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Perfectionism, Moral Thought-Action Fusion and Shame-Proneness as Predictors of
Mental Contamination
Daniella Hallsworth
Submitted for the Degree of
Doctor of Psychology(Clinical Psychology)
School of PsychologyFaculty of Health and Medical Sciences
University of SurreyGuildford, SurreyUnited KingdomSeptember 2016
1
Abstract
Objective: Mental contamination is a term used to describe a psychological state in
which one feels a sense of contamination or dirtiness in response to cognitive
processes such as intrusive thoughts or memories. This gives rise to negative
emotions and an urge to wash. Research has begun to identify predictors that might
explain individual differences in sensitivity to feelings of mental contamination. The
current study aimed to add to this evidence base, exploring perfectionism, tendency
to the cognitive bias moral thought-action fusion and shame-proneness as possible
predictors.
Design: An online survey was designed to assess whether individual differences in
these factors were associated with sensitivity to mental contamination. The survey
measured the above variables, and included an induction task which asked
participants to recall a time they committed a moral transgression toward another
person. Feelings of mental contamination (anxiety, sense of internal and external
dirtiness and urge to wash) were measured before and after the induction, with
changes indicative of sensitivity to mental contamination.
Participants: Participants (N = 131; 71.8% female) were recruited from the general
public via social media advertisement and snowball sampling.
Results: Shame-proneness and subscales of perfectionism (high standards and
discrepancy) were found to correlate positively with indices of mental contamination
(anxiety and feelings of internal and external dirtiness). Shame-proneness emerged as
a significant predictor of these indices. Furthermore, the relationship between shame-
2
proneness and mental contamination indices was found to be moderated by duration
spent thinking about the moral transgression.
Conclusions: Results of this study point to the potential importance of targeting
shame-proneness and rumination in the treatment of mental contamination based
difficulties. Participants varied in their response to the induction procedure which
may point to the importance of idiosyncratic induction procedures in future research.
3
Acknowledgements
I would like to thank my research supervisor, Laura Simonds, for her continued
support and guidance over the last three years. Her knowledge of, and passion for
research has been stimulating and contagious. I am sorry that our supervisory
relationship is coming to an end. I also offer thanks to my clinical tutors and
placement supervisors over the last three years for their support and advice with my
clinical work. I feel grateful to have learnt from such knowledgeable and inspiring
clinicians. Thank you to Emma and Karla, my car supervision buddies who have
supported me through some difficult moments, and shared some celebratory ones.
Thank you for the cake, tea and wine, and for being the only two to really understand
my moans! Lastly, thank you to my family, friends and fiancé. Without you I
wouldn’t have had the courage to complete this challenge. I can’t wait to have more
time to spend with you all!
4
Contents
Research
1. MRP Empirical Paper………………………………………… 6
2. MRP Empirical Paper Appendices…………………………… 63
3. MRP Proposal………………………………………………... 102
4. MRP Literature Review……………………………………… 117
Clinical Experience……………………………………………………….. 173
Assessments……………………………………………………………..... 175
5
MRP Empirical Paper
Perfectionism, Moral Thought-Action Fusion and Shame-Proneness as Predictors of
Mental Contamination
Exact word count: 9714
6
Abstract
Objective: Mental contamination is a term used to describe a psychological state in
which one feels a sense of contamination or dirtiness in response to cognitive
processes such as intrusive thoughts or memories. This gives rise to negative
emotions and an urge to wash. Research has begun to identify predictors that might
explain individual differences in sensitivity to feelings of mental contamination. The
current study aimed to add to this evidence base, exploring perfectionism, tendency
to the cognitive bias moral thought-action fusion and shame-proneness as possible
predictors.
Design: An online survey was designed to assess whether individual differences in
these factors were associated with sensitivity to mental contamination. The survey
measured the above variables, and included an induction task which asked
participants to recall a time they committed a moral transgression toward another
person. Feelings of mental contamination (anxiety, sense of internal and external
dirtiness and urge to wash) were measured before and after the induction, with
changes indicative of sensitivity to mental contamination.
Participants: Participants (N = 131; 71.8% female) were recruited from the general
public via social media advertisement and snowball sampling.
Results: Shame-proneness and subscales of perfectionism (high standards and
discrepancy) were found to correlate positively with indices of mental contamination
(anxiety and feelings of internal and external dirtiness). Shame-proneness emerged as
a significant predictor of these indices. Furthermore, the relationship between shame-
proneness and mental contamination indices was found to be moderated by duration
spent thinking about the moral transgression.
7
Conclusions: Results of this study point to the potential importance of targeting
shame-proneness and rumination in the treatment of mental contamination based
difficulties. Participants varied in their response to the induction procedure which
may point to the importance of idiosyncratic induction procedures in future research.
8
Introduction
Feelings of contamination
Feelings of contamination have been defined as “intense and persisting
feelings of having been polluted or infected or endangered as result of contact, direct
or indirect, with a person/place/object that is perceived to be soiled, impure,
infectious or harmful” (Rachman, 2004, p. 1229). As this definition suggests,
feelings of contamination have typically been understood as being borne from direct
or indirect physical contact with a perceived contaminant, often termed ‘contact
contamination’ in the literature, where an individual feels dirty following physical
contact with a harmful person, place or item (Coughtrey, Shafran & Rachman,
2014b). Contact with this perceived source of contamination usually leads to
attempts to ‘neutralise’ or rid oneself of this sense of dirtiness through washing
behaviours and attempts to avoid the object or source (Rachman, 2004).
Traditionally, feelings of contamination (and associated fears of contamination)
understood in this way have been most often conceptualised and studied within the
context of obsessive-compulsive disorder (OCD). However, recent research has
adopted a much broader lens to both feelings of contamination and those who might
experience it, finding that contamination feelings can be more widely understood as
existing on a continuum of human experience with some individuals seemingly more
vulnerable than others.
Mental contamination
Since Rachman’s (2004) assertion that feelings of being contaminated, dirty
or polluted can arise following physical contact with a perceived contaminant,
evidence has accumulated supporting the idea that these feelings can also be
9
provoked in the absence of a physical contaminant. This phenomenon is termed
‘mental contamination’ and is thought to arise in response to “psychological
processes that do not require direct contact” (Carraresi, Bulli, Melli & Stopani, 2013,
pp. 13). The evidence base suggests that such psychological processes could include
negatively weighted intrusive thoughts, unpleasant memories, unacceptable images,
or exposure to a physical, emotional or moral violation such as being betrayed,
degraded or abused (Coughtrey, Shafran, Knibbs & Rachman, 2012; Coughtrey et
al., 2014b). Whilst diverse in content, these mental processes often have an immoral
quality, and are appraised as repugnant and unacceptable by the individual
experiencing them. This in turn elicits uncomfortable and distressing negative
emotions such as anxiety, shame, disgust, or a sense of immorality (Fairbrother &
Rachman, 2004; Fairbrother, Newth & Rachman, 2005) and may also give rise to
feelings of internal dirtiness, contamination and an urge to wash. This experience is
likely to occur in individuals who have repeated exposure to intrusive negative
thoughts (e.g. OCD) and memories (e.g. post-traumatic stress disorder), but also the
general population in whom negative cognitive intrusions are thought to be common
(Salkovskis, 1999).
Mental contamination has been likened in its nature to contact contamination,
such that both are associated with feelings of anxiety, sense of dirtiness and an urge
to wash (Herba & Rachman, 2007; Lee et al., 2013). This understanding has
influenced the way in which mental contamination has been approached and
conceptualised across existing research and studies. Most commonly, self-report
visual analogue scales (VAS) have been used that tap these main defining features
(Coughtrey et al., 2014b; Coughtrey, Shafran, & Rachman, 2014a; Lee et al., 2013).
10
Coughtrey et al. (2014a) also found the nature of spread in mental contamination to
be similar to contact contamination; participants in their study demonstrated that
contamination could be spread by, in the case of mental contamination, associating
objects with negatively-weighted thoughts, images and memories. This is perhaps
underpinned by the class of cognitive phenomena known as ‘thought-action fusion
beliefs’ which generally describe beliefs in which internal and external reality
become fused (Shafran, Thordarson & Rachman, 1996). In this case, it is possible
that associating objects with contaminating cognitions provoked by the mental
contamination induction procedure, meant the objects became perceived to take on
the immoral qualities of the thoughts.
Although contact and mental contamination share qualities in how they are
experienced, there are some differences. One important discrepancy that has
influenced the measurement of mental contamination lies with its accompanying
negative emotions. Whilst both contact and mental contamination are associated with
emotions such as anxiety and disgust, other affective components appear specific to
mental contamination, namely shame and guilt (Ishikawa, Kobori, Komuro &
Shimizu, 2014). This likely pertains to the immoral quality of the cognitive intrusion
that leads to feelings of mental contamination. Further, in both cases, a sense of
contamination and anxiety causes attempts to remove the contaminant, perhaps
through washing or other neutralising behaviours, but this appears more difficult in
mental contamination (Elliott & Radomsky, 2009). In the case of mental
contamination, washing does not appear to alleviate this internal sense of dirtiness or
contamination better than waiting for it to decay (Ishikawa et al., 2014). In fact, a
recent study (Waller & Boschen, 2015) concluded that physical washing behaviours
11
actually appear to maintain the negative emotional response associated with mental
contamination. This is in keeping with psychological models of anxiety that highlight
the maintaining roles of washing/neutralising behaviours (and avoidance) in many
psychological disorders, particularly OCD (Salkovskis, 1999). However, it is
possible that any differences in response to washing may be because the pollution in
mental contamination is not of a kind that can be removed by washing (and is
associated with a more internal, global sense of dirtiness rather than a localisation of
the dirtiness) even though there is an urge to wash (Waller & Boschen, 2015; Elliott
& Radomsky, 2009).
Induction of mental contamination
Recent experimental studies that have successfully induced mental
contamination in non-clinical populations have done so in varying ways; through
recalling negatively-weighted memories, imagining being victim or perpetrator of a
moral transgression, and being the receptor of objectifying comments (Coughtrey et
al., 2014b; Elliott & Radomsky, 2009; Fairbrother et al., 2005; Rachman, Radomsky,
Elliott & Zysk, 2012). Experimental paradigms commonly rely on recall of actual
situations when participants have been victim or perpetrator of immoral behaviour,
or ask participants to imagine this. Importantly, findings suggest mental
contamination is induced for both imagined and actual scenarios. The former may
link theoretically to understandings of OCD, with individuals imagining past or
future immoral behaviour (either being receptor or perpetrator), feeling contaminated
and engaging in subsequent neutralising behaviours. The latter likely links to theories
and literature on trauma, with individuals left feeling dirty, ashamed or immoral
following actual events.
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Some studies have stressed the idiosyncratic nature of mental contamination,
and have made attempts to induce it in individualised ways to increase ecological
validity (Coughtrey et al., 2014a; Coughtrey et al., 2014b). These studies have
engaged participants in tasks involving both actual and imagined negative
experiences, and utilised the ‘most inducing’ task for each individual for further
exploration. Interestingly, these studies have included tasks which may demonstrate
the role of ‘sympathetic magic’ and the ‘law of contagion’ as described by Nemeroff
and Rozin (1994). This describes implausible beliefs that some individuals hold
about the spread of contamination, particularly regarding the transfer of properties
between objects and people that come into contact. For example, one task in
Coughtrey et al.’s (2014a; 2014b) study asked participants to imagine wearing a
jumper belonging to an alcoholic. Those individuals that reported feelings of
contamination likely demonstrated a belief that any perceived immoral or
unacceptable qualities of someone with an addiction to alcohol can be transferred to
themselves via the jumper. This perhaps further demonstrates the role of thought-
action fusion (as outlined above) in the induction and spread of mental
contamination, such that participants ‘fused’ qualities of the alcoholic with his
jumper, and with themselves after imagining wearing it. This phenomenon has also
been observed clinically in adolescents with so-called ‘transformation obsessions’
(i.e. fears of taking on the properties of an immoral or undesirable person by
association and becoming that undesirable person; Volz & Heyman, 2007).
Individual differences and mental contamination
Although these studies demonstrate that mental contamination can be induced
in the general population, not all participants in these studies experienced feelings of
13
contamination and/or an urge to wash. This relates to the idea that not everyone who
experiences intrusive thoughts has obsessional difficulties, as in OCD. Similarly, not
all individuals exposed to negative events experience later trauma symptoms. Clearly
then, there are individual differences at work. It is possible that sensitivity to mental
contamination could be a mechanism connecting negative cognitions or experiences
to psychological distress and/or subsequent maladaptive behaviour (e.g. neutralising
behaviours), with those more sensitive to mental contamination more vulnerable to
later distress. If this is the case, then sensitivity to mental contamination warrants
further investigation; what makes one individual more vulnerable to feeling mental
contamination following negative cognitions or experiences?
The existing literature on mental contamination identifies several predictors
of mental contamination. To date, the main factors appear to be disgust
sensitivity/propensity, anxiety and general contamination fears (Hallsworth,
unpublished). However, these factors only explain modest amounts of variability in
the experience of mental contamination (Elliott & Radomsky, 2009; 2013; Herba &
Rachman, 2007), and not all studies find these relationships. Whilst this provides
some understanding of what might make one individual more vulnerable to feelings
of mental contamination, there are other factors yet to be explored. The current study
explores perfectionism, shame-proneness and moral thought-action-fusion as
predictors of mental contamination sensitivity with the aim of assessing which of
these related factors has the potential to offer the most parsimonious explanation of
sensitivity to mental contamination.
Perfectionism
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Trait perfectionism is conceptualised as setting unrealistically high standards,
rigid adherence to these standards and defining self-worth in terms of achieving these
standards (Shafran & Mansell, 2001). Distinctions have been made between adaptive
perfectionism (achievement striving) and maladaptive perfectionism (excessive and
evaluative concerns about failing to reach ones standards and criticism from others;
Chang, 2012; Enns, Cox, Sareen & Freeman 2001). Although both are linked to
negative consequences, it is maladaptive perfectionism that is commonly thought to
be problematic in terms of psychological difficulties and distress (Bieling, Israeli &
Antony, 2004; Slaney, Rice, Mobley, Trippi & Ashby, 2001). Individuals high in
maladaptive perfectionism are likely to find negative cognitive intrusions or
memories, in which they are cast in an unfavourable light, threatening to their own
high standards and self-worth. In their paper investigating models of perfectionism,
Bieling et al. (2004) concluded that individuals high in maladaptive perfectionism
may be particularly concerned about how others view and evaluate them (and their
actions), which may bring about vulnerability to anxious and depressive states in
response to any perceived moral transgressions. Further, they suggest that these
concerns are likely to initiate behaviours which ‘put right’ any wrong-doing or make
efforts to regain a sense of worth where possible (Bieling et al., 2004), perhaps
experienced as an urge to wash in those who feel morally ‘dirty’ or impure following
a transgression. Thus, theoretically, trait perfectionism could predict sensitivity to
mental contamination, with individuals higher in perfectionism being more sensitive
to anxiety, perhaps an urge to wash and sense of moral or internal dirtiness (i.e.
feelings of mental contamination) following ‘unacceptable’ cognitions or actions. To
date there have been no studies connecting adaptive or maladaptive perfectionism to
mental contamination. Existing literature does however suggest that ‘negative’
15
(maladaptive) perfectionism is related to the experience of shame.
Phenomenologically, shame is conceptualised as an affective component of mental
contamination (Ishikawa et al., 2014). Fedewa, Burns and Gomez (2005) found
strong positive correlations between maladaptive perfectionism and shame-proneness
(r = .52, p < .001) and state shame (r = .39, p <.001), and suggest this relationship
might be via perceived failure, such that individuals high in maladaptive
perfectionism experience shame in response to perceived failure. Conceptually, this
is likely because shame arises when failure is interpreted as reflecting a fundamental
personal flaw. Given their sensitivity to meeting standards, those high in
perfectionism are likely to make such negative global self-judgements. Relating this
to mental contamination, those high in maladaptive perfectionism may be more
likely to appraise cognitive intrusions as failures (as the intrusion raises the prospect
of being imperfect), leading to the experience of negative affective components of
mental contamination such as feelings of anxiety, distress, shame, disgust and a sense
of contamination. Relating this to mental contamination induction paradigms (as
described above), asking individuals to recall moral transgressions, or imperfect
conduct is likely to produce greater feelings of mental contamination in those high in
maladaptive perfectionism.
Shame-proneness
As noted above, the experience of shame is conceptually linked with mental
contamination because it is suggested to be part of the affective component of this
phenomenon. It has been proposed above that those high in maladaptive
perfectionism are more likely than those lower in this trait to experience the affective
components of mental contamination, including shame, following a perceived
16
‘failure’ (Fedewa et al., 2005). However, given that mental contamination often has a
moral connotation (Herba & Rachman, 2007), it is likely that being prone to
experience shame in general predicts vulnerability to mental contamination given
that shame is a moral self-conscious emotion. As Tangney, Stuewig and Mashek
(2007) highlight, self-conscious emotions such as shame and guilt “function as an
emotional barometer, providing immediate and salient feedback on our social and
moral acceptability” (pp 2). These authors also suggest that one can anticipate likely
emotional reactions based on past experience (i.e. one can experience these emotions
in the absence of actual behaviour, when considering future and past situations;
Tangney et al., 2007). Shame-proneness (or trait shame) is the likelihood of making
global, stable and specific attributions about negative acts (e.g. “I did this because I
am a bad person”), such that negative or immoral events (acts or intrusive thoughts)
mean the individual themselves are bad or immoral (Tracy & Robins, 2006).
Following Herba and Rachman’s (2007) suggestion that mental contamination
involves a sense of (emotional) dirtiness, it stands that an individual judging
themselves as bad or immoral would experience such feelings of dirtiness as they
perceive their whole character is tainted. Further, conceptually, shame is one of
several ‘self-conscious emotions’ and may be a motivator to restoring one’s own
self-image, and thus a motivator to ‘put right’ wrong doings. This would suggest that
those who are more shame-prone may be more likely to employ efforts to neutralise
any moral transgressions, such as washing or neutralising behaviours or experience
strong urges to do so. Hence, not only is trait shame likely to trigger a shame-based
response when exposed to immoral ideas/thoughts/memories, but may also be related
to components of mental contamination such as feeling dirty or an urge to wash.
Several studies have included shame in their understanding of the negative emotional
17
experience associated with mental contamination (Elliot & Radomsky, 2012;
Rachman et al., 2012), however shame-proneness is yet to be explored as a predictor
of sensitivity to mental contamination.
Moral thought-action fusion
A third possible contributing factor to individual differences in sensitivity to
mental contamination is moral thought-action fusion (TAF). TAF is a cognitive bias
that is conceptually and empirically associated with obsessive-compulsiveness (Berle
& Starcevic, 2005). TAF has been defined as comprising two components; 1) the
‘likelihood type’ TAF which pertains to the belief that an event is likely to happen in
reality if one has a thought about it and, 2) the ‘moral type’ TAF; that having a
thought about carrying out an action is the moral equivalent of carrying out the
action (Shafran et al., 1996). Mental contamination is, by definition, triggered by
memories or recollections of adverse events that often have a moral connotation.
Given that moral TAF involves the tendency to attach significance to negative
thoughts in the form of equating such thoughts with an immoral character, moral
TAF is likely to be a positive predictor of feelings of contamination. This resonates
with the above concept of shame-proneness, which postulates that shame-prone
individuals are likely to appraise the core self as ‘bad’ following a ‘bad’ act; perhaps
demonstrating fusion between the self and act (Valentiner & Smith, 2008). Existing
research has found measures of mental contamination positively correlated to
subscales of the TAF scale (moral, likelihood others, likelihood self; r = .25 - .5,
Coughtrey et al., 2012; Cougle, Lee, Horowitz, Wolitzky-Taylor & Telch, 2008).
However, no studies have specifically assessed whether moral TAF beliefs predict
mental contamination sensitivity.
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The current study
This research aimed to expand on the literature on predictors of mental
contamination sensitivity examining whether individual differences in perfectionism
and/or moral TAF and/or shame-proneness predict such sensitivity. It was
hypothesised that, following recollecting a moral violation that the person had
committed in the past:
1) Scores on measures of perfectionism, moral TAF and shame-proneness will
be positively correlated with mental contamination sensitivity,
operationalised as a change in sense of dirtiness (internal and external), urge
to wash and anxiety after recalling a moral violation;
2) Scores on measures of perfectionism, moral TAF and shame-proneness will
predict unique variance in mental contamination sensitivity.
Method
Design
The study adopted a cross-sectional correlational design. Participants were
asked to provide some demographic information and to complete self-report
measures of perfectionism, moral TAF, and shame-proneness. Participants completed
a short task designed to induce mental contamination. Before and after this induction
task participants completed four visual analogue scales (VAS) measuring feelings of
mental contamination that have been used in previous studies (feelings of internal
and external dirtiness, anxiety and urge to wash). Changes in these four VAS items
after the induction procedure were taken to be indicative of mental contamination
sensitivity in response to the mental contamination induction task. Each VAS was
treated as a separate component of mental contamination sensitivity. In keeping with
past research (Coughtrey et al., 2014b), a composite score was not derived as it was
19
not considered conceptually useful to aggregate the separate indices. Participants
answered two questions to gauge their engagement with the induction task. The study
was developed within Qualtrics Online Survey Software and was hosted on the
University server. All participants completed the study online.
To address Hypothesis one, scores on measures of perfectionism, moral TAF
and shame-proneness were correlated with change scores in the four mental
contamination VAS. Regression analyses were used to test Hypothesis Two that
perfectionism, moral TAF and shame-proneness scores would predict sensitivity to
mental contamination (as determined by change in VAS scores). A pilot study was
carried out with five participants to ascertain any potential difficulties with the
survey and to estimate completion time.
Participants
Participants were recruited from the general population using online
advertisements on the social media site, Facebook, and snowball sampling through
personal contacts of the researcher. In order to not restrict sample diversity, anyone
aged 18 or over was eligible to take part. The online advertisement informed
participants that the study formed part of doctoral research, and would require them
to recall a time they have done something that hurt or upset another person.
Participants were asked not to take part if a) they were unable to think of a time they
hurt or upset someone else or, b) thinking about a time they hurt or upset someone
else was likely to make them feel very distressed. For a correlation test, a priori
power analysis for a two-tailed hypothesis indicated a sample size of 82 participants
would achieve 80% power for detecting a medium sized effect of .3 (α = .05). For
multiple regression analyses in this study, a priori power analysis for a two-tailed
20
hypothesis indicated that a sample of 83 participants would achieve 90% power for
detecting a medium effect size of .13 (α = .05).
Induction of mental contamination
This study drew upon past induction methods that have stressed the
idiosyncratic nature of mental contamination and made efforts to induce it in an
individualised way. One of the ‘five tasks’ induction method in Coughtrey et al.
(2014a) was employed. This task asked participants to “recall a time they had
violated a moral standard or caused harm to someone” and to spend one minute
thinking about this time. This allowed participants to draw upon significant personal
memories and experiences, and thus did not rely on imagination ability. Participants
were asked to type a few sentences describing the event in order to increase
engagement with the task, and to allow analysis of the type of scenarios that
participants brought to mind in order to see if they were consistent with the induction
task.
Measures
1. Demographics
Participants were asked to provide information on age, gender, ethnicity, highest
education level, and country where they were completing the survey (Appendix A).
2. Almost Perfect Scale (APS-R, Slaney et al., 2001; Appendix B)
Perfectionism was measured using this 23-item scale. The APS-R asks respondents
to indicate their level of agreement with a list of beliefs and attitudes toward
themselves, their performance, and attitude toward others on Likert scales ranging
from 1 (strongly agree) to 7 (strongly disagree). The APS-R is a three-factor
measure of perfectionism with 12 items measuring discrepancy (the perception that
one consistently fails to meet ones standards; thought to tap maladaptive
21
perfectionism), 7 items measuring high standards and 4 items measuring order (both
thought to tap adaptive perfectionism). All three subscales were used in this study to
explore correlations between both adaptive and maladaptive perfectionism and
indices of mental contamination sensitivity. The APS-R demonstrates good levels of
internal consistency (Cronbach’s α ranging from .82 to .92; Slaney et al., 2001), was
not copyrighted and was available online. With regard to scoring and interpretation,
higher scores indicate higher standards, preference for order and increased
discrepancy, and was used as a continuous measure in the current study.
3. Thought-Action Fusion – moral subscale (TAF-moral; Shafran et al.,
1996; Appendix C)
This 12-item subscale was taken from the 19-item measure used to assess overall
thought-action-fusion (TAF; Shafran et al., 1996). Items ask about participants’ level
of agreement with statements equating immoral thoughts to actions (e.g. “If I wish
harm on someone, it is almost as bad as doing harm”), using Likert scales ranging
from 0 (strongly disagree) to 4 (strongly agree). This subscale demonstrates good
levels of internal consistency (not reported individually, but Cronbach’s α ranging
from .85 to .96 for all subscales; Shafran et al., 1996). This scale was freely available
for public use and available online. Possible scores range from 0 to 48, with higher
scores indicative of greater moral thought-action fusion beliefs.
4. Test of Self-Conscious Affect – Third Edition (TOSCA-3; Tangney &
Dearing, 2002; Appendix D)
Shame-proneness was measured with the shame subscale of the 16-item scenario-
based Test of Self-Conscious Affect – Third Edition (TOSCA-3; Tangney &
Dearing, 2002). The measure provides scenarios and possible responses, to which an
individual rates their likelihood of responding in that way (thus, their likelihood of
22
responses consistent with shame-proneness, from 1 (not likely) to 5 (very likely).
Possible scores range from 16 to 80 with higher scores indicative of greater shame-
proneness. The TOSCA-3 shame subscale shows good levels of internal consistency
(Cronbach’s α = .77; Tangney & Deering, 2002). As with previous scales, this scale
was freely available to use online.
