University of Iowa
Iowa Research Online
Theses and Dissertations
Spring 2015
Social support for people with obsessivecompulsive disorder: uniting the theory of
conversationally-induced reappraisals and the dualprocess theory of supportive communication
outcomes
Melissa Margarite Schnettler
University of Iowa
Copyright 2015 Melissa Margarite Schnettler
This dissertation is available at Iowa Research Online: http://ir.uiowa.edu/etd/1746
Recommended Citation
Schnettler, Melissa Margarite. "Social support for people with obsessive-compulsive disorder: uniting the theory of conversationallyinduced reappraisals and the dual-process theory of supportive communication outcomes." PhD (Doctor of Philosophy) thesis,
University of Iowa, 2015.
http://ir.uiowa.edu/etd/1746.
Follow this and additional works at: http://ir.uiowa.edu/etd
Part of the Communication Commons
SOCIAL SUPPORT FOR PEOPLE WITH OBSESSIVE-COMPULSIVE DISORDER:
UNITING THE THEORY OF CONVERSATIONALLY-INDUCED REAPPRAISALS
AND THE DUAL-PROCESS THEORY OF SUPPORTIVE COMMUNICATION
OUTCOMES
by
Melissa Margarite Schnettler
A thesis submitted in partial fulfillment
of the requirements for the Doctor of Philosophy
degree in Communication Studies in the
Graduate College of
The University of Iowa
May 2015
Thesis Supervisor: Assistant Professor Rachel McLaren
Copyright by
MELISSA MARGARITE SCHNETTLER
2015
All Rights Reserved
Graduate College
The University of Iowa
Iowa City, Iowa
CERTIFICATE OF APPROVAL
____________________________
PH.D. THESIS
_________________
This is to certify that the Ph.D. thesis of
Melissa Margarite Schnettler
Has been approved by the Examining Committee for
the thesis requirement for the Doctor of Philosophy degree
in Communication Studies at the May 2015 graduation.
Thesis Committee:
____________________________________________
Rachel McLaren, Thesis Supervisor
____________________________________________
Leslie Baxter
____________________________________________
Andrew High
____________________________________________
Keli Steuber
____________________________________________
Sarah Harkness
To my family, friends, and those living with OCD
ii
ACKNOWLEDGEMENTS
Writing my dissertation has without a doubt been the most difficult process of my
life thus far. I would not have successfully completed my dissertation without the support
of many people in my life.
First, I wish to thank my advisor, Dr. Rachel McLaren. Without her consistent
guidance and motivation this this process would have been even more difficult. Her faith
in me kept me going, even in moments when I felt immense stress and anxiety. I will
forever remember her dedication to my success.
Second, I wish to acknowledge the support of my doctoral committee. Dr. Leslie
Baxter, Dr. Andrew High, Dr. Keli Steuber, and Dr. Sarah Harkness have traveled with
me throughout this long process. I truly believe they pushed me to produce my best work.
Third, I want to express my sincerest gratitude to my parents Paul and Mary
Kampa and to my husband, Chad Schnettler. There are really no words to express how
beautifully patient and supporting my loved ones have been during this dissertation
process. On an almost daily basis my mother and husband listened to me complain, cry,
and rejoice over this study. I don’t think they will ever truly realize how important they
have been to me during this time in my life.
Lastly, I want to recognize those who suffer from obsessive-compulsive disorder
(OCD). You are not alone in your anxiety. While I write this acknowledgement as a
researcher, parts of this dissertation were fueled by my own battle with OCD. This
dissertation is evidence that mental illness does not have to win the fight and that anything
is possible if you work hard enough.
iii
ABSTRACT
The goal of this investigation was to marry two theories of supportive communication
outcomes in order to test a comprehensive model of social support for people with
obsessive-compulsive disorder (OCD). The theoretical frameworks utilized in this
investigation were the theory of conversationally-induced reappraisals and the dualprocess theory of supportive communication outcomes. These theoretical frameworks
provide a foundation for the conversation of how social network members can help their
loved ones with OCD manage their distressing symptoms as they explore the types of
social support message features (verbal person-centeredness) that are most productive in
achieving emotional improvement for those experiencing emotional distress. The union of
these two theories in the context of social support and OCD management led to the testing
of seven hypotheses.
Participants (n = 168) who self-identified as living with OCD at some point in their
life were recruited to fill out an online questionnaire. Results indicated support for the
theory of conversationally-induced reappraisals, but not for the dual-process theory of
supportive communication outcomes. Overall, the findings of this investigation
highlighted the utility of emotional support messages high in verbal person-centeredness
as they led those with OCD to reassess the intrusive nature of their symptoms, a process
which promoted overall affective improvement. These associations suggest that social
network members can help their loved ones with OCD manage their symptoms through
supportive communication.
iv
PUBLIC ABSTRACT
People with obsessive-compulsive disorder (OCD) report higher levels of anxiety and
distress due to the nature of their symptoms in comparison to the general population.
While various treatment options exist for this disorder, one additional possibility is that
family, friends, and other loved ones can help those afflicted manage their symptoms
through supportive communication. The purpose of this investigation was to explore the
extent to which specific social support messages could aid in this endeavor. More
broadly, this study tested two theories of social support outcomes in an effort to construct
an overall picture of the social support process.
To test the hypotheses of this investigation people with self-identified OCD were
recruited to complete an online questionnaire. Results provided support for one of the
theories of social support outcomes. The results indicated the usefulness of emotional
support messages that enabled the individual with OCD to express and elaborate on their
feelings as this process encouraged the person to reassess the nature of their symptoms.
This reassessment or reappraisal process ultimately led to emotional improvement for
those with the disorder.
The results of this investigation highlight the ability for social network members to
help their loved ones cope with their OCD symptoms by identifying the effectiveness of a
specific type of emotional support in OCD symptom management. For people who feel
helpless in the wake of their loved one’s OCD, this investigation shines light on the ways
in which supportive communication can bring those with mental illness out of the
darkness.
v
TABLE OF CONTENTS
LIST OF TABLES ........................................................................................................viii
LIST OF FIGURES ........................................................................................................ ix
CHAPTER I RATIONALE..............................................................................................1
Obsessive-Compulsive Disrder .............................................................................6
Social Support .................................................................................................... 16
Types of Social Support .......................................................................... 16
Emotional support................................................................................... 17
Theory of Conversationally-Induced Reappraisals .............................................. 22
Dual-Process Theory of Supportive Communication Outcomes .......................... 27
Message content and message elaboration ............................................... 28
Ability and message elaboration .............................................................. 29
Motivation and message elaboration........................................................ 31
Integration of Theoretical Frameworks ............................................................... 31
Social Support and OCD .................................................................................... 33
Current Model .................................................................................................... 35
Current Study ..................................................................................................... 35
Summary............................................................................................................ 41
CHAPTER II METHODS.............................................................................................. 44
Sample ............................................................................................................... 44
Procedure ........................................................................................................... 45
Instrumentation .................................................................................................. 47
Demographic information ....................................................................... 47
OCD severity .......................................................................................... 47
Anxiety/Distress ..................................................................................... 48
Positive and negative affect schedule (PANAS) ...................................... 49
Verbal person-centered messages ............................................................ 50
Message elaboration ............................................................................... 52
Perception of message quality ................................................................. 52
Affective improvement scale ................................................................... 52
Cognitive reappraisal .............................................................................. 53
Interpersonal cognitive complexity.......................................................... 53
Summary............................................................................................................ 55
CHAPTER III RESULTS .............................................................................................. 56
Preliminary Analyses ......................................................................................... 56
Test of Hypotheses ............................................................................................. 59
Summary............................................................................................................ 62
vi
CHAPTER IV DISCUSSION ........................................................................................ 73
Summary of Hypotheses ..................................................................................... 74
Implications for the Dual-Process Model of Supportive Communication
Outcomes ........................................................................................................... 77
Hierarchy of verbal person-centered messages ........................................ 80
Lack of support for the dual-process theory of supportive
communication outcomes........................................................................ 81
Implications for the Theory of Conversationally-Induced Reappraisals ............... 90
Role of positive emotion words in message elaboration ........................... 92
Implications of Results for OCD Research and Treatment ................................... 95
Limitations ......................................................................................................... 97
Conclusion ......................................................................................................... 99
REFERENCES ............................................................................................................ 101
APPENDIX A INSTITUTIONAL REVIEW BOARD APPROVAL ............................ 113
APPENDIX B STUDY QUESTIONNAIRE ................................................................ 117
APPENDIX C COGNITIVE COMPLEXITY CODING MANUAL ............................. 130
vii
LIST OF TABLES
1.
Table 3-1. Correlation Coefficients Among All Major Variables...............................65
2.
Table 3-2. Simple Linear Regression Analysis for Predicting Positive Emotion
Words via Messages that Vary in Verbal Person-Centeredness (H1).....................66
3.
Table 3-3. Hierarchical Regression Analysis for Predicting Positive Emotion
Words (Message Elaboration) via Messages that Vary in Verbal Person
Centeredness, Cognitive Complexity, and the Interaction between these
Variables (H2)………..............................................................................................67
4.
Table 3-4. Hierarchical Regression Analysis for Predicting Positive Emotion
Words (Message Elaboration) via Messages that Vary in Verbal PersonCenteredness, Anxiety before the Message Vignette, and the Interaction
between these Variables (H3)..................................................................................68
5.
Table 3-5. Simple Linear Regression Analysis for Predicting Cognitive
Reappraisal via Messages that Vary in Verbal Person-Centeredness (H4).............69
6.
Table 3-6. Simple Linear Regression Analysis for Predicting Emotional
Improvement via Messages that Vary in Verbal Person-Centeredness (H5a-c).....70
7.
Table 3-7. Simple Linear Regression Analysis for Predicting Cognitive
Reappraisal via Positive Emotion Words (Message Elaboration) (H6)………......71
8.
Table 3-8. Simple Linear Regression Analysis for Predicting Emotional
Improvement via Cognitive Reappraisal (H7a-c)………………………………...72
viii
LIST OF FIGURES
1.
2.
Figure 1-1. Model of the variables of interest within the dual-process theory of
supportive communication outcomes and the theory of conversationallyinduced reappraisals. The variables of ability, motivation, and message
elaboration are associated with the dual-process theory of supportive
communication outcomes while cognitive reappraisal represents the theory of
conversationally-induced reappraisals. Emotional improvement is associated
with both theories.....................................................................................................43
Figure 3-1. Model of the variables of interest within the dual-process theory of
supportive communication outcomes and the theory of conversationallyinduced reappraisals.................................................................................................64
ix
CHAPTER I
RATIONALE
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM) (5th ed.;
DSM–V; American Psychiatric Association, 2013), obsessive-compulsive disorder (OCD)
is a type of debilitating anxiety disorder characterized by the two primary symptom
domains of obsessions and compulsions. The disorder is constituted by a repetitive,
mutually reinforcing cycle of obsessions and compulsions that pervade everyday life and
cause extreme emotional and psychological distress for those afflicted. Due to the
disturbing and distressful nature of OCD, along with the stigma that remains attached to
mental illness (Corrigan, Roe, & Tsang, 2011), individuals with this disorder are often
hesitant to self-disclose their symptoms to others for fear of eliciting responses that
communicate rejection and judgment (Belloch, del Valle, Morillo, Carrio, & Cabedo,
2009; Simonds & Thorpe, 2003). The concealment of OCD can have detrimental effects
on the physical, psychological, and emotional well-being of individuals with this disorder
(Stengler-Wenzke, Kroll, Matschinger, & Angermeyer, 2006).
In addition to the primary symptom domains of obsessions and compulsions, those
with OCD tend to place more significance on the content of their thoughts (Rachman,
1997) and feel a heightened sense of responsibility for the existence of their thoughts
(Rachman, 1993) in comparison to the general population. In other words, those with
OCD tend to present or display symptoms of cognitive dysfunction that result in difficulty
rationalizing or making sense of their intrusive thoughts (Abramowitz, Taylor, & McKay,
2009). It is both beneficial and necessary for the afflicted individual to disclose his or her
symptoms to a social network member he or she trusts because “by sealing off the
1
unwanted obsessions entirely within one’s own psyche, the person is never exposed to
alternative interpretations of the significance of these thoughts” (Newth & Rachman,
2001, p. 458). The process of disclosing the symptoms of OCD to a social network
member might act as the first step in receiving social support from that individual.
Entrenched within the vicious cycle of obsessions and compulsions, those with OCD
could benefit from a support provider who encourages them to reassess the interpretation
of and reaction to the intrusive and unwanted thoughts that fuel the disorder (Newth &
Rachman, 2001).
The study of social support has garnered a long research tradition that spans
multiple disciplines. From a communication perspective, social support involves the
construction and provision of messages intended to help others feel better (Burleson &
MacGeorge, 2002). More specifically, social support involves the stages of selecting,
providing, and receiving/processing messages. The focus of the current investigation is on
the stage in which people receive and process supportive messages from another. In
addition to defining the construct of social support based upon the stages of the process,
social support can also be organized into various types.
Research indicates that emotional, informational, instrumental, esteem, and
network are the main types of social support (Cutrona & Suhr, 1994). The current
investigation will focus on the features of emotional support. Emotional support is often
conceptualized as communicative messages that are constructed for the purpose of
relieving another’s emotional distress (Burleson, 1985). For those with OCD, the
existence and content of intrusive thoughts can often lead to feelings of guilt (Shafran,
Watkins, & Charman, 1996) and shame as well as anxiety and distress (Rachman, 1971).
2
Unproductive behavioral and mental compulsions are often enacted as a response to these
negative emotions and states (5th ed.; DSM-V; American Psychiatric Association, 2013).
Supportive messages that focus on one’s emotional response to intrusive thoughts could
help those with the disorder avoid high levels of anxiety and distress, as well as reduce the
occurrence of compulsive behavior. Ultimately, this investigation seeks to tackle one of
the sources that perpetuates the unproductive cycle of obsessions and compulsions,
specifically the emotional response of individuals with OCD to their intrusive cognitions.
Therefore, this investigation will focus on the utility of emotional support in helping those
with OCD reinterpret their obsessions. Communication research can aid in this endeavor
as it focuses on the features of an emotional support message that best lead to a reduction
in emotional distress.
Verbal person-centered (VPC) messages represent a hierarchical typology of
emotional support that vary in their recognition, elaboration, and legitimization of the
feelings of others (Burleson, 1985). Messages high in VPC are consistently perceived by
support recipients as the most sensitive and effective at alleviating emotional distress as
compared to low VPC messages (Burleson & Samter, 1985; High & Dillard, 2012; Jones,
2004; Jones & Guerrero, 2001; Rack, Burleson, Bodie, Holmstrom, & Servaty-Seib, 2008;
Wilkum & MacGeorge, 2010). Since this investigation is focused on the factors that help
an individual achieve emotional relief, messages that vary in level of VPC act as one
potential outlet for promoting this specific social support outcome. As stated earlier, one
way to reduce the compulsions associated with OCD is to reduce individuals’ levels of
anxiety and distress. A reduction in anxiety and distress can be achieved through a reexamination or reappraisal of the importance that is placed on the intrusive thoughts.
3
Messages that vary in level of VPC might help those with OCD reassess their negative
interpretations (Jones & Wirtz, 2006) as these messages promote a recognition,
elaboration, and acceptance of emotional states.
Two theories seek to explain the factors that influence the process of alleviating
another’s distress through supportive communication. This investigation will focus on the
theoretical frameworks of the theory of conversationally-induced reappraisals (Burleson
& Goldsmith, 1998) and the dual-process theory of supportive communication outcomes
(Burleson, 2009) in an effort to explore the intricacies of the social support process. More
importantly, this study will tie these theories together in order to explore the factors that
lead to the social support outcome of emotional improvement. While these theories have
merit in their own right, they complement one another in that they both focus on how
individuals process social support messages. Together these theories provide a
comprehensive picture of how messages that vary in level of VPC lead to specific social
support outcomes.
The theory of conversationally-induced reappraisals (Burleson & Goldsmith,
1998) asserts that certain message features enacted during a conversation lead to
emotional relief via cognitive reappraisal. Cognitive reappraisal occurs when individuals
reassess or reinterpret their initial reaction(s) to environmental stimuli (Lazarus &
Folkman, 1984). More specifically, this appraisal-based model of comforting proposes
that person-centered messages enable individuals to identify and elaborate on their
thoughts and feelings concerning a distressing event. This opportunity for expression
fuels reappraisal of the stressor and results in subsequent alleviation of emotional distress.
Again, reappraisal constitutes the process whereby a primary cognitive interpretation of an
4
environmental stimulus is re-constructed, thereby resulting in an alternative cognitive and
emotional outcome (Lazarus & Folkman, 1987). Therefore, individuals who experience
negative or aversive emotions could alter their affect through the reappraisal of the
environment or specific situation that elicited the negative response in the first place.
The dual-process theory of supportive communication outcomes seeks to explain
why certain factors, when combined, produce distinct social support outcomes. Among
the variables under consideration, Burleson and his colleagues (2009) often focus on the
factors of individual ability and motivation. The theory hypothesizes that support
recipients’ ability and motivation to process a supportive message impacts the degree to
which various social support outcomes are achieved. In other words, the level of message
processing acts as the mechanism through which supportive messages achieve their
intended outcome. The current investigation will follow the lead of Burleson and his
colleagues and will focus on these two specific individual factors.
The current study seeks to marry the theory of conversationally-induced
reappraisals and the dual-process theory of supportive communication outcomes in order
to construct a more comprehensive model of social support outcomes in the context of
OCD. As previously mentioned, individuals with OCD tend to experience irrational
beliefs that are triggered by their interpretations of their intrusive thoughts (Rachman,
1993, 1997). Therefore, a primary goal for support providers is to help their loved one
reevaluate the significance of their obsessions through the process of cognitive reappraisal.
Ultimately, individuals with OCD need to break the cycle of cognitive dysfunction that
perpetuates the disorder. Person-centered messages, ability, and motivation represent
three potential factors that could influence the degree to which individuals engage in this
5
cognitive reappraisal process. I argue that support provider’s use of messages high in
VPC, as well as support recipients’ ability and motivation to process these messages
extensively will facilitate emotional improvement through a reappraisal of the importance
and severity that is placed on the intrusive thoughts/images. In order to understand the
role of social support in the context of OCD, it is imperative to first explore the etiology,
symptoms, and treatment of the disorder.
Obsessive-Compulsive Disorder
The National Institute of Mental Health (2013) estimates that 1.6% of the U.S.
population suffers from a lifetime prevalence of OCD. Other approximations document
lifetime prevalence as high as 4% (Greenberg, 2013). The National Comorbidity Survey
Replication found results to indicate that over a 12-month period of time about 1% of the
U.S. population suffer from OCD (Kessler, Chiu, Demler, & Walters, 2005). OCD does
not discriminate against race or gender, although the onset and course of the disorder
might vary among racial and gendered populations. The onset of OCD is variable as
individuals might present with symptoms during childhood, adolescence, or adulthood.
However, the average age of onset is estimated to occur between 10-24 years of age
(Greenberg, 2013).
While the aforementioned percentages are fairly small, they do not do justice to the
plaguing nature of the disorder that is perpetuated through the vicious cycle of obsessions
and compulsions. While at first glance OCD management seems to be an issue located
within the fields of psychology and psychiatry, communication scholars can and should
have a voice at the table. One way in which those with OCD can cope with their disorder
is through social support. However, it is not yet clear from research as to which specific
6
types of social support messages help people with OCD manage their symptoms.
Communication scholars can help identify how the cycle of obsessions and compulsions
can be broken through supportive communication.
The etiology of OCD is rather complicated and has yet to be firmly established.
Research suggests that multiple factors are at play in the development of the disorder. Of
these factors, OCD is most often linked to deficits in the neurotransmitters serotonin,
dopamine, and glutamate as well as brain abnormalities in the basal ganglia and
orbitofrontal area of the brain (Greenberg, 2013; Hollander & Wong, 2000). Studies
investigating twins and family members also suggest that OCD has a genetic component
(Pauls, 2010; Stewart & Pauls, 2010). Other potential etiological factors include
infections, neurological damage, and stress (Greenberg, 2013). Apart from these factors,
research also indicates that individuals who develop OCD experience common
