Behaviour Research and Therapy 38 (2000) 347±372

www.elsevier.com/locate/brat

Responsibility attitudes and interpretations are

characteristic of obsessive compulsive disorder
P.M. Salkovskis*, 1, A.L. Wroe, A. Gledhill, N. Morrison, E. Forrester,
C. Richards, M. Reynolds, S. Thorpe
Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK

Abstract

The cognitive±behavioural theory of Obsessive Compulsive Disorder (OCD) proposes that a key
factor in¯uencing obsessional behaviour is the way in which the intrusive cognitions are interpreted. The
present paper reports an investigation of links between clinical symptoms (of anxiety, depression and
obsessionality) and responsibility beliefs. These beliefs include not only measures of general
responsibility attitudes (assumptions) but also more speci®c responsibility appraisals consequent on
intrusive cognitions. The characteristics of two new questionnaires speci®cally designed to measure these
beliefs were assessed in patients su€ering from Obsessive Compulsive Disorder, in patients su€ering
from other anxiety disorders and in non-clinical controls. The scales measuring negative beliefs about
responsibility were found to have good reliability and internal consistency. Comparisons between
criterion groups indicate considerable speci®city for both assumptions and appraisals with respect to
OCD. There was also good evidence of speci®city in the association between responsibility cognitions
and obsessional symptoms across groups, and that this association was not a consequence of links with
anxiety or depressive symptoms. Although the two measures were correlated, they each made unique
contributions to the prediction of obsessional symptoms. Overall, the results are consistent with the
hypothesis that responsibility beliefs are important in the experience of obsessional problems. # 2000
Elsevier Science Ltd. All rights reserved.

* Corresponding author.
1
Paul Salkovskis is a Wellcome Trust Senior Research Fellow. This research was supported by a grant to the
Wellcome Trust

0005-7967/00/$ - see front matter # 2000 Elsevier Science Ltd. All rights reserved.
PII: S 0 0 0 5 - 7 9 6 7 ( 9 9 ) 0 0 0 7 1 - 6
348 P.M. Salkovskis et al. / Behaviour Research and Therapy 38 (2000) 347±372

1. Introduction

People su€ering from Obsessive Compulsive Disorder (OCD) characteristically experience

thoughts which are intrusive, which they ®nd distressing and which are personally unacceptable
to them. However, it has also long been known that the occurrence of unacceptable intrusive
thoughts about possible harm coming to oneself or others is not con®ned to people su€ering
from obsessional problems, but is a universal phenomenon (Rachman & de Silva, 1978;
Salkovskis & Harrison, 1984). Salkovskis (1985) and others (Freeston, Rheaume & Ladouceur,
1996; Rachman, 1997, 1998) have proposed that the key to a cognitive±behavioural
conceptualisation of obsessional problems lies not in an examination of the characteristics of
intrusive cognitions, but rather in the way in which they, and their occurrence, are interpreted/
appraised. That is, it is the signi®cance that patients attach to such intrusions which is regarded
as crucial to the experience of both mood disturbance and the motivation of neutralising
behaviour. The cognitive theory outlined by Salkovskis (1985) di€erentiates between intrusions
and their evaluation (as clinically characterised by ``negative automatic thoughts''). In later
work, the more theoretically appropriate concept of appraisal and interpretation was
emphasised (Salkovskis, 1989).
The fact that people su€ering from OCD are disturbed by intrusions about threats which
they perceive as very unlikely to occur is not inconsistent with the cognitive theory of anxiety.
It is hypothesised that the anxiety associated with a particular perceived threat is proportional
to the product of the perceived probability and perceived severity of the threat (as well as being
inversely related to the sum of perceived ability to cope with the threat and perceived rescue
factors (Beck, Emery & Greenberg, 1985; Salkovskis, 1996a)). In vulnerable individuals, an
in¯ated perception of responsibility of possible harm related to intrusive thoughts is likely to
increase the perceived awfulness of any harmful consequences. Thus, even with low levels of
perceived probability of harm occurring, an individual who evaluates the threatened harm as
particularly awful to them is likely to experience intense levels of anxiety and distress.
The cognitive theory thus proposes that, in obsessional problems, the occurrence and/or
content of intrusions (thoughts, images, impulses and/or doubts) are interpreted (appraised) as
indicating that the person may be responsible for harm to themselves or others. This leads both
to adverse mood (anxiety and depression) and the decision and motivation to engage in
neutralising behaviours (which can include a range of behaviours such as compulsive checking,
washing and covert ritualising). Adverse mood and neutralising behaviours can both have the
e€ect of increasing the likelihood of further intrusions, the perceived threat and the perception
of responsibility, leading to a cycle of negative thinking and neutralising.
The cognitive±behavioural theory speci®es that the origin of particular negative appraisals
will usually lie in learned assumptions. Such assumptions often form as adaptive ways of
coping with early experience, but may trigger an obsessional disorder when activated by critical
incidents (Salkovskis, in press). The theory proposes that assumptions may include not only
beliefs about harm and responsibility, but also about the nature and implications of intrusive
thoughts themselves, as in the religious notion of ``sin by thought'' (e.g. ``Thinking something
 P.M. Salkovskis et al. / Behaviour Research and Therapy 38 (2000) 347±372 349

wicked is as bad as doing it''). The occurrence of an intrusive thought or impulse concerning
some extreme and unacceptable action would, for someone holding this belief, result in very
negative appraisals and consequent e€orts to prevent or ``undo'' such thoughts or prevent their
recurrence.
Other assumptions focus on the harm itself (e.g. ``If one can have any in¯uence over a
harmful outcome, then one is responsible for it.'') and on both the harm itself and the

Fig. 1. Cognitive model of Obsessive±Compulsive Disorder.

