heightened responsibility scores with childhood chores. To further examine the construct validity of the PIRBS, PIRBS Heightened Responsibility scores were correlated with measures of childhood chores.6 PIRBS Heightened Responsibility scores were significantly correlated with the average number of chores performed per week as a child (r = .31, p = b .001), and with the percentage of childhood chores that resembled adult responsibilities (r = .56, p b .001). Further, Z-tests of dependent correlations revealed that the percentage of childhood chores that resembled adult responsibilities was significantly more strongly correlated with PIRBS Heightened Responsibility scores than with any of the other PIRBS subscale scores (all p's b .001).7 Correlations of PIRBS scores with OCD symptoms. Given that interest in the development of inflated responsibility beliefs is primarily driven by a desire to elucidate pathways to the development of OCD, we also conducted preliminary analyses examining the correlation of PIRBS scores and OCD symptoms (OCI scores). The PIRBS Total score, and all subscale scores, were found to be significantly correlated with the frequency of OCD symptoms (r's: Total = .40, HR = .19, RR = .14, OP = .25, and AIC = .42). These results provide initial support for a link between the childhood experiences measured by the PIRBS and OCD symptoms.

discussion In summary, results of Study 2 provide support for the psychometric propeties of the final (23 item) version of the PIRBS. First, a confirmatory factor analysis supported the four-factor structure of the scale, including experiences with Heightened Responsibility, Rigid Rules, Overprotection, and incidents where one's Actions Caused or Influenced Misfortune. Next, support was found for specificity of the relationship of PIRBS Total scores to beliefs regarding inflated responsibility and threat estimation in contrast to beliefs regarding the importance and control of thoughts and beliefs regarding perfectionism and certainty. Further, three of the four PIRBS subscales showed specificity to beliefs regarding inflated responsibility and threat estimation versus beliefs regarding perfectionism and certainty, and two of the subscales also 5

Further detail is available upon request. The measures of childhood levels of responsibility was added after project initiation and was therefore only administered to a subset of participants (n = 170). 7 Further detail is available upon request. 6

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showed specificity to responsibility and threat estimation beliefs versus beliefs regarding the importance and control of thoughts. This provides support for some specificity of the hypothesized childhood experiences to the development of responsibility beliefs in particular. Although these results are in need of replication, they are notable given the high correlations among the various domains of OCD-related beliefs. Finally, support for the convergent validity of individual PIRBS subscales was also found. For example, PIRBS Overprotection scores were significantly positively correlated with parental protectiveness and authoritarianism, and PIRBS Heightened Responsibility scores were significantly positively correlated with the percentage of childhood chores that resembled adult responsibilities. These relationships were also shown to be unique to these particular PIRBS subscales.

General Discussion This paper presents the development of a self-report measure of childhood experiences hypothesized to lead to the development of inflated responsibility beliefs (see Salkovskis et al., 1999)—the Pathways to Inflated Responsibility Beliefs Scale (PIRBS). Although replication is neeeded, results presented herein based on two studies using large unselected student samples are encouraging. If the findings are replicated, the PIRBS holds promise for improving our understanding of the early experiences that lead to the development of inflated responsibility beliefs, and thereby improving our understanding of a style of thinking that has been repeatedly documented to be important in OCD. Given the importance of responsibility beliefs in OCD, the potential availability of a measure to assess the childhood experiences that lead to these beliefs has many important avenues for future research and application. An important next step will be to collect data from clinical samples, as the current study was limited to an unselected college sample. Comparisons of individuals with OCD to anxious controls and nonanxious patient controls will be useful in assessing the specificity of the hypothesized pathways. Comparisons with other hypothesized OC-spectrum conditions and major depression may also serve to delineate the shared and unique pathways to these related disorders. In addition, future research can examine the interaction of temperament and the childhood experiences studied herein. Coles, Schofield, and Pietrefesa (2006) found evidence that overprotective parenting (as measured by the PIRBS Overprotection subscale) moderated the relationship

