How OCD latches onto personal values – A Q&A with Dr. Gillian Alcolado

An exceptionally common experience among tens of millions with Obsessive-Compulsive Disorder (OCD) worldwide, is the way in which the condition latches on the things that are central to who we are as people—our beliefs and values. 

Researchers at St. Joseph’s Anxiety Treatment and Research Clinic, led by Karen Rowa, Ph.D., set out to investigate this experience. Their hope was that a scientific and clinical understanding of how personal values relate to one’s OCD obsessions can allow healthcare professionals to identify and treat the OCD symptoms that matter the most to their patients. I spoke with one of the researchers, University of Manitoba’s Gillian M. Alcolado, Ph.D., to dig deeper into the research and findings. If you’d like to investigate further for yourself, you can read their fascinating research here.

Can you provide some background on how the idea for this study came about? What motivated you to investigate the role of personal values in obsessions within OCD? 

I was completing my doctoral residency in psychology at a hospital that was connected to a university research department. During my residency, I didn’t have time to start a new study but was encouraged to look through the data in case I could come up with a new research question. I am interested in the thoughts and beliefs that affect compulsions because our effective treatments for OCD often end up changing thoughts as part of what helps improve symptoms. 

When I saw there was a questionnaire in the data about personal values, I was intrigued. I wanted to know more about how values and thoughts about values may or may not influence compulsions. I worked with my supervisor and the other team members to conduct this study, hoping that the better we understand the processes that cause/maintain OCD, the better we can make our treatments. 

In your abstract, you mention that the degree of personal significance may play a role in determining which thoughts become obsessions. Could you elaborate on how personal significance is defined and measured in the context of this study? 

The personal significance of obsessions in this study is measured by the DOSS (Dimensions of Self Scale). This is a questionnaire that participants fill out. They write down their most distressing obsession and then rate the degree to which that obsession goes against a list of possible personal values (e.g., kindness, fun, conscientiousness).

The study highlights that OCD is heterogeneous. Could you explain how this heterogeneity influenced your approach to the research and its findings? 

We think that because OCD is heterogeneous, different types of obsessions and compulsions might be more related to personal significance than others. In the paper, we wondered whether, for participants with OCD that are primarily obsession-based (sometimes called “pure obsessions,” although this term is not entirely accurate), their OCD might be more contrary to their values than for other types of OCD (e.g., washing, symmetry), where it might be less about values and more about other fears (e.g., disease, feeling not “just right”). Our research findings supported this assumption.

Could you briefly explain the methodology for collecting and analyzing the archival data? Were there any specific challenges you encountered during this process? 

For everyone who had completed the DOSS, we also pulled the questionnaire they had answered about their symptom severity at pre and post-treatment. We also pulled their demographic questionnaire, where available, so that we could have some general information about our participants. 

We had a few challenges, as there always are in research. The main one for this study was that participants didn’t always write down in the DOSS what their main obsession was, and because it’s old archival data, you can’t find out who the person was and go and ask them to fill in the answer. This made our sample smaller, which was another main challenge. We would have liked to have had a bigger sample to be able to look at all types of OCD separately instead of lumping them into just two categories.

The study observed differences in contradiction ratings across symptom domains. Could you elaborate on how these differences were measured and interpreted in the context of the research? 

We measured the degree to which someone’s main obsession contradicted their values by summing all their answers. Then, we compared average answers across the groups. On average, we found that those who primarily experienced obsessions felt their OCD was more in contrast to their values than those who had other types of OCD. 

We interpreted these findings as fitting well with the cognitive model of our understanding of OCD, i.e., one thing that bothers people about their obsessive thoughts is that they are personally significant because they often feel like they violate or contradict their values. 

It’s interesting that contradiction ratings did not change post-treatment. What are the potential implications of this finding for the understanding and treatment of OCD? 

Luckily, this is actually good news for treatment. Currently, in our treatment, we give education to explain that although obsessions may contradict personal values, that’s okay; the obsessions don’t actually mean anything about you. In fact, it might mean that you have really great values if your obsessions bother you so much. 

So, in that way, we didn’t expect people’s values to change from pre- to post-treatment. So, the implication is that it supports our existing understanding of OCD. 

How might the insights gained from your study impact the way clinicians approach the treatment of OCD, particularly in terms of considering personal values and their relation to obsessions? 

I think clinicians can continue to be confident that this is an important piece of psychoeducation to deliver, particularly if they are working with individuals with primary obsessions, or so-called “Pure O” OCD.

Looking ahead, what are the next steps or areas of research you believe should be explored based on the findings of this pilot investigation? How might this research influence future studies in the field of OCD? 

I would like to be able to do this with a larger sample and make sure that participants fill out all parts of the questionnaire so we don’t have missing data! One thing I would like to measure in my new hypothesis is that even though the degree to which values were contracted post-treatment didn’t change, I wonder if the degree to which participants felt that the contradiction of values mattered might have changed. 

For instance, in treatment, we often teach them that even though their obsessions contradict their values, the obsessions don’t mean anything about them as a person; they don’t mean anything about their values. So, it would be nice to measure whether that is hitting home, and I wonder whether that variable would be more likely to influence treatment outcomes. 

We hear and read countless personal anecdotes from the OCD community about how the condition seems to attack the things that mean the most to them. Do you think that your research in this area might serve to validate people’s personal experiences? 

Absolutely! I think these research findings fit very well with that. I bet that this whole line of research was initially influenced by folks expressing that OCD really affected them because it impacted their values. This is an excellent example of how talking to patients is a really great way to influence research, which can then positively impact future treatments.