vulnerabilities to the disorder. These vulnerabilities include childhood trauma (Berman,
Wheaton, & Abramowitz, 2013), behavioral inhibition, and parental overprotection
(Coles, Schofield, & Pietrefesa, 2006). Therefore, it is likely that a combination of
biological and environmental factors account for the onset and course of the disorder.
OCD is characterized by two primary symptom domains: obsessions and
compulsions. Debate continues to ensue concerning whether or not individuals experience
both obsessions and compulsions or are primarily affected by one or the other. The
current DSM-V (5th ed.; DSM–V; American Psychiatric Association, 2013) includes the
language and/or, although evidence suggests that most individuals suffer from both
obsessions and compulsions (Abramowitz, McKay, & Taylor, 2008). According to the
DSM (5th ed.; DSM–V; American Psychiatric Association, 2013), obsessions are defined
7
as “recurrent and persistent thoughts, urges, or images that are experienced as intrusive
and unwanted.” Types of obsessions might include a fear of germs or contamination,
forbidden sexual acts, or blasphemous religious thoughts, to name a few. The appraisal of
intrusive thoughts as self-relevant and significant leads to anxiety and distress in the
afflicted individual (International OCD Foundation (IOCDF), 2015; Rachman, 1971). In
other words, it is not the mere presence of intrusive thoughts that lead to OCD, but the
interpretation or appraisal of the cognitions.
Compulsions are enacted as a strategy for reducing the anxiety created by the
obsessions. Compulsions are characterized as “repetitive behaviors or mental acts that an
individual feels driven to perform in response to an obsession or according to rules that
must be applied rigidly” (5th ed.; DSM–V; American Psychiatric Association, 2013).
Examples of compulsions might include excessive cleaning or organization, praying, or
repeated checking of potentially harmful objects (e.g., plug-ins, stoves, etc.). Ultimately,
compulsions function as a negative reinforcement for the obsessions and only provide
temporary psychological and emotional relief for the individual (Abramowitz, McKay, &
Taylor, 2008). While compulsions provide immediate emotional relief, they are not a
productive long-term management strategy because they do not address the cognitive
dysfunctions that feed the obsessions. Ultimately, those interested in the treatment for
OCD must focus their attention on the primary source of the disorder’s reinforcement,
cognitive dysfunction. Ultimately, OCD is characterized by the cyclical and reinforcing
occurrence of obsessions and compulsions. Research indicates that obsessions and
compulsions manifest in multiple forms of behavior.
8
Bloch, Landeros-Weisenberger, Rosario, Pittenger, and Leckman (2008)
conducted a meta-analysis in which they analyzed 21 research studies. Two criteria had to
be met for inclusion in the meta-analysis. The study had to include participants with OCD
and utilize the Yale-Brown Obsessive Compulsive Scale (YBOC) Symptom Checklist.
The results from their investigation suggested that the symptoms of OCD filter into a four
factor model, including 1) symmetry, 2) forbidden thoughts, 3) cleaning, and 4) hoarding.
These categories are generally consistent with other research that lists the most common
types of obsessions as 1) contamination, 2) losing control, 3) harming others, 4)
perfectionism, 5) unwanted sexual thoughts, and 6) religious obsessions (Garcia-Soriano,
Belloch, Morillo, & Clark, 2010; IOCDF, 2015; Lipton, Brewin, Linke, & Halperin, 2010;
Prabhu, Cherian, Viswanath, Kandavel, Bada Math, & Reddy, 2013). Specific examples
will help elucidate these common types of obsessions. For example, an individual with
OCD might present with frequent and disturbing forbidden sexual thoughts about their
loved ones (e.g. pedophilia, incest, etc.). On the other hand, another person might have
violent thoughts about killing their family members. Those with contamination
obsessions could fear areas where excessive germs exist, while those with religious
obsessions might have cognitions surrounding blasphemous actions, such as committing a
moral sin or violating one of the Ten Commandments. Mental and behavioral
compulsions stem from these obsessions.
The most frequent compulsive behavior consists of 1) washing/cleaning, 2)
checking, 3) repeating, 4) mental compulsions, 5) reassurance seeking, and 6) situational
avoidance (IOCDF, 2015; Parrish & Radomsky, 2010). Continuing with the examples
above, an individual who has forbidden sexual thoughts about their family members might
9
begin avoiding them, checking arousal levels, or asking reassurance from others that they
would not actually act upon their obsessions. For someone who obsesses about killing
their family members their compulsions might include avoidance of their loved ones or
any items associated with violence (e.g. knives). Those with contamination fears might
clean excessively or avoid places/objects where extreme germs exist, such as public
restrooms, door handles, or public seats. Lastly, people with religious obsessions might
seek reassurance from others that they are a good person or try to avoid or suppress all
threatening cognitions surrounding religion. Overall, the results from these investigations
along with the examples highlight the complex symptomatology of the disorder and how it
can vary from person to person.
In discussing the classification of the symptoms of OCD it is also important to note
that several obsessions and compulsions “load together” during statistical analysis. For
example, contamination obsessions are often accompanied by washing/cleaning
compulsions. Furthermore, doubting obsessions are often associated with checking
compulsions (Abramowitz, McKay, & Taylor, 2008). In looking at these associations it is
not surprising that most individuals with the disorder present with both obsessive and
compulsive behavior. In addition to the symptomatology of OCD, research has also
focused on the specific cognitive vulnerabilities associated with the development and
perpetuation of the disorder.
Cognitive-behavioral and appraisal models of OCD elucidate the cognitive
mechanisms that reproduce the symptoms of the disorder. Research suggests that certain
types of OCD are characterized by dysfunctional beliefs (Julien, O’Connor, & Aardema,
2007; Taylor, Abramowitz, McKay, Calamari, Sookman, Kyrios, Wilhelm, & Carmin,
10
2006). Common dysfunctional beliefs include an inflated sense of responsibility (IR)
(Foa, Amir, Bogert, Molnar, & Przeworski, 2001; Shafran, 2005), thought significance
(Rachman, 1997), thought control (Shafran, 2005), and intolerance for uncertainty
(Carleton, Mulvogue, Thibodeau, McCabe, Antony, Asmundson, 2012; Calleo, Hart,
Bjorgvinsson, & Stanley, 2010; Tolin, Abramowitz, Brigidi, & Foa, 2003). It is these
dysfunctional belief systems that elicit anxiety and compulsive behavior in the afflicted
individual (Shafran, 2005). What follows are brief summaries of each of these cognitive
dysfunctions.
All individuals experience intrusive thoughts of some nature. The occurrence of
intrusive thoughts is not what determines whether or not an individual is diagnosed with
OCD. What separates the general (control) population from those with OCD is the
interpretation or appraisal of these intrusive and unwanted thoughts (Rachman, 1997;
Shafran, 2005). According to a model developed by Salkovskis (1985), individuals with
OCD tend to appraise intrusive thoughts with an inflated sense of responsibility (IR) for
harming either the self or others (Foa et al., 2001; Rachman, 1993). For example, those
who experience intrusive thoughts that revolve around acting violently towards others will
appraise the mere existence of these thoughts as being their responsibility and a sign that
the act could be performed. This appraisal of responsibility coupled with the fact that
those with OCD tend to report higher levels of state and trait guilt, (Shafran, Watkins, &
Charman, 1996) leads to intense fear and anxiety towards acting out those thoughts. It is
this fear and anxiety that lead to compulsive behavior that is enacted in an attempt to
manage the obsessions of responsibility (Shafran, 2005). The link between cognitions and
11
actions is further examined through Rachman’s (1993) thought-action fusion (TAF)
model.
The TAF model (Rachman, 1993) is based upon the observation that individuals
with OCD perceive an inherent causal connection between their thoughts and actions. In
other words, merely having an intrusive thought makes it more likely that a person will act
upon that thought. For example, someone with OCD might believe that having a thought
about killing a family member actually increases the chances of it happening. The TAF
model is further evidence for the cognitive biases that make intrusive thoughts distressing
and personally relevant for those with OCD (Rassin, Murin, Schmidt, & Merckelbach,
2000). The significance that those with OCD attribute to intrusive thoughts is the
mechanism for the development and maintenance of the disorder. In addition to
Salkovskis (1985) and Rachman’s (1993) models, evidence exists to suggest that those
with OCD also tend to place importance on thought control.
Those with OCD function under the false assumption that thoughts are
controllable. Unfortunately, intrusive thoughts, and cognitions in general, are often
uncontrollable in nature (IOCDF, 2015; McLaren & Crowe, 2003). The desire of
individuals with OCD to control their intrusive thoughts coupled with their inability to do
so create distress and anxiety. Additionally, those with OCD interpret their inability to
control their thoughts as a personal failure or deficit, further creating feelings of distress
(Purdon, Rowa, & Antony, 2005; Shafran, 2005). In an effort to control intrusive
thoughts, those who suffer from this disorder tend to engage in thought suppression, which
is considered a type of cognitive compulsion. Unfortunately, engaging in thought
suppression actually reinforces the obsessive thoughts (Purdon, 1999; Rassin, Muris,
12
Schmidt, & Merkelbach, 2000). Tell someone not to think about an elephant and you can
bet their first cognition is that of an elephant. The same process occurs in the context of
intrusive thoughts.
In addition to the need for cognitive control, individuals with OCD also tend to
report intolerance for uncertainty (Calleo et al., 2010; Carleton et al., 2012; Tolin et al.,
2003). The irony behind the existence of this characteristic is that although individuals
with OCD have intolerance for uncertainty, they also have a tendency to experience
excessive doubt (Tolin et al., 2003), which is the reason why OCD is sometimes labeled
“the doubting disease” (Ciarrocchi, 1995). It is this intolerance for uncertainty that leads
those with OCD to engage in more metacognitions than control populations and seek
excessive reassurance from others (Janeck, Calamari, Riemann, Heffelfinger, 2003;
Kobori, Salkovskis, Read, Lounes, & Wong, 2012; Parrish & Radomsky, 2010) in an
attempt to reduce feelings of uncertainty.
While the cognitive dysfunctions associated with OCD are multifaceted, the
commonality that exists among the models is the role of appraisal in the cyclical
reinforcement of obsessions and compulsions. Errors in appraisal represent the cognitive
mechanism that transforms common intrusive thoughts into full-fledged obsessions. In
other words, dysfunction in appraisal is the linchpin that drives the disorder. Therefore,
addressing this dysfunction is vital for both understanding the etiology of the disorder and
effective treatment options. It stands to reason that correcting cognitive dysfunctions or
engaging in a cognitive reappraisal process would help those with OCD reduce the level
of anxiety and distress associated with their intrusive thoughts (Rachman, 1997). The
identification of appraisal as the primary factor that contributes to the maintenance of the
13
disorder is absolutely essential in determining the most effect treatments for OCD
(Shafran, 2005) and will remain a primary focus of this investigation.
Cognitive-behavioral therapy (CBT), and more specifically, exposure and response
prevention (ERP) is one of the more popular and effective treatments for OCD. One of
the primary purposes of CBT and ERP is to help those with OCD 1) reassess the
significance attached to their intrusive thoughts and 2) refrain from or avoid engaging in
compulsive behavior (Fama & Wilhelm, 2005). For example, a patient in CBT might be
asked to discuss one of his or her most intrusive thoughts. The first goal of this exercise is
to heighten the patient’s level of anxiety. The second goal of this activity is for the
individual to learn how to manage his or her level of anxiety without engaging in
compulsive behavior or mental acts. However, one limitation of CBT is that it is restricted
to a professional atmosphere where individuals are able to work with a psychiatric
professional. The progress an individual makes during CBT in a therapeutic context could
cease to continue when individuals return home and lose their professional support
system.
Research indicates that maladaptive family functioning can actually be
counterproductive for an individual with OCD, and even increase their symptoms (Storch,
Lehmkuhl, Pence, Geffken, Ricketts, Storch, & Murphy, 2009). In other words, the
communication patterns between family members and the individual with OCD can either
adversely or positively affect his or her symptoms. Research tends to focus on
dysfunctional familial and partner interactions rather than on functional ways to approach
the management of OCD symptoms. Dysfunctional communication patterns include
criticism, hostility and high emotional expression directed at the individual with the
14
disorder (Renshaw, Steketee, & Chambless, 2005; Zinbarg, Eun Lee, & Yoon, 2007).
These dysfunctional communication patterns suggest that functional communication
between social network members and the afflicted individual might include messages of
acceptance, patience, and love, although the utility of these messages have yet to be tested.
Despite the existence of dysfunctional communication patterns between afflicted
individuals and their loved ones, current research does point to the utility of including
social network members in the treatment of OCD (Black & Blum, 1992; Renshaw,
Steketee & Chambless, 2005; Tynes, Salins, Skiba, & Winstead, 1992). With that being
said, it is imperative that social network members recognize and practice functional
communication patterns if they are to help their loved one manage his or her OCD
symptoms. One of the purposes of this investigation is to examine one such functional
pattern, namely social support.
Social support networks can act as pseudo-therapists at home in the treatment of
this debilitating disorder. Treatment approaches that include family members or other
loved ones recognize that social support network members can be a useful component in
the treatment process. Therefore, communication research that focuses on social support
might provide utility in exploring the specific ways in which social network members can
help their loved one manage their symptoms through supportive communication in a nonclinical setting. Social support research, and more specifically studies on the utility of
messages that vary in level of VPC, might provide some answers as to how loved ones can
aid in the treatment of OCD through effective social support.
15
Social Support
The study of social support has garnered significant attention within the field of
communication over the past 30 years. The long history of social support research is
reflective of the importance that humanity places on social connections. Social support is
associated with a variety of positive social, psychological, and physical outcomes
(Albrecht, Burleson, & Sarason, 1992). For the purposes of this investigation, social
support or supportive communication will be conceptualized as the enacted “verbal and
nonverbal behavior produced with the intention of providing assistance to others perceived
as needing that aid” (Burleson & MacGeorge, 2002, p. 374). While various trends exist
within the social support literature, one of the more advanced strands of research focuses
on the different types of social support messages.
Types of Social Support
Social support research within the field of communication has identified the
following five types of social support: informational, tangible, esteem, network, and
emotional (Xu & Burleson, 2001). Informational support is the act of offering information
or advice in an effort to solve anothers’ problems. Tangible support is also problemfocused in that it refers to the offering of material resources (e.g., money) (Cutrona &
Suhr, 1992). Esteem support is defined as messages that focus on enhancing the selfworth or self-esteem of an individual (Holmstrom & Burleson, 2011). Network support is
communication from social network members that promotes a sense of togetherness.
Lastly, emotional support is a type of social support that focuses on acknowledging and
validating the feelings or emotions of a distressed individual (Cutrona & Suhr, 1992; Xu
& Burleson, 2001). Those with OCD tend to experience anxiety and distress as a result of
16
their symptoms (Rachman, 1971). Receiving emotional support from a social network
member might help those with OCD come to acknowledge, accept and understand how
their symptoms make them feel (Black & Blum, 1992; Renshaw, Steketee & Chambless,
2005; Tynes, Salins, Skiba, & Winstead, 1992). This focus on the emotional response to
symptoms might help those with the disorder reassess the significance of their intrusive
thoughts, a process known as cognitive reappraisal. Given that the focus of this study is
on the social support outcome of emotional improvement via cognitive reappraisal, an
exploration of emotional support is more relevant to the current conversation than other
types.
Emotional support. Emotional support differs from other types of social support
in that messages are directed at recognizing, accepting, and validating anothers’ feelings
or emotions (Burleson, 2003). Emotional support is conceptually connected to the
communicative phenomenon of comforting. As with emotional support, effective
comforting consists of behaviors that relieve another’s emotional distress and is contingent
upon multiple factors, such as the characteristics of the comforter and distressed other as
well as the context in which the comforting occurs (Burleson, 1985). Ultimately,
communication can function as the mechanism for relieving another’s emotional distress
such that messages differ in the extent to which they are comforting and emotion-focused.
In the context of OCD, emotional support could help those with the disorder identify,
accept, and process their negative feelings and emotions (Burleson, 1985). This emotional
processing might then lead to a reappraisal of the intrusive thoughts that triggered the
anxiety and distress in the first place. Again, research suggests that highly effective
emotional support or comforting is characterized by acknowledging, validating, and
17
elaborating on anothers’ emotions (Burleson, 1985; 1987; Burleson & Samter, 1985).
Efforts to identify the most effective features of emotional support messages have resulted
in a research tradition focused on what has been classified as verbal person-centered
messages (Burleson, 1985; 1994; High & Dillard, 2012; Jones & Wirtz, 2006).
Verbal person-centered messages. One of the most highly researched topics in
social support is the foundational concept of messages that vary in level of VPC.
Messages that vary in level of VPC are defined by Burleson (2009a) as “the extent to
which messages explicitly acknowledge, elaborate, legitimize, and contextualize the
feelings and perspectives of a distressed other” (p. 181). Advanced by Burleson (1982),
these messages have become the most significant factor in distinguishing between
effective and non-effective emotional support messages. Rather than focusing on the type
of social support, the concept of verbal person-centeredness focuses on the qualities of a
message that are perceived as most effective in relieving another’s emotional distress
(Burleson, 2009a).
Messages that vary in VPC are hierarchically classified into three levels (Burleson,
1982; High & Dillard, 2012). The first level of the message hierarchy represents
messages low in VPC. These messages reject or criticize another’s feelings. It is not
surprising that messages that invalidate or de-legitimize another’s feelings or emotions are
perceived as ineffective in relieving another’s distress. The second level characterizes
messages moderate in VPC that reframe or implicitly recognize another’s emotions.
While these messages do not actively discredit another’s feelings/emotions, they also do
not directly help another cope with their distress. The third level represents types of
messages that are highest in VPC. Messages high in VPC acknowledge and validate
18
another’s feelings as well as communicate the presence of assistance if needed (Burleson,
1982). Messages that are high in VPC are most highly associated with positive relational
outcomes and perceived helpfulness (High & Dillard, 2012).
A meta-analysis conducted by High and Dillard (2012) suggests that across 23
studies the use of messages high in VPC was consistently associated with positive
outcomes. Of the 23 studies examined in their meta-analysis, positive outcomes included
message quality, helpfulness, comforting, appropriateness, sensitivity, effectiveness, and
affective improvement. Again, these positive outcomes point to the utility of messages
high in VPC at reducing the emotional distress of another. These outcomes also support
the notion that messages high in VPC might help those with OCD achieve emotional
improvement in the wake of their distressing symptoms. In addition to the positive
outcomes of messages high in VPC, High and Dillard (2012) also identified the following
as the two most studied dependent variables: perceptions of support messages and actual
outcomes of receiving support. Several research studies have explored these dependent
variables in a variety of contexts. While the current investigation is focused on the
specific context of OCD, the following research provides a comprehensive review of the
various contexts and factors that have been associated with perceptions of social support
messages as well as distinct social support outcomes. The fact that messages high in VPC
can lead to productive outcomes across diverse contexts points to its potential utility in
helping people manage their OCD symptoms.
Rack, Burleson, Bodie, Holmstrom, and Servaty-Seib (2008) explored the
perceived helpfulness of grief messages in a sample of college students who had
experienced the death of a loved one (e.g. family member, friend, romantic partner).
19
Results indicated that grief messages high in VPC were perceived by participants as the
most helpful. Wilkum and MacGeorge (2010) also examined VPC messages in the
context of bereavement. The purpose of their study was to explore the relationship
between religious content and perceptions of comforting messages. Results from their
study also indicated that messages high in VPC were perceived by the participants as the
most comforting when dealing with the loss of another.
In addition to bereavement contexts, other scholars have focused on the association
between attachment styles and perceptions of effective social support. Jones (2005)
recruited college students to fill out questionnaires on attachment styles, affective
communication styles, and perceptions of messages that varied in levels of VPC. Her
results suggested a relationship between participants’ attachment styles and their
evaluations of VPC messages such that those with dismissive and preoccupied attachment
styles preferred low VPC messages in comparison to those with secure and fearful
attachment styles. Participants with a fearful attachment style were least likely to perceive
low VPC messages as helpful. Lemieux and Tighe (2004) also reported a significant
relationship between attachment styles and perceptions of comforting messages. Their
results suggested that individuals with secure attachment styles preferred messages high in
VPC in comparison to those with anxious/ambivalent and avoidant attachment styles. The
findings of these two studies point to yet another individual difference factor associated
with the ways in which individuals distinguish between effective and non-effective social
support messages.
Apart from bereavement contexts and a focus on attachment styles, research has
examined a host of additional factors associated with the study of VPC and perceptions of
20
social support effectiveness. Some of these factors include event type (Hale, Tighe,
Mongeau, 1997), sex (Burleson, Holmstrom, & Gilstrap, 2005; Hale, Tighe, Mongeau,
1997; Jones & Burleson, 1997), and attribution processes associated with control and
blame (Jones & Burleson, 1997). These additional factors highlight the complexity
surrounding both the production and reception of messages that vary in VPC in contexts
charged with emotional distress.
It is apparent from the literature review thus far that emotional support, and more
specifically, messages that vary in level of VPC, have attracted the attention of social
support scholars within the field of interpersonal communication. However, one
limitation of this body of research is that in comparison to the dependent variable of
perceived effectiveness (PE), what Bodie, Burleson, and Jones (2012) refer to as actual
effectiveness (AE) of messages that vary in VPC has received less attention. As High and
Dillard (2012) note in their meta-analysis, only three of the 23 studies in their sample
focused on actual effectiveness. The research that does examine actual or concrete
outcomes (Burleson, 2009a; 2009b; Jones, 2004; Jones & Wirtz, 2006) suggests that
messages high in VPC can lead to a reduction in emotional distress via the facilitation of
emotional expression and reappraisal of the distressing event. In other words, cognitive
reappraisal is the mechanism that explains why messages that vary in VPC work. The
current investigation will focus on the degree to which messages that vary in VPC will
lead to an actual change in participant’s emotions and levels of anxiety and distress
following an emotional support message. Given the potential relationship between
messages that vary in VPC and cognitive reappraisal, the next section will explore the
21
theoretical underpinnings of the appraisal process within a discussion of the theory of
conversationally-induced reappraisals.
Theory of Conversationally-Induced Reappraisals
