Beliefs about emotions and obsessive-compulsive symptoms - Meta analysis
Year: 2026
Type: other
Abstract: This project is a systematic review and meta-analysis summarizing current research findings on the relationship between negative beliefs about emotions and specific symptom dimensions of obsessive-compulsive disorder (OCD). Its purpose is to test how beliefs about emotions are associated with OCD symptom severity, and whether these associations vary between dimensions. Intrusive thoughts are a prominent feature of OCD, yet they are also commonly experienced by people without the disorder. To explain why similar thoughts without consequence for one person but become persistent and impairing for another, the cognitive model of OCD has shifted the focus from the occurrence of intrusive thoughts, to how they are interpreted: When interpreted as a sign of danger or threat, for example, as evidence that one is dangerous or responsible for preventing harm, a thought may become more recurrent and distressing and more likely to prompt compulsive behavior. Critically, according to this theoretical model, interpretations of thoughts do not arise in a vacuum; they are thoughts to be shaped by one’s broader beliefs about the self, potential threats in the environment, and the world, often referred to as “obsessive beliefs.” These beliefs can span many domains, including the likelihood of danger, one’s responsibility for preventing harm, and the meaning and significance of one’s own mental experiences. For example, metacognitive beliefs that thoughts reveal one’s true character, can influence events in the world, or must be controlled have been associated with more severe OCD symptoms. Seminal accounts of the cognitive model have focused primarily on the misinterpretation of intrusive thoughts. However, thoughts are not the only internal experiences implicated in OCD. Research has also highlighted the role of negative emotions, including anxiety, guilt, disgust, not-just-right experiences, and general distress, as potential drivers of compulsive behaviors. In the cognitive model, these emotions often link obsessions to compulsions: obsessive thoughts and their interpretations evoke distress, which then motivates compulsive behaviors intended to reduce or prevent it. Consistent with this account, individuals who are more prone to experiencing certain negative emotions tend to report more severe OCD symptoms. In the past two decades, researchers have begun to examine not only the emotions themselves but also individuals’ beliefs and attitudes about those emotions. Just as the experience of an intrusive thought may become problematic because of how it is interpreted, the consequences of an emotional experience may depend partly on what the individual believes that emotion means. Consistent with this possibility, OCD symptoms have been associated with stronger negative beliefs about emotions, such as the beliefs that guilt is intolerable or that anxiety is dangerous. This raises the possibility that beliefs about emotions, much like beliefs about thoughts, may contribute to the development or maintenance of OCD symptoms. In this systematic review and meta-analysis, we identified studies that empirically measured the relations between negative beliefs about specific emotions and OC symptoms to establish a comprehensive summary of this topic. We will also aim to detect and clarify any ostensible limitations and misconceptions we detect in the process. We will examine correlations between negative beliefs about emotions and OCD symptom dimensions. Specifically, we aim to examine how negative attitudes toward four specific emotions (guilt, disgust, anxiety/fear, and not-just-right experiences), as well as negative beliefs about distress and negative attitudes toward emotions in general, correlate with every one of the ten OCD symptom dimensions, harmonized across different instruments, including washing and contamination, ordering and symmetry, checking, responsibility for harm, unacceptable thoughts, and hoarding. Importantly, studies were eligible for inclusion in the review if they reported an association between any one of these beliefs and at least one specific OCD symptom dimension. The review team did not work from an exhaustive list of eligible questionnaires; instead, studies were included if they assessed a relevant construct, regardless of the specific instruments that were used. As we were interested in specific symptom dimensions rather than overall severity, only associations with specific symptom dimensions were included; associations with broad measures of overall OCD symptom severity that combined symptoms across multiple dimensions were excluded. Searches of six sources, combining conventional bibliographic databases with AI-assisted discovery tools, and two-stage independent screening by four reviewers,yielded 64 eligible studies contributing 562 effect sizes from 73 samples across 13 countries, aggregating data from approximately 19,390 participants.. Correlations between beliefs and symptoms will be pooled for every belief domain X symptom dimension pairing . Each pairing with at least five independent samples will be meta-analysed using a correlated-and-hierarchical-effects model with cluster-robust variance estimation, which is necessary because a single sample typically contributes several non-independent correlations — multiple subscales of one instrument, multiple instruments measuring one domain, or repeated measurement occasions. We found reported effects for 46 out of 60 possible correlation pairings, among which 26 reached the threshold for quantitative synthesis; the remainder will be described narratively rather than pooled. Heterogeneity will be reported separately at the study, sample and effect levels, alongside prediction intervals. Three sensitivity analyses, all specified in advance, will test how much each result depends on the modelling assumptions and on the algebraically derived values. Two outcomes are expected: First, a set of pooled correlations, with cluster-robust confidence and prediction intervals, quantifying how strongly each belief domain is associated with each symptom dimension. Second, through omnibus moderator tests and contrasts on the belief domain by symptom dimension interaction, our results will indicate whether correlations with different belief domains differ from one another within a given symptom dimension, and whether any such difference is dimension-specific. The substantive research question is whether the pattern is specific or diffuse; in other words, whether specific beliefs are correlated with specific obsessive-compulsive symptoms, potentially serving as unique risk factors for these dimensions. Alternatively, a diffused pattern might surface, indicating that emotions and their related beliefs are associated with OCD severity across dimensions. Specificity would identify candidate treatment targets tailored to specific symptom presentations, whereas a uniform pattern would suggest that beliefs about emotions operate as a general vulnerability rather than a dimension-specific one. A secondary research question pertains to the extent of existing data for every association; our project will draw up a map of where the evidence base is too small to support any conclusion. Data collection and extraction are complete; the synthesis and analysis are pre-registered before any pooled estimates have been computed. On completion, the analysis-ready dataset, the processing and analysis code, and a written log of every judgement made in preparing the data will be submitted as supplementary material alongside the manuscript, so that access does not depend on any single platform remaining available.
Source: Open Science Framework
Institution: Harvard University
Language: English
Subfield: Clinical Psychology
Field: Psychology
Domain: Social Sciences
Open Access status: green
OpenAlex ID: W7213590428