5. Mental Contamination Visual Analogue Scales (VAS; Appendix E)
Previous studies have identified three main responses related to mental
contamination - sense of dirtiness (internal and external), anxiety and urge to wash
(Coughtrey et al., 2014b). Hence, participants were asked “how dirty do you feel
inside your body?”, “how dirty do you feel in general?”, “how anxious do you feel?”
and “how strong is your urge to wash?” Participants moved a pointer on a sliding
scale to indicate a score from 0 (“not at all”) to 100 (“extremely”). Participants
completed the four VAS before and after the induction procedure (pre-VAS and
post-VAS). To examine levels of mental contamination induced, pre-VAS scores
were deducted from post-induction VAS scores. Therefore, the higher the score, the
greater the degree of mental contamination induced (i.e. the greater the mental
contamination sensitivity). Since the VAS constituted four indices of mental
contamination (anxiety, urge to wash, internal and external dirtiness), each
participant produced four indices of mental contamination sensitivity.
6. Task engagement
Following the induction task, participants were asked two questions to gauge level of
engagement with the task. Question one asked, “how much of the allotted time did
you spend thinking about the event?” Question two asked “how vivid or clear was
the memory?” Participants moved a pointer on a sliding scale to indicate a score
23
from 0 to 100 (0 indicating “no time at all/not clear at all,” and 100 indicating “all of
the allotted time/very clear”).
Procedure
Within an online advertisement accessed via Facebook or via an email sent to
social contacts (which snowballed, see above participants section) participants were
provided with a link to the online study. The first screens provided study information
and consent statements (Appendix F). Participants were informed as to the nature of
the questions and induction task. They were informed that their information was
anonymous unless they opted to provide an email address to receive a summary of
the findings and have the option of withdrawing their data later. Participants were
then asked to provide demographic information and then completed the questionnaire
measures (APS-R, Moral TAF, TOSCA-3) followed by the four pre-induction VAS.
To induce feelings of mental contamination, participants were then asked to
“please think of a time you have violated a moral standard or caused harm to
someone”, to think about this for one minute and type a few sentences describing the
event or act. The online survey was set such that participants were not able to skip to
the next page until one minute and thirty seconds had elapsed (thirty seconds were
allowed to read instructions). Following this, participants again completed the four
mental contamination VAS. The two task engagement questions were then presented
to participants.
To leave participants with a balanced view of themselves, at the end of the
survey participants engaged in a short task asking them to spend time thinking about
a time they have helped someone else or made someone feel good. They had the
option of typing a few sentences about this event, but this was not compulsory and
was not analysed.
24
Finally, participants were shown a debrief information screen (Appendix G)
with researcher and mental health charity contact details (www.mind.org.uk) should
the study have left them feeling very upset or with any queries/concerns. They were
offered the option of leaving an email address if they were interested in receiving a
copy of the summary of results, or if they wished the option of withdrawing their
data up to one week following completion of the survey.
Ethical considerations
As per the British Psychological Society’s definition of deception
(“deliberately falsely informing participants of the purpose of the research”; Code of
Human Research Ethics, 2014, pp. 24) participants were not deceived, but they were
not given full information about the aims of the study until they completed measures
and tasks. It was not expected that participants would become very distressed during
this study, however some level of upset was expected due to the nature of emotions
associated with inducing mental contamination. Participants were advised of the
nature of the task before participating in the study and were advised not to participate
if they were worried they might find thinking of an unpleasant memory very
upsetting. Further, by giving participants the freedom to select the event themselves
they were able to avoid anything too upsetting. A similar study conducted by Piper
(2013, University of Surrey, PsychD Clinical) induced mental contamination in a
similar way online, with no adverse effects reported. Participants were informed that
they could withdraw at any point during the study but that they could not withdraw
their data once submitted as the study was anonymous (unless they had supplied an
email address to withdraw their data). Therefore, participation in any part of the
study indicated permission to use collected data, for example permission to compare
data from completers and non-completers of the study (unless otherwise indicated).
25
Participants were debriefed as to the purpose of the study following completion of
the survey or during the study if they decided to terminate early, and were offered
information on where to get support. Ethical approval was sought from The
University of Surrey Faculty of Arts and Human Sciences Ethics Committee, who
offered a favourable opinion (Appendix H).
Results
Descriptive statistics
212 participants began the online survey, with 141 completing and 71
dropping out of the survey at various points (see Appendix I for dropout flowchart).
Comparisons revealed no significant differences on demographics or predictor
variables (APS-R, Moral TAF, or TOSCA-3) between those that completed versus
those that did not complete the survey (see Table 1 for statistics and p values).
Table 1.
Comparisons between completers and non-completers.
Completers (N = 141) Non-completers (N = 45)* Statistic p
Gender Female 70.2%Male 29.8%
Female 62.2%Male 37.8%
x2(1) = 1.01 .359
Mean age in years(Range; SD)✝
33.0 (19-64; 9.68)
33.3 (21-58; 9.15)
U(184) = 2975 .531
Education level No qualifications 0%GCSE 11.3%A-Level 23.4%Undergraduate 30.5%Postgraduate 34.8%
No qualifications 2.2%GCSE 20%A-Level 20%Undergraduate 35.6%Postgraduate 22.2%
x2(4) = 7.17 .12
Ethnicity White British 86.5%White other 7.1%Other 6.3%
White British 77.8%White other 15.5%Other 6.6%
x2(11) = 10.09 .547
Country of completion
UK 93.6%USA 2.1%Australia 1.4%Other 2.8%
UK 88.9%USA 4.4%Australia 2.2%Other 4.4%
x2(3) = 1.17 .847
26
APS-R
High Standards✝
Order✝
Discrepancy✝
39.92 (5.67)
20.19 (4.65)
44.94 (16.73)
(N = 28)*
40.54 (4.79)
20.75 (4.31)
42.57 (14.88)
U(167) = 1870.5
U(167) = 1865.5
U(167) = 1810.5
.663
.648
.492
Moral TAF ✝✝
16.86 (9.78)
(N = 19)*
14.84 (6.70) t(29.5) = 1.15 .257
TOSCA-3 ✝✝
53.23 (9.48)
(N = 18)*
52.28 (6.81) t(157) = .411 .682
*Of 71 non-completers, 45 completed demographics, 28 completed the APS-R, 19 completed the Moral TAF and 18 completed the TOSCA-3; ✝Variable non-normal in one or both groups, ✝✝Variable normal in both groups.
To check that participants did recall a time they had committed an immoral
act of harm, recalled memories were classified according to their content. This was
done by summarising participants’ typed recollections in a short word or sentence,
and grouping those with similar meaning. This process identified 8 common
categories: emotionally hurting others, betrayal, physically hurting others, letting
people down, lying, stealing, drug use and other (those that were deemed to have
brought to mind a mentally contaminating event, but did not fall into one of the
broader themes identified; see Appendix J for catalogue of memories recalled). This
process identified ten participants who did not adhere to the mental contamination
induction procedure and who were excluded from further data analysis. This left 131
participants with valid data for analysis (see Appendix I for reasons for exclusion;
see Table 2 for demographic data for this final sample).
27
Table 2.
Final sample demographics (N = 131).
Demographics
Gender Female 71.8%; Male 28.2%
Mean age in years (Range; SD)
32.47 (19-64; 9.17)
Education level No qualifications 0%GCSE 10.7%A-Level 23.7%Undergraduate 29.8%Postgraduate 35.9%
Ethnicity White British 87.8%White other 6.9%Other 5.4%
Country of completion UK 94.1%USA 2.4%Australia .8%Other 3.1%
Analytic Procedures
Distribution tests. Distribution tests on the final sample revealed that moral
TAF and shame-proneness (TOSCA-3) scores were normally distributed. All other
variables were found to be not normally distributed. Table 3 gives p values of
Kolmogorov-Smirnov and Shapiro-Wilk tests, and z scores of kurtosis and skewness
for each variable. Inspection of histograms (Appendix K) revealed that indices of
mental contamination mostly demonstrated little change after the induction
procedure and had rather leptokurtic distributions, as indicated by large positive
kurtosis values. Distribution tests and histograms were taken into account when
considering the extent to which the assumption of normality was breached.
28
Table 3.
Tests of normality (N = 131).
Kolmogorov-Smirnov p-value
Shapiro-Wilk
p-value
z-kurtosis z-skewness
APS-R - High standards .00 .00 .36 -3.24
APS-R - Order .00 .00 -1.16 -2.53
APS-R - Discrepancy .00 .00 -.90 3.22
Moral TAF .20 .03 -1.10 1.32
TOSCA-3 .20 .71 .94 -.21
Vividness .00 .00 1.12 -4.64
Duration .00 .00 -2.57 -1.81
Anxiety .00 .00 9.88 6.52
Urge to wash .00 .00 22.89 -10.94
Dirtiness (internal) .00 .00 30.76 5.61
Dirtiness (external) .00 .00 24.05 7.92
Table 4 presents descriptive information for each of the variables along with
Cronbach’s alpha for the questionnaire measures. Cronbach’s alpha analysis
suggested the APS-R, Moral TAF, and TOSCA-3 had good internal reliability in this
sample. Measures of central tendency on mental contamination indices (anxiety, urge
to wash, internal dirtiness, external dirtiness) indicate the degree of mental
contamination induced in response to the induction procedure. Means suggest that
participants increased somewhat in reported levels of anxiety, external dirtiness and
internal dirtiness, but decreased in urge to wash. The median for each of the indices
suggest little change to no change on average. Further, the sample ranges highlight
considerable variability within the sample; some demonstrating increases in mental
29
contamination indices, some reporting no change, and some decreases. To examine
this further, patterns of reported change across the indices were assessed (Table 5).
Table 4.
Descriptive statistics for study measures (N = 131).
Median Sample Range
M SD Possible Range
α
APS-R - High standards
APS-R - Order
APS-R – Discrepancy
41
21
42
23 – 49
9 – 28
14 – 84
40.15
20.23
45.31
5.68
4.63
16.83
7-49
4-28
12-84
.83
.80
.96
Moral TAF 16 0 – 42 16.50 9.91 0-48 .92
TOSCA-3 53 22 – 78 53.63 9.44 16-80 .83
Memory Vividness 63 4 – 100 75.86 23.91 0-100
Memory Duration 80 0 – 100 63.93 31.08 0-100
Anxiety change 2 -52 – 94 9.01 19.26 -100-100
Urge to wash change 0 -76 – 30 -1.75 13.53 -100-100
Dirtiness (internal) change
0 -91 – 100 6.95 18.77 -100-100
Dirtiness (external) change
0 -47 – 81 3.93 13.17 -100-100
Table 5.
Change on mental contamination indices in response to induction (N = 131).
Reported no change
Reported increase Reported decrease
Anxiety 30 74 27
Urge to wash 65 34 32
Internal dirtiness 54 59 18
External dirtiness 60 46 25
30
On closer inspection of the data, participants were mostly inconsistent in their
pattern of reported changes across mental contamination indices. Only 33
participants demonstrated a consistent pattern of responses (i.e.
increased/decreased/did not change across all four indices), with 16 reporting
increases, 16 reporting no changes, and one reporting decreases across all domains.
A similar pattern of results has been observed in another online study of mental
contamination (Piper, 2013). This data further supported the decision to assess
mental contamination indices separately.
Hypothesis testing
Bivariate correlation analysis. Since most variables were found to be non-
normal in their distribution, Spearman’s correlation coefficient was used to test
Hypothesis One (that perfectionism, moral TAF and shame-proneness would be
positively correlated with indices of mental contamination sensitivity). Results were
partially supportive. Sample correlation coefficients are presented in Table 6 and the
95% confidence intervals for the correlations are reported below.
With respect to perfectionism, subscales of the APS-R correlated to mental
contamination indices differently. The discrepancy subscale (maladaptive
perfectionism) was significantly positively correlated with anxiety (95% CI
[-.015, .370]) although it is important to note that the effect was small and the
confidence interval contains 0 which may suggest no correlation in the general
population. Additionally, discrepancy was positively correlated with sense of internal
dirtiness (95% CI [.127, .428]) with a small to moderate effect size. Regarding
adaptive perfectionism, high standards was significantly positively correlated with
feelings of internal dirtiness only (95% CI [.018, .357]), with a moderate effect size.
31
The order subscale did not correlate with any indices of mental contamination.
Shame-proneness was found to be significantly positively correlated with anxiety
(95% CI [.023, .357]), sense of internal dirtiness (95% CI [.145, .466]) and sense of
external dirtiness (95% CI [.040, .386) with small to moderate effect sizes.
Regarding moral TAF, scores on this measure did not correlate with any indices of
mental contamination. None of the variables correlated with urge to wash.
There were significant positive inter-correlations between mental
contamination indices. Anxiety was positively correlated with internal dirtiness (95%
CI [.112, .478]) and external dirtiness (95% CI [.077, .418]). Internal dirtiness was
also significantly and positively correlated with external dirtiness (95% CI
[.424, .740]) with a large effect size, and urge to wash (95% CI [.035, .406]).
External dirtiness was significantly positively correlated with urge to wash (95% CI
[.069, .449]). There was little evidence that anxiety and urge to wash were correlated.
The predictors demonstrated some significant positive inter-correlations.
Shame-proneness was positively correlated to the high standards (95% CI
[.058, .385]), discrepancy (95% CI [.264, .563]) and order subscales (95% CI
[.049, .386]) of perfectionism with moderate effect sizes. Shame-proneness and
moral TAF were also positively correlated (95% CI [.195, .499]) with a moderate
effect size. Further, moral TAF was positively correlated with high standards (95%
CI [.016, .352]) and order (95% CI [.041, .355]) with small effect sizes, but not
related to the discrepancy subscale of perfectionism. Finally, regarding the subscales
of perfectionism, high standards was significantly related to order (95% CI
[.223, .524]) and discrepancy (95% CI [.137, .495]); however, discrepancy and order
were unrelated.
32
Table 6.
Correlations between perfectionism subscales, moral TAF, shame-proneness and indices of mental contamination sensitivity.
N = 131 APS-R (Standards)
APS-R(Order)
APS-R(Discrep)
Moral TAF
TOSCA-3 Anxiety Urge to wash
Dirtiness (internal)
Dirtiness (external)
APS-R(Standards) -
APS-R(Order) .379** -
APS-R(Discrep) .320** .127 -
Moral TAF .182* .200* .144 -
TOSCA-3 .220* .225** .421** .349** -
Anxiety .105 .021 .175* .020 .202* -
Urge to wash -.012 -.027 .005 .011 .062 .090 -
Dirtiness (internal) .197* .139 .283** .027 .310** .296** .231** -
Dirtiness (external) .122 .068 .073 .068 .215* .252** .276** .547** -
* p < 0.05 ** p < 0.01
33
Regression analysis. To examine whether measures of adaptive and
maladaptive perfectionism, moral thought-action fusion and shame predicted change
in mental contamination indices (Hypothesis Two), an initial model with all five
predictors was fitted for each mental contamination index separately, except urge to
wash. The bivariate correlation analysis indicated that there was no evidence that
change in urge to wash was related to any of the predictors. Measures of the extent to
which participants engaged in the induction procedure (i.e. measures of reported time
spent thinking about the memory and the reported vividness of the memory) were not
used in the initial regression models because they were considered to be potentially
on the causal pathway. Given that shame-proneness, moral TAF and perfectionism
are all concerned with sensitivity to non-ideal aspects of self, people high in these
characteristics might spend longer thinking about memories in which they have
behaved immorally and might have more vivid memories of such experiences. In
turn, duration and vividness of memory might result in stronger feelings of mental
contamination. Therefore, simultaneous entry regression models were first fitted and
are reported below. After this, post hoc mediation models were fitted to assess
whether vividness and duration could be conceptualised as being on a putative
‘causal’ pathway.
Once the simultaneous entry regression model was fitted with all five
predictors, the next stage was to remove from the model those predictors whose
regression coefficient had p>.2. The value of .2 ensures that important variables
which might need to be controlled for are included in the model, which might be
otherwise missed if the p-value was set at a lower level (Kirkwood & Sterne, 2003).
This process was continued until the model contained only those predictors where
34
p<.2. In the tables below, all summary regression models are shown for each mental
contamination index so that the presence of confounder effects could be assessed
(indicated by a considerable change in the beta coefficient of predictors remaining in
the model once other variables were progressively eliminated). Presenting tables in
this way meant researchers were able to visually assess changes in the coefficients
with each step of progressive removal.
35
Table 7.
Regression models predicting mental contamination sensitivity index anxiety.
Predictor Initial model Model 2 (4 predictors) Model 3 (3 predictors) Final model (2 predictors) ✝
B 95% CI β (p) B 95% CI β (p) B 95% CI β (p) B 95% CI β (p)
Shame .395 [.064, .707] .194 (0.67)
.397 [.096, .686] .195 (.045)
.407 [.117, .714] .200 (.037)
.381 [.092, .681] .187 (.039)
Order -.617 [-1.837, .481] -.148 (.131)
-.618 [-1.73, .443] -.148 (.128)
-.572 [-1.624, .442] -.137 (.132)
-.592 [-.1648, .441] -.142 (.114)
Moral TAF -.077 [-.368, .219] -.040 (.676)
-.077 [-.373, .218] -0.40 (.675)
-.076 [-.366, .2] -0.39 (.679)
Standards .105 [-.513, .625] .031 (.758)
.107 [-.466, .662] .031 (.744)
Discrepancy .003 [-.250, .246] .002 (.981)
Model statistics
F(5,125) = 1.14, p=.341 Adj R Squared = .006
F(4,126) = 1.44, p=.224 Adj R Squared = .013
F(3,127) = 1.90, p=.133 Adj R Squared = .020
F(2,128) = 2.78, p=.066 Adj R Squared = .027
✝ Note: removal of Order from the final model resulted in Shame β = .151 (p=.086), 95% CI [.015, .616] Adj R Squared = .015.
36
Anxiety
In the final model, the combination of shame and the order component of
adaptive perfectionism predicted anxiety change score, F(2,128) = 2.78, p=.066 with
shame significantly contributing to the prediction. The adjusted R squared value
was .027 indicating that 2.7% of the variance in anxiety change score was explained
by the model. According to Cohen’s (1988) conventions, this represents a small
effect. The beta weight for shame in the final model suggests that being high in
shame-proneness predicts an increase in anxiety following recall of an immoral act.
Table 7 shows the beta coefficients for successive models. Additional removal of
order from the final two predictor model indicated that the standardised beta for
shame reduced and the model explained 1.2% less variability.
Internal Dirtiness
In the final model, the combination of shame, order and standards
components of adaptive perfectionism predicted internal dirtiness change score,
F(3,127) = 6.61, p<0.01 with shame significantly contributing to the prediction. The
adjusted R squared value was .115 indicating that 11.5% of the variance in internal
dirtiness change score was explained by the model. According to Cohen’s (1988)
conventions, this represents a small to medium effect. The beta weights for shame
and standards in the final model suggest that being high in shame-proneness and
having high standards in terms of perfectionistic traits predicts an increase in internal
dirtiness feelings following recall of an immoral act. Table 8 shows the beta
coefficients for successive models. Additional removal of order from the final three
predictor model indicated that the standardised beta for shame increased, and for
order decreased, but the model explained 1% less variability.
37
Table 8.
Regression models predicting mental contamination sensitivity index internal dirtiness.
Predictor Initial model Model 2 (4 predictors) Final Model (3 predictors) ✝
B 95% CI β (p) B 95% CI β (p) B 95% CI β (p)
Shame .663 [.311, 1.038] .334 (.001)
.669 [.354, 1.014] .336 (<.001)
.66 [.373, .975] .332 (<.001)
Order -.692 [-1.929, .365] -.171 (.068)
-.694 [-1.818, .291] -.171 (.065)
-.701 [1.771, .266] -.173 (.06)
Standards .462 [-.187, 1.162] .140 (.144)
.468 [-.033, 1.01] .141 (.125)
.466 [-.046, 1.051] .141 (.124)
Moral TAF -.027 [-.323, .236] -.014 (.874)
-.027 [-.3, .244] -.014 (.875)
Discrepancy .008 [-.314, .355] .007 (.943)
Model statistics
F(5,125) = 3.91, p=.003 Adj R Squared = .135
F(4,126) = 4.92, p=.001 Adj R Squared = .108
F(3,127) = 6.61, p<0.001 Adj R Squared = .115
✝ Note: removal of Standards from the final model resulted in Shame β = .355 (p<.001), 95% CI [.362, 1.146] and Order β = -.123 (p=.153), 95% CI [-1.661, .433], Adj R Squared = .105. Further removal of Order resulted in Shame β = .323 (p<.001), 95% CI [.314, 1.01] Adj R Squared = .098.
38
Table 9.
Regression models predicting mental contamination sensitivity index external dirtiness.
Predictor Initial model Model 2 (4 predictors) Model 3 (3 predictors) Final Model (2 predictors)✝
B 95% CI β (p) B 95% CI β (p) B 95% CI β (p) B 95% CI β (p)
Shame .352 [.130, .595] .252 (.017)
.339 [.109, .609] .243 (.016)
.307 [.089, .556] .220 (.016)
.318 [.139, .518] .228 (0.11)
Order -.459 [1.463, .375] -.161 (.098)
-.469 [-1.466, .455] -.165 (.088)
-.456 [-1.448, .398] -.160 (.095)
-.409 [-1.283, .310] -.144 (.108)
Standards .143 [-.219, .520] .061 (.536)
.142 [-.239, .505] .061 (.538)
.109 [-.241, .480] .047 (.623)
Discrepancy -.043 [-.201, .101] -.055 (.588)
-.043 [-.207, .1] -.055 (.581)
Moral TAF -.039 [-.324, .194] .029 (.756)
Model statistics
F(5,125) = 1.617, p=.16 Adj R Squared = .023
F(4,126) = 2.011, p=.097 Adj R Squared = .03
F(3,127) = 2.594, p=.055 Adj R Squared = .035
F(2,128) = 3.97, p=.025 Adj R Squared = .041
✝ Note: removal of Order from the final model resulted in Shame β = .191 (p=.029), 95% CI [.091, .456], Adj R Squared = .029.
39
External Dirtiness
In the final model, the combination of shame and the order component of
adaptive perfectionism predicted external dirtiness change score, F(2,128) = 3.97,
p=.025. The adjusted R squared value was .041 indicating that 4.1% of the variance
in external dirtiness change score was explained by the model, which represents a
small effect (Cohen, 1988). The beta weight for shame in the final model suggests
that being high in shame proneness predicts an increase in sense of external dirtiness
following recall of an immoral act. Table 9 shows the beta coefficients for successive
models. Additional removal of order from the final two predictor model indicated
that the standardised beta for shame reduced and the model explained 1.2% less
variability.
Validity of regression analysis. When checking whether the assumptions for
the above regression models had been met, the residuals appeared somewhat skewed.
Hence, the analysis was re-run using bootstrapping to assess whether the
unstandardized betas were similar to the non-bootstrapped model. For all regression
analyses, bootstrapped betas were identical, thus demonstrating that the slightly
skewed residuals did not impact the validity of results. Tables 7 - 9 (above)
demonstrate the beta 95% confidence intervals as determined by the bootstrapping
method. Regarding the possibility of collinearity, both correlations between measures
and collinearity analysis did not indicate this was a problem.
Vividness and duration. Final regression models for anxiety, internal
dirtiness and external dirtiness suggest that shame-proneness is the important factor
in predicting change in these indices. As outlined earlier, the length of time that
individuals focused on the mental contamination inducing memory, as well as the
40
clarity or vividness of this memory could play a mediating role in predicting feelings
of mental contamination. Table 10 demonstrates the extent to which self-reported
vividness of and duration spent thinking about the memory correlated with shame-
proneness and mental contamination indices.
Table 10.
Correlations between shame-proneness and indices of mental contamination, with
vividness and duration.
Vividness Duration
Vividness -
Duration .264** -
Shame .076 .239**
Anxiety .181* .180**
Internal dirtiness .018 .178*
External dirtiness .095 .153
*p<0.05; ** p<0.01
As can be seen, duration was significantly and positively related to shame-
proneness (95% CI [.073, .408]), anxiety change scores (95% CI [.005, .332]) and
internal dirtiness change scores (95% CI [-.003, .341]). The correlation co-efficient
between duration and external dirtiness approached significance (p = .081, 95% CI
[-.019, .330]). Vividness was only significantly positively related to anxiety change
scores (95% CI [.029, .326]).
Since vividness was not found to be related to shame-proneness, it is unlikely
to emerge as a mediator between shame-proneness and indices of mental
41
contamination. Hence, two mediation models were run. In both models, shame-
proneness was the predictor (or IV) and self-reported duration was the mediator. In
one model, anxiety was the outcome (or DV) and in the other the outcome was
internal dirtiness.
Duration as a mediator. Mediation analysis was conducted using Hayes’
Process macro (www.processmacro.org) within SPSS Version 22.
Figure 1.
The mediation model.
Figure 1 shows a diagrammatic representation of the mediation model. The
conditions that need to be met to demonstrate mediation are:
1. Shame-proneness significantly predicts duration (path a)
2. Duration significantly predicts change in anxiety/internal dirtiness (path b)
3. Shame significantly predicts change in anxiety/internal dirtiness before
duration is entered (path c)
42
c’
ba Duration
Change in anxiety/internal
dirtinessShame-proneness
Shame-proneness
Change in anxiety/internal
dirtinessc
4. The indirect effect of duration must be significantly different from zero. This
is assessed by examining whether the 95% CI encompasses zero.
Table 11 below shows the results of the two mediation analyses.
43
Table 11.
Results of mediation analysis.
Predictor (IV) Mediator (M) Outcome (DV) IV on M
(a path)
M on DV
(b path)
Direct Effect
(c’ path)
Indirect Effect Total Effect
(c path)
(a x b) 95% CI
Shame-proneness
Duration thinking of memory
Change in anxiety
.77 (p=.007) .11 (p=.04) .22(p=.22)
.09 (.008,.236)
.31 (p=.08)
Change in internal dirtiness
.77 (p=.007) .09 (p=.09) .57 (p=.0009) .07 (.004,.196)
.64 (p=.0002)
44
Regarding the analysis for change in anxiety, the confidence interval for the
indirect effect of duration suggests evidence of mediation. However, there is only
weak evidence that condition 3 (c path) is met (p=.08). For change in internal
dirtiness, again the confidence interval for the indirect effect of duration suggests
evidence of mediation. However, there is only weak evidence that condition 2 (b
path) is met (p=.09). Comparison of c and c’ in both models indicate the mediation
effect is partial.