350 P.M. Salkovskis et al. / Behaviour Research and Therapy 38 (2000) 347±372

signi®cance of intrusive thoughts about such harm (e.g. ``If I don't act when I can foresee
danger, then I am to blame for any consequences if it happens''). When someone who holds
such general beliefs experiences intrusive cognitions concerning possible danger, these would
tend to be interpreted as indicating an imperative for preventative action. Thus, this type of
responsibility assumption makes it more likely that the person will react to intrusions with
responsibility appraisals, which in turn increases the likelihood that the person will decide to
seek to do things which they believe will diminish their perceived risk of causing harm by their
action or inaction. Threat and responsibility appraisals also trigger other reactions, such as
selective attention, thought suppression and reassurance seeking which can play a further role
in the maintenance of obsessional beliefs and the re-occurrence of intrusions as indicated in
Fig. 1.
Results from studies using self report questionnaires have been consistent with the
hypothesised association between `in¯ated responsibility' beliefs and OCD. Freeston,
Ladouceur, Gagnon, and Thibodeau (1993) demonstrated that patients with OCD endorse
more beliefs related to responsibility than a group of matched controls. The same group of
researchers used a questionnaire to show a link between responsibility, OCD symptoms and
suppression of thoughts in a non-clinical population. Participants who neutralised intrusive
thoughts rated their thoughts more strongly in terms of responsibility than participants who
did not neutralise their thoughts. Freeston and Ladouceur (1993) also showed that beliefs
about obsessions, including beliefs about responsibility, were linked to OCD symptoms. Other
questionnaire studies had also found that measures of responsibility correlate with obsessive±
compulsive symptoms (Rheaume, Ladouceur, Freeston, & Letarte, 1995; Steketee & Frost,
1994).
With a complex concept such as responsibility, there is considerable scope for
misunderstanding (Clark & Purdon, 1993). A speci®c psychological de®nition of responsibility
perceptions as applied to the characteristic appraisals of people su€ering from OCD has been
proposed as:

The belief that one has power which is pivotal to bring about or prevent subjectively crucial
negative outcomes. These outcomes are perceived as essential to prevent. They may be
actual, that is, having consequences in the real world, and/or at a moral level (Salkovskis,
1996b)

Rheaume et al. (1995) conducted a study to evaluate an earlier (and similar) version of this
de®nition of responsibility. They developed a semi-idiographic task in order to evaluate
responsibility across obsession-related situations, such as contamination, veri®cation, somatic
concerns, loss of control, making errors, sexuality and magical thinking. Participants were
asked to brie¯y describe a possible negative outcome and then to rate this outcome on four
dimensions: (1) probability; (2) severity; (3) in¯uence; and (4) pivotal in¯uence, using a nine
point Likert scale. Finally participants rated perceived responsibility and personal relevance.
Regression analysis suggested that in¯uence and pivotal in¯uence were better predictors of
responsibility ratings than probability and severity. Their ®ndings generally supported the
 P.M. Salkovskis et al. / Behaviour Research and Therapy 38 (2000) 347±372 351

proposed de®nition of responsibility. It is possible that the fact that severity of outcomes did
not predict responsibility may have been due to the uniformly high levels of severity perceived
by all participants in relation to the ratings used.
The cognitive hypothesis of OCD explicitly speci®es two levels of responsibility-related
cognitions: responsibility assumptions (attitudes) and responsibility appraisals (interpretations).
These will interact with other cognitive factors (e.g. general threat appraisals, other
assumptions about controllability etc.) which, the theory suggests, may not be speci®c to OCD.
If this is so, it suggests that it may be important to measure both responsibility attitudes and
responsibility appraisals (and their interaction) in order to understand the psychopathology of
obsessional problems more fully. The present paper evaluates the extent and speci®city of both
responsibility assumptions and appraisals in obsessional patients and controls (both those
su€ering from anxiety disorders and non-clinical participants). If the cognitive theory described
here is broadly correct, then it would be expected that intrusive thoughts will be associated
with responsibility appraisals of intrusive thoughts. Responsibility appraisals are measured here
using a priming approach which seeks to identify the crucial interpretations only after the
person has identi®ed speci®c examples of unacceptable intrusive cognitions which have
occurred in the previous 2 weeks. The subsequent ratings then focus on that type of intrusion.
Responsibility assumptions (attitudes) might be expected to be rather less speci®c, as these are
more distant from the experience of obsessional symptoms. Such assumptions should re¯ect the
more generalised tendency to assume responsibility in a given situation, particularly situations
involving intrusions and doubts. It is possible that such assumptions may be less speci®c to
OCD; they may be associated with guilt and depression. The inclusion of anxious controls in
the present study allows evaluation of the speci®city of any ®ndings to OCD, i.e. it controls for
the possibility that any di€erence between obsessionals and non clinical participants might be
due to relatively high levels of anxiety or depression or to the fact that these individuals
identify themselves as patients.

