Reduced fear‐of‐self is associated with improvement in concerns related to repugnant obsessions in obsessive–compulsive disorder

OBJECTIVE: The potential causal and maintaining role of vulnerable self-themes and beliefs about the self in obsessive-compulsive disorder (OCD) have received increasing attention from cognitive-behavioural theorists. This interest was translated into the development of a self-report measurement of the feared self (the fear of who one might be or become), a construct theoretically and empirically pertinent to unwanted thoughts and impulses in OCD (i.e., repugnant obsessions). METHOD: The current study aimed to provide converging evidence on the relevance of the feared self in OCD, by examining whether improvements in symptoms associated with repugnant obsessions (measured on the Vancouver Obsessional Compulsive Inventory [VOCI] obsessions subscale) would be predicted by reduced feared self-perceptions (measured on the Fear-of-Self Questionnaire [FSQ]) in a sample of 93 patients receiving psychotherapy for OCD. RESULTS: Using a series of hierarchical linear regression models, we found that treatment-related reductions on the FSQ significantly and uniquely predicted reductions on the VOCI obsessions subscale and the contamination subscale. CONCLUSIONS: The current study thus replicated previous research suggesting the relevance of the feared possible self in psychological disorders such as OCD, where negative self-perception is a dominant theme. PRACTITIONER POINTS: Current results suggest that changes in feared self-perceptions may be the mechanism through which OCD symptoms improve via therapy. Interventions specifically aimed at changing feared self-perceptions may prove effective in improving cognitive-behavioural treatments for OCD. One limitation of the current study is the lack of behavioural measures of OCD to supplement self-report measures of OCD. Another limitation is that the small number of patients receiving some of the treatments precludes investigations into which treatments may be more effective in altering feared self-perceptions.