Obsessive-Compulsive Disorder and Thought-Action Fusion: The Roles of Negative Thoughts, Negative Self-Worth Evaluation, and Reaction Time

Thought-action fusion (TAF) is a phenomenon associated with patients with obsessive-compulsive disorder (OCD). Patients with TAF are prone to believe that “Thinking it is doing it”. When their obsessions relate to forbidden actions, they tend to view the obsessions as being morally equivalent to performing them in reality, and these thoughts lead to guilt and self-denigration. (Rachman, 1993) The goal of this study was to investigate factors influencing TAF, and to propose a hypothetic mechanism of it. Hayes (2004) proposed relational frame theory (RFT), suggesting that language is learned through different relations between events. Collins and Loftus (1975) proposed spreading activation theory (SAT) on semantic memory. In their hypothesis, semantic memory is composed in the form of a network. According to the theories above, we further hypothesized that learning experiences in the past form connections between events. People with different level of TAF (high/low) would have different reaction times from the onset of negative thought to their subsequent negative self-evaluations. The first part of the study aimed to explore the relations between TAF, OCD, and the negative self-worth evaluation through correlational approach. In the second part, using lexical decision task, we examined whether there would be a difference on the reaction times from the onset of negative thought to the subsequent negative self-evaluation between participants with different levels of TAF (high/low) groups. An experiment with 2 (TAF group: high/low)×3 (type of the word-sets: general negative/obsessive-compulsive/neutral) mixed factorial design was conducted, with the first factor being between Ss factor, and the second factor being within Ss factor. We hypothesized that level of TAF would be positively correlated with OCD tendency, and both the level of TAF and OCD tendency would positively correlated with level of negative self-worth evaluation. We also hypothesized that, compared with neutral thoughts, the reaction times from the onset of negative thought (composed of general negative and obsessive-compulsive word sets) and their subsequent negative self-evaluation in the high TAF group would be shorter than their low TAF group counterparts. A total of 102 participants completed the questionnaires and performed the lexical decision task. For the data analysis of lexical decision task, we assigned those who scored higher than 40 points and lower than 18 points to be the high and low TAF groups, respectively. The results showed that level of TAF was positively correlated with the level of OC symptoms, and both of which were positively correlated with the level of negative self-evaluations. The results of lexical decision task showed that under the priming effect of wordsets of negative thoughts, the reaction times were shorter for the hight TAF group compared to those of the low TAF group. Our study suggests that when the semantic memory network of general negative/obsessive-compulsive related concepts is activated, those who have high level of TAF have faster reaction time in recognizing corresponding negative evalutions. Therefore, we suggest that negative self-evaluation in TAF paly an important role in the relationship between OCD and TAF, and propose some possible subsequent treatment strategies, accordingly. The related clinical applications are also discussed.