2. Methods

2.1. Participants

In order to investigate the reliability and validity of the responsibility measures, the
questionnaires were given to three groups of participants: people su€ering from DSM IV
(SCID) de®ned Obsessive Compulsive Disorder (OCD; n = 83); from a DSM IV anxiety
disorder (n = 48) and non-clinical participants (n = 218). OCD participants were given the
questionnaires before they started receiving cognitive±behavioural treatment as part of a
research trial or participating in other experiments. The anxious control patients had been
diagnosed using the SCID as having an anxiety disorder other than Obsessive Compulsive
Disorder (Panic with and without agoraphobia, Social Phobia and Generalized Anxiety
Disorder). The non-clinical controls consisted of 29 students at Oxford University and 189
352 P.M. Salkovskis et al. / Behaviour Research and Therapy 38 (2000) 347±372

non-student participants recruited from the community. Since the samples used for each of the
questionnaires are not exactly the same for each of the analyses, information about each
sample is given separately under the analyses of each questionnaire.

2.2. Measures

2.2.1. Responsibility Attitude Scale (RAS)

This 26-item questionnaire was designed to assess general beliefs about responsibility. An
initial pool of items was generated by clinicians with expertise in the clinical application of the
cognitive theory of OCD with the aim of re¯ecting general attitudes and beliefs characteristic
of or likely to predispose to responsibility and harm concerns in OCD. In pilot work, a
preliminary version was given to small groups of obsessional patients and anxious controls.
The scale was then modi®ed on the basis of these ®ndings in order to select items which were
relatively speci®c to OCD and to alter those items showing ceiling or ¯oor e€ects. The format
of this scale was based on that of Beck, Brown, Steer and Weissman (1991) Dysfunctional
Attitude Scale, in which participants were required to indicate the extent to which a series of
statements generally applied to them. They were asked to indicate how much they agreed or
disagreed with speci®c statements (see Appendix) by choosing the anchor which best described
how they think. It was speci®ed that, ``To decide whether a given attitude is typical of your
way of looking at things, simply keep in mind what you are like MOST OF THE TIME''
(original emphasis).
Rating was on a seven point scale: totally agree, agree very much, agree slightly, neutral,
disagree slightly, disagree, disagree very much, totally disagree. The items included:
I often feel responsible for things which go wrong
I must always think through the consequences of even the smallest actions
To me, not acting where disaster is a slight possibility is as bad as making that disaster
happen
I am often close to causing harm.
This scale is reproduced in an appendix at the end of this article; this scale has sometimes
been referred to as the R-Scale (Steketee, Frost & Cohen, 1998).

2.2.2. Responsibility Interpretations Questionnaire (RIQ)

This 22-item questionnaire was designed to assess the frequency of and belief in speci®c
interpretations of intrusive thoughts about possible harm. The preliminary version was
designed by the University of Oxford OCD Research Team and was given to a small group of
obsessionals and non-obsessional controls as described for the RAS. On the basis of feedback
from participants and this pilot data, the original questionnaire was revised to its present form.
The response format of this scale was based on the format of the Chambless Agoraphobic
Cognitions Scale (Chambless, Caputo, Bright & Gallagher, 1984). The Chambless Agoraphobic
Scale assesses participants' reactions when they are `nervous'; in the RIQ, the referent is ``your
reactions to intrusive thought that you have had in the last two weeks'' (original emphasis).
 P.M. Salkovskis et al. / Behaviour Research and Therapy 38 (2000) 347±372 353

Intrusive thoughts, impulses and images are then de®ned and it is indicated that such thoughts
are experienced by ``most people''. Five examples of intrusions are also given. In an attempt to
prime negative interpretations speci®c to intrusive thoughts, the questionnaire asked the
participants to ``write down the intrusions that you have had in the last two weeks''. Again,
this is an attempt to follow the principle established by the Agoraphobic Cognitions
Questionnaire, allowing for the view that participants would ®nd it harder to focus on the
occurrence of intrusions than panic patients would on the recent episodes of intense anxiety or
panic attacks. The last part of the front sheet speci®es that ``Overleaf are some ideas that may
go through your mind when you are bothered by worrying intrusive thoughts which you know are
probably senseless or unrealistic. Think of times when you were bothered by intrusive thoughts,
impulses and images in the last two weeks'' (original emphasis).
They are asked to rate the frequency with which they may have had particular
interpretations using the following rating scale:
0. Idea never occurred
1. Idea rarely occurred
2. Idea occurred during about half of the times when I had worrying intrusive thoughts
3. Idea usually occurred
4. Idea always occurred when I had worrying intrusive thoughts
Having rated the frequency for each of the items, participants are then asked to rate the extent
to which they believed these interpretations at that time using the following scale:

Most items related to high responsibility interpretations. For example:

If I don't resist these thoughts it means I am being irresponsible
I'll feel awful unless I do something about this thought
Since I've had this thought I must want it to happen
Now I've thought of bad things which could go wrong I have a responsibility to make sure I
don't let them happen
The remaining six items were interspersed amongst these and related to low responsibiltiy
interpretations. Examples are:
There's nothing wrong with letting thoughts like this come and go naturally
This is just a thought so it doesn't matter

2.2.3. Other measures

Other questionnaires were administered in the following order: two scales of obsessionality:
the Maudsley Obsessive Compulsive Inventory (MOCI; [Hodgson & Rachman, 1978]) and
Obsessive Compulsive Inventory (OCI; [Foa, Kozak, Salkovskis, Coles & Amir, 1998]); a
measure of depression (Beck Depression Inventory; BDI; [Beck, Ward, Mendelson & Erbaugh,
354 P.M. Salkovskis et al. / Behaviour Research and Therapy 38 (2000) 347±372

1961]); a measure of clinical symptoms of anxiety (Beck Anxiety Inventory-(BAI;[Beck,

Epstein, Brown & Steer, 1988]); and the State-Trait Anxiety Inventory (STAI; Spielberger,
1983).