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between behavioral inhibition and OCD symptoms. It remains to be seen if the other childhood experiences measured by the PIRBS (e.g., exposure to rigid rules), will also moderate the impact of behavioral inhibition. Finally, it is hoped that the PIRBS will also allow researchers to more fully test models regarding the etiology of OCD. For example, as noted by Taylor (2002), it remains to be seen whether early learning experiences account for OCD symptoms or whether they are mediated through their impact on beliefs that then influence OCD symptoms. A notable aspect of the current work is the focus on the etiology of a hypothesized risk factor (beliefs regarding inflated responsibility), in contrast to a focus on the etiology of symptoms or a disorder. Ultimately, we believe that both avenues of research are useful in furthering our understanding of the development of OCD and other forms of anxiety. Information regarding predictors of both symptom change and risk factors will likely inform the development and refinement of prevention programs. Understanding the development of both symptoms and risk factors presents two potential points for intervention. Some initial work has begun addressing the potential ability to modify risk factors such as cognitive vulnerabilities to OCD. For example, Zucker, Craske, Barrios, and Holguin (2002) showed that a very brief educational intervention regarding thought-action fusion (a hypothesized cognitive vulnerability to OCD) leads to reductions in thought-action fusion and decreased anxiety on a behavior task targeting the phenomenon. In addition to interventions seeking to modify identified vulnerabilities, as we develop an increased understanding of the experiences that lead to the development of these vulnerabilities, efforts can also be targeted at modifying the development of these beliefs. For example, instead of identifying individuals who are already elevated on the cognitive risk factor (e.g., who already have inflated responsibility beliefs), information about the childhood experiences associated with these beliefs may suggest avenues for even earlier intervention. In other words, prevention programs could be developed specifically for children who are in environments characterized by the types of experiences studied herein (e.g., exposure to rigid rules of conduct or heightened levels of responsibility). Ultimately, it is hoped that a comprehensive understanding of the etiological chain for the development of OCD will serve to improve prevention efforts. Although the current findings are encouraging, it is important to address limitations of this work. First, complementary data are needed from clinical

samples. It is interesting to note that given that this research focuses on the development of beliefs rather than the disorder of OCD, the emphasis on clinical data is somewhat different than in studies focusing on the development of the disorder. However, data from clinical sample showing that individuals with OCD endorse the types of experiences tapped by the PIRBS, and that these experiences are associated with inflated responsibility beliefs, will increase confidence in the measure. Clinical samples will also facilitate research on potential differences between the various pathways in regards to their relationship with factors such as the types of OCD symptoms observed, the speed of onset of the OCD, and the association between the OCD symptoms and depression. For example, Salkovskis et al. (1999) proposed that early experiences with actions influencing or causing misfortune are likely to be associated with a more rapid onset of OCD symptoms than the other three domains of childhood experiences (e.g., experiences with heightened responsibility, exposure to rigid rules, overprotective parents). Finally, it is reasonable to propose that the content and intensity of responsibility beliefs may differ between unselected and clinical samples. Therefore, additional data from clinical samples could be used to address a host of additional questions. A second limitation of the current study is that information was not gathered regarding the nature of the experiences that respondents' reported caused or influenced misfortune. The addition of such data would be informative, particularly given the lower reliability of scores on this subscale in comparison to the other PIRBS subscales. Finally, there are inherent limitations in reliance on self-report measures. Future studies could utilize other methods, such as performance-based measures of inflated responsibility (e.g., performance on a behavioral task or computerized information processing task) and clinician-rated severity of OCD symptoms to further assess the questions targeted herein. Finally, retrospective reports of childhood experiences are subject to potential biases in recollection. For example, individuals with heightened responsibility beliefs may be biased to endorse specific types of childhood experiences. Therefore, additional data using parent report and/or prospective designs would be a welcome complement to the data presented here. In summary, the current paper presents the development of the PIRBS. The initial data suggest that the PIRBS is a reliable and valid measure of childhood experiences hypothesized to confer vulnerability to the development of beliefs regarding inflated responsibility as proposed by Salkovskis et al. (1999).

pathways to responsibility beliefs Further, the current data provide preliminary support for these hypothesized pathways to inflated responsibility beliefs. Future research can further assess the psychometric properties of the PIRBS and

Appendix A. Copy of the final version of the PIRBS

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its practical utility in advancing our understanding of childhood experiences that may represent an important stepping-stone towards the development of OCD.

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R E C E I V E D : September 15, 2006 A C C E P T E D : September 17, 2007 Available online 20 April 2008