In order to understand the framework of the theory of conversationally-induced
reappraisals, it is first important to explore the foundational elements of appraisal theory.
Appraisal theory stems from a research tradition that focuses on stress and coping and
provides a framework for understanding how humans relate to an ever-changing
environment. The process of cognitive appraisal involves the ways in which individuals
interpret the self-relevance of environmental stimuli (Lazarus & Folkman, 1987). Lazarus
and Folkman (1987) define appraisal as the tendency for humans to “constantly evaluate
what is happening to them from the standpoint of its significance for their well-being” (p.
145). This process of interpretation consists of primary and secondary appraisals.
Primary appraisals constitute the process whereby individuals interpret the selfrelevance of an encountered environmental stimulus and determine whether that stimulus
is irrelevant, benign-positive, or stressful (Folkman & Lazarus, 1985). Peoples’ emotional
reactions stem from this primary appraisal. For example, those with OCD might
experience an intrusive thought and appraise that cognition as both self-relevant and
threatening to their identity. The intrusive cognition becomes a stressor for that
individual. This stress or threat appraisal could lead to a certain emotional reaction, such
as fear. Once individuals identify the self-relevance of the stimulus, they gauge their
ability to cope with the stressor. Secondary appraisals represent the process of
recognizing potential coping strategies (Folkman & Lazarus, 1985). For many individuals
with OCD, coping takes the form of compulsive behavior, which is counterproductive to
22
symptom management (5th ed.; DSM-V; American Psychiatric Association, 2013;
Abramowitz, McKay, & Taylor, 2008). Rather than engaging in compulsive behavior as a
coping technique, it might be more fruitful for those with the disorder to receive social
support from their social network members. The availability of social support from loved
ones could help the afflicted individual manage the negative emotions triggered by his or
her primary appraisal.
The research tradition of stress and coping indicates that coping can be classified
as either problem-focused or emotion-focused, the latter of which applies to this specific
investigation. Emotion-focused coping is motivated by the need to change one’s
emotional reaction to an environmental stimulus (Lazarus, 1993; Lazarus & Folkman,
1984). For people with OCD, the goal is to change their initial emotional reaction to their
intrusive cognitions as this primary appraisal often lead to unproductive coping strategies.
Social support can act as one such strategy for achieving this goal. The process of
emotion-focused coping is contingent upon a number of individual and environmental
factors. These factors might include personal values, general beliefs, demands, resources,
and constraints (Lazarus & Folkman, 1987). One specific type of emotion-focused coping
is cognitive reappraisal.
Cognitive reappraisal essentially occurs when initial judgments are reconsidered
and potentially altered at a later moment in time (Lazarus & Folkman, 1984). It is during
the reappraisal process that individuals might experience an alternative emotional reaction
to a previous stimulus. Inducing reappraisal in a fellow communicator can be productive
if the initial appraisal elicited an unwanted emotional reaction. Again, those who suffer
from OCD could benefit from reappraising their initial negative reactions to their
23
unwanted thoughts as this reappraisal process might help them reassess the importance of
these cognitions and lead to an alternative emotional reaction. The appraisal theories’
perspective on stress and coping has received attention from communication scholars
interested in the possibility that emotional support can induce cognitive reappraisals and
reduce emotional distress. The goal of this investigation is to explore such a process for
those with OCD in order to determine the degree to which messages high in VPC help
those with OCD manage their anxiety through cognitive reappraisal.
Messages high in VPC are often considered the ‘golden’ message of social
support. An accumulation of evidence over the years points to the utility of these
messages in emotionally-charged contexts (Burleson, 2009a; 2009b; Jones, 2004; Jones &
Wirtz, 2006). While this body of research has birthed immense support for messages high
in person-centeredness, Burleson and Goldsmith (1998) argued that it failed to explain
why this message feature was so effective. At the time, an adequate answer to this
question did not exist. More generally, there were no explanations as to why certain types
of messages led to certain outcomes (Burleson, 2009). The theory of conversationallyinduced reappraisals developed as a response to this gap in the literature.
Burleson and Goldsmith (1998) introduced the notion of conversationally-induced
reappraisals in an attempt to identify the linchpin that explained why certain types of
support messages were more effective than others in providing emotional relief. More
specifically, the rationale behind the theory of conversationally-induced reappraisals was
to identify the specific mechanism that would enable a support recipient to reappraise his
or her feelings and emotions.
24
The work of Burleson and Goldsmith (1998) along with Jones and Wirtz (2006)
provided evidence of the link between messages that varied in VPC and cognitive
reappraisal. More specifically, their research suggested that messages high in VPC were
more likely to lead to cognitive reappraisal in comparison to moderate or low personcentered messages. What were their explanations for such as association? Burleson and
Goldsmith (1998) proposed that messages high in VPC enabled support recipients to
identify, accept, and elaborate on their thoughts, feelings, and emotions. This process of
acceptance and elaboration during a conversational interaction with a support provider
acted as the mechanism through which individuals could reassess or reinterpret their initial
emotional response, also known as cognitive reappraisal. More specifically, Jones and
Wirtz (2006) identified the verbalization of positive emotion words (message elaboration)
as the specific mechanism through which cognitive reappraisal was achieved. While
Jones and Wirtz identified the link between the verbalization of positive emotion words
and cognitive reappraisal, the current investigation, as it explores a different context, will
initially approach the concept of message elaboration more broadly. In other words,
message elaboration will not be defined as the processing of positive emotion words
specifically, but of cognitions and emotions in general. The identification of the link
between messages high in VPC and cognitive reappraisal partially satisfied the question of
why some types of social support were more effective than others.
Jones and Wirtz (2006) argued for the relationships among messages that varied in
VPC, message elaboration, cognitive reappraisal, and affective improvement. As stated
previously, messages high in VPC are more likely to lead to message elaboration than
messages moderate or low in VPC. Message elaboration allows an individual to process
25
and disclose their feelings and emotions, which can often lead to cognitive reappraisal.
More specifically, their study indicated that message elaboration, in the form of
verbalizing positive emotions words, led to cognitive reappraisal. It is the process of
cognitive reappraisal that then leads to emotional or affective improvement. In other
words, cognitive reappraisal acts as a prerequisite for emotional change. Not only this, but
cognitive reappraisal mediates the relationship between message elaboration and
emotional improvement.
Holmstrom, Russell, and Clare (2013) also found results to support the relationship
between cognitive reappraisal and affective improvement. Although their research
focused on esteem support, their results pointed to the utility of certain esteem messages in
leading to cognitive reappraisal, job search esteem, and affective change. In the context of
job seeking behavior, they found results to support the theory of conversationally-induced
reappraisals. Additional evidence for the utility of conversationally-induced reappraisals
is found in Matsunaga’s (2011) research on bullying. The results from this investigation
highlighted the relationship between emotional support, cognitive reappraisal, and
subjective well-being, such that effective emotional support enabled bullying victims to
positively reappraise their negative experiences, which often led to improved subjective
well-being. Overall, these studies provide evidence to support the theory of
conversationally-induced reappraisals. These investigations also suggest that this theory
can help explain how message high in VPC induce cognitive reappraisal and emotional
improvement for people with OCD. Similar to bullying victims who are likely to
experience extreme emotional trauma, those with OCD might also benefit from receiving
emotional support that enables them to positively reappraise their distressing intrusive
26
thoughts. It is the hope that this positive reappraisal will lead to feelings of emotional
relief.
While this theory provides a useful framework for understanding social support
outcomes, it does not necessarily focus on the potential impact of messages moderate or
low in VPC on support recipients. This theoretical limitation was identified by Burleson
and his colleagues (2009a) and resulted in the construction of the dual-process theory of
supportive communication outcomes. The theory was constructed because they noticed
that not all messages high in VPC (for example) produced equivalent or consistent results
and because there was variance in the outcomes associated with a given level of VPC.
Dual-Process Theory of Supportive Communication Outcomes
While messages high in person-centeredness are often considered the golden
message of emotional support, evidence suggests that outcomes vary in response to this
message feature. In other words, Burleson and his students (2009a) found evidence to
suggest that other factors (source, recipient, contextual) besides the message feature itself
might influence how people respond. These findings led those interested in this evidence
to ponder the following questions. How do we account for these differences in social
support outcomes? Why do different people experience distinct outcomes from the same
message? More specifically, why do message high in VPC produce different effects for
different people? Burleson and his students were among the first to collectively strive to
answer such questions. It is through the development of their dual-process theory of
supportive communication outcomes (Burleson, 2009) that we are currently more attuned
to the complex process of social support.
27
Influenced by theories of persuasion, the dual-process theory of supportive
communication provides a framework for understanding the varying outcomes associated
with messages that vary in level of VPC. According to the theory, emotional
improvement is identified as the outcome variable of importance (Burleson, 2009a). The
theory contends that the effects or outcomes of messages at varying levels of VPC differ
based upon how extensively that message is processed by the recipient. Several individual
and environmental factors influence how much processing a message receives. The theory
identifies individual ability and motivation as two such factors. When message are not
processed extensively, other factors, such as the sex and attractiveness of the individual or
the type of relationship between the support provider and recipient might influence the
outcome of the message (Burleson, 2009a). Apart from individual levels of ability and
motivation, the actual message content itself could influence the degree to which a
message is processed.
Message content and message elaboration
Previous research suggests that messages high in VPC are more likely to lead to
message elaboration than messages moderate or low in VPC (Burleson & Goldsmith,
1998; Jones & Wirtz, 2006). Such a relationship makes intuitive sense when we consider
that the goal of messages high in VPC is to enable individuals to elaborate on their
thoughts, feelings, and emotions concerning a specific stressor. This process of reflection
characterizes the concept of message elaboration. In this sense, message elaboration is
contingent upon the content or message features of the social support message crafted by
the support provider. Engaging in message elaboration can be a productive process for
achieving emotional improvement following a stressful situation or event as it enables
28
individuals to reassess or reinterpret initial emotional and psychological reactions, a
process known as cognitive reappraisal (Lazarus & Folkman, 1984). The process of
cognitive reappraisal makes it more likely that an individual will achieve emotional relief
in the wake of their specific stressor as it induces an emotional transformation from the
primary appraisal of the stressor itself (Jones & Wirtz, 2006). Despite the relationships
between messages that vary in VPC, message elaboration and cognitive reappraisal, the
theory also proposes that other factors beyond message content influence message
processing. Individual levels of ability and motivation represent two such factors that
influence this relationship.
Ability and message elaboration
Individuals differ in their ability to process or elaborate on social support
messages. Within the dual-process research, ability is often conceptualized as individual
cognitive complexity. Cognitive complexity, in a broad sense, is an individual’s ability to
process social information (Burleson, 2009a). Influenced by the constructivist approach to
communication (Burleson, 2007; Crockett, 1965; Delia & Clark, 1977), cognitive
complexity references an individual’s capacity to receive, interpret, and respond to
messages. Therefore, this individual difference factor becomes relevant in the discussion
as to how individuals process supportive messages that vary in levels of VPC.
The concept of cognitive complexity is measured or operationalized in multiple
ways. Crockett’s (1965) Role Category Questionnaire (RCQ) is a common and reliable
assessment of cognitive complexity often used in dual-process research (Bodie et al.,
2011; Burleson et al., 2009; Burleson & Waltman, 1988) and will therefore be utilized in
this specific study. The cognitions generated using the RCQ can be analyzed according to
29
their organization, abstraction, or differentiation (Burleson & Waltman, 1988). For the
current investigation cognitive complexity will be determined by the number of
cognitions, also known as cognitive differentiation, generated within a participant’s
response. Again, assessing cognitive complexity through cognitive differentiation is a
valid and reliable approach to measuring the construct, as illustrated by prior research
(Bodie et al., 2011; Burleson et al., 2009; Burleson & Waltman, 1988).
According to the dual-process theory of social support, cognitive complexity is
positively associated with message elaboration. In other words, individuals with a higher
level of cognitive complexity are more likely to engage in more extensive message
processing (Bodie et al., 2011; Burleson, 2009). As such, cognitive complexity acts as a
moderating factor between messages that vary in VPC and message elaboration. The
relationship between cognitive complexity and message processing or elaboration has
implications for the influence of message content on emotional improvement. In other
words, the content of supportive messages has a stronger impact on support outcomes
when the message is processed thoroughly versus superficially. Furthermore, cognitive
reappraisal is more likely to occur when levels of message elaboration are high (Bodie et
al., 2011; Bodie & Burleson, 2008). From these results it is apparent that the social
support process is characterized by complex associations between message content,
cognitive complexity, message elaboration, and cognitive reappraisal. The complex
relationships between these variables are further complicated by the inclusion of the
individual difference factor of motivation.
30
Motivation and message elaboration
In addition to an individual’s ability to process a social support message, a
person’s motivation to process the message also has implications for social support
outcomes. Motivation is considered by the dual-process theory as a situational factor in
the social support process. Motivation is often operationalized as emotional upset,
problem severity, or individual distress (Bodie et al., 2011; Burleson, 2009). The current
investigation operationalizes motivation as an individual’s level of anxiety and distress.
The theory contends that individuals who experience higher levels of emotional upset or
distress will be more motivated to process the content of a social support message from a
support provider as they are looking to decrease or alleviate their emotional suffering.
More specifically, people will process message content more thoroughly when their
motivation is high rather than low. In this sense, individual motivation also acts as a
moderating influence on the relationship between messages that differ in VPC and
message elaboration.
Integration of Theoretical Frameworks
As stated previously, the purpose of this investigation is to marry the theory of
conversationally-induced reappraisals with the dual-process theory of supportive
communication outcomes in an effort to construct a more comprehensive model of the
social support process. In their own right, these separate theories provide insight into
specific components of the social support process. For example, the dual-process theory
of supportive communication seeks to explain how individual difference factors such as
ability and motivation influence the extent to which individuals process supportive
messages. The theory of conversationally-induced reappraisals examines the process by
31
which message elaboration or processing of specific thoughts and emotions leads to
emotional improvement via cognitive reappraisal. While each theory elucidates certain
elements of the social support process, alone they do not account for all of the factors and
mechanisms that explain why certain social support messages lead to the outcomes they
do.
While the dual-process theory of supportive communication outcomes identifies
the individual difference factors that lead to message elaboration, the theory does not
examine the mechanism through which message elaboration leads to emotional
improvement, a limitation that the theory of conversationally-induced reappraisals
addresses. On the other hand, while the theory of conversationally-induced reappraisals
accounts for the mechanism of cognitive reappraisal, it does not explore the factors that
lead to individual differences in message elaboration. Once again, this limitation is
explored by the dual-process theory of supportive communication outcomes. Ultimately,
each theory examines aspects of the social support process that the other does not. Given
this statement it seems appropriate to combine these theoretical frameworks as they
complement one another in their effort to explain the social support process.
A comprehensive picture of the social support process is warranted in contexts
such as OCD as those with this disorder often cannot manage their distressing symptoms
alone. Receiving productive social support from a social network member is one type of
coping strategy that might prove useful in the management of OCD symptoms (Black &
Blum, 1992; Renshaw, Steketee, & Chambless, 2005; Tynes et al., 1992). This
investigation proposes that messages that vary in VPC are the most productive type of
emotional support for helping those with the disorder achieve emotional improvement via
32
cognitive reappraisal. The union of the theory of conversationally-induced reappraisals
with the dual-process theory of supportive communication outcomes provides an
explanation of the various factors and mechanisms that account for the relationship
between messages that vary in VPC and emotional improvement. Therefore, unionizing
these theoretical frameworks provides a comprehensive understanding of the social
support process that could ultimately help those with OCD productively manage their
obsessions and compulsions.
Social Support and OCD
The provision of social support for those with obsessive-compulsive disorder
(OCD) can be productive for symptom management. However, what remains to be fully
explored within the OCD literature are the specific social support message features that
result in emotional improvement for those suffering from the disorder. As stated earlier,
most research on communication and OCD focuses on the dysfunctional communication
patterns employed by social network members. The current investigation seeks to address
this limitation. The manifestations of OCD impact work, social, and personal relationship
domains (Abramowitz, 2006; Masellis, Rector, & Richter 2003; Stengler-Wenzke, Kroll,
Matschinger, & Angermeyer, 2006). Ultimately, the symptoms of this disorder impact not
only the afflicted (diagnosed) individual, but their social network as well. Family, friends,
and marital/romantic partners are especially impacted by the pervasive nature of OCD as
these individuals are more likely to engage in everyday interaction with the afflicted
individual (Cooper, 1996). As a result, OCD often becomes, whether desired or not, a
disorder that is co-managed by both the afflicted individual and their loved ones. The
ways in which the disorder is co-managed have implications for whether or not the
33
symptoms are kept “under control”. Therefore, it is essential that those living with OCD,
as well as their loved ones, are aware of and consistently enact productive management
strategies. The current investigation focuses on the provision of social support as one such
management strategy.
The previous examination of the cognitive models associated with OCD led
researchers to conclude that this disorder can be characterized as a disorder of “cognitive
dysfunction” (Abramowitz, Taylor, & McKay, 2009). For those with OCD, primary and
secondary appraisals function as the mechanisms that perpetuate the illness. Those with
OCD experience an intrusive thought and interpret or cognitively appraise that thought as
a threat to the self. It is this sense of threat that leads to anxiety and distress. In order to
relieve this anxiety/distress, people with OCD often cope in maladaptive ways by
engaging in compulsive behavior as they perceive these actions as their only way to
manage their negative emotions. Therefore, it is imperative for people with this disorder
to reevaluate the significance they place on their intrusive thoughts. Receiving social
support from a loved one can help an individual with OCD engage in this reappraisal
process. The theory of conversationally-induced reappraisals acts as a tool for
understanding the capacity for messages high in VPC to lead to emotional improvement
via cognitive reappraisal (Jones & Wirtz, 2006). Additionally, the dual-process theory of
supportive communication outcomes highlights other factors that play a role in how
individuals process supportive messages. Therefore, the primary aim of this investigation
is to merge these theoretical frameworks in order to determine the overall factors that lead
to emotional improvement via cognitive reappraisal for those suffering from OCD.
34
Current Model
The union of the theory of conversationally-induced reappraisals (Burleson &
Goldsmith, 1998) with the dual-process theory of supportive communication outcomes
(Burleson, 2009) led to the construction of a comprehensive model of social support
outcomes (see Figure 1-1). The model depicts the relationships between the following six
variables under investigation: messages that vary in VPC, ability, motivation, message
elaboration, cognitive reappraisal, and emotional improvement. As informed by the dualprocess theory of supportive communication outcomes, the model tests the direct
relationship between messages that vary in VPC and message elaboration. The model also
proposes that the association between these variables will be moderated by individual
factors of ability and motivation. In addition to message elaboration, the current
investigation tests the associations between messages that vary in VPC, cognitive
reappraisal and emotional improvement. As informed by the theory of conversationallyinduced reappraisals, the hypothesized model explores the relationship between message
elaboration and cognitive reappraisal. Lastly, the model depicts a direct association
between cognitive reappraisal and emotional improvement. The associations between
these variables are reflected in the following hypotheses of this investigation.
Current Study
An inclusive model of social support outcomes is constructed through the union of
the theory of conversationally-induced reappraisals (Burleson & Goldsmith, 1998; Jones
& Wirtz, 2006) with the dual-process theory of supportive communication outcomes
(Burleson, 2009). This union highlights the multiple factors that drive the outcome of
affective change or emotional improvement in the context of social support interactions,
35
and in this specific study, the context of OCD management. At one level, the amount an
individual processes or elaborates on a social support message is contingent upon both
individual and contextual characteristics. Apart from these factors, features of the specific
message itself also have implications for how a message is cognitively processed.
It is well established that messages differ in level of VPC (Burleson & Samter,
1985). A large body of research supports the idea that messages high in VPC are most
often perceived as the highest quality support. The theory of conversationally-induced
reappraisals (Jones & Wirtz, 2006) suggests that the features of messages high in VPC
encourage an individual to process and elaborate on their feelings and emotions during a
conversation with a support provider. In other words, message high in level of VPC
encourage a support recipient to reflect upon their current thoughts, emotions, and
reactions surrounding the stressor at hand. In the context of OCD, messages high in VPC
might help those with the disorder acknowledge and understand how their intrusive
thoughts make them feel. The theory contends that this process of reflection can promote
cognitive reappraisal of the stressor, which can ultimately lead to emotional improvement
for the afflicted individual. The postulated relationship between message content and