Discussion
Research has begun to identify factors that explain variability in sensitivity to
mental contamination, and use these to explain the apparent individual differences
found in the extent to which people experience this mental phenomenon (Herba &
Rachman, 2007; Elliott & Radomsky, 2013). This study aimed to add to the current
research base; specifically by exploring perfectionism, shame-proneness and
propensity to moral thought-action fusion as possible correlates and/or predictors of
individual sensitivity to mental contamination in the general population. In the
Introduction, a theoretical case was made that these factors might predict variability
in propensity to experience mental contamination. The Introduction also indicated
that these factors are interrelated. The current study therefore set out to understand
whether these factors predict unique variance in mental contamination and, as a
result, through regression analysis, to assess the most parsimonious account of
variability in mental contamination proneness in the current sample.
Findings
As expected, significant positive correlations were found between scores on
measures of shame-proneness, and self-reported changes in anxiety and sense of
45
external and internal dirtiness, in response to a task designed to induce feelings of
mental contamination. Further, maladaptive components of perfectionism were found
to be positively correlated with self-reported change in anxiety and sense of internal
dirtiness on the same task. Relationships between adaptive components of
perfectionism and reported change in indices of mental contamination were mostly
statistically non-significant, however the high standards subscale was significantly
and positively correlated with reported change in internal dirtiness. Although both
types of perfectionism have been linked to negative psychological experiences,
maladaptive perfectionism has been most associated with psychological concerns or
difficulties and results from this study appear to echo this.
Regression analyses revealed that shame-proneness offered the most
parsimonious explanation of sensitivity to mental contamination in relation to levels
of anxiety, sense of internal dirtiness and sense of external dirtiness. Importantly
though, these indices of mental contamination were best predicted when the order
subscale of perfectionism was also included in the models. More variance in mental
contamination was explained in the model predicting internal dirtiness with the
inclusion of a third variable, the standards subscale of perfectionism. In fact, the
model predicting the internal dirtiness component of mental contamination showed
the largest effect size, with 11.5% of the variance accounted for. The predictive
power of this model may be explained by the similar psychological nature of internal
dirtiness and feelings of shame. Shame is considered to be a powerful emotion
related to the core sense of self, where a person regularly makes deeply personal
evaluations about their adherence to moral standards and their acceptability as an
individual (Tangey et al., 2007). If this core self is judged as bad or immoral and a
46
feeling of shame ensues, it stands that this sense of ‘badness’ may be qualitatively
described as a feeling of core, or internal, dirtiness.
Mediation analysis revealed that the predictive power of shame-proneness on
mental contamination indices (anxiety and internal dirtiness) is likely partly via the
relationship between shame-proneness and duration of time spent thinking about (or
ruminating on) a moral transgression. This suggests that an individual more shame-
prone is likely to spend longer dwelling on an act where they were have deemed to
commit a wrong-doing, and as such more likely to experience anxiety and a sense of
internal dirtiness. Conceptually this may be understood by the connection between
shame and rumination. Orth, Berking & Burkhardt (2006), who found that links
between shame and depression can be explained by the mediating role of rumination,
theoretically explain shame as related to one of the fundamental human need
systems; the need for ‘belongingness’. They explain that shame, which involves an
evaluation of the core self from the perspective of others, provides something of a
cue to likely social rejection which if activated, causes a sense of threat which
becomes the focus of attention and intrusive rumination (Orth et al., 2006). With
regard to findings from the current study, it is probable that this increased focus on
negative parts of the self amplifies feelings of shame, increases anxiety (about being
socially rejected) and sense of the core self as ‘bad’ or internally dirty.
It is important to note though, that the mediation effect found in this study
was partial and there was still a direct effect of shame on feelings of internal
dirtiness. This suggests that for some, the relationship between shame-proneness and
mental contamination is not accounted for by duration (or increased rumination).
This points to two possible ‘routes’ to feelings of mental contamination both
47
triggered by feelings of shame; for some this shame response being enough to evoke
feelings of contamination, for others the rumination that follows leading to feelings
of contamination. It is important to note though that the cross-sectional design used
in the current study cannot confirm causal relationships. Instead, the findings
presented here support the potential validity of a model in which rumination/dwelling
might partly explain a link between shame-proneness and feelings of mental
contamination. Longitudinal designs are required to further test this proposed model.
Unexpected findings, limitations and strengths
The findings partially supported the two hypotheses made, however there
were some unanticipated findings. Firstly, results of this study did not find evidence
that moral thought-action fusion was related to mental contamination. It was thought
that arousing thoughts of a previous moral transgression in those high in moral
thought-action fusion (who tend to ‘fuse’ the morality of thoughts with reality such
that they believe thought and action are morally equivalent), would experience
increased feelings of mental contamination. However, the induction task in this study
involved a memory of an actual event, rather than generating unacceptable thoughts
in participants related to an imagined event. This meant that any moral judgements or
appraisals were related to an actual event, or reality, rather than an unacceptable
thought. Hence, the paradigm for inducing mental contamination in this study did not
provide an opportunity for participants to ‘fuse’ unacceptable or immoral thoughts
with their reality. However, whilst the current findings suggest that moral thought-
action fusion may not explain variability in mental contamination arising from recall
of actual immorality, it could still be argued that moral thought-action fusion could
be conceptually related to sensitivity to mental contamination. This is such that moral
48
thought-action fusion might predict mental contamination in paradigms that ask
people to imagine behaving immorally, such as in the dirty kiss experiment, where
participants are asked to imagine forcing a non-consensual kiss on another individual
(Fairbrother et al., 2005). Future research exploring the role of moral thought-action
fusion in mental contamination should consider utilising a task involving imagined
immorality for these reasons. This could contribute to understandings of conditions
such as OCD, where imagined immorality leads to distress and problematic
behaviour.
A further finding that did not support hypotheses pertains to the index of
mental contamination, urge to wash. Analysis revealed that urge to wash was not
related to any predictor variables. In fact, urge to wash demonstrated very little
variability (i.e. there was no change in this measure for most participants) and thus
there was limited extent to which it could correlate with other factors. This may be
related to a wider issue, which pertained to varied patterns of response to the
induction procedure, with some participants demonstrating evidence of increased
feelings of mental contamination across all indices, some demonstrating no change,
and for some a reduction across indices was evident. Participants were also generally
inconsistent in their increases/decreases across indices such that they increased in
some, but decreased in others. There are a number of possible explanations for this.
Initially it is important to consider the induction procedure used, and whether this
was sufficient to induce feelings of mental contamination in all participants,
particularly urge to wash. The paradigm aimed to increase ecological validity by
allowing participants to use personally relevant material. It is possible that
participants ‘played it safe’ to some degree, utilising memories that were less
emotionally salient than perhaps necessary to induce considerable feelings of mental
49
contamination. Given this was an online study, it was deemed important to advise
participants to use memories that were not too upsetting. Whilst this advice was
important ethically, it may have interfered somewhat with studying ‘clinically-
relevant’ effects. When browsing the catalogue of memories elicited (Appendix J), it
is apparent that some events and situations are more emotionally charged than others,
and this may explain the variability in participants’ reported changes across mental
contamination indices.
Another possible explanation for this variability pertains to the vantage
perspective taken by participants when recalling memories; namely whether
participants took a first or third person perspective (i.e. from the original ‘field’
perspective of the individual, or from the view point of an outside observer; Williams
& Moulds, 2007). Research suggests that recall from the third person perspective
involves more descriptive and less affect-laden information and thus may serve as an
avoidance or detachment strategy against uncomfortable emotions associated with
the memory (McIsaac & Eich, 2004). Regarding the current study, participants
reporting little change on mental contamination indices may have taken this observer
perspective when recalling their memory. The role played by vantage point was not
assessed here, but may be important to explore further in future studies.
Equally, inconsistencies in response to the task may support the notion that
the experience of mental contamination in the general public is highly variable. This
is with regard to both events that trigger a mental contamination based response and
the nature of this response once triggered. Past research has pointed to the
idiosyncratic nature of mental contamination and induction methods such as ‘the five
tasks method’ have reflected this (Coughtrey at al., 2014a; 2014b). This method has
50
an initial stage to identify the ‘most inducing’ task for each participant, who then
proceeds through the experiment undergoing the task most salient for them. This was
recently echoed in personal communication with Coughtrey (2015) who advised that
utilising personally salient induction methods for participants may have produced
more consistent mental contamination responses. Whilst this was not the case in the
current study, results demonstrate that allowing participants to recall any immoral
situation does not consistently evoke a mental contamination response. These
observations relate to a broader issue of ecological validity and a validity vs.
standardisation dilemma. Whilst some paradigms induce mental contamination
successfully through a standardised task that would be generally perceived as
morally unacceptable (e.g. the dirty kiss experiment), other paradigms increase
ecological validity by pre-testing several standardised tasks to see which one a
participant is more sensitive to. In contrast, the paradigm in the current study tried to
maximise ecological validity but the lack of standardisation meant that participants
were free to focus on situations that might have been more innocuous.
Further, it is important to note that this study approached the concept of
mental contamination as something everyone experiences in varying degrees. As a
result, participants were recruited from the general public. Previous studies have pre-
selected participants for studies based on sensitivity to contamination fears
(Coughtrey et al., 2014a), and found more consistent responses to induction tasks.
This may suggest that mental contamination is not something that can be consistently
emulated in non-clinical samples that are not pre-selected. This speaks to the
differences seen between clinical and non-clinical populations with regard to what
individuals find contaminating. Whilst there are individual differences in distress
arising from intrusive thoughts, clinical populations likely become distressed by
51
cognitive intrusions that are innocuous to non-clinical populations. This relates to
appraisals made of the intrusion, such that non-clinical populations are thought to
make benign interpretations of memories or intrusive thoughts whereas clinical
populations are more likely to attribute significant meaning (which serves to increase
anxiety and thus frequency of the intrusion; Salkovskis, 1999). This study had some
constraints on time and resources, but future studies should consider pre-selecting
participants to investigate the nature and correlates of mental contamination.
Whilst the above issues may explain variability in the extent to which one
experiences emotions and cognitions associated with mental contamination, they do
not explain the pattern of results found in those participants who appeared to reduce
in feelings of mental contamination in response to the task. This is difficult to
interpret, but it could be reasonable for some participants to have begun the online
questionnaire in an existing negative state (causing them to rate the pre-VAS above
0) as triggered by the participant information sheet and anticipation of a difficult
induction task. For these participants it is understandable that anxiety levels would
decrease following completion of the task, which seemingly may not be as
challenging as anticipated (particularly if those participants selected a ‘less’
emotionally salient event to focus on). Conversely, some individuals could have been
in either an anxious or ‘dirty’ state irrespective of the participant information sheet.
That is, individuals vary in levels of state anxiety and others could have been in a
physically dirty state at the time of completing (for example, just been to the gym, or
about to shower at the end of the day) and hence this would have impacted ratings of
anxiety, sense of external dirtiness and/or urge to wash. In addition, the statistical
phenomenon known as ‘regression to the mean’ (which states that when something is
measured twice the second measurement tends to be lower) may account for those
52
who demonstrated reductions in mental contamination indices. Some implications for
future measurement and induction of mental contamination have already been
highlighted, but this variability in the experience of mental contamination also points
to the importance of measuring indices as distinct constructs, as in the current study,
and would not support merging them into one measure of mental contamination.
This study had some important strengths. It was the first to explore
perfectionism, shame-proneness and moral thought-action fusion as possible
predictors of sensitivity to mental contamination. It is also the first to consider the
role of so called ‘adaptive’ perfectionism and actually found that ‘high standards’
and ‘order’ have significant positive relationships with some indices of mental
contamination. This may call into question previous understandings of high standards
and order being adaptive.
In terms of statistical power and recruitment of participants, the study had
adequate statistical power to detect medium effect sizes for correlation and
regression analysis. Regarding mediation analysis, to detect medium to small effects
Fritz and MacKinnon (2007) suggest N = 164. Hence, power to detect mediation was
likely reduced, although the analysis did detect evidence of mediation.
Theoretical, Research and Clinical implications
From a theoretical perspective, the findings of the current study indicate that
recalling committing a moral violation is more likely to be associated with feelings
of mental contamination in those who have a propensity to feel shame. The findings
further suggest that the relationship between shame-proneness and feelings of mental
contamination might be due, in some cases, to the association between shame-
proneness and rumination. However, self-reported time spent thinking about the
53
violation was an approximation of rumination in this study and future research
should explore this further. Additionally, given the cross-sectional nature of the study
it is possible that feelings of contamination increase feelings of shame. Nevertheless,
the results of this study are potentially important in considering interventions for
those affected by mental contamination based difficulties. It is plausible that shame-
proneness increases vulnerability to feelings of mental contamination, although a
longitudinal design would be needed to establish this. However, given that the
current study shows a relationship between shame-proneness and feelings of mental
contamination, clinicians should consider targeting patients’ experience of shame,
particularly when they present as highly shame-prone or self-critical. This could
perhaps be via compassionate approaches where individuals are helped to generate
self-reassurance, self-soothing abilities and warmth toward the self (Gilbert &
Procter, 2006). In addition, the mediating effect of duration found in this study
suggests that individuals high in shame-proneness likely experience feelings of
mental contamination (anxiety, internal and external dirtiness) due to the increased
amounts of time spent ruminating on particular events or acts, or perhaps ruminating
on any shame-based appraisals. This points to the importance of exploring patients’
cognitive styles or bias toward rumination, and subsequently the treatment and
prevention of this rumination in decreasing an individual’s feelings of mental
contamination. Again, compassion and acceptance-based approaches can be useful in
allowing a person to reduce perseverative thinking on perceived personal failings.
In sum, this study adds to the evidence base suggesting that individuals can
experience feelings of contamination in response to psychological processes or
mental events (although reactions to these clearly vary). This is important for
clinicians working with individuals with mental health difficulties, particularly those
54
with OCD or trauma related presentations, with regard to assessing whether
individuals are experiencing feelings of mental contamination and informing
treatment and interventions. The inconsistent effect seen in the current study may be
due to the induction paradigm, vantage point taken, or it may be that mental
contamination does not occur in a similar manner in clinical and non-clinical
populations. Further work is required looking at response to actual moral violations
in non-clinical samples using a range of induction methods.
55
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Appendices to MRP Empirical Paper
Appendix A. Demographic data collected.
Appendix B. The Revised Almost Perfect Scale (APS-R; Slaney et al., 2001).
Appendix C. The Thought-Action Fusion Moral Subscale (TAF-moral; Shafran,
Thodorsan & Richman, 1996).
Appendix D. Test of Self-Conscious Affect – Third Edition (TOSCA-3; Tangney &
Dearing, 2002) shame subscale.
Appendix E. Visual analogue scales (VAS) on mental contamination.
Appendix F. Information and consent statements provided to participants.
Appendix G. Debrief information provided to participants.
Appendix H. Faculty of Arts and Human Sciences Ethics Committee; Chair’s action
letter.
Appendix I. Flowchart of participant drop-out.
Appendix J. Catalogue of memories recalled during induction procedure.
Appendix K. Normality tests and plots.
Appendix L. Behaviour Research and Therapy Guidelines for Authors.
63
Appendix A. Demographic data collected.
Please complete the following questions about yourself.
Date of birth:
[Drop box with 1-31] [Drop box with Jan-Dec] [Drop box with years 1900-2014]
Gender (please tick):
FemaleMale
Ethnicity (please tick):
A White British B White Irish C White Any other White background D Mixed White and Black Caribbean E Mixed White and Black African F Mixed White and Asian G Mixed Any other mixed background H Asian or Asian British Indian J Asian or Asian British Pakistani K Asian or Asian British Bangladeshi L Asian or Asian British Any other Asian background M Black or Black British Caribbean N Black or Black British African P Black or Black British Any other Black background R Chinese S Any other ethnic group
Highest Education Level (please tick):
No Qualifications 1-4 GCSEs (or equivalent) 5+ GCSEs (or equivalent) 2+ A-Levels (or equivalent) Apprenticeship Degree or above
Country where completing the study (please type) ……………………
64
Appendix B. The Revised Almost Perfect Scale (APS-R; Slaney et al., 2001).
The following items are designed to measure attitudes people have toward themselves, their performance, and toward others. There are no right or wrong answers. Please respond to all of the items. Use your first impression and do not spend too much time on individual items in responding.
Respond to each of the items using the scale below to describe your degree of agreement with each item.
1 2 3 4 5 6 7
Strongly Agree Slightly Disagree Disagree Neutral Slightly Agree Agree Stongly Agree
1 2 3 4 5 6 7
1 I have high standards for my performance at work or at school.
2 I am an orderly person.
3 I often feel frustrated because I can’t meet my goals.
4 Neatness is important to me.
5 If you don’t expect much out of yourself, you will never succeed.
6 My best just never seems to be good enough for me.
7 I think things should be put away in their place
8 I have high expectations for myself.
9 I rarely live up to my high standards.
10 I like to always be organized and disciplined.
11 Doing my best never seems to be enough.
12 I set very high standards for myself.
13 I am never satisfied with my accomplishments.
14 I expect the best from myself.
15 I often worry about not measuring up to my own expectations.
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16 My performance rarely measures up to my standards.
17 I am not satisfied even when I know I have done my best.
18 I try to do my best at everything I do.
19 I am seldom able to meet my own high standards of performance.
20 I am hardly ever satisfied with my performance.
21 I hardly ever feel that what I’ve done is good enough.
22 I have a strong need to strive for excellence.
23 I often feel disappointment after completing a task because I know I could have done better.
66
Appendix C. The Thought-Action Fusion Moral Subscale (TAF-moral; Shafran, Thodorson & Richman, 1996).
Do you agree or disagree with the following statements? Respond to each of the items using the scale below to describe your degree of agreement with each item. There are no right or wrong answers. Please respond to all of the items. Use your first impression and do not spend too much time on individual items in responding.
0 1 2 3 4
Strongly Disagree Disagree Neutral Agree Strongly Agree
0 1 2 3 4
1 Thinking of making an extremely critical remark to a friend is almost as unacceptable to me as actually saying it.
2 Having a blasphemous thought is almost as sinful to me as a blasphemous action.
3 Thinking about swearing at someone else is almost as unacceptable to me as actually swearing.
4 When I have a nasty thought about someone else, it is almost as bad as carrying out a nasty action.
5 Having violent thoughts is almost as unacceptable to me as violent acts.
6 When I think about making an obscene remark or gesture in church, it is almost as sinful as actually doing it.
7 If I wish harm on someone, it is almost as bad as doing harm.
8 If I think about making an obscene gesture to someone else, it is almost as bad as doing it.
9 When I think unkindly about a friend, it is almost as disloyal as doing an unkind act.
10 If I have a jealous thought, it is almost the same as making a jealous remark.
11 Thinking of cheating in a personal relationship is almost as immoral to me as actually cheating.
12 Having obscene thoughts in a church is unacceptable to me.
67
Appendix D. Test of Self-Conscious Affect – Third Edition (TOSCA-3; Tangney & Dearing, 2002) shame subscale
Below are situations that people are likely to encounter in day-to-day life, followed by a common reaction to those situations. As you read each scenario, try to imagine yourself in that situation. Then indicate how likely you would be to react in the way described.
Please do not skip any items – rate all items.
1 2 3 4 5
Not likely Very Likely
1 2 3 4 5
1 You make plans to meet a friend for lunch. At 5 o’clock, you realise you stood your friend up. What is the likelihood you would think, “I am inconsiderate”?
2 You break something at work and then hide it. What is the likelihood you would think about quitting?
3 You are out with your friends one evening, and you’re feeling especially witty and attractive. Your best friend’s spouse seems to particularly enjoy your company. What is the likelihood you would probably avoid eye contact for a long time?
4 At work, you wait until the last minute to plan a project, and it turns out badly. What is the likelihood you would feel incompetent?
5 You made a mistake at work and find out a co-worker is blamed for the error. What is the likelihood you would keep quiet and avoid the co-worker?
6 For several days you put off making a difficult phone call. At the last minute you make the call and manipulate the conversation so that all goes well. What is the likelihood you would feel like a coward?
7 While playing around you throw a ball and it hits your friend in the face. What is the likelihood you would feel inadequate because you can’t even throw a ball?
8 You have recently moved away from your family and everyone has been very helpful. A few times you needed to borrow money
68
but you paid it back as soon as you could. What is the likelihood you would feel immature?
9 You are driving down the road and you hit a small animal. What is the likelihood that you would think, “I’m terrible”?
10 You walk out of an exam thinking you did extremely well. Then you find out you did poorly. What is the likelihood you would feel stupid?
11 You and a group of co-workers worked very hard on a project. Your boss singles you out for a bonus because the project was such a success. What is the likelihood you would feel alone and apart from your colleagues?
12 While out with a group of friends, you make fun of a friend who is not there. What is the likelihood you would feel small, like a rat?
13 You make a big mistake on an important project at work. People were depending on you, and your boss criticises you. What is the likelihood you would feel like you wanted to hide?
14 You volunteer to help with the local Special Olympics for handicapped children. It turns out to be frustrating and time consuming work. You think seriously about quitting, but then you see how happy the kids are. What is the likelihood you would feel selfish and you’d think you are basically lazy?
15 You are taking care of your friend’s dog whilst your friend is on vacation, and the dog runs away. What is the likelihood you would think, “I am irresponsible and incompetent”?
16 You attend your coworker’s housewarming party and you spill red wine on a new cream-coloured carpet, but you think no one notices. What is the likelihood that you would wish you were anywhere but the party?
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Appendix E. Visual analogue scales (VAS) on mental contamination.
Mark your responses to the following question on the line (where 0 = not at all and 100 = extremely) by clicking.
Please indicate how you feel right now.
1. How dirty do you feel inside your body?
0 100
2. How dirty do you feel in general?
0 100
3. How anxious do you feel?
0 100
4. How strong is your urge to wash?
0 100
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Appendix F. Information and consent statements provided to participants.
Participant Information Sheet
Personality traits, thinking styles and the experience of doing wrong or hurting someone else
Researcher: Daniella Hallsworth, Trainee Clinical Psychologist, University of Surrey
IntroductionI would like to invite you to complete an online survey about your personality and experience of doing something that upset or hurt someone else. This study is part of a doctorate in Clinical Psychology. Before you decide whether or not to take part it is important for you to understand what the research and survey involves. Please read the following information and discuss it with others if you wish before deciding whether or not to take part. What is the project about? The project aims to explore how people feel after thinking about a memory of hurting or upsetting someone else. The survey also asks about different personality traits and thinking styles. I aim to explore whether there is a link between personality traits, thinking styles and the experience of doing something immoral or wrong to another person. It is hoped the results of this study will enhance current understandings of what makes people vulnerable to certain emotional reactions to events and situations. What is involved if I decide to take part? If you decide to take part in the study, please click ‘next' which will take you to the consent form. When you have read the consent form, click ‘next' again which will take you to the survey. Once you have started the survey it is important to complete it in one sitting as it cannot be saved and returned to at a later date. Therefore, please ensure you have sufficient time available to complete the survey when you start it. It should take approximately 30 minutes to complete although some people may take longer than this and others may complete it more quickly. To take part in the study you must: Be at least 18 years of age. Be able to think of a time or event whereby you did something that hurt or upset another person. If you are likely to become very upset or distressed when thinking about this time, you are advised NOT to take part. If you have any questions and would like more information before taking part, please email me: [email protected] Do I have to take part? No, it is completely up to you to decide whether or not to take part. If you choose to take part in the research, and wish to withdraw during the survey, please do so by selecting 'no' to the final question on each screen asking if you would like to proceed. It is important to note that once you have completed the survey, you cannot withdraw
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data unless you have supplied contact details to receive a summary of the results (on the final screen). If you would like to withdraw your data from the study following completion of the survey, provided you have supplied an email address, you can do so up to one week after completion by emailing me: [email protected] Will my information be kept confidential? Yes, unless you choose to tell anyone you are taking part in this research, which is fine. At no point will the survey ask for your name or any identifiable information, unless you would like to provide an email address to receive a summary of the results and have the option to withdraw your data. The survey will ask for some demographic information such as your age and ethnicity. Are there any risks involved in taking part? I do not anticipate any significant risks to you in taking part in this study. However, you will be asked to think about a time you did something that hurt or upset someone else which may involve some uncomfortable thoughts and emotions. If you are likely to become significantly distressed doing this, then please DO NOT take part. If you would like to talk to somebody after you have taken part in the survey, contact details for support organisations are provided. Are there any benefits involved in taking part? There are no direct benefits involved in taking part. What will happen to the results of the study? The results will form part of my Doctorate in Clinical Psychology and may be published in scientific journals. The results may also be presented at conferences or in poster presentations. Your anonymity in such instances remains guaranteed. If you would like me to provide you with a summary of findings when they become available, please let me know by providing an email address at the end of the survey. This project is organised and supported by University of Surrey as part of my Clinical Psychology Training, and has received a favourable ethical opinion from the Faculty of Arts and Human Sciences Ethics Committee, University of Surrey. All data will be collected and stored in accordance with the Data Protection Act 1998. Daniella HallsworthTrainee Clinical PsychologistDepartment of Psychology, University of Surrey. Email: [email protected] Supervised by Dr. Laura SimondsLecturerDepartment of Psychology, University of Surrey. Email: [email protected] If you would like to take part in this project please click ‘next' to continue to the consent form and survey. By clicking on the ‘next' button you confirm you have read and understood the above information and wish to proceed to the consent form and survey.