2.3. Procedure

The questionnaires were completed by the patient in their own time. Obsessional patients
and anxious controls were asked to complete these before treatment began. For test±retest
reliability data, participants were asked to complete a second copy of the relevant
questionnaire after a gap of 2 weeks.

2.4. Overview of investigation

The reliabilities of the RAS and RIQ were investigated by examining internal consistency
and test±retest reliability of each scale. The main part of the study involved a comparison of
scores between three key criterion groups: obsessional patients, non-clinical controls and
anxious controls. It was predicted that the obsessional participants would show much higher
scores than the participants in the other two groups. The comparison between obsessional
patients and patients su€ering from other anxiety disorders indicates the speci®city of the
responsibility beliefs measured to obsessional problems as opposed to anxiety in general.
The concurrent validity of the RAS and RIQ were investigated by correlating the scores of
233 participants with two scales of obsessive compulsive behaviour: the Maudsley Obsessive
Compulsive Inventory (MOCI) and Obsessive Compulsive Inventory (OCI). Two measures
were chosen because the OCI is a relatively new measure (as opposed to the MOCI, which is
well established) in addition, the OCI places a much greater emphasis on obsessional thinking,
which is poorly covered in the MOCI. The speci®city of the measures of obsessional beliefs was
examined by calculating the correlations between scores on the RAS and RIQ and measures of
anxiety and depression (BDI, BAI, STAI-State, STAI-Trait). Finally, regression analyses were
carried out in order to measure the association between the responsibility scales and
obsessionality (measured by the OCI) and other psychological variables (BDI; BAI; STAI-
State; STAI-Trait).

2.5. Study 1: responsibility attitudes

Two hundred and thirty one participants completed the RAS and clinical questionnaires (144
non-clinical participants, 49 obsessional participants and 38 anxious control participants).

2.5.1. Reliability
Test±retest reliability was examined by giving the RAS to 57 participants 2 weeks apart (40
non-clinical participants, ®ve obsessionals and 12 anxious controls). Pearson product moment
correlation coecient was r = 0.94, p < 0.0001. The internal consistency of the 26 items of the
 P.M. Salkovskis et al. / Behaviour Research and Therapy 38 (2000) 347±372 355

RAS was assessed using Cronbach's alpha, giving a=0.92. These results indicate that the
reliability and internal consistency of the RAS is high.

2.5.2. Group comparisons

The main purpose of the RAS is to identify attitudes hypothesised to be characteristic of
people who are su€ering from OCD, so the criterion validity of the scale was assessed by
comparing the scores of people who have been found to ful®l DSM-IV criteria for OCD with
the scores of control groups. One-way ANOVAs and Bonferroni multiple comparisons were
used to compare all questionnaire scores across groups. Results of these comparisons are given
in Table 1. These results indicate that both comparison groups di€ered from the OCD group
on obsessionality, but only the non-clinical group di€ered on anxiety and depression. This
meant that any di€erences found between obsessionals and anxious controls were likely to be
due to obsessionality and not to anxiety, depression or individuals labelling themselves as
patients.
Multiple comparisons on the RAS showed that obsessional participants had signi®cantly
higher mean scores on the RAS than non-clinical control participants ( p < 0.0001) and than
anxious control participants ( p < 0.001), and that the anxious control participants scored
signi®cantly higher than the non-clinical control participants ( p = 0.005). Scores of the RAS
for each group are also shown in Fig. 2.

2.5.3. Concurrent validity

The concurrent validity of the RAS was assessed by examining the association between the
RAS and the two measures of obsessionality. The Pearson product moment correlation

Table 1
Mean and standard deviations (in square brackets) of the scores of obsessional patients and control groups for the
RAS and other measures of psychopathology and age. Note: values on the same line with di€erent superscripts are
signi®cantly di€erent from each other

Obsessionals Non-clinical controls Anxious controls

Gender 19 male 43 male 5 male w2[2]=6.97
30 female 100 female 33 female p = 0.03

RAS mean mean mean

4.69b [1.01] 3.48a [1.01] 4.00c [0.92] F[2,230]=27.32 
Age 34.50 [10.56] 38.39 [16.75] 38.31 [11.41] F[2,220]=1.18, p = 0.31
MOCI 14.16b [6.07] 3.63a [3.26] 5.41a [3.69] F[2,143]=80.34 
OCI 54.87b [30.34] 20.50a [21.35] 17.81a [12.14] F[2,159]=31.73 
BDI 16.70a [8.88] 6.38b [6.40] 20.42a [8.71] F[2,227]=73.07 
BAI 18.88a [9.31] 7.31b [7.12] 25.00c [12.39] F[2,180]=62.86 
STAI-state 49.60a [12.72] 36.72b [13.03] 49.77a [15.00] F[2,90]=8.21 
STAI-trait 53.85a [9.37] 43.78b [9.47] 50.2ab [18.99] F[2,131]=8.42 

 p < 0.0001.

356 P.M. Salkovskis et al. / Behaviour Research and Therapy 38 (2000) 347±372

Fig. 2. Mean scores of RAS.

between the MOCI total score and the RAS was r = 0.57 ( p < 0.0001); and between the OCI
total score and RAS was r = 0.54 ( p < 0.0001). When scores of clinical depression (BDI) and
anxiety (BAI) are partialled out, correlations between RAS and MOCI (r = 0.52, p < 0.0001)
and RAS and OCI (r = 0.55, p < 0.0001) are essentially unchanged.