message elaboration leads to the following hypothesis:
H1: For individuals with OCD, the level of VPC in a supportive message is
positively associated with message elaboration.
In addition to the content of the message itself, the dual-process theory of supportive
communication outcomes proposes that an individual’s ability (cognitive complexity) to
process a message that varies in VPC influences levels of message elaboration as well.
The dual-process theory of supportive communication contends that the relationship
36
between messages that differ in VPC and message elaboration is stronger at higher levels
of cognitive complexity. Therefore, the following hypothesis represents the relationship
between verbal person-centeredness, individual ability and message elaboration:
H2: For individuals with OCD, individual ability moderates the relationship
between messages that vary in VPC and message elaboration, such that messages
that differ in VPC have a stronger positive effect on message elaboration when
individuals display higher levels of cognitive complexity.
In addition to interpersonal cognitive complexity, an individual’s motivation (level of
anxiety and distress) is also associated with message elaboration. The dual-process theory
of supportive communication outcomes (Burleson, 2009) proposes that messages that vary
in VPC are more thoroughly processed when individual motivation is high rather than
low. Therefore, those with OCD might be more likely to extensively process a message
from a support provider when they are experiencing higher levels of anxiety and distress
due to their intrusive thoughts. The relationship between an individual’s level of
motivation and message elaboration is reflected in the following hypothesis:
H3: For individuals with OCD, individual motivation moderates the relationship
between messages that vary in VPC and message elaboration, such that messages
that differ in VPC have a stronger positive effect on message elaboration when
individuals report higher levels of anxiety and distress.
As stated previously, the current investigation hypothesizes that messages that differ in
VPC are associated with varying degrees of message elaboration. Evidence also suggests
that high levels of message elaboration can lead to cognitive reappraisal (Jones & Wirtz,
2006). One way to look at these associations is through the lens of mathematical logic
37
(A+ B+ C). If the conceptual link can be made between messages that vary in VPC (A),
message elaboration (B) and cognitive reappraisal (C), then I propose that a direct link
between messages that vary in VPC (A) and cognitive reappraisal (C) is not a big leap in
conceptual logic. In other words, it is plausible that messages that differ in VPC are
directly associated with cognitive reappraisal, a relationship that will be tested in the
current investigation. This study departs from Jones and Wirtz (2006) in that they do not
test the direct association between these variables. Again, the purpose of conveying
messages high in VPC is to encourage support recipients to acknowledge, accept, and
process their current emotional state (Jones & Wirtz, 2006). If individuals are able to
accept their current feelings and emotions, however distressing they are, they might also
begin to rethink or reappraise the situation that triggered their reaction in the first place. If
individuals with OCD can come to recognize and accept their current levels of anxiety and
distress, as well as the negative emotions they might be experiencing, it might be possible
for them to reassess the importance and self-relevance of these negative emotional states
in the wake of their intrusive thoughts. Over time these negative emotional states could
become less threatening to the individual. The relationship between messages that vary in
VPC and cognitive reappraisal is hypothesized as follows:
H4: For individuals with OCD, the level of VPC in a supportive message is
positively associated with cognitive reappraisal.
As stated earlier, previous research suggests that messages high in VPC are perceived by
individuals as the highest quality emotional support. This type of emotional support is
associated with positive individual outcomes (e.g. well-being) (High & Dillard, 2012;
Rack et al., 2008; Wilkum & MacGeorge, 2010). In addition to the perceived quality of
38
messages that differ in VPC, research indicates that messages high in VPC can lead to
emotional improvement for support recipients (Burleson, 2009a; 2009b; Jones, 2004;
Jones & Wirtz, 2006). For this study, emotional improvement will be defined as evidence
of participant’s 1) level of overall affective improvement, 2) level of anxiety/distress, and
3) intensity of negative emotions. Rather than just define emotional improvement as
affective improvement, the current investigation includes anxiety, distress, and negative
emotions as additional indicators of emotional improvement. This investigation includes
these additional factors as they are often responsible for perpetuating the cycle of
obsessions and compulsions for people with OCD (IOCDF, 2015; Rachman, 1971, 1993;
Shafran, Watkins, & Charman, 1996). These aforementioned research findings suggest
plausibility for the following hypothesis:
H5: For individuals with OCD, VPC is a) positively associated with affective
improvement, b) negatively associated with anxiety/distress after receiving a
supportive message, and c) negatively associated with negative emotions after a
supportive message.
Thus far it has been established that levels of message elaboration or processing are
dependent upon message content as well as an individuals’ ability and motivation to
process that message. The extent to which an individual processes a social support
message has implications for the degree to which he or she will experience cognitive
reappraisal and emotional improvement. In other words, message elaboration is an
important component within the social support process. The theory of conversationallyinduced reappraisals (Burleson & Goldsmith, 1998) contends that more extensive
processing of social support messages during a conversation will lead to greater levels of
39
cognitive reappraisal as individuals who process a message extensively are more likely to
reassess or reinterpret (reappraise) their initial emotional reaction to the specific stressor in
question, which in this specific context refers to the reappraisal of intrusive thoughts. This
espoused relationship leads to the following hypothesis:
H6: For individuals with OCD, elaboration of a supportive message is positively
associated with cognitive reappraisal of a stressor.
The theory of conversationally-induced reappraisals (Jones & Wirtz, 2006) also suggests
that individuals might achieve emotional improvement from messages that vary in VPC
via cognitive reappraisal. In other words, the process of cognitive reappraisal acts as a
vital step in achieving emotional improvement following a distressing event. Again,
cognitive reappraisal is the process in which individuals reassess or reinterpret their initial
emotional reaction to a stressor (Lazarus & Folkman, 1987). If an individual’s initial
response to a stressor is negative, then positively reinterpreting one’s emotional reactions
to the stimuli or stressor could result in a transformation or change in emotion.
A study conducted by Matsunaga (2011) provides support for the link between
cognitive reappraisal and emotional improvement in the context of bullying in that victims
of bullying were more likely to report behavioral and psychological adjustment (type of
positive outcome) following these negative events when they were able to positively
reappraise their bullying experiences. In a similar vein to victims of bullying, those with
OCD often suffer from emotional anxiety and distress (IOCDF, 2015). If those with the
disorder are able to reappraise their negative response to their intrusive thoughts then they
might be able to achieve some sort of emotional relief. Achieving emotional improvement
for those with OCD can be important for symptom management as distress and anxiety
40
often perpetuate the cycle of obsessions and compulsions (Rachman, 1971). The proposed
association between cognitive reappraisal and emotional improvement leads to the
following hypothesis:
H7: For individuals with OCD, cognitive reappraisal is a) positively associated
with affective improvement, b) negatively associated with anxiety/distress after
receiving a supportive message and c) negatively associated with negative
emotions after a supportive message.
Summary
This chapter summarized the major research trends associated with the current
investigation. First, I examined the symptomatology, theoretical models, and treatment
options related to OCD. Second, I offered a summation of the social support literature,
including information on emotional support and VPC messages as they relate to the
current context. Third, I provided an articulation of the two theories under investigation,
namely the theory of conversationally-induced reappraisals (Burleson & Goldsmith, 1998)
and the dual-process theory of supportive communication outcomes (Burleson, 2009).
Again, the purpose of this investigation is to combine these theoretical frameworks in an
attempt to understand how a variety of different factors lead to emotional improvement for
those with OCD. Next, I explored the ways in which social support messages might help
those with OCD manage their symptoms. Lastly, I offered rationales for the hypotheses of
this study
The overall purpose of this chapter was to highlight the potential that
communication has for the overall management of OCD. More specifically, the current
investigation seeks to unionize two theoretical models in order to illuminate the ways in
41
which those with OCD can reduce the anxiety and distress associated with their disorder.
The next chapter will examine the methods employed to test the hypotheses under
investigation.
42
Ability
Motivation
H3
H2
VPC
Message
Cognitive
Emotional
Message
Elaboration
Reappraisal
Improvement
H6
H1
H7a-c
H4
H5a-c
Figure 1-1. Model of the variables of interest within the dual-process theory of
supportive communication outcomes and the theory of conversationally-induced
reappraisals. The variables of ability, motivation, and message elaboration are associated
with the dual-process theory of supportive communication outcomes while cognitive
reappraisal represents the theory of conversationally-induced reappraisals. Emotional
improvement is associated with both theories.
43
CHAPTER II
METHODS
The previous chapter explored both the relevant research and theoretical foundations
associated with the social support process in the context of OCD management. The
current chapter will summarize the methodologies employed to test the hypotheses under
question, and more specifically, the current sample, procedures, and measures chosen to
represent the variables under investigation.
Sample
Participants were both 18 years of age or older and self-identified as living with
OCD. The sample consisted of 126 (73.7 %) females and 42 males (24.6%). The sample
was primarily Caucasian (91.8%, n = 157) while the remaining participants identified as
American Indian or Alaskan Native (2.3%), Asian (5.3%), Black or African American
(1.2%), Hispanic or Latino (2.9%), and Other (1.2%). Participants ranged in age from 18
to 67 (M = 28.38, SD = 11.11). The average age at which participants first started to
suspect their symptoms was 16 years old (SD = 7.74). Approximately 43.9% (n = 75) of
the sample have received a professional medical diagnosis for their OCD. In addition to
OCD, approximately 55 participants suffered within the past 12 months from other
psychological disorders as well, such as depression, anxiety, and attention-deficit
hyperactivity disorder (ADHD). The severity of participants’ symptoms within the past
month ranged from one to 20.33 out of a possible score of 72. The mean severity score of
this study (M = 10.50, SD = 4.49) can be compared to other research using the obsessivecompulsive inventory-revised (OCI-R) (Foa, Huppert, Leiberg, Langner, Kichic, Hajcak,
& Salkovskis, 2002) that produced means of 27.9 (SD = 11.1), 28 (SD = 13.53), and
44
27.02 (SD = 13.22) (Abramowitz & Deacon, 2006). The investigation conducted by Foa
et al. (2002) determined that a mean score of 21 (cut-off score) successfully differentiated
between those with OCD and non-anxious controls. Approximately 56.1% (n = 96) of
the current sample receives no current treatment while the rest are currently utilizing
medication (33.9%), individual therapy (23.4%), marital therapy (0.6%), group therapy
(1.2%), and other treatment options (4.7%).
Procedure
The following recruitment was conducted under the approval of the University of
Iowa’s Institutional Review Board (IRB) (see Appendix A for IRB approval). Due to the
potential difficulty in recruiting individuals with OCD, several recruitment methods were
employed to achieve the desired sample size. Recruitment sites included the following:
University of Iowa listserv, University of Iowa health care Noon News newsletter, OCD
Twin Cities website, National Alliance on Mental Illness (NAMI) website,
Communication, Research, and Theory Network (CRTNET), and Facebook. For each of
these recruitment sites a description of the study was presented along with a link to the
online survey. Individuals who wished to participant in the study were directed to an
online survey where they were asked to read a consent statement and indicate their
willingness to participant in the study (see Appendix B for complete survey with items).
Once participants were identified as meeting the inclusion criteria, they indicated consent
and answered demographic questions concerning their sex, ethnicity, age, age at onset of
OCD, whether or not they have been professionally diagnosed with OCD, and
identification of other psychiatric disorders.
45
Following demographic information, participants completed an inventory to assess
the severity of their OCD symptoms. Next, a prompt directed participants to think about
one of their most recent, frequent, and distressing intrusive thoughts (obsessions) and to
write in a detailed manner about the thoughts and emotions they associated with the
identified obsession. This priming task encouraged participants to extensively reflect on
an obsessive thought. Following this task, participants indicated their current level of
distress and anxiety and the extent to which they were experiencing a variety of positive
and negative emotions as a means for measuring their current emotional state.
Once participants completed the priming activity, they randomly received one of
three potential emotional support messages that differed in verbal person-centeredness
(VPC) (low, medium, and high). Participants were then shown the following prompt.
In the previous section we asked you to indicate the extent to which you were
experiencing a number of different emotions and feelings of distress. We would
now like you to imagine that you ran into a friend and had a conversation with
him/her. During the conversation your OCD happened to come up and the two of
you discussed how you have been managing it recently. Now imagine that during
this conversation your friend provides you with the following message.
The three levels of VPC messages were adapted from High and Dillard (2012) for this
specific context and pilot-tested prior to use with this sample. After participants read their
assigned message, they were asked with two open-ended questions to provide their initial
response (thoughts, feelings, reactions, etc.) to the support message and/or the support
provider. Following these responses participants once again reported on their current level
of anxiety, distress, and emotions as a type of post-test to determine the extent to which
46
messages that varied in VPC led to a change in the participant’s emotional state. Subjects
also answered questions assessing their perceptions of the quality of the message, affective
improvement, and level of cognitive reappraisal.
Once participants completed assessments of their assigned social support message,
they completed a measure of cognitive complexity. Subjects listed the initials and
subsequent characteristics of an individual whom they both liked and disliked. The sum of
these distinct characteristics across both categories represented an individual’s level of
cognitive complexity (Crockett, 1965).
Completion of the survey took approximately 30 minutes to an hour. Once
participants completed the online questionnaire they provided their name, permanent
address, and email so that the $10 compensation check could be sent to them. Participants
were thanked for their participation and given both contact information for the principal
investigator should they have any questions and/or concerns, and information about the
International Obsessive-Compulsive Disorder Foundation (IOCDF), a site where they can
seek help if needed/desired.
Instrumentation
Demographic information
Participant’s background information included questions pertaining to their sex,
ethnicity, age, age at onset of OCD, whether or not they had been professionally
diagnosed with OCD, and identification of other psychiatric disorders.
OCD severity
Participants completed an 18-item Obsessive-Compulsive Inventory (revised)
(OCI-R) to assess the severity of their OCD symptoms (Foa et al., 2002). The inventory
47
consists of the following six subscales: washing, checking, ordering, obsessing, hoarding,
and neutralizing. Sample items from this scale included: “I have saved up so many things
that they get in the way”; “I find it difficult to control my own thoughts”; “I am upset by
unpleasant thoughts that come into my mind against my will”. Participants responded to
the 18 items on a 4-point scale (0 = not at all and 4 = extremely) based upon how
distressful the symptoms had become in the past month. Results from a confirmatory
factor analysis conducted in SPSS using a principal components analysis supported the
existence of six subscales with the following reliabilities: washing (M = 1.43, SD = 1.19;
α = 0.87), obsessing (M = 1.94, SD = 1.26; α = 0.90), hoarding (M = 1.56, SD = 1.10; α =
0.83), checking (M = 1.91, SD = 1.09; α = 0.84), ordering (M = 2.32, SD = 1.17; α =
0.89), and neutralizing (M = 1.41, SD = 1.17; α = 0.77). The scales were summed to
produce an overall OCD severity score (M = 10.50, SD = 4.49; α = 0.86), which is
consistent with how the scale is usually represented (Abramowitz, & Deacon, 2006; Foa et
al., 2002).
Anxiety/Distress
The current investigation measured participants’ emotional improvement by
assessing their levels of anxiety and distress after receiving a social support message that
varied in VPC. Participants’ answered three questions crafted specifically for this study
by the author to assess their current level of anxiety and distress. Participants responded
to the following three questions on a scale from 0-100: “How upset are you right now?”
“How overwhelmed do you feel right now?” “How anxious do you feel right now?”
Participants reported on their level of anxiety/distress both before and after they read their
assigned verbal person-centered vignette. On average, participants’ levels of anxiety and
48
distress before the vignette were 45.07 (SD = 26.38) and after the vignette 42.99 (SD =
26.65) (out of 100). The reliabilities for the measure of anxiety and distress before the
vignette and anxiety and distress after the vignette were acceptable at α = 0.87 and α =
0.91, respectively.
Positive and negative affect schedule (PANAS)
An individual’s level of emotional improvement was also defined in this
investigation through the extent to which he or she experienced negative emotions after
receiving a social support message. Participants answered questions concerning their
current positive and negative feelings/emotions using the 20-item Positive and Negative
Affect Schedule (PANAS) (Watson, Clark, & Tellegen, 1988). Sample items included the
following feelings/emotions: interested, distressed, excited, ashamed, inspired, and
nervous. Participants reported the intensity in which they currently felt each
feeling/emotion on a 5-point scale (1 = very slightly or not at all and 5 = extremely).
Participants completed the PANAS both before and after they read their randomly
assigned VPC vignette. Based upon the results of a factor analysis, the items of the
PANAS scale before the vignette were aggregated into the following three factors with
acceptable reliabilities: negative emotions (M = 2.39, SD = 0.93; α = 0.88), shame (M =
2.30, SD = 1.15; α = 0.82), and positive emotions (M = 2.16, SD = 0.86; α = 0.88). The
PANAS scale after the vignette was also aggregated into the following three factors with
respective reliabilities: negative emotions (M = 2.33, SD = 0.90; α = 0.88), shame (M =
2.14, SD = 1.10; α = 0.84) and positive emotions (M = 2.09, SD = 0.85; α = 0.88).
Although the PANAS scale includes three factors, the current investigation will only focus
on the factor of negative emotions both before and after the message vignette as this study
49
is focused on reducing the intensity of negative emotions individuals with OCD
experience due to the symptoms of the disorder.
Verbal person-centered messages
Participants were randomly exposed to one of three potential messages that varied
in VPC. The content of each message was adapted from High and Dillard (2012) for the
specific context of this study. More specifically, the shell of the messages, or the overall
meaning of each message, were kept intact, while specific words were changed by the
principal investigator and Dr. High to represent an individual with OCD receiving social
support from another. The message high in VPC included content that recognized,
legitimated, and elaborated on the support recipient’s thoughts and emotions. The
following is the high VPC message employed in this investigation.
I am so sorry you are going through this right now. What do you think is making
your OCD symptoms so bad right now? Please talk with me about it. I am here for
you for support or someone to talk to. You are trying the best that you can and I
know how much it hurts when you are trying so hard but your symptoms won’t go
away, especially when they are not really under your control. I don’t blame you for
being upset and frustrated lately. You’re probably not only hurt but angry at being
stuck with this disorder. I hope that you will get better soon.
Messages moderate in VPC recognized the other’s feelings but also attempted to change
the topic, provide a clarification of the situation, and reduce the other’s emotional distress
rather than helping the other understand their current feelings. Below is the moderate
VPC message used in this study.
You are a good person and I know your OCD has made your life tough lately. I’m
sure if you work at it enough your symptoms will decrease. I’m really sorry that
this is happening to you. It’s too bad you are feeling this way, but maybe we can
go to dinner to get your mind off of your problems. You will be able to get through
it. You know, there are a lot of people in this world who have problems just like
you. You know you’re a great individual and things will get better in the future.
50
Messages low in VPC does not allow an individual to recognize or elaborate on their
emotions but instead include criticism and deny the legitimacy of the individual’s distress.
Below is an example of the low VPC message that was utilized in this investigation.
I don’t think you should be upset with anyone but yourself because your OCD is
your problem, not others. I don’t see what you are worrying about. You have to
stop thinking about your intrusive thoughts. You have to work at getting better, it
doesn’t just come easily. This is really your problem to figure out and you have to
take responsibility for it. There is really nothing I can do for you. Shake it off.
Everyone has problems. Life happens, just deal with it. It’s not the end of the
world and I’m sure you’ll get over it.
Dr. High and I tried to keep the number of words in each message similar. In the end, the
messages high, moderate, and low in VPC consisted of 109, 99, and 99 words,
respectively. The adapted messages were tested prior to the study using both an expert (N
= 4) and student (N = 19) sample in order to validate that each message did in fact vary in
perception of message quality. Results of a repeated measures MANOVA revealed a
significant difference in message quality as a function of VPC for the expert sample,
Wilks’ ^ = .01, F(2,2) = 113.37, p < .05, partial η2 = 0.99, and the student sample, Wilks’
^ = 0.13, F(2,17) = 57.94, p < .000, partial η2 = 0.87. The experts rated the message
quality of the VPC messages significantly different in expected ways. For both the expert
and student sample, each level differed from every other level such that for the expert
sample the message low in VPC differed (M = 1.30, SD = 0.42) from both the messages
moderate (M = 4.53, SD = 0.62) and high (M = 6.53, SD = 0.15) in VPC. Similarly, the
student sample perceived a significant difference in message quality between low (M =
2.00, SD = 0.98), moderate (M = 5.05, SD = 1.00), and high (M = 5.99, SD = 0.89) levels.
51
Message elaboration
Following the message vignettes that differed in VPC, participants revealed
everything they were thinking and feeling while reading their specific message.
Participants’ responses were transferred to an excel file, which were then transferred to the
Linguistic Inquiry and Word Count (LIWC) software program for analysis. As a reminder,
message elaboration refers to the process in which individuals reflect upon their thoughts,
feelings and emotions concerning a specific stressor (Burleson & Goldsmith, 1998).
Based upon this definition and prior research (Jones & Wirtz, 2006), message elaboration
was measured as the percentage of positive emotion words, negative emotion words and
cognition words within a participant’s response to the message they received. On average,
4.33% of participant’s total word usage was positive emotions (SD = 6.60), 3.59%
negative emotions (SD = 8.45), and 10.50% cognition words (SD = 6.69).
Perception of message quality
Participants reported their perceptions of the quality of their assigned message that
varied in VPC using 14-items on a 7-point semantic differential scale (Jones & Burleson,
2003). Sample items included: “helpful-unhelpful”; “effective-ineffective”; and “caringuncaring”. The perception of message quality (M = 3.94, SD = 1.68) scale produced high
reliability at α =0.97.
Affective improvement scale
Participants responded to eight items from the Affective Improvement Scale (Clark,
Pierce, Finn, Hsu, Toosley, & Williams, 1998; Jones & Burleson, 2003) that were adapted