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Consent Form
Personality traits, thinking styles and the experience of doing wrong or hurting someone else
Researcher: Daniella Hallsworth, Trainee Clinical Psychologist, University of Surrey Please read the following statements carefully and click 'yes' below if you agree with them: I voluntarily agree to take part in this study. I have read and understood the Participant Information Sheet provided in the previous window. I have read this explanation by the investigators of the nature, purpose, location and likely duration of the study, and of what I will be expected to do. I have been advised about any discomfort and possible ill-effects on my health and well-being. I agree to comply with any instruction given to me during the study and to co-operate fully with the survey. I understand that I am free to withdraw at any point during the survey by closing the web browser and that I am advised to do this if I feel very upset or distressed. I understand that all data is held and processed in the strictest confidence, and in accordance with the Data Protection Act (1998). I agree that I will not seek to restrict the use of the results of the study on the understanding that my anonymity is preserved. I understand that I am free to withdraw from the study, and exit the survey at any time without needing to justify my decision and without prejudice. You are free to withdraw from participation in the survey by selecting 'no' to the final question on each screen regarding whether you would like to proceed. By selecting 'no' the survey will be exited and you will be re-directed to a webpage detailing where you can get help and support if distressed.
I understand that I cannot withdraw my data once I have submitted it unless I have provided my email address to receive a summary of the findings. I understand that if I would like to withdraw my data, and have provided an email address, I must do so within one week of completing the survey. I confirm that I have read and understood the above and freely consent to participating in this study. I have been given adequate time to consider my participation and agree to comply with the instructions and restrictions of the study. By selecting 'yes' below you confirm your agreement with the above statements and wish to proceed to the survey. Selecting 'no' will indicate that you do not wish to participate in this research and you will not be taken to the survey.
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Appendix G. Debrief information provided to participants.
For participants declining consent:
Thank you for your interest in this research.
You selected 'no' on the previous page and did not give your consent to participate in the research, and therefore the survey will not be displayed to you.
If you have any specific concerns or queries regarding this study please feel free to contact the researcher, Daniella Hallsworth via email: [email protected]
If you feel very upset by anything raised in the information sheet or consent form, please visit www.mind.org.uk for support. Additionally, if you feel concerned for your wellbeing in any way then please visit your GP.
Thank you for your time.
For participants indicating they are under 18 years old:
Thank you for your interest in this research.
In the previous screen, you identified your age as less than 18 years old. Since participants must be 18 years old or over, the survey will not be displayed to you and you can not take part in this study.
If you have any specific concerns or queries regarding this study please feel free to contact the researcher, Daniella Hallsworth via email: [email protected]
If you feel very upset anything raised in the survey so far please visit www.mind.org.uk for support. Additionally, if you feel concerned for your wellbeing in any way then please visit your GP.
Again, thank you for your interest and time.
For participants who do not wish to proceed with the survey at any point:
Thank you for your interest in this research.
When asked if you would like to proceed on the previous page, you selected 'no' which indicates you do not wish to proceed with the survey. The remaining questions will not be shown to you and you can exit the browser. Thank you for your time in completing the questions thus far.
If you have any specific concerns or queries regarding this study please feel free to contact the researcher, Daniella Hallsworth via email: [email protected]
If you feel very upset by anything raised in the information sheet or consent form, please visit www.mind.org.uk for support. Additionally, if you feel concerned for your wellbeing in any way then please visit your GP.
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Thank you again for your time.
For participants who reach the end of the survey:
You have now reached the end of the survey.
Thank you for your time in answering these questions, and contributing to this research.
This study is exploring the links between personality variables (specifically perfectionism, proneness to shame, and whether we believe having a thought of an immoral act is as bad as doing the immoral act) and our emotional experience following having done something wrong to another person. Everyone has done things they feel guilty about or regret, but equally everyone also has experiences of helping out another person, or doing them a favour and making them feel good in some way. This study is interested in the emotional impact of doing wrong to someone, but we also asked you to think about something positive you had done to reflect the fact that we all do both!
There is something called 'mental contamination' which refers to feeling dirty, anxious and experiencing an urge to wash. Some people experience these feelings when they have done something immoral to another person. It is hypothesised that individuals high in perfectionism, proneness to shame and high in the belief that immoral thoughts are as bad as doing them will be more sensitive to experiencing mental contamination.
If you feel upset about the memory you brought to mind in this study, we would like to reassure you that this is normal. Everyone feels bad about doing things they think are wrong. These feelings though should not last very long. However, if you feel very upset please visit www.mind.org.uk for support. Additionally, if you feel concerned for your wellbeing in any way then please visit your GP.
If you have any specific concerns or queries regarding this study please feel free to contact the researcher, Daniella Hallsworth via email: [email protected]
Thank you.
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Appendix H. Faculty of Arts and Human Sciences Ethics Committee; Chair’s Action Letter.
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Appendix I. Flowchart of participant drop-out.
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Participants exited survey prematurely (N = 54)After consent form N = 9 After demographics N = 17 After APS-R = 9After Moral TAF = 1After pre-VAS = 17After induction procedure = 1
Participants did not consent (N = 1)
Participants exited after reading consent form (N = 16)
Participants consented to survey(N = 195)
Participants opened survey(N = 212)
Participants completed survey(N = 141)
Participants excluded for incorrect induction (N = 10)Denied experience N = 4Described feelings only N = 3Nothing typed N = 2Victim experience described N = 1
Final data set(N = 131)Emotionally hurting others N = 58Betrayal N = 24Physically hurting others N = 13Letting people down N = 13Lying N = 11Stealing N = 6Other N = 5Drug use N = 1
Appendix J. Catalogue of memories recalled during induction procedure.
Note: Shaded rows indicate invalid memory for the purpose of this study. Data from these participants were removed from analysis.
Participant Typed memory Category1. Cheated on a boyfriend Betrayal2. When I was about 10 I stole a pair of my friend's earrings and I
immediately felt terrible and knew it was wrong. I've never forgotten it and it still haunts me to this day. I don't understand why I did it at the time, I didn't even have pierced ears at that age.
Stealing
3. A man I was dating who I was in love with looked through my phone and saw I had been flirting with someone else. I felt betrayed because he had looked through my phone and he felt betrayed because I was flirting with someone else. He walked out and then came back but the rest of the relationship (another 5 months) was painful because he never really forgave me and I lived with the guilt.
Betrayal
4. I made a comment to somebody whig was perhaps not worded as I had intended and the person was offended, and i was embarrassed and felt guilty because that was not my intention.
Emotionally hurting others
5. My best friend was having an affair with my husband. I found out and was very hurt, my marraige ended and to date I feel betrayed and dont trust anyone sadly. I have moved on and realise that it was not my fault as I am not responsible for other adults choices, there is no reason to hurt someone you care about. Its was their choices tgat they made their actions and the resulting behaviour was selfish and hurtful and the consequence at the end of the day i am no longer friends with either of them as they lack integrity.
Victim
6. I cheated on my boyfriend, he found out and I broke his heart. I blamed him for cheating first but nothing made the guilt go away. Nothing made me feel less sick for hurting him so much.
Betrayal
7. On a girls holiday - five of us ganged up and excluded the sixth girl for no real reason. / On return from.the holiday we never invited her out with us etc anymore / For no reason / Just bitchiness
Emotionally hurting others
8. Lied to someone to get what I wanted out of them Lying 9. Upsetting my sister talking about my friendship with her best
friend when I knew it upset her discussing our new friendshipEmotionally hurting others
10. Haven't Denied experience
11. A project at work is becoming very time consuming and it has made me start to dislike the colleague who conceived the idea.
Other
12.Got involved in a fight that wasn't started by me
Physically hurting others
13. Allowed friend to take blame for smoking and lied to her parents by saying I didn't smoke.
Lying
14. Hurt a friend by abusing her trust eventually we made up but I still feel guilty we are no longer friends because she moved away
Betrayal
15. I sent a text about a friend, discussing how rude and selfish they were, to them rather than the intended recipient. It caused a lot of upset and angst and I didn't even really mean it. I was trying to comfort the intended recipient as they were upset by the individuals actions.
Emotionally hurting others
16. Lied to parent about location. They were only concerned for my Lying
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wellbeing. Felt bad. 17. Slept with a married man Betrayal18. Arguing with someone over something silly but saying truly
hurtful things because I was in the heat of the moment.Emotionally hurting others
19. I cheated on my boyfriend with my sisters boyfriend Betrayal20. Did not respond to a request for help in a timely manner from a
family memberLetting people down
21. I had cheated on a boyfriend of 4 years with someone I knew whilst on a night out. I initially tried to keep it from him but after a couple of days I confronted him and ended the relationship.
Betrayal
22. Drank too much and kissed an ex-partner whilst in a relationship Betrayal23. I left my partner for a few days all alone after they were horrible
to me but they were all alone and I had family around me. Emotionally hurting others
24. I banned my husband from the birth of our baby due to him going off with someoe else the week I was induced. I feel sick that I have allowed My personal feelings to affect him seeing our baby born. It was a magical moment & he missed it. I feel I've effected the bond that they could of had. I feel guilty that my 1st baby had her Dad there & my son didn't. I allowed,my personal feelings to stop him seeing our sons first breath / /
Emotionally hurting others
25. I was nasty as a teenager and often made people feel sad By calling them names and generally being very spiteful
Emotionally hurting others
26. I split up with my girl and it was one of the most difficult days of my life. I knew it was going to happen long before, she never saw it coming.
Emotionally hurting others
27. Invited somebody to an event forgetting that another friend felt uncomfortable around them leading to upset
Emotionally hurting others
28. Guilty, upset, ashamed, in the wrong, feel like I've betrayed Emotions described only
29. An argument broke out and tried to break it up by using violence to stop the person beating up another.
Physically hurting others
30. A friend was selfish and irresponsible. Rather than handling the situation calmly I let my anger build up and then lashed out verbally. My friend suffers with mental illness so I should have dealt with her better.
Emotionally hurting others
31. Talked about Co workers behind their backs in an unprofessional manner. Should have focused on working relationship or issues with this. Instead made it personal. Made complaints to a manager (along with others) about their conduct and one of the individuals moved from the department as a result
Emotionally hurting others
32. I felt like an absolute idiot and immature Emotions described only
33. At work a colleague asked me to carry out a task whilst he was away. I forgot and when he returned the deadline was up.
Letting people down
34. when I was very young (teens) I told a short boy that I thought he was 'stunted' I felt very bad after as I knew I hurt his feelings
Emotionally hurting others
35. Kissed friend's boyfriend Betrayal36. I flirted and sent explicit images to a married man, whilst aware
of the fact he was married. Betrayal
37. I was very angry with my boyfriend and I kissed another boy. He discovered it and obviously he felt very upset with me
Betrayal
38. I was at university when a friend celebrated a milestone birthday. I had promised to attend an important appointment and spend the day with them, but completely forgot. they were incredibly hurt and felt let down and as a result we did not speak for some time. I felt awful for not recalling my need to attend and support this person. As a result this has had impacted hugely on how I nopw
Letting people down
79
interact with others, as I would hate for this to occur again, despite it not being a deliberate choice, merely a mistake. Yet a mistake nonetheless which meant this person felt upset and hurt, when it could have easily been avoided.
39. can't think of anyone Denied experience
40. As a young teenager, I once stole something from a shop and felt horrendously guilty for days.
Stealing
41. At my graduation my mum wanted to take loads ofpipictures because my brother never graduated but I took my cap and gown off before she could and refused to put them back on. She was really hurt I could tell but she didn't force me to.
Letting people down
42. As a teenager I asked a girl with sticky out ears when she was having her operation to have them pinned back, even though I knew she had already had it done.
Emotionally hurting others
43. A friend at work is on a course with me and is taking the training very seriously. They have changed their personality/the way they interact with people. I discussed this with another mutual friend who had remarked that they had noticed this too. I made rude remakes about her behaviour, which she would be upset about if she had overheard.
Emotionally hurting others
44. In a car with friends, in the passenger seat, we were driving late in the evening with eggs in the car. I threw an egg into the back of a smartly dressed man who was walking down the road and we continued to drive on.
Physically hurting others
45. I snapped during an argument and hit my boyfriend. I immediately regretted it and hated myself. I don't know what came over me.
Physically hurting others
46. Kissed my best friends ex when she moved away. Betrayal47. n/a Nothing typed48. Upset someone with my intended actions / / Telephone call from
someone in tearsEmotionally hurting others
49. When saying something about a friend to another friend, and they heard what I was saying about them.
Emotionally hurting others
50. Having split parents, that have not comminucated in some time. I often feel I cause upset when choosing one over the other. Particularly when chosing for special occasions such as seeing one on my birthday
Letting people down
51. An animal was almost dead and was in pain so i had to hit it to make sure it was dead and end its misery. Horrid feeling I felt terrible
Other
52. Shouting at someone for something that had done which was not such a big problem over reacted
Emotionally hurting others
53. I cannot think of a situation where i upset someone in this way in my persoanl life as i feel i often go out of my way to avaoid conflict etc.
Denied experience
54. Once we left out one of my friends from a day night out and maybe told a white lie to why she couldnt come, now I know how horrible it can be to not being included it made me feel, sad, anxious and not a very nice person.
Emotionally hurting others
55. I used to feel a bit annoyed when my cousin from New Zealand stayed over with our family when I was younger as she used to follow me around all the time. Now I realise she was only trying to be friendly, but I think I could have made her time with us much more enjoyable if only I had made more of an effort.
Emotionally hurting others
56. I made a joke about a friend who it turned out felt very sensitive about that particular issue. I did not apologise at the time as I felt she was making a mountain out of a molehill. I subsequently
Emotionally hurting others
80
apologised to her but refused to her demands for a particular act of public contrition. She either accepted my apology or not.
57. conducted a sickness review and advised poor attendance which made assistant cry
Emotionally hurting others
58. Cheated on my husband Betrayal59. MAking constant mistakes at a dream job I have. I feel like I have
let myself down and jumping in too deep. I set high expectations of myself and I know I have slacked off my work and thought I could get away with it. / / But it appears and shows when it all comes back. I have no control over my work.
Letting others down
60. leaving a partner, but not telling him in advance. so he was totally upset and surprised.
Emotionally hurting others
61. got into a concert without paying Stealing62. A friend passed away, he was elderley but I did not attend the
funeral due to someone else that was there and not wanting to see them. I still feel bad about not attending due to putting personal feelings ahead of the person who the day was actually for.
Letting people down
63. Lied to someone about a situation. Felt worse about the actual lying, and in the end hurting them when I came clean, than the actual situation. Then felt bad that I didn't feel bad about what I'd done, just about hurting them.
Lying
64. I dyed my hair red and it permanently stained the pillows of the house I was a guest in. I didn't admit to it even though it was very clear that it was me!
Lying
65. Built a relationship with my friends husband and ultimately cheated on my husband. My husband was working a lot and friends husband was helping babysit
Betrayal
66. There was a time when I was upset about something and my sister gave me some advice. After she gave me the advice I dismissed it and told her that it was a rubbish thought/idea. She then became upset and said that it wasn't nice to be horrible to someone when they were just trying to help. She helped me to realise that you really shouldn't dismiss someone's ideas, no matter how you are feeling because it's unkind and ungracious.
Emotionally hurting others
67. Upset a friend due to inconsiderate teasing- despite being friends for 15 years I was insensitive and made someone upset!
Emotionally hurting others
68. ashamed of my self Emotions described only
69. Lied to someone I loved, and never told the truth even though they asked me to them honestly.
Lying
70. Deliberately conspired to exclude someone from an event behind their back even though I knew they would have been interested in it.
Emotionally hurting others
71. i ambushed a respected friend with eggs whilst on holiday, after he had put some nice clothes on to go out. i feel very embarrassed about now and wish i could undo it. i go hot when i think about it and relive it.
Physically hurting others
72. I lied about something I knew I had lost, said it had gone missing, the owners couldn't have it back even though it was on sentimental value, I felt sad for them but still lied about ut
Lying
73. I accidentally made a friend feel uncomfortable whilst out when we came across a girl he used to date.
Emotionally hurting others
74. A friend of mine is extremely difficult at the moment. She blames herself for everything that goes wrong even if its nothing to do with her. I see this trait in myself and it winds me up. One day I decided to call her out on it because its starting to impact our friendship, but I chose the moment and my words badly. I ended up apologising and pretending I'd misunderstood, but I think I
Emotionally hurting others
81
really hurt her.75.
Talking about a friend behind their back. Emotionally hurting others
76.Talked about a friend behind their back
Emotionally hurting others
77. Colleague was upset by something Colleague B had said to her. I felt upset for A and tried to get B to apologise to A. B got angry with A and went and verbally abused her, shouting at her. A ended up in tears and shouted at me. I felt awful too.
Emotionally hurting others
78. I told a group of friends another friends secret behind her back. It was a big secret and it was awful to tell other people about it. This was nearly ten years ago and I still worry she will find out.
Betrayal
79.I upset a friend by saying something unkind.
Emotionally hurting others
80. I got back with an ex-boyfriend causing him to break up with his girlfriend at the time. I then decided he was not right for me and ended it with him. Leaving him extremeley hurt and alone.
Emotionally hurting others
81. I once allowed someone else to be blamed for an incident at work , they were very upset as they thought they were actually to blame, when I was .
Lying
82. A woman who had bullied and humiliated me for years said something rude to me one day at work and I snapped. I told her if she got hit by a bus I would step over her and would not call an ambulance. She cried. I didn't care. Later I felt like a horrible person, especially when others asked why she was crying. This hostility was very uncharacteristic of me.
Emotionally hurting others
83. Grabbing my daughter's wrist hard when she was walking away from me and ignoring my instructions. / I threw away the stick she was holding and she became very upset. I raised my voice and shouted at her for ignoring me.
Physically hurting others
84. I reacted to something that was supposed to be a small practical joke. I felt I needed to react heavily to regain some form of macho-ness. My reactions were over the top and unnecessary and I now wish that I hadn't behaved in such a way as it was actually embarrassing.
Other
85. Cheated on a girlfriend at a party whilst she was not there. Betrayal86. Cheated on partner while travelling and living apart. Betrayal87. A friend and I inadvertently belittled another friends life decisions
by making fun of him. Emotionally hurting others
88. I betrayed someones trust to ensure a project was successful at work. they told me a piece of information in confidence about another colleagues intentions to leave the company and i took this into account when planning the project resource and had to voice my reason for doing so. betraying said persons trust.
Betrayal
89. Got drunk and cheated on my boyfriend, felt very guilty the next day
Betrayal
90. Based on my past experience of two people who's antidepressant drugs made them rather "out of it", I made a remark to someone about always being able to tell when people are on antidepressants. I later realised that in fact the person I was speaking to was also on antidepressants, with no side effects at all. I have ever since regretted this inconsiderate and hurtful remark.
Emotionally hurting others
91. Forgot birthday of mother. / She was very upset and I felt bad and useless for not being able to remember this type of thing. / Tried to explain that I struggle to track time/dates/etc. Only able to keep track of people I see, feel useless that I forget about people who I do not regularly see. Not conscious but unconscious.
Letting people down
82
92. If I did as a Christian I would ask for forgiveness and ask the Lord fo0r His Grace. Life happens and how we deal with it is the reality of life. I would never intentionally hurt anyone.
Denied experience
93. I married without inviting or telling any members of my family. They were told this news afterwards.
Lying
94. In a moment of emotional conflict brought about by a work related matter I unintentionally deeply upset a senior colleague at work. I thought she was fully up to managing the situation but she became very upset and left the room in tears. The experience was one we both worked on and as a result we now work well together.
Emotionally hurting others
95. I was asked to do a big favour for a friend of a friend who was facing a deadline. It would have been a time consuming task (atleast a few hours) requiring a lot of attention and thinking. I didnt know the person and though i wanted to help my friend i couldnt muster the energy or the willingness to help her friend. I gave excuses for not being able to help.
Letting people down
96. Was not honest about my intentions for a relationship, knowing what the other person wanted and what to say to appease them. Then having to break off the relationship.
Lying
97. Guilty for not standing by a friend when they needed me but I did not understand the severity of that need and was too busy to really notice.
Letting people down
98. . Nothing typed99. We were planning a family trip to Cambodia and as I was paying
for my parents' tickets, I didn't really want to share this experience with my sister so I made sure she wouldn't want to go. And she could read in my eyes that I didn't want her to go.
Emotionally hurting others
100. We ganged against someone at school. One of the girl slapped another girl. I have loads of regrets as the girl turned out to be a great friend.
Physically hurting others
101.Sending a text about someone to that person by mistake
Emotionally hurting others
102. Breaking up with a girl and then hearing she was hospitalised as a result of her emotional distress. She had ongoing mental health issues I was not aware of the severity of.
Emotionally hurting others
103.I said an extremely hurtful thing to my partner.
Emotionally hurting others
104. Engaged in a relationship with someone already taken. Their relationship went on too fail. Ours survived.
Betrayal
105. In school i remember teasing someone i vaguely knew over a messenger tool. It was before social media really boomed and for a teenager it was quite easy to make fun of someone online. It was quite easy to do and it was very unsettling for the recipient and it caused her a lot of emotional pain and distress
Emotionally hurting others
106. Stole alcohol from my boss one night whilst I was working behind the bar. Giving away free drinks. Very guity and wanted to hide. Did not get fired but felt as if I didn't deserve to be treated so humanely.
Stealing
107. I stole money as a child from my mother for sweets. I felt too guilty to buy them and was caught putting it back in her purse.
Stealing
108. someone I knew had gone through a particular hard time . we went on a trip together and she was being quite annoying. i was EXTREMEY rude during that trip despite the hard time this person was going throuhg. i've felt guilty ever since.
Emotionally hurting others
109. Stayed up all night drinking with best friends wife while he was sleeping. / Nothing happened but it still felt in heinsight like the wrong thing to do. / I still think whether what I did was wrong or
Betrayal
83
not.110. It's hard to pinpoint something but generally it involves over use
of alcohol and being obnoxious to other people. Also when you wake up after drinking too much and maybe have done something regrettable or been flippant wth some ones affections.
Emotionally hurting others
111. Was unfaithful. Betrayal112. I broke up with an ex boyfriend because I knew I didn't love him,
but I knew that he loved me and he was very upset. Emotionally hurting others
113.Said something nasty to a friend
Emotionally hurting others
114. A male that I was attracted to appeared interested in my friend and kissed her. I engineered the situation so he spent the rest of the night with me and we dated after this event had happened.
Other
115. I was angry with my husband for watching pornography and I blurted this in front of friends, which was humiliating for him. I immediately felt terribly guilty and was accepting of any consequences for myself.
Emotionally hurting others
116.I told a friend that I did not think she was being a good friend.
Emotionally hurting others
117. Me and some colleagues discussing a game we are all involved in. Colleague made a comment about how he had spent £30 of real money on the game. I said "that's because you're stupid" and regretted it instantly because it was not what I meant. He didn't respond, and looked hurt by the comment.
Emotionally hurting others
118. cheating on my fiancée, whilst drunk with a work colleague. Betrayal119. A pub quiz organised by the place I was working. We thought
that every team was cheating, so we cheated a bit (using mobile phones to look some answers up) so as not to finish last - but as it turned out we ended up winning by a lot of points. We got a small trophy for it, but the next day our cheating was revealed to everyone else, and we were stripped of our 'victory'.
Lying
120. I can't remember why, but I was very irritated with my brother and squeezed his arms hard, so that my nails dug into his skin. He didn't retaliate or say anything. I felt awful after it happened and couldn't apologise enough. Later on Mum noticed the marks on my brother's arms and asked what had happened. he said he had fallen into a rose bush. I felt mixed emotions. On one I was relieved that I had got away with it and wouldn't be in trouble (more than I was telling myself off for what I'd done), but I also felt very guilty, knowing that I had done nothing to deserve his kindness and feeling as though I owed him even more now.
Physically hurting others
121. I once got angry and annoyed and stabbed someone in the arm with a pen.
Physically hurting others
122. I broke up with a girlfriend for no reason apart from being bored by them and wanted to move on with my life and do other things despite me being happy at the time and them being completely in love with me
Emotionally hurting others
123. I was arguing with someone and didn't listen to their side of the argument, and just put my own feelings first.
Other
124. I upset a mum at the school because I didn't take my child to her childs birthday party over the bank holiday weekend.
Letting people down
125. I refused an invite to someone's wedding as she had been horrible to me a couple of years previous. I told her in the email that I didn't like her and I didn't think she was a nice person and she'd upset a lot of people and I didn't want to go to her wedding. She never spoke to me again and I was pleased about it.
Emotionally hurting others
126. I left my fiancé for another man Betrayal
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127. My younger sister had upset me so I sent a very rude, cutting and insensitive email to her resulting in my family and I not speaking for several months.
Emotionally hurting others
128. I seduced over a period of time a colleague and used my power to make her love me. I the. Couldn't cope when she became atoattached
Emotionally hurting others
129. Playing football at school another child kept hacking my shins I reported this to a teacher who responded with "stop complaining and get on with it" the game went on and the child again attacked my shins and I responded by grabbing hold of the child and choking him unconscious with my bare hands. The incident took 3 staff members to pull me off the other child. The child was taken to hospital for treatment. I was excluded from the school. As a result of this incident I developed a reputation for being violent and people avoided me, or treated me like I was just a tool to get what they wanted, I became very got at threatening or intimidating others to get my own way.
Physically hurting others
130. Rowed with my mum and sister over babysitting. Didn't speak to either for eighteen months. D
Emotionally hurting others
131. I went to give a friend of mine a lift in a Land Rover and only realised when I got to her house that she would never get in one because she was in a fatal accident in one a few years before in which her son, daughter-in-law and unborn grandson were killed
Emotionally hurting others
132. I was visiting a male friend at their new house, and when I met their two male flatmates, I made a joke about if the other males were bullying him, they laughed and I felt I had embarassed him.
Emotionally hurting others
133. Ignored a friend in need of help when I should of been there for them. I had other activities happening and was selfish not to be there for my friend and felt bad for putting myself first
Letting people down
134. I was harsh and I wish I had thought it through better. I felt that my decision to end the friendship was valid, but I wished I had done it differently. A year later the lady I was harsh with apologised to me and we have a new acquaintanceship.