2.6. Study 2: the responsibility interpretations questionnaire

Two hundred and sixty participants completed the RIQ (138 non-clinical participants, 76
obsessional participants and 46 anxious control participants).

2.6.1. Reliability
Test±retest reliability was examined by giving the RIQ to 70 participants 2 weeks apart (23
non-clinical participants, 25 obsessional participants and 22 anxious control participants).
Reliabilities were calculated separately for the items in the questionnaire relating to high
responsibility and those relating to low responsibility, which were interspersed. Pearson
product moment correlation coecients were 0.90 for the frequency of the high responsibility
interpretations, 0.69 for the frequency of the low responsibility interpretations, 0.80 for the
belief of the high responsibility interpretations but only 0.22 for the belief of the low
responsibility interpretations. The test±retest reliability is satisfactory for the high responsibility
interpretations factors, but was not considered satisfactory for the low responsibility
interpretations.
The internal consistency of the RIQ was assessed using Cronbach's alpha. For the frequency
of the high responsibility interpretations Cronbach's alpha was a=0.93; for the frequency of
the low responsibility interpretations, it was a=0.86; for the belief of the high responsibility
interpretations it was a=0.92; and for the belief of the low responsibility interpretations it was
 P.M. Salkovskis et al. / Behaviour Research and Therapy 38 (2000) 347±372 357

a=0.91. This indicates that there is a satisfactory degree of internal consistency each
subsection of the RIQ.

2.6.2. Group di€erences

The RIQ was devised to evaluate the hypothesis that people su€ering from Obsessive
Compulsive Disorder are more likely than controls to make negative appraisals concerning
responsibility when they experienced intrusive cognitions. The criterion validity was therefore
assessed by comparing the scores of people who have been found to ful®l DSM-IV criteria for
OCD (Association, 1994) with scores of control participants. One-way ANOVAs and
Bonferroni multiple comparisons were used to compare the scores of non-clinical participants,
obsessional participants and anxious control participants. Scores on other psychological
measures were also analysed (BDI; BAI; STAI; MOCI and OCI; see Table 2). The results
indicate that both comparison groups di€ered from the OCD group on measures of
obsessionality, and that the non-clinical group di€ered from both clinical groups on anxiety
and depression. The two clinical groups did not di€er in terms of anxiety and depression

Table 2
Mean and standard deviations (in square brackets) of the scores of obsessional patients and control groups for the
RIQ and other measures of psychopathology and age. Note: values on the same line which share a superscript are
not signi®cantly di€erent from each other

Obsessionals Non-clinical controls Anxious controls

Gender 34 male 61 male 9 male w2[2]=9.73
42 female 77 female 37 female p < 0.01

RIQ mean mean mean

Frequency: 1.94a 0.67b 1.04c F[2,255]=73.36

high responsibility interpretations [0.87] [0.61] [0.85]
Belief: high responsibility interpretations 49.46a 15.76b 27.91c F[2,255]=63.35

[22.77] [17.52] [25.56]
Age 33.64a 38.75a 36.93a F[2,242]=2.87
[10.90] [16.05] [11.54] p = 0.06
MOCI 14.63b 4.99a 6.07a F[2,202]=103.53

[5.58] [3.50] [3.80]
OCI 60.97b 17.92a 18.73a F[2,232]=104.27

[28.42] [15.96] [14.43]
BDI 16.88a 6.33b 19.50a F[2,251]=73.55

[9.23] [6.17] [8.94]
BAI 18.79a 7.27b 24.26c F[2,254]=92.94

[9.36] [6.16] [11.41]
STAI-state 50.43a 34.67b 50.71a F[2,199]=44.35

[12.57] [10.49] [13.98]
STAI-trait 57.14a 38.79b 51.67a F[2,188]=46.11

[9.61] [9.85] [17.37]

 p < 0.0001.

358 P.M. Salkovskis et al. / Behaviour Research and Therapy 38 (2000) 347±372

Fig. 3. Mean scores of frequency and belief of high responsibility interpretations of RIQ.

scores. This meant that any di€erences found between obsessionals and anxious controls are
likely to be due to obsessionality and not likely to be due to anxiety per se.
Results show that obsessional participants had signi®cantly higher scores on both frequency
and belief of high responsibility interpretations than non-clinical control participants and than
anxious control participants ( p < 0.0001 in both cases). The anxious control participants had
signi®cantly higher scores of frequency and belief of high responsibility interpretations than the
non-clinical control participants ( p < 0.002 in both cases).
The items evaluating low responsibility interpretations were not analysed further as the test±
retest reliability had been found to be unsatisfactory. Scores frequency and belief ratings for
high responsibility thoughts are shown in Fig. 3.

2.6.3. Concurrent validity

The concurrent validity of the RIQ was assessed by examining the association between
scores on the RIQ and the obsessionality measures. The Pearson product moment correlation
between the frequency score of high responsibility interpretations of the RIQ and the MOCI
was r = 0.56 ( p < 0.0001), and with the OCI was r = 0.68 ( p < 0.0001). When BDI and BAI
scores were partialled out, the ®gures become r = 0.39 ( p < 0.0001) and r = 0.57 ( p < 0.0001).
The RIQ belief score for high responsibility interpretations was r = 0.55 ( p < 0.0001) with the
MOCI and r = 0.63 ( p < 0.0001). Partialling BDI and BAI scores modi®ed these ®gures to r
= 0.39 ( p < 0.0001) and r = 0.53, ( p < 0.0001) respectively.