specifically for this investigation in order to assess their level of affective improvement.
Sample items from this scale included: “I feel better after hearing the message from my
52
support provider”; “The way my support provider responded to me irritated me”; “My
support provider made me feel better about myself.” Participants answered these
questions on a 7-point scale (1 = very strongly disagree and 7 = very strongly agree),
which produced a mean of 3.54 (SD = 1.54). The reliability for this scale was sufficient at
α = 0.93.
Cognitive reappraisal
Upon receiving a message that differed in VPC from their imagined conversational
partner, participants answered questions concerning the reappraisal of their intrusive
thoughts using a 5-item reappraisal scale (Jones & Wirtz, 2006). Sample items included:
“The message I received from my support provider made me think about the thoughts and
emotions I described earlier about my OCD”; “Receiving the message from my support
provider about my OCD helped me get my mind off it”; “I understand my OCD better
now that I received a support message from my support provider”. Participants answered
these questions on a 7-point scale (1 = very strongly disagree and 7 = very strongly agree),
which produced a mean of 3.11 (SD = 1.41). Item three was reverse coded such that the
higher number represented higher levels of reappraisal. One item (R1) was removed from
the scale to improve reliability. With the removal of the first item, the reliability for this
scale was deemed appropriate at α = 0.77.
Interpersonal cognitive complexity
Participants’ completed Crockett’s (1965) Role Category Questionnaire (RCQ) in
order to determine their level of interpersonal cognitive complexity. Participants first
indicated the initials of both a person whom they liked and disliked. Following this task,
participants recorded as many “habits, beliefs, mannerisms, relations to others, and
53
characteristics” as they could about both the liked and disliked individual. No time limit
was set for this task. An individual’s level of cognitive complexity was determined based
upon the sum of characteristics they included about each individual across both categories.
Interrater reliability (Kappa) was assessed by the principal investigator and an
additional coder using a small sample of cases (n = 25) (see Appendix C for coding
manual). The unit of analysis was the discrete characteristics reported for both liked and
disliked individual. While reading through participant’s responses for the first time, the
two coders determined which responses were considered appropriate characteristics of
interpersonal cognitive complexity. This determination was based upon Crockett’s (1965)
definition of a characteristic as one that reflected an individual quality, trait, motivation,
belief, habit, mannerism or behavior. A characteristic was deemed unfit as a
representation of cognitive complexity if it referenced a person’s physical characteristics,
appearance, demographic information, or social role(s). Characteristics were coded as
either relevant or irrelevant with these categories in mind. Although participants were
instructed to include only one characteristic per answer line, some lines contained more
than one characteristic and were thus considered separate units of analysis. After reading
through the small sample of data, the coders discussed any discrepancies they might have
had in determining which characteristics followed the instructions for the activity. Once
these discrepancies were discussed the remaining sample was analyzed, with periodic
conversations occurring between the coders to ensure reliability throughout the overall
process. Interrater reliability produced sufficient results for both the like (κ = 0.70) and
dislike category (κ = 0.83). On average, and across both categories, participants provided
19.36 (SD = 9.95) characteristics.
54
Summary
In this chapter I reviewed the characteristics of the recruited sample, the details of
the procedure, and the instruments used to measure each variable within the study. The
next chapter summarizes the results of this investigation.
55
CHAPTER III
RESULTS
The previous chapter included the descriptive statistics, procedures and measures
employed for this study. The current chapter contains the preliminary and substantive
analyses used to test the study’s hypotheses. First, I report the results of four preliminary
analyses.
Preliminary Analyses
First, I used G-power (3.1) to conduct a power analysis. With a sample of 154
individuals there was 27% power to detect small effect sizes, 99% power to detect
medium effect sizes, and 100% power to detect large effect sizes.
Second, I performed a manipulation check on the three levels of VPC using an
analysis of variance (ANOVA) with message quality as the dependent variable. Although
a pilot study was previously conducted to test the differences between the messages that
varied in VPC using both a student and expert sample, a manipulation check was
warranted given that this study recruited a different sample altogether. A significant main
effect existed for message quality on level of VPC, F(2,158) = 48.77, p < .001, partial η2 =
.38. Post hoc analyses using a Tukey HSD test indicated significant differences between
the three levels. More specifically, messages low in VPC (M = 2.30, SE = .20) differed
significantly from both messages moderate (M = 4.54, SE = .19) and high (M = 4.63, SE
= .17) in VPC. However, the messages moderate and high in VPC did not differ
significantly from one another, a result reported in other research (Bodie, 2011; Bodie &
Jones, 2012). Given this result, the messages moderate and high in VPC were collapsed
into one category of high VPC.
56
Third, as a manipulation check to determine whether participants’ levels of anxiety
and distress and intensity of negative emotions changed following the message vignette, I
conducted a series of paired sample t-tests. When using the total sample (N = 155) the
results indicated that participants’ levels of anxiety and distress differed significantly from
before (M = 47.12, SD = 25.73) to after (M = 43.17, SD = 26.64) reading the social
support message vignette, t (154) = 2.31, p = 0.02. On the other hand, results showed that
the intensity of negative emotions experienced from before (M = 2.39, SD = 0.92) to after
(M = 2.34, SD = 0.92) reading the message vignette did not differ significantly, t (152) =
0.90, p = 0.37. A paired sample t-test was also conducted after splitting the files into two
groups based upon whether or not the participant received a message low or high in VPC.
For those who received a message low in VPC (n = 46), the level of anxiety and
distress from before (M = 50.65, SD = 27.15) to after (M = 52.80, SD = 27.92) reading
the message vignette did not differ significantly, t (46) = -0.63, p = 0.53. For this same
group (n = 44), the reported intensity of negative emotions from before (M = 2.50, SD =
0.97) to after (M = 2.74, SD = 0.91) the vignette was also not significant, t (44) = -2.01, p
= 0.05. On the other hand, for participants who received a message high in VPC (n =
109), the level of anxiety and distress from before (M = 45.64, SD = 25.08) to after (M =
39.11, SD = 25.12) the message vignette did differ significantly, t (109) = 3.40, p = .001.
Similarly, for those in this same group (n = 108), the intensity of negative emotions from
before (M = 2.34, SD = 0.90) to after (M = 2.17, SD = 0.87) the message vignette differed
significantly, t (108) = 2.92, p = .004. These results indicate that the people that received
the message high in VPC had significantly less anxiety, distress and negative emotions
after reading this vignette.
57
Fourth, I conducted a preliminary analysis to determine how to best operationalize
message elaboration. In a previous research study, Jones and Wirtz (2006) conducted a
LIWC analysis and concluded that message elaboration was mostly comprised of the
following three categories: negative emotion words, positive emotion words, and
cognition words. Of these three categories, their results indicated that the verbalization of
positive emotion words by support recipients was the only factor significantly associated
with cognitive reappraisal. Given these results, I conducted an LIWC analysis using the
same three categories of message elaboration as Jones and Wirtz. Similar to Jones and
Wirtz (2006) the results also indicated through a regression analysis that only positive
emotion words were significantly associated with cognitive reappraisal, R2Δ =0.03, F
(1,157) = 4.78, p = .03. In light of these results, message elaboration will henceforth be
operationalized as positive emotion words for all subsequent analyses. More specifically,
message elaboration will refer to the percentage of positive emotion words within a
participant’s response to his or her specific social support message.
The intercorrelations among all of the major variables involved in this study can be
found in Table 3-1. Correlation analyses using Pearson’s correlation (r) indicated several
relationships among the main variables. Level of VPC was positively correlated with
positive emotion words, reappraisal and affective improvement and negatively correlated
with anxiety after the social support message. In other words, messages high in VPC were
associated with a higher percentage of positive emotion words during message
elaboration, higher levels of reappraisal and affective improvement and lower levels of
anxiety after the social support message vignette. Positive emotion words were positively
associated with cognitive reappraisal and affective improvement. Cognitive reappraisal
58
was positively associated with affective improvement while affective improvement was
negatively correlated with anxiety after the message vignette.
Test of Hypotheses
To test the hypotheses under investigation, I ran a series of simple and hierarchical
regressions. H1 (see Table 3-2) hypothesized a positive association between messages
that differ in VPC and message elaboration. Recall that based on the preliminary analyses,
message elaboration was operationalized using the percentage of participant’s positive
emotion word use. Results from the linear regression indicated that messages that differed
in VPC were positively associated with positive emotion words, R2Δ = .04, β = .21, p =
.01.
H2 hypothesized (see Table 3-3) that the individual characteristic of cognitive
complexity would moderate the relationship between messages that varied in VPC and
positive emotion words. I conducted a linear hierarchical regression analysis to test H2 in
which VPC was entered on the 1st step, cognitive complexity on the 2nd step, and the
interaction term for these two variables on the 3rd step. As found for H1, results yet again
indicated that VPC was significantly associated with positive emotions words, R2Δ= .04, β
= 0.21, p = .01. On the other hand, cognitive complexity, R2Δ = .01, β = -.09, p = .23 and
the interaction term of VPC and cognitive complexity, R2Δ = .00, p = .95; β = -.01, p = .95
did not significantly predict positive emotion words. Thus, H2 was not supported.
For H3 (see Table 3-4) I predicted that anxiety before the vignette (the
operationalization for individual motivation) would moderate the relationship between
messages that varied in VPC and positive emotion words. In other words, H3 predicted
that VPC has a larger effect on positive emotion words when motivation to process the
59
social support message is high. This prediction was tested using a linear regression
analysis in which VPC was entered on the 1st step, anxiety before on the 2nd step, and the
interaction between the two terms on the 3rd step. As seen in H1, results indicated that
VPC corresponded significantly with positive emotion words, R2Δ = .04, β = .21, p = .01.
The addition of anxiety before was not significant, R2Δ = .00, β = .03, p = .66, and neither
was the addition of the interaction term between VPC and anxiety before, R2Δ = .00, β =
.00, p = .97. Thus, H3 was not supported.
H4 (see Table 3-5) posited a positive association between level of VPC and
cognitive reappraisal. Results indicated that messages that varied in VPC corresponded
positively with cognitive reappraisal of intrusive thoughts, R2Δ = .03, β = .17, p = .04.
Therefore, H4 was supported.
H5 (see Table 3-6) focused on the hypothesized relationship between the level of
VPC and overall emotional improvement. As a reminder, emotional improvement was
defined using three variables all measured after reading the vignette: affective
improvement, anxiety and distress, and negative emotions. H5 hypothesized a positive
relationship between a) VPC and affective improvement and a negative relationship
between b) VPC and anxiety/distress and c) VPC and negative emotions after the message
vignette. Regression analyses were performed to test H5a-c. Results from H5a showed
that VPC is positively associated with affective improvement, R2Δ = .27, β = .51, p = .00.
Thus, H5a was supported.
For H5b, I controlled for initial levels of anxiety/distress by including that variable
on the first step of the model in a hierarchical linear regression. The second step
contained the level of VPC where the dependent variable was the level of anxiety/distress
60
after reading the vignette. Results indicated a significant negative association between
messages that varied in VPC and anxiety and distress after the message vignette, after
controlling for anxiety and distress levels before the message vignette, R2Δ = .03, β = -.18,
p = .00. Therefore, H5b was supported.
For H5c, I conducted another hierarchical linear regression with initial level of
negative emotions included on the first step as a co-variate. Level of VPC was included
on step two and the dependent variable was negative emotions after reading the vignette.
Results showed a significant negative association between messages that varied in VPC
and negative emotions after the message vignette, after controlling for negative emotions
before the message vignette, R2Δ = .05, β = -.23, p = .00. Thus, H5c was supported as
well.
Originally, I predicted a positive association between message elaboration and
cognitive reappraisal (H6). Recall that based on the results of the preliminary analyses
and previous research (Jones & Wirtz, 2006), message elaboration is defined in this study
as positive emotion words. Results indicated (see Table 3-7) that positive emotion words
were positively associated with cognitive reappraisal, R2Δ = .03, β = .17, p = .03.
Therefore, H6 was supported.
H7 predicted the association between cognitive reappraisal and overall emotional
improvement (see Table 3-8). More specifically, it was hypothesized that cognitive
reappraisal is positively associated with a) affective improvement and negatively
associated with b) anxiety/distress and c) negative emotions after the message. Regression
analyses were performed to test H7a-c. Results from H7a suggested that cognitive
61
reappraisal significantly corresponds to affective improvement in a positive direction, R2Δ
= .38, β = .62, p = .00. Thus, H7a was supported.
To test H7b, I controlled for initial levels of anxiety/distress by including it on the
first step of the model. Cognitive reappraisal was included on the second step and was
significantly and negatively associated with anxiety/distress, as predicted, R2Δ = .02, β =
-.16, p = .011. Therefore, H7b was supported. For H7c I controlled for initial levels of
negative emotions by including it on the first step of the model. Cognitive reappraisal was
included on the second step and corresponded inversely with negative emotions after
when controlling for negative emotions before, R2Δ = .02, β = -.14, p = .01. Thus, H7c
was supported as well.
Summary
The previous results provide a complex and intriguing picture of the social support
process in the context of OCD management. As predicted, messages that varied in VPC
were significantly associated with message elaboration (positive emotion words) (H1).
Results indicated that cognitive complexity (H2) and anxiety and distress before the
message vignette (H3), variables that represent the dual-process theory of supportive
communication outcomes, did not significantly influence the intensity of the relationship
between messages that varied in VPC and message elaboration (positive emotion words).
On the other hand, results did provide support for the theoretical framework of the theory
of conversationally-induced reappraisals. Messages that varied in level of VPC were
significantly associated with cognitive reappraisal (H4), and overall emotional
improvement (H5). Results also indicated significant relationships between positive
emotion words (message elaboration) and cognitive reappraisal (H6) and between
62
cognitive reappraisal and emotional improvement (H7). Overall, the predictions
associated with the theory of conversationally-induced reappraisals were supported, while
those associated with the dual-process theory of supportive communication outcomes
were not. The implications of these findings will be explored in the next chapter.
63
Ability
Motivation
H3
H2
VPC
Message
Cognitive
Emotional
Message
Elaboration
Reappraisal
Improvement
H6*
H1**
H7a***
H7b*
H7c*
H4*
H5a***; H5b***; H5c***
Figure 3-1. Model of the variables of interest within the dual-process theory of supportive communication
outcomes and the theory of conversationally-induced reappraisals. *p < .05, **p < .01, ***p < .001
64
Table 3-1. Correlation Coefficients Among All Major Variables
V1
V2
V3
V4
V5
V6
V7
V8
V9
V1: VPC (high/low)
---
V2: Cognitive complexity
.14
---
V3: Anxiety before
-.11
.03
---
V4: Positive emotion words
.21** -.07
.01
---
V5: Message elaboration
-.05
.01
.08
.59** ---
V6: Reappraisal
.17* -.06
.10
.17*
V7: Affective improvement
.51** .04
-.02
.35** .09
V8: Anxiety after
-.24** .09
.67** -.14
.00
-.06
-.28** ---
V9: Negative emotions after
-.28** .10
.61** -.21** -.01
-.06
-.33** .75** ---
V10: OCD severity
-.11
.03
.45** -.08
.02
.01
V10
--.62** ---
.03
-.06
.43** .51** ---
Note. N ranged from 151-171 due to missing data. Verbal person-centeredness (VPC) is a dichotomous variable coded as 1 for
the low VPC condition and 2 for the high VPC condition.
*p < .05, **p < .0
65
Table 3-2. Simple Linear Regression Analysis for Predicting Positive Emotion Words via
Messages that Vary in Verbal Person-Centeredness (H1)
Positive Emotion Words
Step 1
R2Δ
VPC
.04**
.21**
Note: N = 171. Coefficients represent βs. Verbal person-centeredness (VPC) is a
dichotomous variable coded as 1 for the low VPC condition and 2 for the high VPC
condition.
*p < .05, **p < .01
66
Table 3-3. Hierarchical Regression Analysis for Predicting Positive Emotion Words
(Message Elaboration) via Messages that Vary in Verbal Person Centeredness, Cognitive
Complexity, and the Interaction between these Variables (H2)
Step 1
R2Δ
VPC
.04**
.21**
Step 2
R2Δ
VPC
Cognitive complexity
.01
.22*
-.09
Step 3
R2Δ
VPC
Cognitive complexity
VPC x Cognitive complexity
.00
.22**
-.09
-.01
Note: N = 171. Coefficients represent βs. Verbal person-centeredness (VPC) is a
dichotomous variable coded as 1 for the low VPC condition and 2 for the high VPC
condition.
*p < .05, **p < .01
67
Table 3-4. Hierarchical Regression Analysis for Predicting Positive Emotion Words
(Message Elaboration) via Messages that Vary in Verbal Person-Centeredness, Anxiety
before the Message Vignette, and the Interaction between these Variables (H3)
Step 1
R2Δ
VPC
.05**
.21**
Step 2
R2Δ
VPC
Anxiety before
.00
.22**
.03
Step 3
R2Δ
VPC
Anxiety before
VPC x Anxiety before
.00
.22**
.03
.00
Note: N = 169. Coefficients represent βs. Verbal person-centeredness (VPC) is a
dichotomous variable coded as 1 for the low VPC condition and 2 for the high VPC
condition.
*p < .05, **p < .01
68
Table 3-5. Simple Linear Regression Analysis for Predicting Cognitive Reappraisal via
Messages that Vary in Verbal Person-Centeredness (H4)
Cognitive Reappraisal
Step 1
R2Δ
VPC
.03*
.17*
Note: N = 159. Coefficients represent βs. Verbal person-centeredness (VPC) is a
dichotomous variable coded as 1 for the low VPC condition and 2 for the high VPC
condition.
*p < .05
69
Table 3-6. Simple Linear Regression Analysis for Predicting Emotional Improvement via
Messages that Vary in Verbal Person-Centeredness (H5a-c)
Affective Improvement
Anxiety After
Negative Emotions After
Step 1
R2Δ
VPC
Anxiety before
Neg. emotions
before
.27***
.51***
.45***
.52***
.67***
.72***
Step 2
R2Δ
Anxiety before
Neg. emotions before
VPC
.03**
.65***
-.18**
.05***
.71***
-.23***
Note: N = 152-159. Coefficients represent βs. Verbal person-centeredness (VPC) is a
dichotomous variable coded as 1 for the low VPC condition and 2 for the high VPC
condition.
*p < .05, **p < .01, *** p < .001
70
Table 3-7. Simple Linear Regression Analysis for Predicting Cognitive Reappraisal via
Positive Emotion Words (Message Elaboration) (H6)
Step 1
R2Δ
Positive emotion words
.03*
.17*
Note: N = 159. Coefficients represent βs.
*p < .05
71
Table 3-8. Simple Linear Regression Analysis for Predicting Emotional Improvement via
Cognitive Reappraisal (H7a-c)
Affective
Improvement
Anxiety/Distress
After
Negative Emotions
After
Step 1
R2Δ
.38***
Cognitive
reappraisal
.62***
Anxiety before
Neg. Emotions before
.45***
.52***
.67***
.72***
Step 2
R2Δ
Anxiety before
Neg. Emotions before
Cognitive reappraisal
.02*
.69***
-.16*
Note: N = 154-158. Coefficients represent βs.
*p < .05, **p < .01, *** p < .001
72
.02*
.74***
-.14*
CHAPTER IV
DISCUSSION
Every day people with OCD suffer from the debilitating symptoms of the disorder. Due to
the recurrent nature of obsessions and compulsions, those living with OCD are confronted
with cognitive dysfunctions that impact daily life functioning. Cognitive dysfunction
refers to the tendency of those with OCD to misinterpret the significance and relevance of
their intrusive thoughts (obsessions) (Rachman, 1993, 1997). Research indicates that one
potential way to combat this dysfunction is to receive support from social network
members, such as family or friends (Newth & Rachman, 2001). In light of the current
research on social support, the current study proposed that messages that vary in VPC are
the optimal messages for helping a support recipient feel better (Burleson, 1985) because
they enable an individual to process and elaborate on his or her thoughts and emotions
(Burleson & Goldsmith, 1998) about the specific stressor at hand. It is this process of
message elaboration that subsequently promotes cognitive reappraisal and ultimately
emotional improvement (Jones & Wirtz, 2006). One purpose of this investigation was to
explore the utility of messages that vary in VPC in facilitating emotional improvement for
those suffering from OCD as the symptoms of this disorder often incite intense feelings of
anxiety and distress (Rachman, 1971). A second and broader goal of this study was to
identify the underlying factors and mechanisms that explain the overall social support
process.
In order to identify these underlying mechanisms, I utilized two theoretical models
of social support outcomes. More specifically, I proposed a union between the theory of
73
conversationally-induced reappraisals (Burleson & Goldsmith, 1998) and the dual-process
theory of supportive communication outcomes (Burleson, 2009). The theory of
conversationally-induced reappraisals highlights the complex associations between
messages that vary in VPC, message elaboration, and cognitive reappraisal, while the
dual-process theory of supportive communication outcomes proposes that support
outcomes are influenced by certain factors, such as individual ability and motivation.
Both of these theories are focused on the social support outcome of emotional
improvement. The union of these theories provides a more nuanced explanation of the
factors and mechanisms through which people can achieve emotional improvement via the
process of cognitive reappraisal. This integrated model led to the testing of several
hypotheses.
Summary of Hypotheses
The main purpose of the dual-process theory of supportive communication
outcomes is to highlight the factors that influence the varying outcomes of social support
messages (Burleson, 2009). The pertinent question posed by the theory is the following:
Why is it that people experience different outcomes from the same message? The answer
to this question revolves around the following three variables of interest: content of
messages that vary in VPC, ability and motivation.
For H1, I hypothesized a positive association between messages that vary in VPC
and message elaboration. As a reminder, message elaboration was operationalized as the
percentage of positive emotion words within a participant’s response text. Results
indicated that messages that differed in VPC positively predicted positive emotion words.
74
Therefore, messages that were higher in levels of VPC were more likely to lead to a higher
percentage of reported positive emotion words by recipients when they were asked to
respond to the specific social support message vignette they were presented with during
the survey.
For H2, I sought to test the individual factor of cognitive complexity (ability) as it
relates to messages that vary in VPC and message elaboration. In other words, the theory
predicts that message qualities have their strongest influence on outcomes when they are
processed thoroughly and that people who report higher levels of cognitive complexity are
more likely to engage in thorough processing of a message (Burleson, 2009a). Results
from this investigation did not support this prediction. While this result does not
invalidate the usefulness of this factor within the social support process, it does call into
question its utility in this specific context with this specific sample.
In addition to cognitive complexity, the dual-process theory of supportive
communication outcomes (Burleson, 2009) includes the contextual factor of individual
motivation, or in this case level of anxiety and distress. In light of this theory I proposed
that motivation would act as a moderating variable for the relationship between the level
of VPC messages and message elaboration (H3). In other words, I predicted that
messages that differed in VPC would have more of an effect on message elaboration when
individual motivation was high rather than low. Again, the results did not support this
hypothesis.
For H4 I hypothesized a positive relationship between messages varying in VPC
and cognitive reappraisal. Results indicated support for this hypothesis. More
75
specifically, messages higher in VPC were directly associated with higher levels of
cognitive reappraisal in participants. Further analysis indicated that messages that varied
in VPC were also associated with overall emotional improvement (H5). More
specifically, messages high in VPC were correlated with higher levels of affective