Emotionally hurting others
135. In primary school I and a friend gave a peer a drink with salt water in for a joke. We later found out that he had drunk the drink and had thrown up, and we got into trouble with a teacher whom he had told this to. I felt horrendous, and really ashamed of myself.
Physically hurting others
136. As a child I wilfully kicked another child and hurt them in a sensitive area. I had not meant it to hurt them so bad. It looked intentional and the feeling made it so, but the action hurt harder than I ever thought it would.
Physically hurting others
137. recreational drugs Drug use138. My friend and I were talking to someone she wanted to impress at
a bar. She works in health care and had been feeling very worried about having almost made a mistake at work. I was drunk and made a joke to the person she was trying to impress that she 'almost killed someone today'. She was extremely hurt and I felt awful.
Emotionally hurting others
139. When I was about 16, I was riding the bus home with some friends. We were int he IVth form and a younger child form our school came to us and told us that a chiuld from another school had been anti semitic and thrown light bulbs at them saying Hitler should have gassed all the Jews. There had been prior inter school difficulties. Impulsively we acted a gang and bundled on to the other bus. Whne the other person was pointed out, we beat them up. At the time it felt exhilirating but for many years when I consider this I feel guilty about it and know that I dealt with it
Physically hurting others
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irreesponsibly.140. Didn't thank a family for friend for helping me find a new car at
the time as I was busy, then my mum texted me saying he was annoyed and I ought to contact him.
Letting people down
141. I sometimes take food that does not belong to me (e.g. milk) which I think is immoral, and it makes me feel bad afterwards.
Stealing
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Appendix K. Normality tests and plots.
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Appendix L. Behaviour Research and Therapy Guidelines for Authors..
INTRODUCTIONThe major focus of Behaviour Research and Therapy is an experimental psychopathology approach to understanding emotional and behavioral disorders and their prevention and treatment, using cognitive, behavioral, and psychophysiological (including neural) methods and models. This includes laboratory-based experimental studies with healthy, at risk and subclinical individuals that inform clinical application as well as studies with clinically severe samples. The following types of submissions are encouraged: theoretical reviews of mechanisms that contribute to psychopathology and that offer new treatment targets; tests of novel, mechanistically focused psychological interventions, especially ones that include theory-driven or experimentally-derived predictors, moderators and mediators; and innovations in dissemination and implementation of evidence-based practices into clinical practice in psychology and associated fields, especially those that target underlying mechanisms or focus on novel approaches to treatment delivery. In addition to traditional psychological disorders, the scope of the journal includes behavioural medicine (e.g., chronic pain). The journal will not consider manuscripts dealing primarily with measurement, psychometric analyses, and personality assessment.
The Editor and Associate Editors will make an initial determination of whether or notsubmissions fall within the scope of the journal and/or are of sufficient merit andimportance to warrant full review.
The CONSORT guidelines (http://www.consort-statement.org/?) need to be followed for protocol papers for trials; authors should present a flow diagramme and attach with their cover letter the CONSORT checklist. For meta-analysis, the PRISMA (http://www.prisma-statement.org/?) guidelines should be followed; authors should present a flow diagramme and attach with their cover letter the PRISMA checklist. For systematic reviews it is recommended that the PRISMA guidelines are followed, although it is not compulsory.
Contact detailsAny questions regarding your submission should be addressed to the Editor in Chief:Professor Michelle G. CraskeDepartment of Psychology310 825-8403Email: [email protected]
BEFORE YOU BEGINEthics in publishingFor information on Ethics in publishing and Ethical guidelines for journal publication seehttps://www.elsevier.com/publishingethics and https://www.elsevier.com/journal-authors/ethics.Human and animal rightsIf the work involves the use of human subjects, the author should ensure that the work described has been carried out in accordance with The Code of Ethics of the World Medical Association (Declaration of Helsinki) for experiments involving humans, http://www.wma.net/en/30publications/10policies/b3/index.html; Uniform Requirementsfor manuscripts submitted to Biomedical journals, http://www.icmje.org. Authors should include a statement in the manuscript that informed consent was obtained for experimentation with human subjects. The privacy rights of human
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subjects must always be observed. All animal experiments should be carried out in accordance with the U.K. Animals (Scientific Procedures) Act, 1986 and associated guidelines, EU Directive 2010/63/EU for animal experiments, or the National Institutes of Health guide for the care and use of Laboratory animals (NIH Publications No. 8023, revised 1978) and the authors should clearly indicate in the manuscript that such guidelines have been followed. All animal studies need to ensure they comply with the ARRIVE guidelines. More information can be found at http://www.nc3rs.org.uk/page.asp?id=1357.Conflict of InterestAll authors are requested to disclose any actual or potential conflict of interest including any financial, personal or other relationships with other people or organizations within three years of beginning the submitted work that could inappropriately influence, or be perceived to influence, their work. See also http://www.elsevier.com/conflictsofinterest. The Conflict of Interest form can be found at: http://ees.elsevier.com/brat/img/COI.pdf . And for further information, please view the following link:http://service.elsevier.com/app/answers/detail/a_id/286/supporthub/publishing .Submission declarationSubmission of an article implies that the work described has not been published previously (except in the form of an abstract or as part of a published lecture or academic thesis or as an electronic preprint, see https://www.elsevier.com/sharingpolicy), that it is not under consideration for publication elsewhere, that its publication is approved by all authors and tacitly or explicitly by the responsible authorities where the work was carried out, and that, if accepted, it will not be published elsewhere including electronically in the same form, in English or in any other language, without the written consent of the copyright-holder.Changes to authorshipAuthors are expected to consider carefully the list and order of authors before submitting their manuscript and provide the definitive list of authors at the time of the original submission. Any addition, deletion or rearrangement of author names in the authorship list should be made only before the manuscript has been accepted and only if approved by the journal Editor. To request such a change, the Editor must receive the following from the corresponding author: (a) the reason for the change in author list and (b) written confirmation (e-mail, letter) from all authors that they agree with the addition, removal or rearrangement. In the case of addition or removal of authors, this includes confirmation from the author being added or removed. Only in exceptional circumstances will the Editor consider the addition, deletion or rearrangement of authors after the manuscript has been accepted. While the Editor considers the request, publication of the manuscript will be suspended. If the manuscript has already been published in an online issue, any requests approved by the Editor will result in a corrigendum.Article transfer serviceThis journal is part of our Article Transfer Service. This means that if the Editor feels your article is more suitable in one of our other participating journals, then you may be asked to consider transferring the article to one of those. If you agree, your article will be transferred automatically on your behalf with no need to reformat. Please note that your article will be reviewed again by the new journal. More information about this can be found here: https://www.elsevier.com/authors/article-transfer-service.CopyrightUpon acceptance of an article, authors will be asked to complete a 'Journal Publishing Agreement' (for more information on this and copyright, see https://www.elsevier.com/copyright). An e-mail will be sent to the corresponding author confirming receipt of the manuscript together with a 'Journal Publishing Agreement' form or a link to the online version of this agreement. Subscribers may reproduce tables of contents or prepare lists of articles including abstracts
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for internal circulation within their institutions. Permission of the Publisher is required for resale or distribution outside the institution and for all other derivative works, including compilations and translations(please consult https://www.elsevier.com/permissions). If excerpts from other copyrighted works are included, the author(s) must obtain written permission from the copyright owners and credit the source(s) in the article. Elsevier has preprinted forms for use by authors in these cases: please consult https://www.elsevier.com/permissions.For open access articles: Upon acceptance of an article, authors will be asked to complete an 'Exclusive License Agreement' (for more information see https://www.elsevier.com/OAauthoragreement).Permitted third party reuse of open access articles is determined by the author's choice of user license (see https://www.elsevier.com/openaccesslicenses).Author rightsAs an author you (or your employer or institution) have certain rights to reuse your work. For more information see https://www.elsevier.com/copyright.Role of the funding sourceYou are requested to identify who provided financial support for the conduct of the research and/or preparation of the article and to briefly describe the role of the sponsor(s), if any, in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication. If the funding source(s) had no such involvement then this should be stated.Funding body agreements and policiesElsevier has established a number of agreements with funding bodies which allow authors to comply with their funder's open access policies. Some authors may also be reimbursed for associated publication fees. To learn more about existing agreements please visit https://www.elsevier.com/fundingbodies.Open accessThis journal offers authors a choice in publishing their research:Open access• Articles are freely available to both subscribers and the wider public with permitted reuse• An open access publication fee is payable by authors or on their behalf e.g. by their research funder or institutionSubscription• Articles are made available to subscribers as well as developing countries and patient groups through our universal access programs (https://www.elsevier.com/access).• No open access publication fee payable by authors.Regardless of how you choose to publish your article, the journal will apply the same peer review criteria and acceptance standards. For open access articles, permitted third party (re)use is defined by the following Creative Commons user licenses:Creative Commons Attribution (CC BY)Lets others distribute and copy the article, create extracts, abstracts, and other revised versions, adaptations or derivative works of or from an article (such as a translation), include in a collective work (such as an anthology), text or data mine the article, even for commercial purposes, as long as they credit the author(s), do not represent the author as endorsing their adaptation of the article, and do not modify the article in such a way as to damage the author's honor or reputation.Creative Commons Attribution-NonCommercial-NoDerivs (CC BY-NC-ND)For non-commercial purposes, lets others distribute and copy the article, and to include in a collective work (such as an anthology), as long as they credit the author(s) and provided they do not alter or modify the article. The open access publication fee for this journal is USD 3550, excluding taxes. Learn more about Elsevier's pricing policy: https://www.elsevier.com/openaccesspricing.
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MRP Research Proposal
Perfectionism and Moral Thought-Action Fusion as Predictors of Sensitivity to
Mental Contamination
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Background and Theoretical Rationale
Mental contamination has been defined as a feeling of dirtiness, internal and
external, that arises following intrusive thoughts, images, memories or exposure to a
physical, emotional or moral violation, and in the absence of physical contact with a
perceived contaminant (Carraresci, Bulli, Melli & Stopani, 2013; Coughtrey,
Shafran, Knibbs & Rachman, 2012). It has been likened in its nature to contact
contamination, whereby feelings of dirtiness and anxiety arise following physical
contact with something perceived as contaminating. In both cases, this sense of
contamination prompts anxiety and attempts to remove the contaminant, perhaps
through washing or other neutralising behaviour(s), but this is more difficult in
mental contamination as the contaminant is not physical (Elliott & Radomsky, 2009).
This definition has influenced the way in which mental contamination has been
conceptualised and measured across existing research and studies. Most commonly,
self-report visual analogue scales (VAS) have been used that tap four main defining
features of mental contamination; sense of internal dirtiness, sense of external
dirtiness, anxiety and urge to wash (Coughtrey, Shafran, & Rachman, 2014b; 2014a;
Lee, Shafran, Burgess, Carpenter, Millard & Thorpe, 2013).
Although the concept of mental contamination has been derived from accounts of
obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD, in
particular when the trauma has been assaultive in nature), there is evidence that
mental contamination is also relevant to non-clinical populations. Many recent
studies have successfully induced mental contamination in non-clinical populations
through recalling negatively-weighted memories, imagining being victim or
perpetrator of a moral transgression, and following objectifying comments
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(Coughtrey, Shafran, & Rachman, 2014b; Elliott & Radomsky, 2009; Fairbrother,
Newth & Rachman, 2005; Rachman, Radomsky, Elliott & Zysk, 2012). In such
studies, participants complete mental contamination VAS pre- and post-induction to
gauge sensitivity to mental contamination.
Although these studies demonstrate that mental contamination is likely to be a
universal experience, not all participants in these studies experienced feelings of
contamination and/or urge to wash. Clearly, therefore, there are individual
differences in sensitivity to mental contamination. Clinically it is important to
understand these individual differences in vulnerability to mental contamination in
order to identify vulnerable individuals and inform treatment. The existing literature
on mental contamination identifies several predictors (or vulnerability factors) of
mental contamination. To date, the main factors seem to be disgust
sensitivity/propensity, anxiety and general contamination fears. However, these
factors only explain modest amounts of variability in the experience of mental
contamination (Elliott & Radomsky, 2009; 2013; Herba & Rachman, 2007). Whilst
this provides some understanding of what might make one individual more
vulnerable to mental contamination than another, there are clearly other factors at
work. The current study proposes to study perfectionism and moral thought-action
fusion as possible factors explaining individual differences in sensitivity to mental
contamination.
Perfectionism, or perfectionist, describes someone who sets themselves unrealistic
high standards, adheres to them rigidly and defines their self-worth in terms of
achieving these standards (Shafran & Mansell, 2001). Cox, Sareen and Freeman
(2001) make a distinction between adaptive (achievement striving) and maladaptive
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(evaluative concern) perfectionism; although both are linked to negative
consequences, it is negative or maladaptive perfectionism that is mostly commonly
thought to be problematic in terms of psychological difficulties and distress (Bieling,
Israeli & Antony, 2004; Slaney, Rice, Mobley, Trippi & Ashby, 2001). It is this
maladaptive perfectionism that will be the focus of this study. Individuals high in
maladaptive perfectionism are likely to find ‘wrong’ or ‘incorrect’ (or perhaps,
immoral or unacceptable) actions or thoughts threatening to their own high standards
and self-worth. It stands that these individuals are likely to have a negative emotional
reaction to such thoughts or acts and perhaps experience an urge to ‘put it right’,
more so than individuals low in perfectionism. Theoretically, perfectionism is a
possible predictor of sensitivity to mental contamination, with individuals higher in
this trait being more sensitive to feelings of mental contamination following an
unacceptable thought, act, image or memory. To date there have been no studies
connecting perfectionism to mental contamination, however existing literature
suggests perfectionism is linked to the experience of shame. Fedewa, Burns and
Gomez (2005) found strong positive correlations between maladaptive perfectionism
and shame-proneness (r = 0.52, p < .001) and state shame (r = .39, p <.001), and
suggest this relationship might be via perceived failure, such that perfectionists
experience shame in response to perceived failure. In summary, those high in
perfectionism may appraise immoral thoughts or actions as failures, and
subsequently experience shame and feelings of mental contamination (i.e. anxiety,
feelings of external and internal dirtiness and an urge to wash).
A second possible contributing factor to individual differences in sensitivity to
mental contamination is moral thought-action fusion (TAF). TAF has been defined
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as comprising two components; 1) the ‘likelihood type’ TAF which pertains to the
belief that an event is likely to happen in reality if one has a thought about it and, 2)
the ‘moral type’ TAF; that having a thought about carrying out an action is the moral
equivalent of carrying out the action (Shafran, Thodorson & Richman, 1996).
Therefore if an individual high in moral thought-action fusion experiences an
immoral/unacceptable thought, memory or image (and believes this to be morally
equivalent to engaging in this action/event), it stands that they are likely to conclude
they are immoral or unacceptable as a person. Further it is possible that the
individual might experience an urge to neutralise these thoughts or mental events in
some way, and restore their morality. Existing research has found measures of
mental contamination positively correlated to subscales (moral, likelihood others,
likelihood self) of the TAF scale (r = .25 - .5, Coughtrey et al., 2012; Cougle, Lee,
Horowitz, Wolitzky-Taylor & Telch, 2008) but none of these have specifically
explored moral TAF as a possible predictor of mental contamination sensitivity.
Main Hypotheses
This research sets about to expand on the literature on predictors of mental
contamination, focusing on perfectionism and moral TAF, asking whether individual
differences in perfectionism and/or moral TAF predict differences in sensitivity to
mental contamination. It will explore whether these factors predict mental
contamination, and to what magnitude. Based on the above, hypotheses of this study
will be as follows;
1) Perfectionism will be positively correlated with feelings of mental
contamination, i.e. sense of dirtiness (internal and external), urge to wash and
anxiety;
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2) Moral TAF will be positively correlated with feelings of mental
contamination;
3) Perfectionism and moral TAF will predict unique variance in mental
contamination.
Method
Design
The study will take a cross-sectional correlational design. Participants will be asked
for demographic information before completing a number of questionnaire measures
on perfectionism, moral TAF and visual analogue scales (VAS) measuring baseline
feelings of mental contamination. Participants will then complete a short task
designed to induce mental contamination. VAS on mental contamination will then be
repeated (‘post-VAS’). Changes in VAS will be indicative of mental contamination
sensitivity in response to the mental contamination induction task. Participants will
also answer two manipulation check questions. Scores on measures of perfectionism
and moral TAF will be correlated with change scores in VAS on mental
contamination. Regression analyses will be used to test the hypothesis that
perfectionism and moral TAF scores predict sensitivity to mental contamination (as
determined by change in VAS scores).
Induction of mental contamination
Past studies have stressed the idiosyncratic nature of mental contamination and have
made efforts to induce it in individualised ways. This study intends to draw upon
these methods and induce mental contamination through asking participants to
“recall a time they had violated a moral standard or caused harm to someone” (one
of the ‘five tasks’ induction method in Coughtrey, Shafran & Rachman, 2014a) and
spend one minute thinking about this time.
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Measures
Predictor variables
Standardised measures will be administered to measure possible predictor variables.
Perfectionism will be measured using the 23-item Revised Almost Perfect Scale
(APS-R; Slaney et al., 2001; see Appendix A). The APS-R is a three-factor measure
of perfectionism (discrepancy, high standards and order) which show good levels of
internal consistency (Cronbach’s alpha ranging from .82 to .92) and distinguishes
between adaptive and maladaptive perfectionism. This scale is not copyrighted and is
available online. Moral thought-action fusion will be measured with the 12-item
Thought-Action Fusion moral subscale (TAF-moral; Shafran, Thodorson &
Richman, 1996; see Appendix B) which demonstrates good levels of internal
consistency (Cronbach’s alpha for the TAF subscales moral, likelihood self and
likelihood other are reported as ranging from .85 to .96). This scale is also freely
available for public use and available online.
Mental contamination
VAS will be administered to assess subjective feelings of mental contamination (see
Appendix C). As described in the ‘introduction’ section of this proposal, previous
studies have identified three main responses related to mental contamination; sense
of dirtiness (internal and external), anxiety and urge to wash. Hence, participants will
be asked “how dirty do you feel inside your body?”, “how dirty do you feel in
general?”, “how anxious do you feel?” and “how strong is your urge to wash?”
Participants will mark an X on a 100mm scale from 0 = not at all to 100 = extremely
(based on Coughtrey, Shafran & Rachman, 2014b). These VAS will be completed
pre- and post-induction task in order to assess change in mental contamination as a
result of the induction procedure.
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Procedure
In order to maximise number of participants and aid efficient data collection, willing
participants will be directed to an online survey. They will initially be presented with
an ‘information screen’ stating that the study will last around 20 minutes (based upon
length of measures and mental contamination induction) and will be asking them to
remember a time they had committed an immoral act, or done something that hurt or
upset someone and answering a number of questions about their personality. They
will also be informed that their information will be anonymous, they are able to
terminate the study at any point, and asked to tick a box indicating they have read the
information and consent to take part.
Section one
Demographic information (gender, age, ethnicity, highest education level, and
country where completing the study; see Appendix D) will be collected first (any
participants indicating they are under the age of 18 at this point will be denied access
to the survey). Measures on predictor variables (APS-R and TAF-moral) will then be
completed by participants. This will be followed by VAS on mental contamination,
in order to ascertain baseline levels of feelings of mental contamination.
Section two
Participants will then be taken to section two of the survey and asked to “recall a
time they had violated a moral standard or caused harm to someone” (as outlined
above). They will be asked to think about this for one minute (following Piper, 2013,
unpublished PsychD thesis) and type a few sentences describing the event or act for
later content analysis. Participants will then be presented with post-VAS measuring
mental contamination. As a manipulation check, participants will be taken to a final
screen with two questions regarding the memory they had recalled in the previous
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part of the survey. Question 1 will ask; “how much of the allotted time did you spend
thinking about the event?”, and question two will ask; “how vivid or clear was the
memory?” Participants will mark an X on a 100mm scale from 0 to 100 (0 indicating
no time at all, or not clear at all, and 100 indicating all of the allotted time, or very
clear). This will be the end of the survey and it will be timed from beginning
(presentation of demographics screen) to end (completion of manipulation check
questions).
Participants will be shown a final information sheet detailing phone numbers and
websites of mental health charities should the study have raised any
concerns/questions for them, and provided with the researcher’s information should
they have any questions about the study.
Participants
Participants will be recruited from the general population using online
advertisements on social media sites such as Facebook and Twitter and snowball
sampling. In order to not restrict sample diversity, anyone aged 18 or over will be
eligible to take part. The online advertisement will inform participants that the study
is part of doctoral research, and will ask about a time they have done something that
hurt or upset another person and their experience of this. They will be informed in
the advertisement that demographic information will be collected but that all
responses are anonymous. Participants will be asked not to take part if a) they are
unable to think of a time they hurt or upset someone else or, b) thinking about a time
they hurt or upset someone else is likely to make them feel distressed. For a
correlation test, a priori power analysis for a two-tailed hypothesis indicated a sample
size of 82 participants achieve 80% power for detecting a medium sized effect of 0.3
(α = 0.05). For multiple regression analyses with four predictors (see ‘proposed data
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analysis’ section), a priori power analysis for a two-tailed hypothesis indicated that a
sample of 83 participants achieve 90% power for detecting a medium effect size of
0.13 (α = 0.05).
Contingency plan
If the sampling method does not produce enough participants for the study, other
sampling methods and participant pools could be considered. A link to the survey
could be emailed to psychology undergraduates, with participation exchanged for
course credits. A pilot study will be used to flag potential difficulties with the
study/survey which can then be addressed (see ‘involving and consulting interested
parties’ section below).
Project costing
This project is using the Revised Almost Perfect Scale (APS-R), the Moral Thought-
Action Fusion Scale (TAF-moral) and VAS scales to measure mental contamination.
All of these are free to use, and therefore there are no predicted costs for this study.
Ethical considerations
Participants will be informed generally about the study, but not given full
information until they have completed measures and tasks. As per the British
Psychological Society’s definition of deception (“deliberately falsely informing
participants of the purpose of the research”; Code of Human Research Ethics, 2010,
pp. 24) participants will not be deceived in any way. Asking participants to
remember a time they committed a moral transgression has the potential to cause
upset and this will be made clear in the participant information, i.e., that thinking
about this time might be upsetting, and participants will be advised not to participate
that if they are likely to become distressed. Further, by giving participants the
freedom to select the event themselves they are able to avoid anything too upsetting.
109
Of note is that a similar study conducted by Piper (2013, University of Surrey,
PsychDClinical) induced mental contamination in a similar way online, with no
adverse effects. Examples that participants bought to mind included; stealing money
from a friends purse, cheating in an exam, calling into work ‘sick’ when not sick,
driving over the speed limit, and cheating on a partner.
Participants will be informed that they can drop out at any point during the study but
that they cannot withdraw their data once submitted as the study is anonymous.
Participants will be fully debriefed as to the purpose of the study following full
completion of the survey or during the study if they decide to terminate, and will be
given information on where to get support or help. Ethical approval will be sought
from the University of Surrey Faculty of Arts and Human Sciences Ethics
Committee. The data will be stored on a password protected SPSS file for a
minimum of ten years as per University regulations. During this time the data will be
accessible to the researcher and supervisor only. Participants will be informed of this.
Proposed data analysis
Pearson’s correlation coefficient will be used to look for significant correlations
between scores on the APS-R, TAF-moral and VAS mental contamination change
scores. Manipulation check questions will also be analysed for correlation with VAS
indices of mental contamination. A four predictor multiple regression model will be
used to look for significant predictors of mental contamination. Possible predictors
will be entered into a block-entry model, with step one entering two manipulation
check questions (if they are found to be positively correlated with mental
contamination change scores) and step two entering perfectionism and TAF scores.
Involving and consulting interested parties
110
Since mental contamination is considered a universal phenomenon induced and
experienced across non-clinical and clinical samples, this study approaches the
concept of mental contamination as a universal human experience (but experienced
to varying degrees). Although mental contamination has been studied in the context
of OCD and PTSD diagnoses, the study of mental contamination is relevant in non-
clinical samples. For this reason it does not feel meaningful to approach the
University of Surrey service user and carer advisory panel, but to seek advice and
consultation from members of the general population. When designed, this study will
be piloted with an opportunity sample of participants, to ensure the survey works
practically and feedback and suggestions will be sought on their experience of the
survey and tasks.
Dissemination strategy
The study will aim for publication in the Personality and Individual Differences
journal. Personality and Individual Differences publishes studies and research on
personality variables and individual differences in concepts derived from various
psychology disciplines (including clinical psychology). The journal has a high
impact factor (1.861; Elsevier, 2014) which will be important in developing
practicing clinicians and researchers’ awareness of mental contamination as a
concept as well as identifying individuals that might be vulnerable and using this to
inform treatment.
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References
Bieling, P. J., Israeli, A. L. & Antony, M. M. (2004). Is perfectionism good, bad, or
both? Examining models of the perfectionism construct. Personality and
Individual Differences, 36, 1373-1385.
Carraresi, C., Bulli, F., Melli, G. & Stopani, E. (2013). Mental contamination in
OCD: Its role in the relationship between disgust propensity and fear of
contamination. Clinical Neuropsychiatry, 10, 13-19.
Coughtrey, A. E., Shafran, R., Knibbs, D. & Rachman, S. J. (2012). Mental
contamination in obsessive-compulsive disorder. Journal of Obsessive-
Compulsive and Related Disorders, 1, 244-250.
Coughtrey, A. E., Shafran, R. & Rachman, S. J. (2014b). The spontaneous decay and
persistence of mental contamination: An experimental analysis. Journal of
Behavior Therapy and Experimental Psychiatry, 45, 90-96.
Coughtrey, A. E., Shafran R. & Rachman, S. J. (2014a). The spread of mental
contamination. Journal of Behavior Therapy and Experimental Psychiatry,
45, 33-38.
Cougle, J. R., Lee, H., Horowitz, J. D., Wolitzky-Taylor, K. B. & Telch, M. J.