3. Results

The results demonstrate that the frequency of and belief in high responsibility interpretations
and the frequency of low responsibility interpretations have satisfactory test±retest reliabilities,
 P.M. Salkovskis et al. / Behaviour Research and Therapy 38 (2000) 347±372 359

internal consistencies, concurrent validities and criterion validities. However, the scales of the
test±retest reliability of the belief of low responsibility interpretations is not satisfactory,
despite good internal consistency, concurrent validity and criterion validity. The scores of the
low responsibility interpretations were therefore not analysed further.

3.1. Regression analyses

Regression analyses were carried out in order to investigate the relationship between the two
responsibility questionnaires and key subtypes of obsessional symptoms as assessed by the OCI
subscales. These were the washing, checking, obsessions and neutralising scales. Regression
analyses were conducted using each of these OCI scales as a dependent variable.
Scores on the BDI, BAI, STAI-state, STAI-trait, RAS, frequency score of high responsibility
interpretations of the RIQ, and belief score of high responsibility interpretations of the RIQ
were allowed to enter freely in stepwise regression analyses. Seventy-seven participants (24
obsessional participants, 25 non-clinical controls and 28 anxious controls) had completed all of
these questionnaires so were considered in these regression analyses.
Results of a regression analysis using the total score of the OCI as a dependent variable
show that frequency of the high responsibility interpretations scale of the RIQ, the RAS and
the Spielberger anxiety all entered the regression. In total 51% of the variance is explained. No
other variables entered in subsequent analyses at a probability less than 0.05.
However, it is possible that high scores on the RIQ and RAS indicate high levels of anxiety
and/or depression rather than being measures of factors having a speci®c association with
OCD symptoms. In order to investigate this possibility, a further analysis was carried out in
which anxiety and depression scales were forced in ®rst, allowing the responsibility scales to
follow. When the OCI was used as a dependent variable, the BDI was found to explain 14%
of the variance. The BAI did not make a signi®cant independent contribution. The next
variable to enter was the frequency of high responsibility interpretations of RIQ followed by
the RAS scores, which together added a further 33% of the variance.
It is possible that the RAS and RIQ are simply associated with high general levels of
psychopathology (such as anxiety and depression) rather than speci®cally with obsessional
symptoms. Further regression analyses were carried out to assess the association between the
RAS and RIQ (which are presumed to have a special relationship with obsessional symptoms)
with measures of symptoms of anxiety and depression, which the cognitive theory suggests will
not show any strong or speci®c associations. Regression analyses were carried out investigating
the extent to which they explain variance ®rstly of the BDI and secondly of the BAI. Overall,
the results of these regression analyses show that the responsibility measures are more closely
related to obsessionality than to anxiety and depression.

3.2. Regression analyses of the subscales of the OCI

Four subscales of the OCI were identi®ed as theoretically related to responsibility:

360 P.M. Salkovskis et al. / Behaviour Research and Therapy 38 (2000) 347±372

Table 3
Independent variables predicting the total score on the Obsessive Compulsive Inventorya

Independent variables Beta Cumulative R 2 Change in R 2 Cumulative adjusted R 2 F/


Frequency of high responsibility 0.61 0.38 0.38 0.37 F[1,74]=44.48
interpretations of RIQ

RAS 0.38 0.46 0.08 0.45 F[2,73]=31.61

STAI-2 0.21 0.50 0.04 0.48 F[3,72]=24.33

STAI-1 0.21 0.53 0.03 0.54 F[4,71]=20.27
a
No other independent variables entered (BDI, BAI, and belief score of high responsibility interpretations of the
RIQ).

p < 0.0001.

obsessions, washing, checking, and neutralizing. Regression analyses were carried out on these
subscales. Separate analyses were carried out allowing the RAS and the RIQ to enter. Scores
of the BDI, BAI, STAI-state and STAI-trait were also allowed to enter in these regression
analyses.
The results show that a signi®cant proportion of variance of the ritualising subscales of the
OCI (washing, checking and neutralising) and obsessions subscales are accounted for by factors
of the responsibility scales, Table 3.

3.3. Summary of the regression analyses

The regression analyses suggest that the total scores of the RAS and the RIQ are speci®cally
related to obsessionality as measured by OCI and its subscales. They are stronger predictors of

Table 4
Independent variables signi®cantly predicting the total score on the Obsessive Compulsive Inventory when de-
pression and anxiety scores are forced into the equation ®rsta

Independent variables Beta Cumulative R 2 Change in R 2 Cumulative adjusted R 2 F


BDI 0.38 0.15 0.15 0.14 F[1,117]=20.14

frequency of high responsibility 0.61 0.44 0.29 0.43 F[2,116]=45.52
interpretations of RIQ

RAS 0.27 0.48 0.04 0.47 F[3,115]=35.23
a
No other independent variables entered (BAI, and belief score of high responsibility interpretations of the RIQ).

p < 0.0001.
 P.M. Salkovskis et al. / Behaviour Research and Therapy 38 (2000) 347±372 361

Table 5
Independent variables predicting scores on the Beck Depression and Anxiety inventories

Dependent variable Independent variables

STAI-state, STAI-trait, BAI, RIQ-frequency high
responsibility, RIQ-belief high responsibility, RAS

BDI BAI R 2=0.66

STAI-state R 2=0.07
Total R 2=0.73
BAI BDI R 2=0.67
belief high resp R 2=0.01
Total R 2=0.68

obsessionality than scores of depression and anxiety. The results also demonstrate that the
RAS and RIQ are not primary predictors of general anxiety and depression, Table 4.