improvement (5a), lower levels of anxiety and distress (5b), and a reduced intensity of
negative emotions (5c) after the message vignette. Messages high in VPC were more
likely to lead to affective improvement, as well as a decrease in anxiety/distress and
negative emotions for those with OCD, even after controlling for anxiety, distress, and
negative emotions reported before the message vignette. These findings suggest that
messages that differ in VPC are associated with concrete outcomes and not merely
perceived message effectiveness.
Apart from the relationship between messages that differ in VPC and message
elaboration, results from this investigation indicated support for the positive association
between positive emotion words and cognitive reappraisal (H6). Therefore, participants
who reported higher percentages of positive emotion words following their social support
message vignette were more likely to engage in higher levels of cognitive reappraisal.
The final hypothesis of this investigation argued for the relationship between
cognitive reappraisal and overall emotional improvement (H7). Our results indicated that
cognitive reappraisal was in fact positively associated with affective improvement (H7a)
and negatively associated with anxiety and distress (H7b) and negative emotions (H7c)
after the message vignette. In other words, cognitive reappraisal was identified as one of
the mechanisms through which overall emotional improvement could be achieved. In the
76
following sections I will discuss the implications of these findings on the dual-process
model of supportive communication outcomes and the theory of conversationally-induced
reappraisals. I will also discuss my findings in relation to current OCD research and
treatment as well as the limitations of the current investigation.
Implications for the Dual-Process Model of Supportive Communication Outcomes
One of the major contributions of this dissertation is that it examined a change in
participant’s anxiety and distress both before and after processing a supportive message.
This contribution is important when we consider that one goal of this investigation was to
examine the social support message features that would decrease an individual’s level of
anxiety and distress in the wake of their OCD symptoms. This approach is in contrast to
the previous literature that explores individuals’ perceptions of a supportive message that
differs in level of VPC at one point in time. In their meta-analysis of studies (n = 23)
investigating person-centered messages, High and Dillard (2012) discovered that the
majority of studies utilizing this message typology focused on participants’ perceptions of
the quality of the message. More specifically, the research design asked participants who
were presented with a predetermined set of messages that differed in level of VPC to rate
the quality of each message given a specific event or situation (e.g. parking ticket). This
process is known as the message perception paradigm. While these results are productive
in determining individuals’ perceptions of the levels of messages that differ in VPC, they
do not illustrate whether or not these messages can lead to concrete or measurable
outcomes. One of the purposes of this investigation was to address this limitation and
examine the degree to which messages that varied in VPC could lead to actual changes in
77
participants’ level of anxiety, distress, and negative emotions. More broadly, this study
focused on whether or not messages that varied in VPC could actually help those with
OCD feel better when confronted with a specific obsession.
Unlike studies that focused on the perception of the quality of messages that
differed in VPC (Jones, 2005; Jones & Guerrero, 2001; Wilkum & MacGeorge, 2010),
this investigation focused on whether or not messages that varied in VPC could actually
lead to changes in anxiety, distress, and negative emotions for those with OCD. Concrete
change was determined by measuring participants’ levels of anxiety/distress and intensity
of negative emotions both before and after they were randomly presented with one of
three messages that differed in degree of VPC qualities. No other dual-process study has
employed this specific method design. The results from this investigation point to an even
stronger benefit associated with messages high in VPC, the fact that they actually relieve
emotional distress for those with OCD. This study responded to the call for more studies
to focus on the concrete, rather than perceptual, benefits of messages that differ in VPC
(High & Dillard, 2012).
In the midst of tackling issues surrounding the perceptual vs. concrete
effectiveness of messages that vary in VPC, this study employed a message design not yet
utilized in current dual-process research. As High and Dillard (2012) contended in their
meta-analysis, studies focusing on messages that differ in VPC tend to adopt two different
methods. As mentioned previously, one design asks participants to rate the quality of
various messages with differing degrees of VPC and is referred to as the message
perception paradigm (Burleson, 2003). The other design involves the use of a confederate
78
who is trained to communicate messages that vary in VPC and is known as the
experimental paradigm. The current investigation purposely strayed in specific ways from
both of these message designs and utilized a new approach as I measured participants’
levels of anxiety, distress, and negative emotions both before and after receiving the
message vignette in order to assess whether or not the message invoked an actual change
in these factors. The current investigation diverged from other dual-process research in
other ways as well.
This investigation included the random assignment of one of three messages that
varied in VPC (experimental paradigm) but did not include an interaction between the
participant and another individual or confederate, but rather a person with whom they
imagined interacting with in a social support episode. Therefore, this study differed
slightly from how traditional experimental/confederate designs using the dual-process
approach are usually employed. Additionally, while this study asked participants to rate
the quality of their randomly assigned message (message perception paradigm), message
quality was not the support outcome (DV) of concern but rather used as a manipulation
check to ensure that the messages differed in level of VPC in expected ways. Ultimately,
this study was informed by other dual-process research in an attempt to create a new
approach to exploring the effectiveness of messages that differed in VPC in a new support
context. The fact that this approach led to some expected outcomes opens the door for
social support scholars interested in messages that vary in VPC to broaden their minds to
the idea of new and innovative message designs.
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Hierarchy of verbal person-centered messages
This dissertation indicates that the hierarchy of messages that differ in VPC
deserves further attention. The results suggest that participant’s did not distinguish
between messages moderate and high in VPC. The original VPC scheme includes nine
message levels (Burleson, 1982). This investigation initially employed three message
levels (LPC, MPC, and HPC). The intention was to keep these three levels during the
analyses. However, the participants did not perceive a significant difference between
moderate and high messages, even though all three levels were significantly different from
one another in the pilot test. This result led to the collapse of messages moderate and high
in VPC. The decision to collapse these two categories has implications for the future
operationalization of these messages. It appears that the general populations’ perceptions
of messages that vary in VPC are not consistent with the way these messages are
traditionally categorized within research by experts. This inconsistency begs the question
of whether or not the hierarchy of messages that vary in VPC should reflect lay peoples’
perceptions or be driven by expert opinion. In addition to my study, two other studies
have dealt with this specific issue.
Bodie (2011) conducted an investigation in which he utilized the message
perception paradigm. More specifically, participants were asked to envision a stressful
event or situation and subsequently rate social support messages that differed in VPC.
The results indicated that participants did not perceive a difference between messages
moderate and high in VPC. While there is no mention in the study of collapsing these
categories, it illustrates that people might have difficulty differentiating between moderate
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and high levels. While participants did not perceive any differences between the MPC and
HPC messages, the article mentions that experts achieved “100% agreement that VPC was
correctly manipulated” (p. 544). The implications of the schism between participant and
expert perceptions deserve further attention.
Bodie also conducted a study with Jones (2012) in which they utilized the
experimental (confederate) paradigm. Once again, participants had difficulty in
distinguishing between moderate and high message levels. The results of these
investigations beg the following question: Do scholars continue to use the original
operationalization of these messages (Burleson, 1982) or adapt the hierarchy based upon
participants’ perceptions? If participants’ are unable to differentiate between multiple
levels of VPC messages, scholars, especially those working with theories of social
support, need to start a conversation about whether these results are anomalies or
indicators of an operationalization issue.
Thus far I have highlighted the ways in which the current investigation both
conforms to and deviates from the current research on social support outcomes. Apart
from these conversations, it is also imperative to explore the unexpected results of this
study and their potential implications for the dual-process theory of supportive
communication outcomes.
Lack of support for the dual-process theory of supportive communication outcomes
The results of this investigation indicated that the association between messages
that varied in VPC and message elaboration was not moderated by individual ability and
motivation. This result does not support the contention of the dual-process theory of
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supportive communication outcomes that individual ability and motivation moderate this
specific association. The lack of support for the dual-process theory of supportive
communication outcomes raises concerns as to the utility of this theory in explaining the
social support process for people with OCD.
The dual-process model asserts that social support outcomes are dependent upon
more than just message content (Burleson, 2009a). One of the major variables associated
with the dual-process theory is the individual factor of cognitive complexity. Again, the
theory posits that message content has more of an impact on message outcomes when
individuals have a higher level of cognitive complexity. However, the results of this study
did not support this prediction. In fact, cognitive complexity was not significantly
associated (Table 3-1) with any of the major variables under investigation. In addition to
cognitive complexity, individual motivation is the variable most often studied under the
dual-process theory (Burleson, 2009a). Similar to cognitive complexity, participants’
levels of anxiety/distress, which is what I used to operationalize their motivation to
process the supportive message, were not significantly related to message elaboration, as
predicted. The lack of overall impact of cognitive complexity and individual motivation
on message elaboration has implications for the functionality of the dual-process theory in
explaining supportive outcomes in this specific context. One way to make sense of this
lack of functionality is to further examine some of the differences between the studies that
employed the dual-process theory and the current investigation.
First, many of the studies employing the dual-process theory focus on the college
student population (Bodie, 2011; Bodie, Burleson, Gill-Rosier, McCullough, Holmstrom,
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Rack, Hanasono, & Mincy, 2011; Bodie, Burleson, Holmstrom, McCullough, Rack,
Hanasono, & Rosier, 2011). Second, research conducted using the dual-process theory of
supportive communication outcomes often asks participants to assess the quality of
various social support messages in the following predetermined scenarios: everyday
college stressors (Bodie, 2011; Burleson, Hanasono, Bodie, Holmstrom, Rack, Rosier, &
McCullough, 2009), common stressors (Bodie et al., 2011; Holmstrom, Bodie, Burleson,
McCullough, Rack, Hanasono & Rosier, 2013), and bereavement (Bodie et al., 2011;
Burleson et al., 2009; Rack, Burleson, Bodie, Holmstrom, & Servaty-Seib, 2008). Third,
the support outcomes of concern (DVs) in research exploring messages that differ in VPC
often include factors such as helpfulness, affect improvement, sensitivity, appropriateness
and message quality (High & Dillard, 2012). Apart from affect improvement, the current
investigation deviates from this research and focuses on the outcomes of anxiety/distress
and negative emotions. Lastly, a majority of the aforementioned studies focus on concrete
events/situations that individuals might find distressing. In other words, the distressing
events/situations are not prolonged or chronic in nature. The identification of these trends
is important to note, as the individuals within the current sample, the chosen support
outcomes (DVs), and the stressor under study are quite different from current social
support outcome research.
The current investigation focuses on a specific group of individuals who selfidentify as living with OCD. The individuals within my sample experience certain
cognitive and behavioral symptoms (obsessions and compulsions) that distinguish them
from the general population. It is often the case that these symptoms lead to intense levels
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of anxiety, distress, and negative emotions (Rachman, 1971; Shafran, Watkins, &
Charman, 1996). The role of anxiety, distress, and negative emotions in perpetuating the
symptoms of the disorder is the main reason why these factors are the social support
outcomes under investigation and deviate from the DVs often employed in other dualprocess research (High & Dillard, 2012). In addition, the participants in this study are
experiencing real, not hypothetical, struggles that arise from managing OCD on a daily
basis. While everyday stressors (Bodie et al., 2011) and bereavement (Rack et al., 2008)
are contexts which create certain levels of distress (individual motivation) for participants,
there is the expectation that at some point this distress will become less acute over time.
Unlike the contexts often chosen for dual-process research, this study focuses on the
chronic nature of OCD. In other words, the dual-process theory has yet to explore
contexts in which the stressor under study is prolonged. The question then becomes: is
there something unique about chronic stressors that the dual-process theory does not
account for? There are several potential answers to this question that deserve mention.
It has already been established in the literature review that OCD symptoms are
often distressing and anxiety provoking (IOCDF, 2015; Rachman, 1971). Since intrusive
thoughts are often repetitive and uncontrollable in nature, (5th ed.; DSM–V; American
Psychiatric Association, 2013) those with OCD are likely to experience ongoing levels of
distress that wax and wane over time. Therefore, it could be the case that individuals with
OCD learn how to live and adapt to prolonged periods of distress. If this is the case, then
measuring anxiety/distress at one point in time might not provide an accurate picture of
people’s motivation to process supportive messages. If those with OCD experience higher
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levels of distress than the general population, it seems plausible that they could develop a
higher tolerance for distress if it is a psychological state they often experience as a result
of their symptoms.
In their comprehensive review of distress tolerance, Leyro, Zvolensky, and
Berstein (2010) define the concept as the “perceived capacity to withstand negative
emotional and/or other aversive states” (p. 4) and “the behavioral act of withstanding
distressing internal states elicited by some type of stressor” (p. 4). Research suggests that
distress tolerance is an identifiable risk factor for a number of anxiety disorders (Leyro,
Zvolensky, & Berstein, 2010). More specifically, studies indicate that distress tolerance is
correlated with obsessive symptoms (Keough, Riccardi, Timpano, Mitchell, & Schmidt,
2010), even after controlling for anxiety and depression (Cougle, Timpano, Fitch &
Hawkins, 2011). Overall, these studies suggest that the factor of distress tolerance impacts
an individual’s ability to manage their symptoms over a long period of time.
Considering that those with OCD often experience anxiety and negative emotions,
it seems fitting that an individual’s level of distress tolerance might influence his or her
motivation to manage his or her symptoms and process social support messages that vary
in VPC. Individuals who have a high level of distress tolerance might not be as motivated
to process a social support message if they feel as though they are capable of managing or
withstanding their distress alone. On the other hand, people who exhibit lower levels of
distress tolerance might have a greater sensitivity to their negative feelings and emotions
and thus report higher levels of motivation to elaborate on a social support message
intended to help them feel better. Therefore, the extent to which individuals process or
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elaborate on a specific social support message could depend upon their level of distress
tolerance concerning a specific stressor. Given this line of reasoning, I argue that future
research that marries the dual-process theory to the OCD context should examine the
degree to which distress tolerance acts as an indicator of individual motivation, rather than
level of emotional upset or individual distress (Burleson, 2009).
Apart from individual motivation, cognitive complexity was the other variable of
interest within the hypothesized model that did not produce expected results. The lack of
association between cognitive complexity and message elaboration incites a certain level
of curiosity as to why this individual ability factor was not an informative variable in this
specific context. One potential explanation for the lack of support surrounding cognitive
complexity revolves around the operationalization or measurement of the construct.
As a reminder, cognitive complexity refers to an individual’s ability to receive,
interpret, and respond to messages (Burleson, 2007; Crockett, 1975; Delia & Clark, 1977).
Cognitive complexity was measured using Crockett’s (1975) RCQ in which participants
were asked to list the characteristics, behaviors, mannerisms, etc. of individuals whom
they both liked and disliked. Ultimately, the RCQ generates a list of interpersonal
constructs. It is apparent that the conceptualization and most common operationalization
of cognitive complexity are at odds with one another. In other words, the RCQ is not
actually assessing an individual’s ability to receive, interpret, and respond to messages,
but rather his or her capacity to list the qualities of two distinct individuals. This
discrepancy is bothersome as the RCQ (Crockett, 1975) is a very common assessment of
cognitive complexity. I argue that future research focused on the construct of cognitive
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complexity needs to reflect upon whether or not the RCQ is an appropriate assessment for
measuring this variable. Apart from this discussion of the seemingly inaccurate
measurement of cognitive complexity, the lack of association between cognitive
complexity and message elaboration highlights the need to examine other individual
ability factors that may prove insightful given this specific context. Two specific variables
that might relate to OCD symptomatology and message processing are resilience and selfefficacy.
Resilience is defined as a “dynamic process encompassing positive adaptation
within the context of significant adversity” (Luther, Cicchetti, & Becker, 2000, p. 1).
Research on adolescents has identified that resilience is negatively associated with OCD
symptoms and predicts depression, anxiety, and stress (Hjemdal, Vogel, Solem, Hagen, &
Stiles, 2011). In other words, resilient individuals are less likely to report psychological
symptoms, most likely because they are able to positively adapt to their stressful
environment. Resilience might act as a “protective buffer” against psychological
symptoms (Hjemdal, Friborg, Stiles, Rosenvinge, & Martinussen, 2006). In the context of
OCD, it could be the case that resilient individuals are better able to manage their
symptoms through processing supportive messages from their social network in
comparison to their less resilient counterparts. This hypothesized positive association
between resilience level and message elaboration might be attributed to the idea that those
with higher levels of resilience have a greater ability to positively process their feelings
and emotions when provided with a social support message. This process of positive
message elaboration could promote positive emotional and psychological adaption in the
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wake of a disorder that is often anxiety producing. I argue that this association deserves
further attention and potential testing in the future as it might provide evidence of a factor
that moderates the relationship between messages that vary in VPC and message
elaboration or processing. In addition to individual resilience, perceptions of self-efficacy
might also prove useful as an individual ability factor within the dual-process model.
Bandura (1977) defines efficacy expectation as “the conviction that one can
successfully execute the behavior required to produce the outcomes” (p. 193). In the
context of OCD, the required behavior might be the processing or elaboration of a social
support message. I argue that individuals’ levels of self-efficacy could influence the
extent to which they process a supportive message that varies in VPC. For example, an
individual who receives a message high in VPC might not have the ability, or even the
emotional capacity, to process or elaborate on their thoughts and emotions concerning
their specific stressor. For some with OCD, their symptoms may lead to a certain level of
cognitive and affective overload in which they are ultimately unable to process messages
that relate to their disorder. In other words, social support outcomes might be impacted by
the extent to which an individual with OCD can process, interpret, and cope with a support
message that varies in VPC. Again, the relevance of self-efficacy to the context of OCD is
hypothetical in nature and needs to be tested in future research.
Apart from resilience and self-efficacy, other potential ability factors related to this
context include self-esteem and self-worth. In many respects, self-esteem and self-worth
function as individual resources that influence our interactions with others. In the context
of OCD, resources in the form of self-esteem and self-worth may prove beneficial for
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those who are suffering from a disorder whose symptoms often contradict a person’s sense
of self. For those with OCD, levels of self-esteem and/or self-worth may influence how
they process a supportive message from a social network member. For example, people
with lower levels of self-esteem may have difficulty processing a message high in VPC as
they may not believe they are worthy of receiving a message that communicates concern
and acceptance. On the other hand, an individual with a high level of self-esteem or selfworth may be more likely to extensively process a message high in VPC as that message
recognizes and validates their established positive sense of self. Again, future research
that utilizes the dual-process theory of supportive communication outcomes in the context
of OCD could focus on these individual ability factors as they may play a role in how
individuals with the disorder process social support messages.
There was an overall lack of support for the dual-process theory of supportive
communication outcomes. More specifically, cognitive complexity and individual
distress/anxiety did not impact the relationship between messages that differed in VPC
and message elaboration in expected ways. I offered some general explanations for this
lack of support and introduced distress tolerance, resilience, self-efficacy, self-esteem, and
self-worth as potential future factors to consider when utilizing the dual-process theory of
supportive communication outcomes. In the next section I will discuss the implications
associated with the other theoretical framework utilized in this study, namely the theory of
conversationally-induced reappraisals.
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Implications for the Theory of Conversationally-Induced Reappraisals
The results of this investigation point to the utility of the theory of
conversationally-induced reappraisals in explaining various social support outcomes. This
theoretical framework found support despite the current investigation diverging
methodologically from how the theory is normally tested. Again, the participants in this
investigation were randomly presented with a social support message vignette rather than
having a conversation with a confederate, a common methodology employed to test this
theory. Despite the fact that this theory (Burleson & Goldsmith, 1998) is predicated on
the assumption that cognitive reappraisal is promoted through conversation or dyadic
interaction, the results of this study highlight that cognitive reappraisal can be achieved
through one message that varies in VPC.
In one of the only studies to test this theoretical framework, Jones and Wirtz
(2006) conducted a confederate message design in which they had participants interact
with a trained confederate for five minutes. During this time the confederate enacted one
of three messages that differed in level of VPC. Their results indicated that messages that
varied in VPC led to cognitive reappraisal through the verbalization of positive emotion
