Do appraisals of responsibility affect the amount of mental contamination

experienced in a comparison between ‘victims’ and ‘perpetrators’ of moral

transgressions?

Katie Piggott

Submitted for the Degree of

Doctor of Psychology(Clinical Psychology)

School of PsychologyFaculty of Health and Medical Sciences

University of SurreyGuildford, SurreyUnited KingdomSeptember 2016

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Abstract

Mental contamination refers to the feeling of being contaminated in the absence of

physical contact and can be triggered by immoral behaviour. Differences have been found

between victims and perpetrators of immoral behaviour in how much mental contamination

they experience. This study aimed to investigate this variability by assessing whether feelings

of responsibility could explain the differences found between groups. An online experimental

paradigm was conducted where participants (N=121) were asked to recall an

autobiographical memory of being either a victim or a perpetrator of immoral behaviour.

Mental contamination was measured through participants’ ratings of negative emotions pre

and post manipulation. It was found that responsibility was related to mental contamination

through ratings of disgust and contamination, but there was no effect of responsibility on

group differences when a between groups ANCOVA was conducted. A between groups

ANOVA found that victims reported more mental contamination through ratings of anger and

the behavioural measure (intention to neutralise). Conversely, perpetrators reported more

shame and guilt than victims. These differences suggest that experience of mental

contamination is different between groups, with victims having an external negative response

and perpetrators reporting more internal negative emotions. These findings are discussed

along with potential implications.

3

Acknowledgements

I could not have got through the last three years without the support and guidance of

the staff on the PsychD programme. In particular I would like to thank my research

supervisors, Dr Jason Spendelow and Dr Laura Simonds for helping me to get to the end. I

would also like to thank Dr Sarah Johnstone my clinical tutor for her support, particularly

during a difficult time.

I would also like to thank all of the teams and supervisors that I have been lucky

enough to learn from over the course of training, Drs. Alessandra de Acutis, Isobel Foster,

Angela Reason, Tracey Lintern, Rachel Ames and Katy Davis. I have learned so much from

you all, not only about how to be an excellent clinical psychologist, but also how to use those

skills more widely to both challenge and develop the wider systems in which we work. I have

been encouraged to find and follow my passions and am therefore indebted to you all as I

look towards life after training starting my career in clinical psychology.

Last, but by no means least, I would like to thank my friends and family. This has

been the most challenging three years of my life and I could not have survived it without the

support you provide and also the understanding when I forget to do something I said I would,

or if haven’t been able to see you for a while because of a deadline. I would especially like to

thank Andy, who’s had to put up with my roller-coaster of emotions and stress day in and day

out and is still here smiling and offering to make me a cup of tea, you’re a star!

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Contents

Content Page Number

Research Component

MRP Empirical Paper 5

MRP Empirical Paper Appendices 52

MRP Proposal 87

MRP Literature Review 104

Clinical Component

Clinical Experience: A brief overview 146

Academic Component

Table of titles of all academic assessments

completed on training

149

5

Major Research Project Empirical Paper

Do appraisals of responsibility affect the amount of mental contamination experienced in a

comparison between ‘victims’ and ‘perpetrators’ of moral transgressions?

Statement of Journal Choice

The target peer-reviewed journal for this paper is Behaviour Research and Therapy.

The rationale for identifying this journal was due to its focus on research into

psychopathological processes and direct implications for clinical practice which relates well

to the topic of this research and future directions discussed. The scope of the journal (see

Appendix R) is appropriate due to the topic of the research being an analysis of a construct

that has important theoretical and clinical implications; including the potential for adapted

Cognitive Behavioural Therapy (CBT) approaches in treatment. The audience identified for

this journal include: clinical psychologists, psychiatrists, and psychotherapists, which makes

it an appropriate target journal for this paper. The impact factor of the journal is 3.471 (2012).

Word Count: 9771 words

6

Abstract

Mental contamination refers to the feeling of being contaminated in the absence of

physical contact and can be triggered by immoral behaviour. Differences have been found

between victims and perpetrators of immoral behaviour in how much mental contamination

they experience. This study aimed to investigate this variability by assessing whether feelings

of responsibility could explain the differences found between groups. An online experimental

paradigm was conducted where participants (N=121) were asked to recall an

autobiographical memory of being either a victim or a perpetrator of immoral behaviour.

Mental contamination was measured through participants’ ratings of negative emotions pre

and post manipulation. It was found that responsibility was related to mental contamination

through ratings of disgust and contamination, but there was no effect of responsibility on

group differences when a between groups ANCOVA was conducted. A between groups

ANOVA found that victims reported more mental contamination through ratings of anger and

the behavioural measure (intention to neutralise). Conversely, perpetrators reported more

shame and guilt than victims. These differences suggest that experience of mental

contamination is different between groups, with victims having an external negative response

and perpetrators reporting more internal negative emotions. These findings are discussed

along with potential implications.

Keywords: Mental contamination, Responsibility, Victim, Perpetrator, Morality.