(2008). An exploration of the relationship between mental pollution and OCD
symptoms. Journal of Behavior Therapy and Experimental Psychiatry, 39,
340-353.
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Elliott, C. M. & Radomsky, A. S. (2009). Analyses of mental contamination: Part I,
experimental manipulations of morality. Behaviour Research and Therapy,
47, 995-1003.
Elliott, C. M. & Radomsky, A. S. (2013). Meaning and mental contamination: focus
on appraisals. Clinical Psychologist, 17, 17-25.
Enns, M. W., Cox, B. J., Sareen, J. & Freeman, P. (2001). Adaptive and maladaptive
perfectionism in medical students: a longitudinal investigation. Medical
Investigation, 35, 1034-1042.
Herba, J. K. & Rachman, S. (2007). Vulnerability to mental contamination.
Behaviour Research and Therapy 45, 2804-2812.
Fairbrother, N., Newth, S. J. & Rachman, S. (2005). Mental pollution: feelings of
dirtiness without physical contact. Behaviour Research and Therapy, 43, 121-
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Fedewa, B. A., Burns, L. R. & Gomez, A. A. (2005). Positive and negative
perfectionism and the shame/guilt distinction: adaptive and maladaptive
characteristics. Personality and Individual Differences, 38, 1609-1619.
Lee, M., Shafran, R., Burgess, C., Carpenter, J., Millard, E. & Thorpe, S. (2013). The
induction of mental and contact contamination. Clinical Psychologist, 17, 9-
16.
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Piper, R. (2013). An experimental study of mental contamination: the role of disgust,
shame and guilt (Unpublished doctoral thesis). University of Surrey,
Guildford.
Rachman, S., Radomsky, A. S., Elliott, C. M. & Zysk, E. (2012). Mental
contamination: The perpetrator effect. Journal of Behavior Therapy and
Experimental Psychiatry, 43, 587-593.
Shafran, R. & Mansell, W. (2001). Perfectionism and psychopathology: A review of
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Shafran, R., Thodorson, D. S. & Richman, S. (1996). Thought-action fusion in
obsessive compulsive disorder. Journal of Anxiety Disorders, 10(5), 379-391.
Slaney, R. B., Rice, K. G., Mobley, M., Trippi, J. & Ashby, J. S. (2001). The revised
almost perfect scale. Measurement and Evaluation in Counselling and
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beneath the surface in OCD: The cognitive treatment of a case of pure mental
contamination. Behavioural and Cognitive Psychotherapy, 40(4), 383-399.
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MRP Literature Review
Mental Contamination: A Systematic Literature Review
115
Abstract
Mental contamination has been defined as feelings of dirtiness, internal and external,
that arise following intrusive thoughts, images, memories or exposure to a physical,
emotional or moral violation (Coughtrey, Shafran, Knibbs & Rachman, 2012b;
Carraresci, Bulli, Melli & Stopani, 2013). This systematic review aimed to review
and synthesise the current literature and findings on mental contamination by
conducting a series of searches across three online databases. This search returned a
total of 27 relevant studies. Collectively, the studies suggest the presence of mental
contamination in both clinical and non-clinical populations. Across these studies,
mental contamination has been induced experimentally or assessed by self-report
measures. Some studies exploring properties of such measures, find the Mental
Pollution Questionnaire (MPQ) and Vancouver Obsessive Compulsive Inventory –
Mental Contamination subscale (VOCI-MC) effective measures of mental
contamination, amongst others. Predictors of mental contamination have consistently
been found to be anxiety, contamination fears and disgust sensitivity. The small
evidence base suggests cognitive-behavioural interventions for mental contamination
are most effective when adapted or tailored toward treatment of mental
contamination and associated symptoms. Several issues on generalizability and
methodologies are discussed, such as the tendency toward female participants as well
as issues with cross-sectional designs. Suggestions for future research are made
where appropriate.
116
Statement of Journal Choice
This review is aimed at the Clinical Psychology Review journal because it is a novel
and important review of the existing literature on the experience of mental
contamination. Clinical Psychology Review accepts literature reviews, has a broad
scope of topics relevant to clinical psychology and a wide audience including
practicing clinicians in mental health. Since mental contamination is a new and
developing topic area for clinical psychology, publishing this article in a high impact
and well-established journal such as Clinical Psychology Review is important to
increase practicing clinicians and researchers’ awareness of this concept.
117
Feelings of contamination have been defined as “an intense and persisting feeling of
having been polluted or infected or endangered as result of contact, direct or indirect,
with a person/place/object that is perceived to be soiled, impure, infectious or
harmful” (Rachman, 2004, p. 1229). Clinically, contamination fears have been
reported by 50% of individuals diagnosed with obsessive-compulsive disorder
(OCD) and are understood to underlie much of the symptomatology associated with
this disorder, particularly compulsive washing and avoidant behaviours (Rachman,
2004; Rachman & Hodgeson, 1980). However in recent years, fear of contamination
has been more broadly understood as existing on a continuum of human experience.
Typically contamination fears have been understood as being borne from
direct physical contact with a perceived contaminant, often termed ‘contact
contamination’ in the literature, where an individual feels dirty following this
physical contact with a harmful person, place or item (Coughtrey, Shafran &
Rachman, 2014). However, recently evidence suggests that feelings of being
contaminated, dirty or polluted can also arise in the absence of a physical
contaminant. This phenomenon is termed ‘mental contamination’ (MC) and is
thought to arise in response to “psychological processes that do not require direct
contact” such as intrusive thoughts, memories or images (Carraresi et al., 2013).
Mental contamination is associated with negative emotions, such as guilt, shame,
anxiety and disgust (Cougle, Lee, Horowitz, Wolitzky-Taylor & Telch, 2008;
Badour, Babson, Blumenthal & Dutton, 2013b; Carraresi et al., 2013), and is also
thought to be related to perceived experiences of moral, emotional or physical
violations, for example being betrayed, degraded or abused (Coughtrey et al., 2012b;
Coughtrey, Shafran & Rachman, 2014b).
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Although contact and mental contamination share many qualities in how they
are experienced, there are several distinguishing factors. Although both are
associated with a feeling of dirtiness and an urge to wash (Herba & Rachman, 2007;
Lee et al., 2013), in mental contamination this washing behaviour does not appear to
alleviate this internal sense of dirtiness or contamination better than waiting
(Ishikawa et al., 2014). This may be because contact contamination is associated with
localisation of the dirtiness, often at the site of contact, and mental contamination is
thought to be associated with an internal, global sense of dirtiness (Elliott &
Radomsky, 2009). According to the literature, contact and mental contamination can
co-occur. This relationship is said to be asymmetrical such that the majority of those
reporting mental contamination also report co-occurring contact contamination.
However, a large proportion of individuals experiencing contact contamination do
not report mental contamination (Coughtrey et al., 2012b).
Throughout the literature, the concept of mental contamination has also been
referred to as ‘mental pollution’, as in Fairbrother & Rachman (2004), and appears to
have been defined as the same. However, in more recent years, mental pollution has
been understood as a subtype of mental contamination that can be induced through
thoughts, images, insults, memories and results in a sense of internal dirtiness not
responsive to washing or cleaning (Herba & Rachman, 2007; Lee et al., 2013). Lee et
al. (2013) describe other subtypes of mental contamination as; physical and/or
psychological violation (perhaps after sexual or physical assault), self-contamination
(following intrusive immoral thoughts for example) and morphing (a fear of being
transformed into someone or something else undesirable, just by being in close
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proximity). This final subtype, morphing, has also been termed transformation
obsession (Volz & Heyman, 2007).
Rachman (1994) first introduced the notion of mental contamination as a
concept, following his work with OCD patients when he noticed feelings of
contamination arose without contact with a physical contaminant. Researchers then
began exploring mental contamination experimentally in sexual assault victims as
well as its association with post-traumatic stress symptoms (Fairbrother & Rachman,
2004; Olatunji, Elwood, Williams & Lohr, 2008), concluding that individuals with
post-traumatic stress disorder (PTSD) can experience mental contamination and
associated emotional responses, particularly when the trauma has involved a
violation of some degree (Fairbrother & Rachman, 2004). Alongside this field of
research, studies have also begun to explore in more depth how mental
contamination might be induced, the nature of this phenomenon, and individual
differences in the experience of mental contamination.
Awareness and understanding of mental contamination as a distressing
phenomenon, particularly prevalent in those with OCD, is growing and it remains
important to continue exploring this experience further, in the hope of developing
effective treatment and facilitating recovery in OCD (Fairbrother & Rachman, 2004).
Although interest in this topic area is growing, to date there has been no review of
the expanding literature and research into mental contamination as a concept. This
review aims to explore this mounting evidence base and consider possible avenues
for future research.
Method
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A systematic approach was taken to searching the existing literature and
research on mental contamination as a concept as defined above. An online search of
three databases, Scopus, Web of Science and PsychInfo, took place in February
2014. Based on a preliminary review of the existing literature, the following search
terms were used; "mental contam*" OR "mental pollut*" OR "imag* contam*" OR
"imag* pollut*" OR "mental contagion" OR “morphing obsession*” OR
“transformation obsession*”. Due to the anticipated small number of relevant
articles, search domains (e.g. title, abstract, key words) and dates of articles were not
specified or restricted at this stage. For the same reason, no exclusion criteria were
applied to participant type or age of participants. Articles eligible for review were
required to have operationalised mental contamination as per Rachman’s (2004)
definition; a feeling of being dirty, or endangered or contaminated in some way
without direct physical contact with a contaminant. Additionally, studies were only
included in this review if they had either directly assessed mental contamination, or
attempted to induce it with an experimental method and subsequently assessed it
with relevant indices (such as visual analogue scales or Likert scales). Studies were
only included if they were written or available in the English language. Articles
eligible for this review were also required to be published peer reviewed journal
articles.
1.
121
Figure 1. Search method flowchart.
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Excluded after screening (N = 14):Theory paper N = 4Overview of treatments N = 1Different concept of MC N = 3Not relevant (does not directly measure or induce MC) N = 5Dissertation N = 1
Excluded – did not meet criteria (not available in English, different concept of MC, not peer reviewed article) (N = 423)
Articles included in the review (N = 27)
Full text articles assessed for eligibility (N = 41)
Exclusion of duplicate records (N = 205)
Potentially eligible records (N = 464)
Potentially eligible records identified through database searches (N = 669)PsychInfo = 66Web of Science = 284Scopus = 319
Results
The search identified a total of 27 papers eligible for review (see Figure 1).
An overview of these papers can be seen in Table 1.
Across the studies a total of 3,070 participants were used; 2390 (77.9%)
female and 680 (22.1%) male with a mean age of 26.01 years. The studies recruited a
range of participant types; 12 used non-clinical undergraduate samples, five used
clinical samples (i.e. those diagnosed with OCD, transformation obsessions or other
clinical disorder), two studies used sub-clinical samples (i.e. those with ‘moderate’
or ‘high’ levels of mental contamination or OCD), three studies used mixed samples
of non-clinical and clinical/sub-clinical, and five studies used assault victims
(sexual, physical or attempted rape).
The majority of studies (N = 15) used experimental designs and several (N =
9) used correlational cross-sectional designs. One study used a mixed design (non-
randomised experiment with cross-sectional correlation), and two studies used
qualitative approaches (thematic analysis, and case series). Most of the studies took
place in either Canada (N = 9) or the UK (N = 9), but five were carried out in the
USA, two in Europe (Italy and Germany), one in Japan, and one across both the USA
and China.
The existing literature and research could be classified into three domains; (1)
Studies that attempted to operationalise mental contamination (through either
experimental induction and subsequent measure through relevant scales or through
self-report measures), (2) studies that explored predictors of mental contamination,
and (3) studies that looked into how mental contamination responds to psychological
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interventions. These areas will now be considered in more depth. Quality assessment
of studies has been guided by the “QualSyst” quality assessment criteria for both
qualitative and quantitative research (Kmet, Lee & Cook, 2004).
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Table 1. Results of search.
Study N Age: M (sd)ª Sample type Design LocationBadour et al. (2013b) 40 28.18 (13.93) Assault victims Non randomised experimental USABadour et al. (2013a) 38 32.34 (13.55) Assault victims Cross-sectional correlation USABerman et al. (2012) 264 19.46 (2.75) Non-clinical Cross-sectional correlation USACarraresi et al. (2013) 83 32.6 (9.6) Clinical (OCD) Cross-sectional correlational ItalyChen, Teng & Zhang (2013) 161 20.4 (.86)
30.59 (12.52)33.78 (11.35)
Non-clinical 3 x randomised control trials China & USA
Coughtrey et al. (2012b) 177 34.4 (11.43) Sub-clinical 2 x cross-sectional correlation UKCoughtrey et al. (2012a) 20 36.15 (11.01) Clinical (C-OCD) Qualitative, thematic analysis UKCoughtrey, et al. (2013) 12 28.83 (8.54) Clinical (OCD) Non-randomised quasi-
experiment UK
Coughtrey, Shafran & Rachman (2013) 90 34.29 (10.85)22.31 (5.08)
Non-clinical and clinical (C-OCD)
Cross-sectional correlation UK
Coughtrey, Shafran & Rachman (2014b) 100 22.6 (5.33)20.53 (4.3)
Non-clinical and sub-clinical (moderate MC)
Non-randomised experiment and randomised control trial
UK
Coughtrey, Shafran & Rachman (2014a) 60 20.53 (4.3) Sub-clinical Non-randomised experiment UKCougle et al. (2008) 549 19.45 (5.3) Non-clinical Cross-sectional correlation USAElliott & Radomsky (2009) 148 22.86 (4.46) Non-clinical Randomised control trial CanadaElliott & Radomsky (2012) 140 22.7 (5.29) Non-clinical Randomised control trial CanadaElliott & Radomsky (2013) 59 21.59 (4.01) Non-clinical Non-randomised experiment CanadaFairbrother & Rachman (2004) 50 24.5 ( - ) Assault victims Mixed: Experiment and cross-
sectional correlationCanada
Fairbrother, Newth & Rachman (2005) 121 20.51 (3.17) Non-clinical Randomised control trial CanadaHerba & Rachman (2007) 120 20.73 (4.73) Non-clinical Cross-sectional correlation CanadaIshikawa et al. (2014) 48 18.36 (2.31) Non-clinical Randomised control trial JapanJung & Steil (2012) 2 38 ( - ) Assault victims Quasi- experiment (case Germany
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study)Lee et al. (2013) 60 22.25 (8.22) Non-clinical Randomised control trial UKOlatunji et al. (2008) 48 19.52 (1.23) Assault victims Cross-sectional correlation USARachman et al. (2012) 159 20.36 (1.63)
20.63 (2.93)21.53 (4.95)22.75 (5.45)
Non-clinical 4 x randomised control trials Canada
Radomsky & Elliott (2009) 70 23.3 (4.77) Non-clinical Randomised control trial CanadaRadomsky et al. (in press) 491 36.13 (10.99)
43.81 (14.86)38.13 (14.45)22.45 (4.48)
Clinical (C-OCD and OCD), sub-clinical and non-clinical
Cross-sectional correlation Canada
Volz & Heyman (2007) 9 14.89 (1.96) Clinical (TO) Qualitative, case series UKWarnock-Parkes, Salkovskis & Rachman, (2012)
1 “in forties”(-) Clinical (C-OCD) Quasi-experiment (case study)
UK
OCD = Obsessive-compulsive disorder; C-OCD = Contamination-based obsessive-compulsive disorder; TO = Transformation Obsession ª Some studies have more than one group of participants and thus have reported more than one mean or standard deviation
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Conceptualisation and operationalization of mental contamination
Across the studies, operationalization of mental contamination has been
approached in two different ways. Some (N = 10) have approached it as a
phenomenon to be experimentally induced or evoked and have subsequently utilised
relevant scales (such as visual analogue scales or Likert scales) to measure it. These
have all used non-clinical or sub-clinical participant groups. Others (N = 3) have
operationalised mental contamination though the use of self-report measures that tap
a pre-existing propensity to this experience. These will be discussed further in the
below sections.
Of note, is that only one study (Coughtrey et al., 2012a) explored features of
mental contamination qualitatively. This study used the Mental Contamination
Interview (MCI) developed by Rachman (2006), with a sample of twenty individuals
with contamination-based obsessive-compulsive disorder (C-OCD). Using thematic
analysis, the study uncovered seven features common to the experience of mental
contamination; contamination without physical contact, multiple sources (e.g.
memories, unwanted/repugnant thoughts, dreams), human sources (i.e. a dirty,
dangerous, unpleasant or harmful person including the self), sense of internal
dirtiness, emotional distress, urge to wash, neutralise and avoid, generalisation and
spreading.
Experimental induction
A table showing studies experimentally inducing mental contamination can
be seen in Table 2. One of the most common induction methods are adapted versions
of the ‘dirty kiss’ experiment, first used by Fairbrother, Newth and Rachman (2005).
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Originally used to demonstrate that mental contamination can be induced without
physical contact, this study asked participants to imagine receiving a consensual or
non-consensual kiss, and found that the non-consensual group experienced higher
levels of internal and external dirty feelings, urges to wash and negative emotion.
This experiment has since been adapted to explore differences between dirty and
clean perpetrators (Elliott & Radomsky, 2012), moral and immoral circumstances
(Elliott & Radomsky, 2009), and how these dirtiness feelings respond to washing
(Ishikawa, Kobori, Komuro & Shimizu, 2014). Collectively, these studies suggest
that feelings of mental contamination are at their height when an imagined kiss is
forced or non-consensual, the perpetrator perceived as physically dirty, or immoral,
and that mental contamination decays over time with or without washing. Despite
offering very valuable information regarding the circumstances necessary to induce
mental contamination, all of these studies used only female participants and thus
these findings cannot be generalised to males. One study that did use males adapted
the ‘dirty-kiss’ paradigm so that participants imagined themselves as perpetrator of
the kiss rather than the victim (Rachman, Radomsky, Elliott & Zysk, 2012).
Importantly, this study found that perpetrators of an immoral act also experience
feelings of mental contamination (and more so when elements of betrayal and social
repercussion are added). However, since they were placed in the ‘perpetrator’ role,
these findings do not offer any information on the male victim experience, or the
female perpetrator experience. In order for all of these important findings to be
generalizable, this gender bias needs to be addressed in future research. Further, all
of these studies using the dirty kiss paradigm have relied on participant’s ability to
imagine given scenarios, which seems relatively uncontrolled. The ethical
implications of setting up a real life non-consensual kiss obviously mean this is
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highly unlikely to be addressed, however future research might consider use of a
video-tape, or perhaps recruiting participants that have direct experience of this.
Other experimental procedures have also been established to induce mental
contamination in non-clinical samples. Lee et al. (2013) developed a scenario in
which individuals were asked to move a bucket of vomit (imagined and actual), and
successfully induced feelings of internal dirtiness, disgust, anxiety and urge to wash
across all participants. Importantly, this study found no significant group differences
between imagined and actual contact conditions in measures of feelings of
contamination (except for urge to wash, which was greater in the contact condition).
Although this study did recruit male participants, a high proportion (83.3%) of this
study’s participants were female. Also, alike the dirty-kiss paradigm, this study relied
on participants’ ability to imagine in the imagined contact condition. Experimental
procedures whereby participants are both subject to objectifying comments, and
asked to recall experiences of receiving them have also been shown to induce
feelings of contamination (Chen, Teng & Zhang, 2013), as well as sinful feelings.
Some studies have stressed the idiosyncratic nature of mental contamination,
and have made attempts to induce it in individualised ways (Coughtrey, Shafran &
Rachman, 2014a; Coughtrey, Shafran & Rachman 2014b). These studies have asked
participants to perform five different tasks ([1] recall a time when they had felt
humiliated, ashamed, betrayed, received bad news or had been harmed in some way,
[2] recall a time they had violated a moral standard or caused harm to someone, [3]
bring to mind an unacceptable, unpleasant or unwanted thought, image or impulse,
[4] imagine wearing a jumper belonging to an immoral person, and [5] imagine
wearing a hat belonging to an alcoholic), and measured feelings of contamination
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using visual analogue scales (VAS) after each. The studies have then utilised the
‘most inducing’ task for each individual for exploration of the experience of mental
contamination. Coughtrey, Shafran and Rachman, (2014b) also found large effect
sizes on indices of mental contamination when they asked individuals to recall
personal memories associated with negatively-weighted emotional cue words (i.e.
disgust, humiliate, shame, violated, degraded, dirty, betrayed, contaminated, impure,
immoral). However, since these studies have used different methods for different
participants, it is possible that these studies may have explored different forms or
experiences of mental contamination.
Only one study explored the induction of mental contamination in a sub-
clinical sample. Fairbrother and Rachman (2004), the first study to experimentally
investigate mental contamination, used victims of sexual assault already reporting
mental contamination and found feelings of dirtiness and urge to wash increased
when asking them to recall the most distressing memory of their assault. This
procedure might be likened to the process of re-living or re-experiencing trauma in
those with PTSD. This study focused on those experiencing mental contamination
following assault, however did not look into those who experience sexual assault
without subsequent mental contamination. It may have been useful to also include
this group in the study in order to draw conclusions or hypotheses about what makes
the difference between these groups, i.e. what causes one person to experience
mental contamination following sexual assault, but not another?
Some of the above studies have used the induction of mental contamination
to go on and explore its nature and features. Coughtrey, Shafran and Rachman
(2014a) looked into the spread of mental contamination to objects (specifically,
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pencils). Following the induction procedure (five short tasks, as outlined above),
participants were asked to transfer contamination onto an uncontaminated pencil
through associating it with memories, thoughts and images from the induction task.
They were then asked to transfer this contamination to a further 12 pencils through
either touching them to one another (contact condition) or without touching (mental
condition). The study found medium effect sizes for the spread of contamination
without physical contact, although these effect sizes were not as strong as when the
objects were physically touched. Although this provides interesting information on
the nature of the spread of mental contamination, this method relied on participants
being asked to imagine the contamination spreading, which is not necessarily
ecologically valid. Thus it remains unclear whether this contamination would have
spread in a similar way if participants were simply left in a room with the objects, for
example. Studies have also looked at the re-evocation and degradation of mental
contamination (Coughtrey, Shafran, & Rachman 2014b; Ishikawa et al., 2014).
Coughtrey, Shafran and Rachman (2014b) looked at mental contamination levels
when left alone for 20 minutes, compared to when it is repeatedly re-evoked through
induction methods and followed with washing. The study found large effect sizes in
differences between groups such that mental contamination levels spontaneously
decreased significantly when left alone, but when re-evoked and followed by
washing, mental contamination appeared to persist. However, this study could not
conclude whether the persistence of mental contamination was due to repeated re-
evocation or washing since the two were not clearly separated. Future research might
consider separating the roles of re-evocation and washing to determine the individual
roles played by each. Ishikawa et al., (2014) aimed to investigate the impact of
washing following the induction of mental contamination, and found that feelings of
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being contaminated degraded irrespective of washing. This might suggest in the
previous study by Coughtrey, Shafran and Rachman (2014b), the persistence of
mental contamination may have been due to the re-evocation rather than the
subsequent washing behaviour.
Self-report measures
Some studies (N = 3) have approached the operationalization of mental
contamination using self-report measures, as well as exploring psychometric
properties of these measures. These studies have used a mixture of clinical (i.e. with
a diagnosis of OCD or contamination-related-OCD [C-OCD]) and non-clinical
populations, and have collectively explored the Mental Contamination Imagery
Questionnaire (MCIQ; Coughtrey, Shafran & Rachman, 2013b), the Mental
Pollution Questionnaire, (MPQ; Cougle et al., 2008), the Vancouver Obsessional
Compulsive Inventory-Mental Contamination Scale, the Contamination Sensitivity
Scale, and the Contamination Thought-Action Fusion Scale (VOCI-MCC, CSS, and
CTA; Radomsky, Rachman, Shafran, Coughtrey, & Barber, in press). An overview
of these studies can be seen in Table 3.
In their study comparing imagery associated with mental contamination in C-
OCD and non-clinical samples, Coughtrey, Shafran and Rachman (2013b) developed
the 20-item MCIQ. This measure includes items assessing vividness and ease of
dismissal of the image, urge to wash, imagery perspective and associated distress.
The study found large effect sizes in differences between groups on all these
domains, except urge to wash. Coughtrey, Shafran and Rachman, (2013b) found this
measure to be internally consistent in both clinical and non-clinical samples
(Cronbach’s alpha = .90 and .92, respectively), and found it to successfully
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discriminate between clinical and non-clinical samples in experience of
contaminated-based imagery. This study also found the MCIQ to correlate
moderately to highly with other measures of mental contamination (the highest of
which was with the VOCI-MC, r = .68, .73 for clinical and non-clinical samples,
respectively). This is positive in that it suggests the measure is measuring the same
concept, however if the correlation were higher it might suggest the measure were
too similar to the VOCI-MC. A drawback is that this paper provides no information
on how this measure was developed, how items were chosen, and is not clear in
whether this was the first time this measure was used. Also, no information has been
reported on this measure’s test-retest reliability or its validity and further research is
warranted.
A second self-report measure that has been explored in depth is the MPQ.
This was developed by Cougle et al., (2008), who aimed to develop and validate a
measure of mental contamination. It was originally developed with 11-items, but
only 8 showed distinctive factor loadings and were taken into the final measure.
Following factor analysis the MPQ items were found to load onto two subscales:
sense of dirtiness in response to internal stimuli such as thoughts, images or emotions
(ideation subscale), and washing behaviour in response to these internal stimuli
(washing subscale). According to Cougle et al. (2008), this measure and its subscales
were found to have excellent test-re-rest reliability (overall, r = .88), good
convergent validity with other measures, but not to correlate too strongly with other
measures such as the BDI-II.
Radomsky et al. (in press) simultaneously looked into three “new” measures
of mental contamination, the VOCI-MC, CSS and the CTAF with clinical (those
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diagnosed with OCD, and those with an anxiety-related clinical disorder) and non-
clinical samples. All measures were shown to have excellent internal reliability,
convergent, divergent and discriminant validity.