words. Interestingly, the current investigation is one of the first to replicate components of
Jones and Wirtz’s (2006) model. While their study was used as a general model for the
current investigation, this study differed methodologically in that it did not utilize a
confederate message design. Alternatively, I chose to employ a message scenario design.
Participants randomly read one of three messages that differed in VPC and were instructed
to write their emotional and psychological reactions to that message. Despite the
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difference in method design, the results of the current investigation mirrored those of
Jones and Wirtz (2006). Ultimately, this investigation points to the notion that messages
that vary in VPC can lead to cognitive reappraisal via the written expression of positive
emotion words, which leads me to another implication surrounding this theory.
The aforementioned result mirrors the findings of Jones and Wirtz (2006) and
highlights the usefulness of the expression of positive emotion words in reaction to a
social support message. As stated earlier, participant’s verbalization of positive emotion
words in a written format predicted cognitive reappraisal. As a reminder, message
elaboration was operationalized as the percentage of positive emotion words within a
participant’s response text. This decision was based upon the fact that positive emotion
words were the only component of message elaboration that was significantly associated
with cognitive reappraisal. If one of the main goals of OCD research is to identify the
factors that help those with OCD reappraise their intrusive thoughts (Newth & Rachman,
2001), then this finding provides insight into the type of message elaboration that would
trigger this process. In other words, positive emotion words act as the mechanism through
which those with OCD reappraise the significance and relevance of their intrusive
thoughts. If people are to achieve cognitive reappraisal they need to go through the
process of reassesses or reinterpreting their initial reaction to the stressor that elicited the
response in the first place. Given the anxiety, distress, and negative emotions often
elicited due to unwanted intrusive thoughts (obsessions), it makes sense that focusing on
positive emotions during message elaboration might help those with OCD transform their
initial negative reactions to the stressor. The positive relationship between positive
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emotion words and cognitive reappraisal has immense theoretical and practical
implications.
The theory of conversationally-induced reappraisals speaks to the relationship
between VPC messages, message elaboration, and cognitive reappraisal. In addition to
Jones and Wirtz (2006), the results of this study provide further evidence of the mediating
role of message elaboration in the social support process. In a context such as OCD, this
finding is extremely productive to the conversation of how we help individuals with this
disorder manage their symptoms through positive expression and cognitive reappraisal.
Role of positive emotion words in message elaboration
The results of this investigation indicate that the written expression of positive
emotion words induces the process of cognitive reappraisal for people with OCD. The
inherent role of cognitive reappraisal in the management of OCD is well recognized
among OCD researchers (Abramowitz, Taylor & McKay, 2009; Newth & Rachman,
2001; Rachman, 1993, 1997). However, the results provide further validation of the
importance of cognitive reappraisal in helping those with OCD achieve emotional
improvement in the wake of their symptoms. Despite the importance of cognitive
reappraisal in OCD management, little research had established the specific ways in which
to trigger or induce this process. This study addressed such an issue and identifies positive
emotion words as the trigger. The positive relationship between positive emotion words
and cognitive reappraisal raises the question of how one such factor leads to the other.
How is it that the written expression of positive emotion words leads one to reassess their
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distressing thoughts? Research on the utility of positive emotion words might provide an
answer to such a question.
For over two decades researchers have explored the positive physical,
psychological, and emotional benefits of positive emotion words. A consistent finding
across this research is that both the verbalization and written expression of positive
emotion words are associated with overall well-being (Pennebaker, Mayne, Francis, 1997;
Pennebaker, Zech, & Rime, 2001) and better physical health (Pennebaker, 1997). The
oral and written expression of positive emotion words is often referred to as the disclosure
and writing paradigm (Pennebaker, Zech, & Rime, 2001). Overall, positive emotion
words are linked to a number of positive outcomes. If positive emotion words are
associated with psychological and physical benefits, it seems important to examine the
underlying mechanisms through which these results are produced.
Frederickson’s (2001, 2004) broaden-and-build theory of positive emotions seeks
to explain why positive emotions are beneficial. The underlying assumption of the theory
is that the expression of positive emotion words leads to a broadening of what she calls
“thought-action repertoires”. Thought-action repertoires refer to an individual’s initial
emotional response and subsequent behavioral reaction to an environmental stimulus. For
example, she references the tendency for people to escape when experiencing fear. The
broaden-and-build theory proposes that positive emotion words lead to an increase in an
individual’s thoughts and action tendencies. Isen (1990) proposes that positive emotion
words lead to cognitive flexibility, which could have implications for an individual’s
ability to engage in cognitive reappraisal. The action tendencies associated with positive
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emotion words include approach behavior in which individuals are likely to interact with
their surroundings (Frederickson, 2001). It is these tendencies that then lead to an
accumulation of physical, emotional, and psychological resources. The theory contends
that these resources increase an individual’s level of resilience, emotional well-being, and
coping capability (Tugade & Frederickson, 2007; Tugade, Frederickson, & Feldman
Barrett, 2004). While it is not the purpose of this summary to explore all of the relevant
literature associated with the broaden-and-build theory of positive emotions, I argue that
the theoretical underpinnings of this theory might explain why positive emotion words led
to cognitive reappraisal for those with OCD in this investigation.
Second to cognition words, 4.33% of a participant’s response to his or her support
message consisted of positive emotion words. According to the aforementioned theory,
the written expression of these positive emotion words was likely to lead to an increase in
both thoughts and actions. Since positive emotion words were positively associated with
cognitive reappraisal, it seems plausible that this increase in cognitions was the
mechanism through which individuals were able to reassess their interpretation of their
intrusive thoughts. In other words, cognitive reappraisal might function as a type of
thought-tendency triggered by the expression of positive emotion words. If this is the
case, then those interested in OCD symptom management should explore the utility of
positive emotions or positive message elaboration in dealing with distressing cognitions.
In addition to message elaboration, the results of this study, and even the current
conversation, point to the extremely important role of cognitive reappraisal in the
management of OCD.
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This study validates cognitive reappraisal as the mechanism through which people
with OCD achieve emotional improvement. The current study identifies two variables
that lead directly to this process. Namely, messages high in VPC and positive emotion
words are directly associated with higher levels of cognitive reappraisal. These results are
supported by other research (Jones & Wirtz, 2006; Matsunaga, 2011) that identifies the
role of these two factors in promoting the cognitive reappraisal process. Considering the
importance of cognitive reappraisal in driving the cycle of obsessions and compulsions,
we now have a model of supportive communication outcomes that provides an
explanation as to the specific role of cognitive reappraisal in the social support process.
The practical implications of this model are endless and will be explored next.
Implications of Results for OCD Research and Treatment
In addition to providing insight into the social support process from a
communication perspective, the results of this study have implications for psychiatric
research that focuses on the treatment of OCD, and more specifically treatment that
focuses on the relationship between the afflicted individual and their social network
members. One of the main findings of this investigation was that messages high in VPC
actually helped those with OCD feel better. These feelings of relief were manifested
through a decrease in anxiety, distress and negative emotions upon reading a specific
support message. Rather than focusing on general forms of social support, this study
identified the specific features of an emotional support message that promoted emotional
improvement and psychological relief. Given this result, I argue that clinicians who work
with people with OCD and their loved ones would benefit from promoting the provision
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of messages high in VPC by social network members as they appear to be the most
effective at helping those with OCD deal with their anxiety and distress. For social
network members who often feel helpless in the midst of their loved ones’ disorder (Black
& Blum, 1992), the results of this study unveil specific social support message features
they can employ to help that loved one manage his or her symptoms. Although I
recognize that the focus of this study was not on the provision of social support, but rather
the processing of support messages, the findings none the less have implications for how
social network members can support their loved ones with this disorder.
Unpacking the factors and mechanisms that promote the social support process
also has implications for how individuals with the disorder can process supportive
messages in order to achieve emotional relief from their symptoms. Again, the results
indicated that participants were more likely to engage in cognitive reappraisal when they
wrote down a higher percentage of positive emotion words after reading the social support
message. Given this result, clinicians or therapists should promote this process of positive
elaboration as it leads to reappraisal of the stressor (intrusive thought) and subsequent
emotional improvement. Inducing cognitive reappraisal is one of the primary purposes of
CBT therapy (Fama & Wilhelm 2005). The link between message elaboration (in this
case, operationalized using percentage of positive emotion words) and cognitive
reappraisal provides an explanation as how to individuals with OCD can achieve this
reappraisal process. In other words, this result provides a more nuanced perspective into
the process of CBT therapy as it identifies one of the mechanisms through which cognitive
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reappraisal is induced. Overall, the results of this investigation have implications for how
we discuss the treatment options for those with OCD.
Limitations
No study is without its limitations. There are a number of shortcomings within
this investigation that deserve attention and could be remedied in future versions. First,
this study focused on the short-term (one-time) management of an identified intrusive
thought. It has already been established that OCD is often chronic in nature and that those
who suffer from the disorder often experience multiple intrusive thoughts that differ in
content over time. The results from this study demonstrate that messages high in VPC can
lead to reappraisal and emotional improvement at one point in time.
Future research should explore the extent to which the relationships between these
variables can be sustained over multiple episodes of OCD management. More
specifically, a future version of this study could focus on a longitudinal methodology that
explores whether or not those with OCD can learn how to self-reappraise their intrusive
thoughts. A very significant implication from this study is that it might be possible for
those with OCD to develop the skills to reappraise their intrusive thoughts through
multiple interactions with their social support provider. OCD management then becomes
an issue of self-efficacy. While this study did not focus on the individual management of
OCD symptoms, future research should explore the possibility that supportive interactions
can function as a precursor to individual symptom management skills.
Second, there are limitations associated with the methodology employed in this
investigation. Similar to other dual-process studies (High & Dillard, 2012) this
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investigation used prefabricated messages that differed in VPC. While pre-manufactured
messages can ensure that all three levels are represented, they are artificial in nature and
lack the spontaneity that comes from live conversation. It could be beneficial for future
studies to utilize an interaction methodology in which OCD sufferers and support
providers gather to converse in a laboratory setting. The support provider could
communicate messages that vary in VPC, which could then be coded according to the
established hierarchy (High & Dillard, 2012). Employing this type of methodology would
test the extent to which the dual-process theory of supportive communication outcomes
and the theory of conversationally-induced reappraisals translate to actual interactions
between participants.
Third, the choice to run multiple regression analyses rather than structural equation
modeling (SEM) increased the likelihood of a type I error. In order to adjust for an
increased type I error a Bonferroni family wise correction could be used. With an adjusted
p-value of .005, some of my significant results would no longer be significant. In the
future, I plan to test my proposed model using SEM, which will control for an inflated
type I error and allow me to test for the overall fit of the proposed model.
Fourth, I failed to include a measure for the perceived realism of the support
messages. Because this measure was not included, I was not able to conduct a
manipulation check to ensure that the messages were seen as realistic. Although they
were pilot-tested, the pilot-test only measured perceptions of quality and not realism. For
vignette studies, measures of perceived realism are important. In the future, I will include
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this component in order to ensure that the message vignettes are perceived as realistic by
the participants.
The final limitation of this study revolves around the operationalization of message
elaboration. In conjunction with Jones and Wirtz (2006) I measured message elaboration
using the LIWC software program. Ultimately, the decision was made to only define
message elaboration as the proportion of positive emotion words within a participant’s
response to the message they received. While this decision is warranted by past research
(Jones & Wirtz, 2006), it does not coincide with other operationalizations of the variable.
More specifically, Burleson et al. (2009), in their message scenario design study,
measured message elaboration as the number of thoughts a participant reported following
a supportive message. On the other hand, Bodie et al. (2011a) measured message
elaboration using a “message quality discrimination index” in which they calculated the
difference in the perception of message quality between messages high and low in VPC.
The greater the difference in perceived quality between these messages the greater the
level of message elaboration or processing. These studies indicate that a common
operationalization of message elaboration does not exist. Future research should explore
whether or not these differences in measurement impact results. If they do, then future
conversations need to occur in order to establish the best technique for assessing message
elaboration.
Conclusion
OCD is a psychologically and emotionally exhausting disorder for both the
afflicted individual and their social network members. The purpose of this dissertation
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was to explore the extent to which social support messages that varied in VPC would help
those with the disorder manage their symptoms, and specifically their intrusive thoughts
(obsessions). The results indicated that messages high in VPC enabled those with OCD to
reappraise their intrusive thoughts and achieve short-term emotional improvement. In
other words, the rationale behind the theory of conversationally-induced reappraisals
found support in this specific context. The utility of messages that vary in VPC for the
management of OCD symptoms via cognitive reappraisal has implications for both
research on social support and OCD. Overall, the results of this dissertation bring us one
step closer to understanding the ways in which social support can help those with OCD
manage their symptoms.
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REFERENCES
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Social Psychology, 86, 320-333. doi:10.1037/0022-3514.86.2.320
Tugade, M. M., Frederickson, B. L., & Feldman Barrett, L. (2004). Psychological
resilience and positive emotional granularity: Examining the benefits of positive
emotions on coping and health. Journal of Personality, 72, 1161-1190.
doi: 10.1111/j.1467-6494.2004.00294.x
Tynes, L. L., Salins, C., Skiba, W., & Winstead, D. K. (1992). A psychoeducational and
support group for obsessive-compulsive disorder patients and their significant
others. Comprehensive Psychiatry, 33, 197-201. doi: 10.1016/0010440X(92)90030-T
Vangelisti, A. L., & Caughlin, J. P. (1997). Revealing family secrets: The influence of
topic, function, and relationships. Journal of Social and Personal Relationships,
14, 679-705. doi: 10.1177/0265407597145006
Van Noppen, B. L. & Steketee, G. (2001). Individual, group, and multifamily cognitivebehavioral treatments. In M. T. Pato & J. Zohar (Eds.), Current Treatments of
Obsessive-Compulsive Disorder (133-172). Washington DC: American
Psychiatric Publishing.
Watson, D., Clark, L. A., & Tellegen, A. (1988). Development and validation of brief
measures of positive and negative affect: The PANAS scales. Journal of
Personality and Social Psychology, 54, 1063-1070. doi: 10.1037//00223514.54.6.1063
Wilkum, K., & MacGeorge, E. L. (2010). Does God matter?: Religious content and the
evaluation of comforting messages in the context of bereavement. Communication
Research, 37, 723-745. doi: 10.1177/0093650209356438
Xu, Y., & Burleson, B. R. (2001). Effects of sex, culture, and support type on perceptions
of spousal social support: An assessment of the ‘‘support gap’’ hypothesis in early
marriage. Human Communication Research, 24, 535–566. doi: 10.1111/j.14682958.2001.tb00792
Zinbarg, R. E., Eun Lee, J., & Yoon, K. L. (2007). Dyadic predictors of outcome in a
cognitive-behavioral program for patients with generalized anxiety disorder in
committed relationships: A “spoonful of sugar” and a dose of non-hostile
criticism may help. Behaviour Research and Therapy, 45, 699-713.
112
APPENDIX A
INSTITUTIONAL REVIEW BOARD APPROVAL
IRB ID #:
201401779
To:
Melissa Kampa
From:
IRB-02
DHHS Registration # IRB00000100,
University of Iowa, DHHS Federal wide Assurance # FWA00003007
Re:
Test of the dual process model of social support in the context of OCD
Approval Date:
04/15/14
Next IRB Approval
Due Before: 02/03/15
Type of Application: Type of Application Review:
New Project
Continuing Review
Modification
Full Board:
Meeting Date:
Expedited
Approved for Populations:
Children
Prisoners
Pregnant Women, Fetuses, Neonate
Exempt
Source of Support: Executive Council of Graduate and Professional Students (ECGPS)
This approval has been electronically signed by IRB Chair:
John Wadsworth, PHD
04/15/14 0953
113
IRB Approval: IRB approval indicates that this project meets the regulatory
requirements for the protection of human subjects. IRB approval does not absolve the
principal investigator from complying with other institutional, collegiate, or departmental
policies or procedures.
Agency Notification: If this is a New Project or Continuing Review application and the
project is funded by an external government or non-profit agency, the original HHS 310
form, “Protection of Human Subjects Assurance Identification/IRB
Certification/Declaration of Exemption,” has been forwarded to the UI Division of
Sponsored Programs, 100 Gilmore Hall, for appropriate action. You will receive a signed
copy from Sponsored Programs.
Recruitment/Consent: Your IRB application has been approved for recruitment of
subjects not to exceed the number indicated on your application form. If you are using
written informed consent, the IRB-approved and stamped Informed Consent Document(s)
are attached. Please make copies from the attached "masters" for subjects to sign when
agreeing to participate. The original signed Informed Consent Document should be placed
in your research files. A copy of the Informed Consent Document should be given to the
subject. (A copy of the signed Informed Consent Document should be given to the subject
if your Consent contains a HIPAA authorization section.) If hospital/clinic patients are
being enrolled, a copy of the IRB approved Record of Consent form should be placed in
the subject’s electronic medical record.
Continuing Review: Federal regulations require that the IRB re-approve research
projects at intervals appropriate to the degree of risk, but no less than once per year. This
114
process is called “continuing review.” Continuing review for non-exempt research is
required to occur as long as the research remains active for long-term follow-up of
research subjects, even when the research is permanently closed to enrollment of new
subjects and all subjects have completed all research-related interventions and to occur
when the remaining research activities are limited to collection of private identifiable
information. Your project “expires” at 12:01 AM on the date indicated on the preceding
page (“Next IRB Approval Due on or Before”). You must obtain your next IRB approval
of this project on or before that expiration date. You are responsible for submitting a
Continuing Review application in sufficient time for approval before the expiration date,
however the HSO will send a reminder notice approximately 60 and 30 days prior to the
expiration date.
Modifications: Any change in this research project or materials must be submitted on a
Modification application to the IRB for prior review and approval, except when a change
is necessary to eliminate apparent immediate hazards to subjects. The investigator is
required to promptly notify the IRB of any changes made without IRB approval to
eliminate apparent immediate hazards to subjects using the Modification/Update Form.
Modifications requiring the prior review and approval of the IRB include but are not
limited to: changing the protocol or study procedures, changing investigators or funding
sources, changing the Informed Consent Document, increasing the anticipated total
number of subjects from what was originally approved, or adding any new materials (e.g.,
letters to subjects, ads, questionnaires).
115
Unanticipated Problems Involving Risks: You must promptly report to the IRB any
serious and/or unexpected adverse experience, as defined in the UI Investigator’s Guide,
and any other unanticipated problems involving risks to subjects or others. The
Reportable Events Form (REF) should be used for reporting to the IRB.
Audits/Record-Keeping: Your research records may be audited at any time during or
after the implementation of your project. Federal and University policies require that all
research records be maintained for a period of three (3) years following the close of the
research project. For research that involves drugs or devices seeking FDA approval, the
research records must be kept for a period of three years after the FDA has taken final
action on the marketing application.
Additional Information: Complete information regarding research involving human
subjects at The University of Iowa is available in the “Investigator’s Guide to Human
Subjects Research.” Research investigators are expected to comply with these policies
and procedures, and to be familiar with the University’s Federalwide Assurance, the
Belmont Report, 45CFR46, and other applicable regulations prior to conducting the
research. These documents and IRB application and related forms are available on the
Human Subjects Office website or are available by calling 335-6564.
116
APPENDIX B
STUDY QUESTIONNAIRE
Instructions: For each statement, please fill in the blank or indicate the choice(s) that bests
describes you.
Please indicate your sex _______
Please indicate which option(s) best describe you. Select all that apply.
 American Indian or Alaskan Native
 Asian
 Black or African American
 Hispanic or Latino
 Native Hawaiian or Other Pacific Islander
 White or Caucasian
 Other (please specify) ____________________
Please indicate your age ________
At what age did you start to suspect that you were experiencing symptoms of obsessivecompulsive disorder (OCD)?
Have you ever been medically diagnosed with OCD?
 Yes
 No
Within the past 12 months (year) have you been diagnosed with another psychological
disorder? If 'yes' then please indicate below your medical diagnosis or diagnoses (e.g.
depression; anxiety). If 'no' please leave blank.
117
Which type(s) of treatment are you currently receiving for your OCD? Select all that
apply.
 None
 Medication
 Individual therapy
 Marital therapy
 Group therapy
 Other (please specify) ____________________
Instructions: The following statements refer to experiences that many people have in their
everyday lives. Please indicate the answer that best describes HOW MUCH that
experience has DISTRESSED or BOTHERED you during the PAST MONTH.
Not at
all
A
little
Moderately
A
lot
Extremely
I have saved up so many things that they get in the way