3.4. Intercorrelation between the two measures of responsiblity

The responsibility measures were highly correlated with each other. The RAS was correlated
at r = 0.65 ( p < 0.0001) with the frequency of high responsibility interpretations, and at r =
0.64 ( p < 0.0001) with the belief ratings for these interpretations, Table 5.

4. Discussion

The results of the studies reported here are consistent with the theory that people
su€ering from obsessional problems are characterised by and experience an ``in¯ated sense
of responsibility'' for possible harm, linked to the occurrence and/or content of intrusive
cognitions. Appraisals involving responsibility for causing or preventing harm are important
because it is hypothesised that it is these appraisals, rather than the intrusions per se,
which lead to discomfort and motivate attempts to neutralise intrusions (Rachman, 1993;
Salkovskis, 1985; Salkovskis, Richards & Forrester, 1998a; Salkovskis, Forrester, Richards
& Morrison, 1998b). The present study demonstrates (i) that obsessional patients are more
likely to endorse general responsibility beliefs and assumptions than are nonobsessionals
and (ii) that they are also more likely to make responsibility-related appraisals of intrusive
thoughts about possible harm. There was also evidence of an association between
responsibility cognitions and the occurrence of compulsive behaviour and neutralising. The
data suggest speci®city of responsibility cognitions in OCD, as obsessional patients di€ered
not only from the non-clinical group but also from the clinically anxious comparison group
362 P.M. Salkovskis et al. / Behaviour Research and Therapy 38 (2000) 347±372

who had very similar levels of anxiety and depression. Additionally, the measures of
in¯ated responsibility used here were found to have good test±retest reliabilities and
internal consistency.
There was evidence of a strong association between the measures of responsibility and of
obsessionality. The multiple regression analyses indicate that both types of responsibility
measure make unique and substantial contributions to the prediction of scores on measures
of obsessional symptoms. Further analyses indicated that the responsibility measures were
less strongly associated to measures of symptoms of depression and anxiety. As depression
and anxiety symptoms are themselves associated with obsessional symptoms, this result
suggests that the responsibility measures used may be tapping something other than general
dysfunction and dysphoria. Consistent with this view, it was found that responsibility
measures did not make a unique contribution to the prediction of depression symptoms,
and only a very minor contribution to clinical anxiety symptoms (only 1% of the total
68%).
A common problem in investigations of the type described here is criterion contamination.
That is, the measures of cognition used may include items which are actually ratings of the
intensity of symptoms speci®c to the disorder under investigation. For example, an item
phrased ``I am greatly troubled by unwanted upsetting thoughts'' is very likely to be selectively
endorsed by obsessional patients because it embodies one of the most common symptoms
experienced by obsessional patients. Care was taken in the scales used in the present study to
avoid such a confound.
A novel feature of the present study was the inclusion of ``low responsibility'' interpretations
(e.g. ``This is just a thought so it doesn't matter''). However, despite the belief ratings for the
low responsibility interpretations scale having reasonable internal consistency, the test±retest
reliability was unacceptably low. It was decided not to conduct any detailed analyses of
frequency or belief ratings of these interpretations because of these problems. Given the
reasonable level of internal consistency (often taken as an indication of reliability), it is
possible that the test±retest results re¯ect `sensitivity'; that is, there may be considerable actual
¯uctuations in the extent to which individuals believe low responsibility interpretations (e.g.
``Having this thought doesn't mean I have to do anything about it'' and ``There's nothing
wrong with letting such thoughts come and go naturally''). Future research needs to solve this
problem, especially given that in cognitive±behavioural treatment emphasis is placed on these
alternative, non-threatening interpretations of cognitive intrusions (Salkovskis, 1996a). An
alternative explanation of the low test±retest reliability of these interpretations is that
individuals may have misread them; they were interspersed with the high responsibility
interpretations so may have lead to errors in the understanding of the statements and in the
direction of the rating scales. A subsequent version of the RIQ separates these items in order
to investigate this possibility (see Appendix).
There has been some previous work on the measurement of excessive responsibility in
obsessionality, although few of these studies have included samples of obsessional patients
and fewer still have included anxious controls as a comparison group. Rachman,
 P.M. Salkovskis et al. / Behaviour Research and Therapy 38 (2000) 347±372 363