Across the literature on mental contamination included in this report, one of
the most widely used tools for operationalising mental contamination has been the
Mental Contamination Report (MCR), which to date has not been sufficiently
explored or validated as a reliable and valid measure. Future research should
consider looking into the validity of this as a measure.
From all of these studies on the operationalization of mental contamination, it
is apparent that feelings of mental contamination can be induced in non-clinical (but
majority female, populations). This is yet to be explored in OCD or clinical samples,
and there is a need for further research into male experiences. Further, many of these
studies experimentally inducing mental contamination rely on participants’ ability to
imagine, which may be relatively uncontrolled. Regarding self-report measures and
assessment of mental contamination, there is wide variation; however measures
explored to date show good validity and reliability.
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Table 2. Studies on the induction of mental contamination.
Study Measure of MC
Induction Findings Conclusions
Chen, Teng, & Zhang (2013)
Likert scales (internal dirtiness and cleansing urges)
Objectifying comments, recalling past experience of objectification
Objectification induced greater feelings of dirtiness (p < .01, η² = .27),
sinfulness (p = .02, ηp2
= .14), intention of purchasing cleansing
products (p = .02, ηp2
=.14) and feelings of contamination (p = .001, ηp2
= .17) in the experimental group than the control group.
MC induced and increased by sexual objectification, and perceived personal responsibility.
Coughtrey, Shafran, & Rachman (2014b)
VAS (general and internal dirtiness, cleansing urges and anxiety)
Personal memories associated with negative emotion words and ‘five tasks’ (see p. 11)
Recall of personal memories resulted in significant increases in general dirtiness (d = 1.07), internal dirtiness (d = 1.24), urge to wash (d = .79), and anxiety (d = 1.29).‘Five tasks’ resulted in significant increases in almost all indices of mental contamination, effect sizes ranged for different tasks (η² = .32 - .69). When left, MC decreased significantly more in; general dirtiness than re-evoke (d = 1.59) and washing conditions (d = .72), internal dirtiness than re-evoke (d = 1.07) and washing (d = .81), urge to wash than re-evoke, (d = 1.19) and washing (d = .69), and anxiety than re-evoke, (d = 1.49) and washing conditions (d = 1.29).
MC induced by memories associated with cue words, and by ‘five tasks’ method. If left, MC decays over time (20 minutes). Revoking with/without washing prevents decay.
Coughtrey, Shafran & Rachman (2014a).
VAS (anxiety, general and internal dirtiness, disgust and urge to wash).
One of ‘five different tasks’(see p. 11) and pencil task
Tasks successfully induced mental contamination (no statistics given).Contamination ratings of pencils significantly increased from baseline to initial rating in contact condition (d = 1.09), and the no contact condition (d = .71). Change in contamination significantly greater in contact condition (d = .41).
Contamination more readily spread in contact contamination, but can be spread in MC.
Elliott & Radomsky (2009).
MCR, BBQ Dirty kiss In non-consensual group, greater MC (p < 0.001, η² = 0.34), feelings of dirtiness (p < 0.001, η² = 0.26), and urges to wash (p < 0.001, η² = 0.32) than consensual group. Within consensual group, greater MC in immoral group (p < 0.026, η² = 0.04) than moral group.
MC induced by imagined kiss, higher MC if non-consensual, higher if man is described as immoral.
Elliott & Radomsky (2012).
MCR, BBQ Dirty kiss (physical dirtiness) Greater MC in non-consensual group, (p < .001, ηp
2 = .39), than
consensual. Greater MC in dirty perpetrator group, (p < .001, ηp2
= .37)
MC induced by imagined kiss, more so when non-consensual or with physically dirty man.
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than clean perpetrator. MCPD group showed greatest MC (p < .01, ηp2
=
.06), feelings of dirtiness (p < .001, ηp2
= .54), urge to wash (p < .001,
ηp2
= .37), negative internal emotions, (p < .001, ηp2
= .27) and external
negative emotions, (p < .001, ηp2
= .61). No significant differences in washing behaviour.
Fairbrother, Newth & Rachman (2005)
USES Dirty kiss NC group showed greater feelings of general dirtiness (p < 0.001), external dirtiness (p < 0.001), internal dirtiness (p < 0.001), dirty in non-physical terms (p < 0.001), upset (p < 0.001), anxious (p < 0.001), sad (p < 0.001), angry (p < 0.001), sleazy (p < 0.001), ashamed (p < 0.001), immoral (p < 0.001), and stronger urge to wash (p < 0.001) than consensual. 95% of neutralisation from NC group.
MC induced through NC kiss and associated with feelings of dirtiness, negative emotions and urges to wash.
Fairbrother & Rachman (2004)
MPI, SARA Hold in mind most distressing part of sexual assault memory
Following assault 70% reported strong urge to wash. These met average of 3.1/6 of mental pollution criteria, and scored higher on SARA-MC (p < 0.001), than 30% that did not report urge to wash. Following induction, anxiety, distress, dirtiness and urge to wash higher than pleasant memory, (p < 0.001). Those that washed (20.9%) showed greater urge to wash (p = 0.006) and MPI scores (p = 0.001).
Sexual assault victims experience mental pollution which can be further induced by memories of assault.
Ishikawa et al. (2014)
MCR Dirty kiss (washing vs. no washing)
All groups showed increased feelings of dirtiness (p < .001, ηp2
= .446),
urge to wash (p < .001, ηp2
= .452), internal negative emotions (p
< .001, ηp2
= .413) and external negative emotions (p < .001, ηp2
= .447). No difference between washing and no washing groups.
MC degrades over time, with or without washing.
Lee et al. (2013)
VAS (disgust, internal dirtiness, anxiety urge to wash)NBQ
Bucket of vomit (actual vs. imagined)
All groups showed greater disgust (p < 0.001, ηp2
= 0.66), internal
dirtiness (p = 0.01, ηp2
= 0.11), anxiety (p = 0.001, ηp2
= 0.17) and
greater urges to wash (p = 0.001, ηp2
= 0.164). No difference between
groups, but greater urge to wash in contact condition (p = 0.021, ηp2
=
MC can be induced in a non-clinical sample, through imagining something disgusting.
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0.09). Rachman et al. (2012).
Likert scales (dirtiness, urge to wash and negative emotions) washing observed
Dirty kiss (perpetrator)
With female narrator NC showed greatest feelings of anxiety (p = 0.004), disgust (p < 0.001) and dirtiness (p = 0.036). With male narrator and added social repercussions, NC showed greatest feelings of anxiety, (p = 0.026), disgust (p < 0.001), shame (p = 0.03), anger (p = 0.045), guilt (p = 0.012) and dirtiness (p = 0.028). When social repercussions increased, NC showed greater anxiety (p = 0.06), disgust (p < 0.001), shame (p = 0.002), anger (p =
0.006), guilt (p = 0.048) and sadness (p = 0.013), feelings of dirtiness (p < 0.001) and urges to wash (p < 0.001). When replicated in different
setting, NC showed greater anxiety (p = 0.03, ηp2
= .12), disgust, (p <
0.001, ηp2
= .44), shame (p < 0.001, ηp2
= .29), anger (p = 0.001, ηp2
= .26), guilt (p = 0.001, ηp2
= .25) and sadness (p < 0.01, ηp2
= .20), feelings of dirtiness (p < 0.001) and urge to wash, (p = 0.007).
MC can be induced in perpetrators of an immoral act. These feelings are increased when elements of betrayal and negative social repercussions are added.
MC = Mental contamination; VAS = Visual Analogue Scales; VOCI-MC = Vancouver Obsessional Compulsive Inventory – Mental Contamination subscale; MCIQ = Mental Contamination Imagery Questionnaire; C-OCD = Contamination-based Obsessive-Compulsive Disorder; MCI = Mental Contamination Interview; MCR = Mental Contamination Report; NBQ = Neutralising Behaviour Questionnaire; BBQ = Break Behaviour Questionnaire; NC = non-consensual; PD = physically dirty; PC = physically clean; USES = Unwanted Sexual Experiences Survey, assesses mental pollution, general distress, avoidance, and urge to wash; MPI = Mental Pollution Interview; SARA = Sexual Assault and Rape Appraisals; MPQ = Mental Pollution Questionnaire; SARA=Sexual assault and Rape Appraisals; PTS = Post-traumatic stress
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Table 3. Studies assessing properties of self-report mental contamination questionnaires
Study Measure Participants Statistical findingsCoughtrey, Shafran, & Rachman (2013b)
MCIQ Non-clinical and clinical
Correlations with VOCI-MC: Clinical, r = .68*, non-clinical, r = .73*; OCI-R (washing): non-clinical, r = .48, p = 0.001; OCI-R (obsessions): clinical, r = .53*, non-clinical r = .44, p=0.002; TAF clinical: r = .47, p = 0.001; BDI-II: clinical, r = .53*. BDI-II partialled out; VOCI-MC r = .56*, TAF r = .45, p=0.002. α = .9 clinical; α = .92 non clinical.
Cougle, et al. (2008)
MPQ Non-clinical Overall α = .86. WR subscale (32.7% of variance, α = .86), IC (29.5% variance, α = .85). Item-total correlations r = .56-.69 (adequate item validity). Confirmatory factor analysis: good fit of two-factor model: χ² (N = 257) = 46.30**; GFI = .95; AGFI =.91; CFI =.98; TLI = .96; RMSEA = .08. Test– retest reliability: Overall, r = .88***; subscales washing: r = .90***; ideation: r = .82***. Convergent/divergent validity: MPQ-I with VOCI(obsess) r = .44** VOCI(contamination) r = .36**, TAF subscales r = .33 - .37**, RAS r = .48**, GI-trait r = .56*. MPQ-W with VOCI(obsess) r = .46**, VOCI(contam) r = .51**, TAF subscales r = .25-.5**, RAS r = .36**.
Radomsky et al. (in press)
VOCI-MC, CSS, CTAF
Clinical, sub-clinical and non-clinical
VOCI α = .93 - .97; CSS α = .90 - .94; CTAF α = .93 - .96. Convergent validity: VOCI-MC-CSS, r = .61 - .87*, VOCI-MC-CTAF, r = .34-.45*, CSS-CTAF, r = .58* (only sig. in non-clinical sample). Divergent validity: VOCI-MC with VOCI-C r = .61 - .7*, BDI-II, DS, ASI not all significant. CSS with VOCI-C, r =.67 - .75*, BDI, DS, ASI not all significant. CTAF with VOCI-C, BDI, DS, ASI not all significant. Discriminant validity: VOCI-MC and CSS successfully discriminated between those with contamination related concerns and those without. CTAF only discriminated between clinical and non-clinical.
MCIQ = Mental Contamination Imagery Questionnaire; MPQ = Mental Pollution Questionnaire; VOCI-MC = Vancouver Obsessional Compulsive Inventory-Mental Contamination Scale; CSS = Contamination Sensitivity Scale; CTAF = Contamination Thought-Action-Fusion Scale; OCI-R = Obsessive Compulsive Inventory-Short Version; TAF = Thought Action Fusion Scale; BDI-II = Beck Depression Inventory; RAS = Responsibility Attitudes Scale; GI-trait = Guilt Inventory-Trait subscale; DS = Disgust Scale; ASI = Anxiety Sensitivity Inventory*p<0.001 **p<0.01 ***p <0.0001
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Predictors of mental contamination
Several studies (N = 11) have explored variables that correlate with mental
contamination, some following an experimental procedure as outlined above (N = 4),
but some in a purely cross-sectional correlational, non-experimental manner (N = 7).
These studies have used standardised measures of mental contamination, the
characteristics and properties of which have been covered in the previous section of
this review. An overview of these studies and measures used and can be seen in
Table 4. Correlations extracted from these studies can be seen in Table 5. Possible
emerging predictors will be discussed in the text below.
Regarding current co-existing difficulties found to correlate with levels of
mental contamination, measures of clinical symptomatology (OCD, PTSD
symptomatology) have shown some of the highest correlations. However, effect sizes
for correlations between mental contamination and obsessive compulsiveness (r
= .27- .7), and PTS symptoms (r = .34 - .66), are variable (possible reasons for this
are discussed below). In their study with female victims of sexual assault, Badour et
al. (2013b) found in those with a history of sexual assault, post-traumatic stress
symptoms significantly predicted feelings of dirtiness (β = .82, p < .001, sr² = .32)
and urge to wash (β = .85, p < .001, sr² = .26). Although this suggests that post-
traumatic stress symptoms are likely linked to the experience of mental
contamination, because this study was cross-sectional, the direction or causality in
this relationship cannot be inferred. In addition, this study used only female
participants, so this relationship may not be generalizable to males.
As can be seen in Table 5, other variables shown to correlate with mental
contamination include; depressive symptoms, disgust proneness and cognitive biases
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such as proneness to thought- action-fusion and responsibility appraisals. Again
variability in effect sizes is evident.
Some variables correlate with mental contamination in a more consistent
manner, such as anxiety (r = .25 - .29) and neuroticism (r = .22 - .39). In their study
on the role of post-event appraisals in the development of mental contamination,
Elliott and Radomsky (2013) found anxiety (B = 0.98, SE = 0.45, β = .35, t = 2.15, p
= .04) and disgust sensitivity (B = 2.04, SE = 0.96, β = .35, t = 2.12, p = .04) to be
significant predictors of urge to wash. Additionally, contamination fears (B = 1.02,
SE = 0.57, β = .24, t = 1.80, p = .08) predicted internal negative emotions associated
with mental contamination. However, this study used female participants only and
the ‘dirty kiss’ paradigm and thus relied on participants’ imagination.
Berman, Wheaton, Fabricant and Abramowitz (2012) found modest
correlations between scores on the Mental Pollution Questionnaire (MPQ) and
extrinsic or external motivation for religion (r = .13 - .31). Extrinsic motivation
refers to individuals assessing the importance of religion based on its social rewards,
such as ‘fitting in’ socially (Berman et al., 2012). This external or social motivation
for religion also emerged as a significant predictor of scores on the washing subscale
of the MPQ (β = .33, t = 4.88, p < .001).
Additionally, Berman et al. (2012) found several historical factors or
experiences correlated with MPQ scores. They found modest to large correlations
between past childhood trauma and mental contamination scores, but with quite a
large effect size range (r = .13 - .49). However, when the MPQ subscales (washing
and ideation) were assessed, more consistent, moderate correlations were found
between childhood abuse (sexual and physical abuse, and physical neglect, r = .46
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- .49) and the washing subscale, with sexual abuse emerging as a significant
predictor, (β = .25, t = 3.31, p < .001) of reported washing behaviours. Emotional
abuse also emerged as a significant predictor of the ideation subscale (β = .28, t =
2.36, p < .001). This study also found modest to moderate correlations (r = .16 - .43)
with parental guilt induction strategies, the highest correlate being parental use of
disparagement, which was found to be a significant predictor of reported washing
behaviours/urges, (β = .47, t = 4.42 p < .001). However, one drawback of this study
is that it used only participants affiliated with religious groups, and thus may not be
generalizable to other groups.
Several other variables have been explored but thus far have been found not
to correlate with measures of mental contamination. These include; religiosity
(Berman et al., 2012), personal significance (this refers to the importance an
individual places on intrusive thoughts and images, Coughtrey et al., 2012b), sexual
attitudes and previous experience of unwanted sexual acts (Herba & Rachman,
2007), and fear of negative evaluation (Elliott & Radomsky, 2013).
An issue with this area of research is the variation in measures used, not only
for mental contamination but also for other variables. For example, disgust has been
measured with three different scales, the Disgust Scale (Radomsky & Elliott, 2009),
the Disgust Sensitivity Scale (Herba & Rachman, 2007), and the Disgust Propensity
Questionnaire (Carraresi et al., 2013). This might mean that variations in the degree
to which they correlate or predict mental contamination might be down to the
variations in measure used. Also, despite several emerging measures of mental
contamination becoming more popular (most commonly the MCR, MPQ, VOCI-
MC), there still remains variation in scales and indices used. These measures
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conceptualise mental contamination in slightly different ways. The MCR assesses
levels of mental contamination using four subscales; feelings of dirtiness, urge to
wash, external negative emotion, and internal negative emotion (Elliott & Radomsky,
2013). The MPQ assesses internal feelings of dirtiness and urges to wash (Cougle et
al., 2008; Berman et al., 2012) and studies using the VOCI-MC have not specified
which areas of mental contamination are specifically assessed by this measure.
Consequently it remains possible that these measures are not all measuring and
capturing the same experiences, and thus correlations will inevitability show
variability. Several studies (Olatunji et al., 2008; Fairbrother & Rachman, 2004) have
amalgamated several measures to tap mental contamination, and consequently it is
impossible to tease apart which measures of mental contamination are better
correlated with other variables (it is for this reason that these studies have not been
included in Table 5).
Another major drawback of this methodology is that one cannot infer
causality from these correlations. It cannot be appropriately concluded that these
highly correlated variables lead to mental contamination, nor that mental
contamination leads to the variables. Future research would ideally look into large
scale longitudinal methodologies to explore vulnerability factors for later
development of mental contamination.
Finally, only one of these studies used a clinical sample of individuals
diagnosed with OCD (Carraresi et al., 2013). Consequently, many of these correlates
and associated factors cannot appropriately be generalised to a clinical population.
Future research should consider vulnerability factors associated with mental
contamination in OCD, and other relevant clinical samples such as PTSD. Perhaps
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this should also be considered in individuals with specific phobia due to the potential
overlap in reported experiences of disgust. This will be discussed further in the
discussion section.
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Table 4. Studies looking at correlates/predictors of mental contamination
Study MC measure Variables Measures Badour et al. (2013a) SARA-MC Disgust sensitivity, post-traumatic stress symptoms DPSS-R, CAPS
Badour et al. (2013b) MCR Assault characteristics, post-traumatic stress symptoms, obsessive compulsiveness, disgust, anxiety
AIHI, CAPS, OCI-R, VAS
Berman et al. (2012) MPQ Religiosity, motivation for religion (intrinsic/extrinsic), parental guilt induction, childhood trauma
SCRFS, I/E-R, MGI, CTQ-SF
Carraresi et al. (2013) VOCI-MC Disgust propensity, obsessive compulsiveness, anxiety and depression DPQ, DOCS, BAI, BDI-II
Coughtrey et al. (2012b) VOCI-MC Obsessive compulsiveness, thought-action-fusion, sensitivity to contamination, anxiety, depression, personal significance
OCI-R, TAF, TAF-CTN, S-CTN, BAI, BDI, PSS
Cougle et al. (2008) MPQ Depression, anxiety, responsibility attitudes, thought action fusion, obsessive compulsiveness
BDI-II, STAI-T, RAS, TAF, VOCI
Elliott & Radomsky (2013) MCR Anxiety sensitivity, disgust, fear of negative evaluation, neuroticism, contact contamination fears, responsibility
ASI, DS, FNEB, BFI-N, VOCI-CTN, MCRª
Fairbrother & Rachman (2004) MPI, SARA Post-traumatic stress symptoms CAPS, PSSRHerba & Rachman (2007) MCR Contamination fears, disgust sensitivity, anxiety, fear of negative evaluation, sexual
attitudes, previous experience of unwanted sexual actsVOCI-CTN, DSS, ASI, FNEB, DSFI, MCRª
Olatunji et al. (2008) MPQ, SARA-MC
Post-traumatic stress symptoms and cognitions, sexual victimisation experiences, anxiety and depression
PPTS-R, PTCI, SES, BAI, BDI-II
Radomsky & Elliott (2009) MCR Anxiety, disgust sensitivity, fear of negative evaluation, neuroticism, contamination fears, responsibility
ASI, DS, FNEB, BFI-N, VOCI-CTN, MCRª
SARA-MC = Sexual Assault and Rape Appraisals - Mental Contamination; MCR = Mental Contamination Report; MPQ = Mental Pollution Questionnaire; VOCI-MC = Vancouver Obsessional Compulsive Inventory-Mental Contamination subscale; DPSS-R = Disgust propensity sensitivity scale-revised; CAPS = Clinician administered PTSD scale; AIHI = Assault information and history interview; OCI-R = Obsessive Compulsive Inventory-Short Version; VAS = Visual Analogue Scales; SCRFS = Santa Clara Religious Faith Scale; I/E-R = Intrinsic/Extrinsic-Revised; MGI = Maladaptive Guilt Induction Measure; CTQ-SF = Childhood Trauma Questionnaire-Short Form; DPQ = Disgust Propensity Questionnaire; DOCS = Dimensional Obsessive-Compulsive Scale; BAI = Beck Anxiety Inventory; BDI-II = Beck Depression Inventory; TAF = Thought-Action Fusion Scale; TAF-CTN = Thought-Action Fusion Scale – Mental Contamination scale; S-CTN = Sensitivity to contamination scale; PSS = Personal Significance Scale; STAI-T = State-Trait Anxiety Inventory-Trait version; RAS = Responsibility attitudes scale; ASI = Anxiety
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sensitivity Index; DS = Disgust Scale; FNEB = Fear of negative evaluation-brief version; BFI-N = Big Five Inventory-Neuroticism; DSFI = The Sexual Attitudes subscale of the Derogatis Sexual Functioning Inventory; PPTS-R = Perdue Posttraumatic Stress Disorder Scale – Revised; PTCI = Posttraumatic Cognitions Inventory; SES = Sexual Experiences Survey – Modified; VOCI-CTN = Vancouver Obsessional Compulsive Inventory-Contamination subscale. ªMCR includes a measure of responsibility and previous unwanted sexual acts
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Table 5. Correlations extracted from studiesª
MCRb MPQ VOCI-MC SARA-MC RangeContamination fears
No of studiesNo of sig. correlationsEffect size range (r)
28, p < 0.05
.25-.36
12, p < 0.01
.36-.51
11, p < 0.001
.56
-
.25-.56Disgust sensitivity
No of studiesNo of sig. correlationsEffect size range (r)
47, p < 0.05
.23-.43
- 11, p < 0.01
.29
11, p < 0.01
.43 .23-43Neuroticism
No of studiesNo of sig. correlationsEffect size range (r)
12, p < 0.05
.22-.39
- - -
.22-.39Anxiety
No of studiesNo of sig. correlationsEffect size rang (r)
45, p < 0.05
.25-.29
1None
2None
-
.25-.29PTSD symptoms
No of studiesNo of sig. correlationsEffect size range (r)
12, p < 0.05
.34-.39
- - 11, p < 0.001
.66 .34-.66Post-event responsibility
appraisalNo of studiesNo of sig. correlationsEffect size range (r)
217, p <0.05
.25-.55
- - -
.25-.55Ext mot. for religion
No of studiesNo of sig. correlationsEffect size range (r)
- 12, p < 0.05
.13-.31
- -
.13-.31Parental guilt
No of studiesNo of sig. correlationsEffect size range (r)
- 14, p < 0.05
.16-.43
- -
.16-.43Childhood trauma
No of studiesNo of sig. correlationsEffect size range (r)
- 19, p < 0.05
.13-.49
- -
.13-.49Responsibility attitudes
No of studiesNo of sig. correlationsEffect size range (r)
- 12, p < 0.01
.36-.48
- -
.36-.48Obsessive CompulsivenessNo of studiesNo of sig. correlationsEffect size range (r)
1None
14, p < 0.01
.36-.51
29, p < 0.001
.26-.7
-
.26-.7Thought-action-fusion
No of studiesNo of sig. correlationsEffect size range (r)
- 16, p < 0.01
.25-.5
13, p < 0.001
.26-.36
-
.25-.5Depression
No of studiesNo of sig. correlationsEffect size range (r)
- 12, p < 0.05
.17-.4
21, p < 0.001
.47
-
.17-.47MCR = Mental Contamination Report; MPQ = Mental Pollution Questionnaire; VOCI-MC = Vancouver Obsessional Compulsive Inventory – Mental Contamination Scale; SARA-MC = Sexual
146
Assault and Rape Appraisals - Mental Contamination subscale; - : Represents where no studies have correlated the measure with variable; ª Olatunji et al. (2008) and Fairbrother & Rachman (2004) correlations have not been included in this table as these studies have used combined measures of mental contamination; bAll subscales of MCR included.
Response to treatment
Following treatment of fear of contamination, it appears to have a proneness
to return (Rachman, 2006). Moreover according to Rachman (2004), “too high a
proportion [of those with contamination fears] decline treatment” (p. 1228). Thus, it
is clear that treatment of contamination fears is still something requiring further
investigation and development. Since much of the therapeutic work in OCD and fear
of contamination might emphasise contact contamination, it is possible mental
contamination may have been missed or overlooked.
Some studies have looked into treatment and interventions for mental
contamination (N = 4). An overview of these studies and their findings can be seen in
Table 6. All of these studies have aimed to treat those diagnosed with OCD or PTSD
(as a result of childhood-sexual abuse) but whose main difficulty is fear of being
contaminated. One study (Volz & Heyman, 2007) used a CBT approach with
adolescent participants whose main difficulty was transformation obsessions. This
refers to the distressing intrusion and fear of turning into someone or something else
undesirable, just by being in close proximity. This study did not report any scores or
significance tests on the outcome of their study/findings, but was instead a series of
case descriptions and intervention details. Authors concluded that normalisation and
psychoeducation alongside anxiety management and changing ritualistic behaviours
associated with the transformation obsession were effective in reducing the obsession
strength and distress.
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All studies appear to have used a cognitive-behavioural approach, and some
have adapted this to specifically target and focus on contamination fears. In their
case-study of 12 individuals diagnosed with OCD, Coughtrey, Shafran, Lee and
Rachman, (2013) concluded that mental contamination is responsive to CBT
treatment based on contact contamination treatment, but tailored to mental
contamination. Participants in their study showed significant reductions in all
measures of OCD and mental contamination symptoms with moderate to large effect
sizes (see Table 6). The study also acknowledged clinically significant change and
reported that seven of the twelve participants no longer met criteria for clinical OCD.
