Part 2. They scare because we care: The relationship between obsessive intrusive thoughts and appraisals and control strategies across 15 cities

• Interview on most distressing intrusive thought, in 15 cities from 13 countries.
• Thought frequency, distress, ease and importance of dismissal all varied by site.
• The relationship with appraisals and control strategies did not vary.
• Repugnant thought content did not influence the appraisal-thought relationship.
• Appraisals and actions partially mediated between OCD-beliefs and intrusions.

Cognitive models of Obsessive Compulsive Disorder (OCD) purport that obsessions are normal intrusive thoughts that are misappraised as significant, leading to negative emotional responses and maladaptive attempts to control the thoughts and related emotions. This paper utilised a large multi-national dataset of interview data regarding intrusive thoughts, to investigate three questions related to the cognitive model of OCD and to its stability across cultures. First, the paper aimed to investigate the implicit yet-hitherto-untested assumption of cognitive models that misappraisals and control strategies for intrusive thoughts relate similarly across cultures. Second, this study aimed to build upon recent studies categorising intrusive thoughts into repugnant and non-repugnant categories, by investigating whether the content of intrusive thought moderates the relationship between the thoughts and appraisals and control strategies. Finally, this study aimed to provide further evidence regarding whether general beliefs implicated in cognitive models of OCD (e.g., responsibility, importance of thoughts) influence the occurrence of intrusions via maladaptive appraisals and control strategies. Overall, it was found that while overall intrusive thought frequency, distress, ease and importance of dismissal all varied significantly by site, their relationship with appraisals and control strategies did not. Generally, appraisals and action taken to confront the thought were the more consistent predictors, with the notably caveat that the relationship between thought frequency and appraisals was not strong. Second, repugnant vs. non-repugnant thought-content differed only with respect to thought frequency, but thought-content did not moderate the relationship between intrusive thoughts and control strategies and appraisals. Finally, appraisals and control strategies generally partially mediated the relationship between general OCD-related beliefs and the occurrence of, and distress associated with, intrusive thoughts. The results are taken to add credence to cognitive models of OCD and their validity across cultures.