Throdarson, Shafran and Woody (1995) conducted two psychometric studies in non-clinical
participants to develop a reliable self-report scale for measuring responsibility, and found
four factors: responsibility for harm, responsibility in social contexts, a positive outlook
toward responsibility, and thought-action fusion (TAF). Rheaume, Ladouceur, Freeston and
Letarte (1994) developed a semi-idiographic questionnaire measuring responsibility and
found satisfactory reliability and validity using non-clinical participants. Freeston et al.
(1993) developed a questionnaire about beliefs concerning intrusive thoughts and
responsibility; the control of such thoughts and their possible consequences; and
appropriateness of guilt and neutralizing behaviour as a response. A signi®cant relationship
between obsessive±compulsive symptoms and beliefs about obsessions were found in 87
non-clinical participants and 14 patients. Bouvard, Harvard, Ladouceur and Cottraux (1997)
also found responsibility beliefs as measured by a French translation of the RAS to be
important in a comparison between obsessionals and nonobsessionals. These researchers
also found that the consequences imagined by the two groups were similar, di€ering in
terms of the evaluation of severity and probability of the consequences and the in¯uence
they can have on them.
In another study which included both OCD patients and anxious controls, Steketee,
Frost and Cohen (1998) used several belief measures, including one of those used here (the
RAS) and Freeston et al.'s (1993) Inventory of Beliefs Related to Obsessions (IBRO).
Findings are consistent with the hypothesis that obsessional problems are associated with
beliefs about responsibility, control, threat estimation, tolerance of uncertainty, concern
about anxiety and coping. However, there was very little evidence of speci®city in the
beliefs measured; for example, threat estimation was elevated in OCD but not in anxious
controls, (an extremely surprising result). However, the results of that study are dicult to
interpret for a number of reasons. Items for all scales on the beliefs measure devised for
this study were selected speci®cally because they correlate with a speci®c measure of clinical
obsessional symptoms (YBOCS). There was considerable criterion contamination in many of
the items used (Steketee personal communication, 18/1/99). For example, at least ten of the
threat estimation items (from a total of 16) referred to risk associated with obsessional
symptoms, accounting for the speci®city of this scale to OCD. Other items from this scale
appeared to be thought±action fusion items (e.g. ``Imagining something bad happening to
someone makes it more likely to occur.'') We understand that there were similar problems
in the other scales. Further problems arise from the way participants were diagnosed (self
report of having a particular diagnosis) and because cuto€ scores on measures of
obsessional symptoms were used to exclude anxiety disorder patients.
In the study reported here, the SCID de®ned clinical groups had demonstrably comparable
(high) levels of anxiety and depression. The inclusion of such `anxious controls' in the analyses
tests the possibility that any di€erence between obsessionals and nonobsessionals is a general
e€ect of either anxiety, depression or the fact that an individual is a patient. The observed
di€erences between OCD patients compared with both non-clinical controls and anxious
patients suggests that the present ®ndings are speci®c to OCD.
364 P.M. Salkovskis et al. / Behaviour Research and Therapy 38 (2000) 347±372

A range of other belief domains are likely to be relevant to OCD, and have been well
summarised by the Obsessive Compulsive Cognitions Working Group (1997). These are (i)
in¯ated responsibility; (ii) overimportance of thoughts; (iii) beliefs about the importance of
controlling one's thoughts; (iv) overestimation of threat; (v) intolerance of uncertainty and (vi)
perfectionism. The ®rst three domains are almost entirely subsumed by the de®nition of
responsibility for harm used here. All three are relevant to obsessional symptoms because they
are likely to lead to the appraisals of intrusions in ways which motivate preventative or
restitutive reactions. Intolerance of uncertainty and, in particular, overestimation of threat, are
likely to be general vulnerability factors which may contribute to the misinterpretation and
negative appraisal of intrusions in important but less speci®c ways (Beck et al., 1985). These
beliefs are likely to occur in a range of psychological problems other than OCD. Perfectionism
is usually de®ned in terms which suggest more enduring personality-type characteristics, which
might be expected to interact with the appraisal of intrusions, particularly when such intrusions
concern the completion (or non completion) of particular actions.
The present ®nding that responsibility assumptions and appraisals are signi®cantly elevated
in obsessionals compared to controls is consistent with the cognitive±behavioural theory.
However, the presence of such an association could also be interpreted as indicating that such
beliefs might arise as a consequence of having OCD. Evidence consistent with a causal role for
responsibility beliefs comes from experimental studies on the impact of the manipulation of
responsibility. Ladouceur et al. (1995) used such an experimental manipulation with the results
being as predicted by the cognitive model. Lopatka and Rachman (1995) conducted an
experiment with obsessional patients (mainly checkers) and demonstrated that a decrease in
perceived responsibility was followed by decreased discomfort and by a decline in the urge to
carry out compulsive checking. Shafran (1997) found that these e€ects were not con®ned to
checkers, but occurred in obsessional patients with a range of symptoms.
The present study sought to measure responsibility interpretations and attitudes, and found
that it was possible to reliably measure such beliefs using self report questionnaires. We have
found these questionnaires to be useful clinical tools. The Responsibility Interpretations
Questionnaire assists in helping the therapist identify and target speci®c misinterpretations
made by obsessional patients throughout the process of therapy. It is also useful as a way of
measuring change and providing the patient with feedback by identifying actual changes and
the mechanisms involved in these. The revised version (as given in Appendix) is particularly
helpful, as the positive belief section allows the patient and therapist to monitor the
development of alternative, less threatening interpretations (eg ``Thinking of something
happening does not make me responsible for whether it happens''). The attitude measure is
most useful in helping the patient develop a cognitive behavioural conceptualisation of their
problems (c.f. Fig. 1) and later in therapy when patient and therapist seek to identify residual
responsibility beliefs which may predispose to relapse. The results reported here are consistent
with the hypothesis that responsibility attitudes and interpretations are characteristic of
Obsessive Compulsive Disorder.
 P.M. Salkovskis et al. / Behaviour Research and Therapy 38 (2000) 347±372 365

Appendix1

1
#Wellcome Trust Obsessive Compulsive Disorder Group (Oxford) 1999. Used by permission
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368 P.M. Salkovskis et al. / Behaviour Research and Therapy 38 (2000) 347±372
P.M. Salkovskis et al. / Behaviour Research and Therapy 38 (2000) 347±372 369
370 P.M. Salkovskis et al. / Behaviour Research and Therapy 38 (2000) 347±372
 P.M. Salkovskis et al. / Behaviour Research and Therapy 38 (2000) 347±372 371

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