However, this study potentially has limited applicability since treatment was
delivered by two highly specialised and experienced OCD therapists, and may not
produce the same results if delivered by a therapist whom was perhaps recently
qualified or deemed not as highly experienced or specialised. Of note is that this
study appears to be the only study on the treatment of mental contamination that
reports statistical effect sizes.
Cognitive behavioural therapy (CBT) has also been adapted and developed as
‘cognitive restructuring and image modification’ (CRIM; Jung & Steil, 2012) with
individuals who have suffered childhood sexual abuse reporting ongoing fears of
contamination relating to their childhood experience. Cognitive restructuring
involves addressing and adapting appraisals related to the fear of contamination and
image modification aims to modify “stored associations contributing to affective
reactions” and is related to intrusive imagery (Jung & Steil, 2012). This study was a
case report using two individuals, so did not report any statistical change levels,
however provided very in depth information on treatment. Authors concluded that
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the intervention resulted in a reduction in feelings of contamination and in PTSD
symptoms.
Warnock-Parkes, Salkovskis and Rachman, (2012) also used a case report
approach with one male individual diagnosed with OCD whose main concern was
contamination fears. Researchers began delivering Cognitive Behavioural Therapy,
however when this was deemed unhelpful, cognitive therapy focused on mental
contamination (CTMC) was delivered. Overall, decreasing scores on measures used
(see Table 6) meant this study concluded treatment was successful, however scores
showed some increases at 6 month follow up compared to immediately post-
treatment. Since no further follow-up was included in this study, it is uncertain
whether the patient’s scores continued to rise. In addition, because this participant
received six weeks of standard CBT prior to adapted cognitive therapy for
contamination, it cannot be appropriately concluded that these effects were purely
down to the adapted cognitive therapy. Aside from the lack of significance tests on
these outcomes, a further issue with this study is treatment was delivered by a highly
specialised OCD therapist. This treatment may not be effectively implemented by
therapists that are not considered as experienced and specialist.
An initial concern with these studies is that only one reports statistical
findings. Consequently it is difficult to establish whether the treatment has made a
significant difference in most cases. An additional concern, but understandably
difficult, is that the sample sizes across these studies are relatively small. However,
difficulties in recruiting clinical samples with specific clinical difficulties is a
widespread difficulty, not limited to this cluster of symptoms or topic area, and
several of these studies have used available information to approach the outcome in a
149
case study-like manner. Also, across studies there is variation in whether individuals
are taking prescribed medication alongside psychological intervention and therefore
this appears relatively uncontrolled.
Overall these findings highlight the potential need for adapted treatment for
mental contamination, and the need to recognise/assess specifically for mental
contamination. Given the high therapy drop-out and relapse rate in OCD, further
research in this area is necessary to continue development of effective assessment
and treatment strategies in this clinical group.
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Table 6. Studies assessing treatment of mental contamination.
Study Participants Treatment Outcome post-treatment (and follow up)
Coughtrey et al. (2013)
12 (OCD) CBT, 10 – 20 sessions of 50 minutes
YBOCS (d = 1.55), OCI-R (d = 1.84), VOCI-MC (d = 1.42), TAF (d = 2.24), BDI (d = 0.79), BAI (d = 0.6) all improved. Maintained at 3 and 6 month follow up.
Jung & Steil (2012).
2 (PTSD and FBC)
CRIM, 2 sessions of 90 and 50 minutes
PDS, CAPS and VAS (intensity, uncontrollability, vividness, distress) all decreased. Case 1. PDS; t(0): 33, t(1): 28; t(2) 15. CAPS t(0): 75; t(2) 59.Case 2. PDS; t(0): 24, t(1): 20; t(2) 15. CAPS t(0): 49; t(2) 31.
Volz & Heyman (2007)
9 (OCD and TO)
CBT with/without medication
“All of the cases described made significant clinical and functional improvements”
Warnock-Parkes, Salkovskis, & Rachman, (2012)
1 OCD – contamination based problem
CBT and CTMC, 13 sessions of 60 or 120 minutes
Pre, post, 6 month follow-up scores: YBOCS (34, 7, 8), OCI-R (47, 32, 38), PHQ-9 (16, 10, 17), GAD-7 (16, 5, 10), WSAS, (35, 16, 20).VOCI-MC (38, 29 mid and post only)
CBT = Cognitive Behavioural Therapy; YBOCS = Yale-Brown Obsessive-Compulsive Scale; OCI-R = Obsessive Compulsive Inventory-Short Version, VOCI-MC = Vancouver Obsessive Compulsive Inventory-Mental Contamination Scale; TAF = Thought-Action Fusion Scale; BDI-II = Beck Depression Inventory; BAI = Beck Anxiety Inventory; PTSD = Post-Traumatic Stress Disorder; FBC = Feeling of being contaminated; CRIM = Cognitive Restructuring and Image Modification; PDS = Post-Traumatic Diagnostic Scale; CAPS = Clinician Administered PTSD Scale; VAS = Visual Analogue Scales; TO = Transformation Obsessions; CTMC = Cognitive Therapy focused on Mental Contamination; PHQ-9 = Patient Health Questionnaire-9; GAD-7 = Generalised Anxiety Disorder-7 Item; WSAS = Work and Social Adjustment Scale.
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Discussion
This review aimed to systematically locate and synthesise existing literature
and findings on mental contamination. In February 2014, three online databases were
searched using carefully selected search terms. After application of exclusion criteria
and screening several returns, the search yielded 27 articles eligible for this review.
Across the studies, a range of participant types and methodologies were utilised, and
took place in a range of countries.
Generally, studies have been relatively consistent in their findings. They
provide evidence that mental contamination can be induced in non-clinical
populations in a variety of ways including recalling negatively-weighted personal
memories (Coughtrey, Shafran, & Rachman, 2014b), being victim to a moral code
break as in the ‘dirty kiss’ paradigm or following objectifying comments
(Fairbrother, Newth & Rachman, 2005; Elliott & Radomsky, 2009). There is also
evidence that mental contamination is alike in its nature to more traditional
understandings of contact contamination in the nature of its spread and decay
(Coughtrey, Shafran & Rachman 2014a; 2014b). Studies exploring correlates of
mental contamination have found it to be positively and significantly related to post-
traumatic stress symptoms following sexual assault (Badour et al., 2013b) general
contamination fears, obsessive compulsiveness, anxiety and disgust (Elliott &
Radomsky, 2013). Regarding measures used for mental contamination, across studies
there is great variation in how authors have measured it. Experimental studies often
use subjective indices such as visual analogue scales or Likert scales which measure
different dimensions of mental contamination; typically feelings of dirtiness (internal
and external), urge to wash and anxiety. To date, these have no evidence for their
152
validity or reliability, and whether they are sufficient to tap mental contamination
remains questionable. Other studies have conceptualised mental contamination using
more structured psychometric scales some of which have been explored and found to
be promising in terms of internal consistency and correlations with other relevant
measures. Despite this, some studies have used other measures that are yet to
demonstrate their reliability and validity, and thus these findings might be
approached with caution.
Further, studies looking at treatment outcome, although small in number and
participants, have suggested that CBT and adapted forms specifically for mental
contamination are efficacious in the treatment of mental contamination, and show
promising findings (Coughtrey et al., 2013; Warnock-Parkes, Salkovskis, &
Rachman, 2012).
Overall, the study of mental contamination is still relatively new, and as such
there are still many gaps in research and understanding. Currently, much of the
findings on the induction and nature of mental contamination have used female
participants and for these findings to be generalizable, many of these experiments
ought to be replicated with males. In particular studies using the ‘dirty kiss’
paradigm have demonstrated a clear gender bias for females to be placed in the
victim role and males in the perpetrator role.
There appear to be limited studies on the induction and nature of mental
contamination in clinical samples, such as those diagnosed with OCD or PTSD.
Further, given that mental contamination has been shown to be linked to feelings of
disgust, it might be interesting to look into other groups that demonstrate similar
emotional reactions, such as phobias. Some simple phobias have been linked with
153
disgust propensity and theoretically it is possible that this group also experience a
higher propensity to mental contamination. This is yet to be explored and may prove
an interesting avenue for future research. Furthermore, if this is found to be true, it
might stand that mental contamination is more a transdiagnostic experience across
anxiety disorders associated with higher levels of disgust propensity than the general
population.
Across studies on correlates and predictors of mental contamination, a range
of participant types (clinical, sub-clinical, and non-clinical) have been recruited
which is promising in terms of generalisation of findings. However, despite a
considerable amount of research in this area, all of these studies have used cross-
sectional designs, sometimes following an initial experimental induction procedure.
This limits the authors’ ability to make any statements about causality, and
subsequently one can only conclude that these experiences are related in some way.
For example, studies that have found significant predictors of mental contamination
to be PTSD symptoms (following sexual assault), anxiety and disgust sensitivity, still
do not further our understanding about the causality or root of mental contamination.
These factors may well be vulnerability factors, but might also arise from a
propensity to feel contaminated. One study did explore experiences of childhood
abuse/trauma, which logically might be a precursor; however this study relied on
adult accounts of this which might be influenced by current relationships or mood.
Future research should consider the use of longitudinal large-scale study designs in
order to gain an understanding about the cause and development of vulnerability to
experiencing mental contamination.
154
Studies have begun looking into the treatment of mental contamination and
have focused on cognitive behavioural approaches (Coughtrey et al., 2013; Jung &
Steil, 2012; Volz & Heyman 2007; Warnock-Parkes, Salkovskis, & Rachman, 2012).
However, there is a lack of significant statistics and effect sizes reported in this area
and it remains important for future research to continue exploring treatment for
mental contamination, particularly in larger sample sizes in order for significant
effects to be found. As discussed above, therapy drop-out and relapse rates in OCD
remain high in comparison to other clinical disorders and since mental contamination
has been reported by this clinical group, treatment of this difficulty may prove
critical. In addition, these studies have commonly delivered treatment by a highly
specialised experienced OCD therapist, which may in some part contribute to very
high effect sizes. Perhaps if these studies were replicated in research using newly
qualified clinical psychologists, or psychologists whom were not deemed extremely
specialist, smaller effect sizes or significance might be found.
Finally, the majority of research into mental contamination has been
conducted in western countries (majority in USA or UK) and there is a need for
studies to be replicated or developed in eastern countries and cultures in order to
conclude that these experiences and effects are generalizable across human
populations. There is potential for differing ideas across cultures on what is
polluting, both physically and morally and it would be useful to gain an
understanding of how this would impact upon different cultures’ experiences of
feeling contaminated.
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Appendix
Appendix 1. Clinical Psychology Review ‘Guidelines for Authors’
GUIDE FOR AUTHORS
BEFORE YOU BEGIN Ethics in publishing For information on Ethics in publishing and Ethical guidelines for journal publication see http://www.elsevier.com/publishingethics and http://www.elsevier.com/journal-authors/ethics. Conflict of interest All authors are requested to disclose any actual or potential conflict of interest including any financial, personal or other relationships with other people or organizations within three years of beginning the submitted work that could inappropriately influence, or be perceived to influence, their work. See also http://www.elsevier.com/conflictsofinterest. Further information and an example of a Conflict of Interest form can be found at: http://help.elsevier.com/app/answers/detail/a_id/286/p/7923. Submission declaration Submission of an article implies that the work described has not been published previously (except in the form of an abstract or as part of a published lecture or academic thesis or as an electronic preprint, see http://www.elsevier.com/postingpolicy), that it is not under consideration for publication elsewhere, that its publication is approved by all authors and tacitly or explicitly by the responsible authorities where the work was carried out, and that, if accepted, it will not be published elsewhere including electronically in the same form, in English or in any other language, without the written consent of the copyright-holder. Changes to authorship This policy concerns the addition, deletion, or rearrangement of author names in the authorship of accepted manuscripts: Before the accepted manuscript is published in an online issue: Requests to add or remove an author, or to rearrange the author names, must be sent to the Journal Manager from the corresponding author of the accepted manuscript and must include: (a) the reason the name should be added or removed, or the author names rearranged and (b) written confirmation (e-mail, fax, letter) from all authors that they agree with the addition, removal or rearrangement. In the case of addition or removal of authors, this includes confirmation from the author being added or removed. Requests that are not sent by the corresponding author will be forwarded by the Journal Manager to the corresponding author, who must follow the procedure as described above. Note that: (1) Journal Managers will inform the Journal Editors of any such requests and (2) publication of the accepted manuscript in an online issue is suspended until authorship has been agreed. After the accepted manuscript is published in an online issue: Any requests to add, delete, or rearrange author names in an article published in an online issue will follow the same policies as noted above and result in a corrigendum. Copyright This journal offers authors a choice in publishing their research: Open Access and Subscription.
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long as they credit the author(s), do not represent the author as endorsing their adaptation of the article, and do not modify the article in such a way as to damage the author's honor or reputation. Creative Commons Attribution-NonCommercial-ShareAlike (CC BY-NC-SA): for non- commercial purposes, lets others distribute and copy the article, to create extracts, abstracts and other revised versions, adaptations or derivative works of or from an article (such as a translation), to include in a collective work (such as an anthology), to text and data mine the article, as long as they credit the author(s), do not represent the author as endorsing their adaptation of the article, do not modify the article in such a way as to damage the author's honor or reputation, and license their new adaptations or creations under identical terms (CC BY-NC-SA). Creative Commons Attribution-NonCommercial-NoDerivs (CC BY-NC-ND): for non- commercial purposes, lets others distribute and copy the article, and to include in a collective work (such as an anthology), as long as they credit the author(s) and provided they do not alter or modify the article.
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of figures, tables and text graphics will be required whether or not you embed your figures in the text. See also the section on Electronic artwork. To avoid unnecessary errors you are strongly advised to use the 'spell-check' and 'grammar-check' functions of your word processor. Article structure Manuscripts should be prepared according to the guidelines set forth in the Publication Manual of the American Psychological Association (6th ed., 2009). Of note, section headings should not be numbered.
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It is authors' responsibility to ensure their reviews are comprehensive and as up to date as possible (at least through the prior calendar year) so the data are still current at the time of publication. Authors are referred to the PRISMA Guidelines (http://www.prisma-statement.org/statement.htm) for guidance in conducting reviews and preparing manuscripts. Adherence to the Guidelines is not required, but is recommended to enhance quality of submissions and impact of published papers on the field. Appendices If there is more than one appendix, they should be identified as A, B, etc. Formulae and equations in appendices should be given separate numbering: Eq. (A.1), Eq. (A.2), etc.; in a subsequent appendix, Eq. (B.1) and so on. Similarly for tables and figures: Table A.1; Fig. A.1, etc. Essential title page information
Title. Concise and informative. Titles are often used in information-retrieval systems. Avoid abbreviations and formulae where possible. Note: The title page should be the first page of the manuscript document indicating the author's names and affiliations and the corresponding author's complete contact information.
Author names and affiliations. Where the family name may be ambiguous (e.g., a double name), please indicate this clearly. Present the authors' affiliation addresses (where the actual work was done) below the names. Indicate all affiliations with a lower-case superscript letter immediately after the author's name and in front of the appropriate address. Provide the full postal address of each affiliation, including the country name, and, if available, the e-mail address of each author within the cover letter.
Corresponding author. Clearly indicate who is willing to handle correspondence at all stages of refereeing and publication, also post-publication. Ensure that telephone and fax numbers (with country and area code) are provided in addition to the e-mail address and the complete postal address.
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Present/permanent address. If an author has moved since the work described in the article was done, or was visiting at the time, a "Present address"' (or "Permanent address") may be indicated as a footnote to that author's name. The address at which the author actually did the work must be retained as the main, affiliation address. Superscript Arabic numerals are used for such footnotes.
Abstract
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Acknowledgements Collate acknowledgements in a separate section at the end of the article before the references and do not, therefore, include them on the title page, as a footnote to the title or otherwise. List here those individuals who provided help during the research (e.g., providing language help, writing assistance or proof reading the article, etc.). Footnotes Footnotes should be used sparingly. Number them consecutively throughout the article, using superscript Arabic numbers. Many wordprocessors build footnotes into the text, and this feature may be used. Should this not be the case, indicate the position of footnotes in the text and present the footnotes themselves separately at the end of the article. Do
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not include footnotes in the Reference list. Table footnotes Indicate each footnote in a table with a superscript lowercase letter. Electronic artwork General points • Make sure you use uniform lettering and sizing of your original artwork. • Embed the used fonts if the application provides that option. • Aim to use the following fonts in your illustrations: Arial, Courier, Times New Roman, Symbol, or use fonts that look similar. • Number the illustrations according to their sequence in the text. • Use a logical naming convention for your artwork files. • Provide captions to illustrations separately. • Size the illustrations close to the desired dimensions of the printed version. • Submit each illustration as a separate file. A detailed guide on electronic artwork is available on our website: http://www.elsevier.com/artworkinstructions You are urged to visit this site; some excerpts from the detailed information are given here. Formats If your electronic artwork is created in a Microsoft Office application (Word, PowerPoint, Excel) then please supply 'as is' in the native document format. Regardless of the application used other than Microsoft Office, when your electronic artwork is finalized, please 'Save as' or convert the images to one of the following formats (note the resolution requirements for line drawings, halftones, and line/halftone combinations given below): EPS (or PDF): Vector drawings, embed all used fonts. TIFF (or JPEG): Color or grayscale photographs (halftones), keep to a minimum of 300 dpi. TIFF (or JPEG): Bitmapped (pure black & white pixels) line drawings, keep to a minimum of 1000 dpi. TIFF (or JPEG): Combinations bitmapped line/half-tone (color or grayscale), keep to a minimum of 500 dpi. Please do not: • Supply files that are optimized for screen use (e.g., GIF, BMP, PICT, WPG); these typically have a low number of pixels and limited set of colors; • Supply files that are too low in resolution; • Submit graphics that are disproportionately large for the content. Color artwork Please make sure that artwork files are in an acceptable format (TIFF (or JPEG), EPS (or PDF), or MS Office files) and with the correct resolution. If, together with your accepted article, you submit usable color figures then Elsevier will ensure, at no additional charge,that these figures will appear in color on the Web (e.g., ScienceDirect and other sites) regardless of whether or not these illustrations are reproduced in color in the printed version. For color reproduction in print, you will receive information regarding the costs from Elsevier after receipt of your accepted article. Please indicate your preference for color: in print or on the Web only. For further information on the preparation of electronic artwork, please see http://www.elsevier.com/artworkinstructions. Please note: Because of technical complications which can arise by converting color figures to 'gray scale' (for the printed version should you not opt for color in print) please submit in addition usable black and white versions of all the color illustrations.
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Citations in the text should follow the referencing style used by the American Psychological Association. You are referred to the Publication Manual of the American Psychological Association, Sixth Edition, ISBN 1-4338-0559-6, copies of which may be ordered from http://books.apa.org/ books.cfm?id=4200067 or APA Order Dept., P.O.B. 2710, Hyattsville, MD 20784, USA or APA, 3 Henrietta Street, London, WC3E 8LU, UK. Details concerning this referencing style can also be found at http://humanities.byu.edu/linguistics/Henrichsen/APA/APA01.html Citation in text Please ensure that every reference cited in the text is also present in the reference list (and vice versa). Any references cited in the abstract must be given in full. Unpublished results and personal communications are not recommended in the reference list, but may be mentioned in the text. If these references are included in the reference list they should follow the standard reference style of the journal and should include a substitution of the publication date with either 'Unpublished results' or 'Personal communication'. Citation of a reference as 'in press' implies that the item has been accepted for publication. Web references As a minimum, the full URL should be given and the date when the reference was last accessed. Any further information, if known (DOI, author names, dates, reference to a source publication, etc.), should also be given. Web references can be listed separately (e.g., after the reference list) under a different heading if desired, or can be included in the reference list. References in a special issue Please ensure that the words 'this issue' are added to any references in the list (and any citations in the text) to other articles in the same Special Issue. Reference management software This journal has standard templates available in key reference management packages EndNote (http://www.endnote.com/support/enstyles.asp) and Reference Manager (http://refman.com/support/rmstyles.asp). Using plug-ins to wordprocessing packages, authors only need to select the appropriate journal template when preparing their article and the list of references and citations to these will be formatted according to the journal style which is described below. Reference style
References should be arranged first alphabetically and then further sorted chronologically if necessary. More than one reference from the same author(s) in the same year must be identified by the letters "a", "b", "c", etc., placed after the year of publication. References should be formatted with a hanging indent (i.e., the first line of each reference is flush left while the subsequent lines are indented).
Examples: Reference to a journal publication: Van der Geer, J., Hanraads, J. A. J., & Lupton R. A. (2000). The art of writing a scientific article. Journal of Scientific Communications, 163, 51-59.
Reference to a book: Strunk, W., Jr., &White, E. B. (1979). The elements of style. (3rd ed.). New York: Macmillan, (Chapter 4).
Reference to a chapter in an edited book: Mettam, G. R., & Adams, L. B. (1994). How to prepare an electronic version of your article. In B.S. Jones, & R. Z.
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Smith (Eds.), Introduction to the electronic age (pp. 281-304). New York: E-Publishing Inc.
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Clinical Experiences
Summary of clinical placement experiences from November 2013 – September 2016
YEAR 1: Adult Mental Health (November 2013 – September 2014)
Setting: Community Mental Health Recovery Service for Working Age Adults. Also conducted a neuropsychology assessment as part of a specialist neuropsychology service.
Clients and presenting difficulties: Adults (18 – 65 years) with moderate to severe and enduring mental health problems. Presentations of clients I worked with included borderline personality disorder, depression, anxiety, psychosis, obsessive compulsive disorder (OCD), post-traumatic stress disorder (PTSD), chronic pain, bipolar disorder and bulimia.
Main models used: CBT and ACT models
Modes and types of work: Direct work with individuals, group work, indirect work, joint working with other professionals, presentations to staff on working psychologically with those affected by psychosis.
YEAR 2: People affected by Learning Disabilities (October 2014 – March 2015)
Setting: Psychology service working with adults affected by learning disabilities, Attention Deficit and Hyperactivity Disorder and Autistic Spectrum Conditions.
Clients and presenting difficulties: Adults (18 + years) with a learning disability and mental health difficulties. Presentations included depression, social anxiety, psychosis, behaviour that challenges, difficulties associated with downs syndrome, autistic spectrum disorder, and dementia.
Main models: Systemic and psychodynamic
Modes and types of work: Direct work with individuals, carers and staff groups, group work, indirect work via consultations for care home staff, neuropsychological assessments.
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YEAR 2: Children and Adolescents (April 2015 – September 2015)
Setting: Child and Adolescent Mental Health Service (CAMHS; integrated social and health care team)
Clients and presenting difficulties: Children and adolescents (0 – 18 years) with moderate to severe mental health difficulties. Presentations included depression, self-harm, panic disorder, eating disorders, obsessive compulsive disorder and generalised anxiety.
Main models: CBT, systemic and narrative
Modes and types of work: Direct assessment and work with children, adolescents and families, indirect work with carers and schools, neuropsychological assessments, presentations to parents and carers on CBT, input to family therapy clinic.
YEAR 3: Older Adults (October 2015 – March 2016)
Setting: Split placement across a Community Mental Health Team for Older Adults, a Dementia Assessment Ward, and a functional mental health ward for older adults.
Clients and presenting difficulties: Older adults (65 + years) affected by dementia and/or mental health difficulties. Presentations included depression, post-traumatic stress disorder, psychosis, bereavement, anxiety and difficulties associated with dementia and/or physical health difficulties.
Main models: CBT, systemic and CAT
Modes and types of work: Direct work with individuals, carers, families and staff teams, indirect work with staff teams, supervision and reflective practice for nursing staff and assistant psychologists, joint working with other MDT professionals, and neuropsychological assessments.
YEAR3: Specialist Inpatient Forensic (April 2016 – September 2016)
Setting: High Secure Hospital
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Clients and presenting difficulties: Males (18+) with a forensic background and mental health difficulties and/or personality disorder. Presentations included psychosis, paranoia, anxiety, depression, personality disorders, difficulties associated with bereavement, loss and trauma. The work also included consideration of offending behaviours and managing risk.
Main models: Integrative
Modes and types of work: direct work with individuals, group work, indirect work, CPA work, multidisciplinary team working, structured risk assessments, structured personality assessments.
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Assessments
PSYCHD CLINICAL PROGAMME
TABLE OF ASSESSMENTS COMPLETED DURING TRAINING
Year I Assessments
ASSESSMENT TITLE
WAIS-III Short report of WAIS-III data and practice administration
Service-Related Project Evaluating the efficacy of a recovery workshop
Practice Case Report Cognitive behavioural assessment and formulation with a woman in her late forties with a long standing diagnosis of bipolar disorder
Problem Based Learning – Reflective Account
Relationship to change
Major Research Project Literature Review
Mental contamination: A systemic literature review
Adult – Case Report 1 Cognitive behavioural therapy with a woman in her late forties with a long standing diagnosis of bipolar disorder
Adult – Case Report 2 Neuropsychological assessment with a woman in her mid-sixties showing signs of cognitive impairment
Major Research Project Proposal
Perfectionism and moral thought-action fusion as predictors of sensitivity to mental contamination
Year II Assessments
ASSESSMENT TITLE
Professional Issues Essay “Physical contact with clients/service users is never acceptable.” Discuss this statement in the context of your practice with clients across the life-span and specialities
Problem Based Learning – Reflective Account
The Stride family
People with Learning Disabilities – Case Report
Systemic consultation with a staff team supporting a man in his late sixties affected by a learning disability and an alcohol
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addiction
Personal and Professional Learning Discussion Groups – Process Account
Personal and Professional Learning Discussion Group Process Account
Child and Family– Oral Presentation of Clinical Activity
Reflections on development of therapeutic techniques
Year III Assessments
ASSESSMENT TITLE
Major Research Project Empirical Paper
Perfectionism, Moral Thought-Action Fusion and Shame-Proneness as Predictors of Mental Contamination
Personal and Professional Learning – Final Reflective Account
On becoming a clinical psychologist: A retrospective, developmental, reflective account of the experience of training
Older People – Case Report
Extended assessment with a male in his seventies with a traumatic history and symptoms of post-traumatic stress disorder
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