I check things more often than necessary





I get upset if objects are not arranged properly





I feel compelled to count while I am doing things





I find it difficult to touch an object when I know it has
been touched by strangers or certain people





I find it difficult to control my own thoughts





I collect things I don’t need





I repeatedly check doors, windows, drawers, etc





I get upset if others change the way I have arranged
things





I feel I have to repeat certain numbers





I sometimes have to wash or clean myself simply
because I feel contaminated





I am upset by unpleasant thoughts that come into my
mind against my will





I avoid throwing things away because I am afraid I
might need them later





I repeatedly check gas and water taps and light
switches after turning them off





I need things to be arranged in a particular order





I feel that there are good and bad numbers





I wash my hands more often and longer than necessary





I frequently get nasty thoughts and have difficulty in
getting rid of them





118
Instructions: People with OCD often experience repetitive, uncontrollable and unwanted
intrusive thoughts, or obsessions, such as cleanliness, violence, incest, religion, etc. We’d
like to know more about ONE of your MOST RECENT or DISTRESSING intrusive
thoughts. This should be a thought that you experience frequently and which causes you
distress. In the space below please write freely about the following: 1) your thoughts
concerning your obsession, 2) how it made you feel at the time, 3) what you were doing
when you were experiencing the intrusive thought, and 4) how you are currently feeling
about the obsession. Provide as many details as you can. Remember, there is no right or
wrong answer and your comments will remain anonymous. Feel free to write as much as
you can about your experiences with this intrusive thought (obsession).
Instructions: Now that you have reflected on one of your most recent and distressful
intrusive thoughts or obsessions, we’d like you to answer the following questions about
how you are currently feeling by sliding the bar on a scale from 0-100, in which 100
represents EXTREME feelings of discomfort.
______ How upset are you right now?
______ How overwelmed do you feel right now?
______ How anxious do you feel right now?
119
Instructions: This scale consists of a number of words that describe different feelings and
emotions. Read each item and indicate the extent to which you are currently experiencing
the following feelings and emotions.
Very slightly or not at all
A little
Moderately
Quite a bit
Extremely
Interested





Distressed





Excited





Upset





Strong





Guilty





Scared





Hostile





Enthusiastic





Proud





Irritable





Alert





Ashamed





Inspired





Nervous





Determined





Attentive





Jittery





Active





Afraid





Instructions: In the previous section we asked you to indicate the extent to which you were
experiencing a number of different emotions and feelings of distress. We would now like
you to imagine that you ran into a friend and had a conversation with him/her. During the
conversation your OCD happened to come up and the two of you discussed how you have
been managing it recently. Now imagine that during this conversation your friend
provides you with the following message.
I don’t think you should be upset with anyone but yourself because your OCD is
your problem, not others. I don’t see what you are worrying about. You have to
stop thinking about your intrusive thoughts. You have to work at getting better, it
doesn’t just come easily. This is really your problem to figure out and you have to
take responsibility for it. There is really nothing I can do for you. Shake it off.
120
Everyone has problems. Life happens, just deal with it. It’s not the end of the
world and I’m sure you’ll get over it.
Instructions: In the previous section we asked you to indicate the extent to which you were
experiencing a number of different emotions and feelings of distress. We would now like
you to imagine that you ran into a friend and had a conversation with him/her. During the
conversation your OCD happened to come up and the two of you discussed how you have
been managing it recently. Now imagine that during this conversation your friend
provides you with the following message.
You are a good person and I know your OCD has made your life tough lately. I’m
sure if you work at it enough your symptoms will decrease. I’m really sorry that
this is happening to you. It’s too bad you are feeling this way, but maybe we can
go to dinner to get your mind off of your problems. You will be able to get through
it. You know, there are a lot of people in this world who have problems just like
you. You know you’re a great individual and things will get better in the future.
Instructions: In the previous section we asked you to indicate the extent to which you were
experiencing a number of different emotions and feelings of distress. We would now like
you to imagine that you ran into a friend and had a conversation with him/her. During the
conversation your OCD happened to come up and the two of you discussed how you have
been managing it recently. Now imagine that during this conversation your friend
provides you with the following message.
I am so sorry you are going through this right now. What do you think is making
your OCD symptoms so bad right now? Please talk with me about it. I am here for
you for support or someone to talk to. You are trying the best that you can and I
know how much it hurts when you are trying so hard but your symptoms won’t go
away, especially when they are not really under your control. I don’t blame you for
being upset and frustrated lately. You’re probably not only hurt but angry at being
stuck with this disorder. I hope that you will get better soon.
Instructions: Please list everything you were thinking while you were reading the previous
message you received from your friend. These thoughts may be about the friend or about
their message to you. Please separate each thought with a period (.)
Instructions: Now, we would like you to think about how you would react to the previous
message your friend gave you. What would you say to the person who gave you this
121
message? Please be as specific as possible and include anything you might say
to your friend regarding your OCD and your feelings and thoughts about the message you
received.
Instructions: After reading the above message and imagining a friend said that to you,
we’d like you to answer the following questions about how you are currently feeling by
sliding the bar on a scale from 0-100, in which 100 represents EXTREME feelings of
discomfort.
______ How upset are you right now?
______ How overwelmed do you feel right now?
______ How anxious do you feel right now?
122
Instructions: This scale consists of a number of words that describe different feelings and
emotions. Read each item and indicate the extent to which you are currently experiencing
the following feelings and emotions.
Very slightly or not at all
A little
Moderately
Quite a bit
Extremely
Interested





Distressed





Excited





Upset





Strong





Guilty





Scared





Hostile





Enthusiastic





Proud





Irritable





Alert





Ashamed





Inspired





Nervous





Determined





Attentive





Jittery





Active





Afraid





123
Instructions: Below is a list of words that describes various qualities of a message. Please
rate on the following scales (e.x. unhelpful-helpful) your perception of the qualities of the
message you received above.
1
2
3
4
5
6
7
Unhelpful:Helpful







Insensitive:Sensitive







Unsupportive:Supportive







Inappropriate:Appropriate







Unsuitable:Suitable







Inadequate:Adequate







Ineffective:Effective







Incompetent:Competent







Incapable:Capable







Not perceptive:Perceptive







Not
understanding:Understanding







Not beneficial:Beneficial







Uncaring:Caring







Cold:Warm







124
Instructions: Please answer the following questions concerning how the message you
received above currently makes you feel.
Very strongly
disagree
2
3
4
5
6
Very strongly
agree
I feel better after hearing the message from my
support provider

    

After receiving the message from my support
provider, I feel less depressed

    

The way my support provider responded to me
irritated me

    

Receiving the previous message from my support
provider helped me get my mind off my OCD

    

I feel more optimistic after hearing the message
from my support provider

    

My support provider made me feel better about
myself

    

I felt that my support provider was putting me down

    

My support provider seemed really concerned about
me

    

Instructions: The following questions ask you to think about how you currently feel about
your OCD after reading the above message. Please indicate below the extent to which the
previous message from your friend helps you to think about your OCD.
Very
strongly
disagree
2
3
4
5
6
Very
strongly
agree
The message I received from my support provider
made me think about the thoughts and emotions I
described earlier about my OCD

    

I feel that I ought to re-evaluate my thoughts and
emotions now after the message

    

I don’t really see my OCD in a different light after
receiving the message

    

Receiving the message from my support provider
about my OCD helped me get my mind off it

    

I understand my OCD better now that I received a
support message from my support provider

    

Thank you for providing your feedback on the hypothetical message from a friend. Now,
we'd like to shift gears.
125
Instructions: Our interest in this portion of the survey is to learn how people describe
others whom they know. Our concern here is with the habits, mannerisms – in general,
with the personality characteristics, rather than the physical traits – which characterize a
number of different people. In order to make sure you are describing real people, we have
set down a list of two different categories of people. In the blank space beside each
category below, please write the initials of a person you are acquainted with who fits into
that category. Be sure to use a different person for each category.
1. A person your own age whom you like
2. A person your own age whom you dislike
Spend a few moments looking over the two individuals you chose. Mentally compare and
contrast the people you have in mind for each category. Think of their habits, their beliefs,
their mannerisms, their relations to others, any characteristic they have which you might
use to describe them to other people.
Please look above and place the initials you have used to designate the person in category
1 (whom you like) here
Now, describe this person as fully as you can. Write down as many defining
characteristics as you can. Do not simply put down those characteristics that distinguish
him/her from others on your list, but include any characteristic that he/she shares with
others as well as characteristics that are unique to him/her. Pay particular attention to
his/her habits, beliefs, ways of treating others, mannerisms, and similar attitudes.
Remember, describe him/her as completely as you can, so that a stranger might be able to
determine the kind of person he/she is from your description.
This person is (use as many lines as you need, with one characteristic per line):
Now, please place the initials you have used to designate the person in category 2 (whom
you dislike) here
Please follow the same instructions as above as you describe this individual as fully as you
can.
This person is (use as many lines as you need, with one characteristic per line):
126
Some people with OCD talk about their symptoms, thoughts, and emotions they
experience as a result of their OCD with a close social network member, such as a parent,
sibling, significant other, friend, etc. Have you disclosed any symptoms, thoughts, or
emotions associated with your OCD to someone in your social network?
 Yes
 No
Please indicate in the space below who you generally go to in order to receive support for
your OCD. Why do you go to this individual(s) for support with your OCD?
Instructions: Now we would like you to think about ONE person in your social support
network. Please indicate in the space below the INITIALS of the person who you
are MOST LIKELY to talk to about your OCD.
What is your relationship with the support provider you indicated above (e.x. mother,
sister, friend, etc)?
127
Instructions: Please answer the following questions about your relationship with this
support provider. Please think of this particular individual whenever you see the words
[support provider] below.
Not at
all
2
3
4
5
6
Very
much
How close are you to your [support provider]?

    

How much do you like your [support provider]?

    

How often do you talk about personal things with your
[support provider]?

    

How important is your [support provider’s] opinion to you?

    

How satisfied are you with your relationship with your
[support provider]?

    

How much do you enjoy spending time with your [support
provider]?

    

How important is your relationship with your [support
provider]?

    

My [support provider] and I like a lot of the same things

    

My [support provider] and I share a lot of the same attitudes
about things

    

My [support provider] and I have very different values

    

My [support provider] and I are very similar

    

My [support provider] and I have a similar outlook on life

    

How often to you see your [support provider]?

    

How central is your [support provider] to your everyday life?

    

How often to you talk to your [support provider]?

    

Please indicate in the space below the reason(s) why you do not speak to your social
network about your OCD.
We would now like you to think about your current social network. Rather than focusing
on one individual, we would like you to imagine all of the individuals in your social
network who could provide you with support for your OCD.
How many people do you have in your life that give you support in relation to your OCD?
On a scale from 1-100, in which 100 represents the highest level of quality support, how
would you rank the quality of support you receive from your social network as a whole?
______ .
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Imagine that you approach either one person or multiple individuals in your social
network in order to gain support for your OCD. What would a high quality support
message look like? For example, think about the type of support and characteristics of a
message that you would find most supportive when talking to others about your OCD.
Please write below an example of the type of message you would want to receive from
your social network.
Now, what would a low quality or poor support message look like? In other words, what is
something that someone could say about your OCD that would not be supportive?
You have now reached the end of the survey! Thank you for your participation. Please
read the following information: Important: For this study you were randomly assigned to
receive a good, moderate, or poor social support message from a friend. In other words,
the messages varied in quality and were assigned to participants by a computer program.
OCD is a very extreme and distressing disorder that affects individuals on a physical,
emotional, and psychological level. Individuals with OCD are not in control of their
obsessions and compulsions and should never be blamed by others for their disorder. You
may have been randomly assigned an unsupportive message. In this case, the message you
received is in no way a reflection of you or how you are managing your disorder. If you
are experiencing anxiety or distress from participating in this study and need to talk with
someone you can find support resources at the International OCD Foundation website by
going to www.ocfoundation.org.
Thank you for participating in this investigation. If you have any questions/concerns about
your participation in this study please contact the principal investigator Melissa Kampa at
[email protected] or the faculty supervisor Dr. Rachel McLaren at [email protected]. Again, if you are experiencing anxiety or distress from participation
in this study and need to talk with someone you can find support resources at the
International OCD Foundation website by going to www.ocfoundation.org. Please move
to the next page in order to provide information for your compensation.
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APPENDIX C
COGNITIVE COMPLEXITY CODING MANUAL
Cognitive complexity refers to the extent to which an individual’s cognitive
structure differs on three levels: differentiation, abstraction, and organization. In the
specific context of this dissertation we are interested in participants’ perceptions of
individuals whom they both like and dislike. Since we are examining individual
perceptions of another, we are ultimately gauging participant’s interpersonal cognitive
complexity. Further, previous research indicates that solely measuring an individual’s level
of differentiation is an acceptable assessment of interpersonal cognitive complexity.
Therefore, this coding manual will only focus on cognitive complexity differentiation.
Differentiation coding refers to any mention of “a characteristic, quality, trait, motivation,
belief, habit, mannerism, or behavior that is attributed by the subject” to their chosen
individuals. Coding for these specific impressions will result in defining an individual’s
interpersonal construct differentiation.
In coding for interpersonal construct differentiation, we do not want you to code
the following: physical characteristics, appearance, demographic characteristics, or social
roles (e.g., mom, doctor, etc.)
Please read the characteristics on each separate space provided by the participant.
As you are reading these characteristics, please refer to the following rules for coding.
1. If two constructs are similar to one another they should be coded as more than
one construct.
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2. Some individuals may attach an adverb or adjective to a noun. If so, the phrase
should be considered one construct (e.g., extremely selfish, undeniably kind, etc.)
3. The participant may provide identical words or characteristics. If this occurs, the
identical words or characteristics should be coded as one construct, not two.
4. Short phrases should be coded as one construct.
5. Code only those constructs which actually relate to the task at hand. Again, do
not code responses that refer to physical characteristics, appearance, demographic
characteristics, or social roles.
6. Overall statements about the subjects’ own beliefs and “should” statements
should not be coded as a construct (e.g., “I would like to be friends with this
person”, “They should be nicer to other people, etc.).
After you are finished coding a participant’s response, please sum all of the
characteristics together in order to determine each participant’s level of cognitive
complexity.
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