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Introduction

The Development of Mental Contamination

Mental contamination is defined by Rachman (1994) as “a sense of internal un-cleanness

which can and usually does arise and persist regardless of the presence or absence of external,

observable dirt” (p. 311). The construct was borne out of clinical work with people with

Obsessive Compulsive Disorder (OCD). Obsessions involving contamination fears are

common in OCD where approximately 50% of people report a fear of contamination and are

the most phobic in nature of all obsessions (Rachman & Hodgson, 1980). Rachman (1994)

noticed that for some who present with OCD, there was a persistent fear of contamination

even in the absence of a physical, external stimulus. This fear of contamination could be

induced or intensified by thoughts, feelings or images that had no tangible source, such as

humiliations, betrayal and insults. Mental contamination is a cognitive based phenomenon,

with a focus on appraisals (e.g. responsibility) (Elliott & Radomsky, 2009). This makes it

consistent with theories of other forms of OCD (Rachman, 1998) and with anxiety disorders

more widely, where appraisals are core components (Elhers & Clark, 2000).

Since the identification of mental contamination clinically, there has been exploration of

the construct in regards to how it is measured and understood (Coughtrey, Shafran &

Rachman, 2014; Fairbrother, Newth & Rachman, 2005), what some of the vulnerabilities

underlying it may be (Herba & Rachman, 2007), and how it relates to, but is a different

construct to contact contamination (Radomsky, Rachman, Shafran, Coughtrey & Barber,

2013). The construct needs to evoke feelings of dirtiness and an urge to wash in the absence

of physical stimuli for it to be defined as mental contamination (Herba & Rachman, 2007).

However, due to the absence of a physical source of contamination in the body, mental

contamination is often expressed through associated emotional distress, which can be

experienced internally (e.g. shame, guilt) or externally (e.g. anger) (Rachman, 2006). The

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different emotions experienced therefore may vary between individuals. Four indices have

been identified as consistent and reliable factors through which mental contamination can be

measured: feelings of dirtiness, urges to wash, internal negative emotions (INE) (e.g., shame),

and external negative emotions (ENE) (e.g., anger) (Elliott & Radomsky, 2009). For the

purpose of this paper, mental contamination experienced through its indices will be referred

to more generally as ‘sensitivity to mental contamination’.

In contact contamination, feelings of contamination are attributable to a physical source

(e.g. dirt and/or disease). Evidence suggests that there is phenomenological overlap between

contact and mental contamination (Coughtrey, Shafran, Lee & Rachman, 2012a). The

“internal sense of dirtiness” experienced in mental contamination is similar to the “external

dirtiness” experienced in contact contamination with both inducing discomfort and distress in

the sufferer. Rachman (2004, 2006) outlined that the main differences between contact and

mental contamination included: the effectiveness of washing behaviour; the provocation of

contamination; and the process through which contamination occurs. For example, contact

contamination occurs via physical contact with a surface and mental contamination occurs

through mental stimuli. It is these differences, amongst others, that have led to the

differentiation of contact and mental contamination as distinct constructs of contamination

fear (Rachman, 2004). This distinction is important clinically as it has led to adapted forms of

treatment for OCD specifically for those experiencing mental contamination (Coughtrey,

Shafran & Lee, 2013a). Now that this distinction has been recognised both within the

literature and clinically (Herba & Rachman, 2007; Coughtrey, Shafran, Knibbs & Rachman,

2012a; Radomsky, et al., 2013), the field is now able to begin developing its understanding of

mental contamination in other directions.

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Immorality and Mental Contamination

Mental contamination is experienced in relation to a non-physical source and often as a

result of actual or perceived immoral behaviour (e.g. lying, stealing or a betrayal or

imagining committing these acts). Therefore, the experience of immoral behaviour can be a

pertinent trigger for mental contamination. Coughtrey, Shafran, Lee, and Rachman, (2012b)

found a relationship between mental contamination and violation of moral standards, with

60% of participants reporting more contamination when they felt they had done something

“bad” or “sinful”. Immoral behaviour, or moral transgressions can be defined as the idea that

“the individual being evaluated has violated a sense of right and wrong” (Tilghman-Osborne,

Cole & Felton, 2010, p. 539). It is this provocation of contamination that is one of the main

factors differentiating contact and mental contamination.

Most of the research investigating moral transgressions and sensitivity to mental

contamination to date, has focused on the victims’ response. For the purpose of this study,

“victims” are defined as the recipients of immoral behaviour and “perpetrators” defined as

the instigators of immoral behaviour. Research by Rachman, Radomsky, Elliott and Zysk

(2012) found victims showed a greater increase in mental contamination than perpetrators;

however, perpetrators did still experience it. This was measured through the negative

emotions of anxiety, guilt, shame and anger, which are conceptualised as part of the INE

index. They postulated that the mechanisms underlying the generation of mental

contamination therefore may be similar in each group.

Clinical observations by Evans, Elhers, Mezey and Clark (2007) found that mental

contamination was subsequently experienced by both perpetrators of a violent crime, and

victims of assault. This was also found to be consistent in a recent replication of the “dirty

kiss” paradigm, a method of inducing mental contamination using an imagined scenario of a

non-consensual kiss, (Waller & Boschen, 2015) with a nonclinical female sample. This

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research highlights that mental contamination can be successfully induced in general

population samples as well as being seen clinically.

As it has been proposed that similar mechanisms may be underlying the generation of

mental contamination for both victims and perpetrators, understanding more about why

differences are seen in sensitivity to mental contamination is important as this may help to

explain why victims have been found to experience more mental contamination than

perpetrators (Rachman et al., 2012). This has important implications in helping to reduce the

frequency with which people re-experience traumatic or negative memories and also has the

potential to develop more targeted interventions for both victims and perpetrators.

Mental Contamination and Responsibility

Responsibility is such a factor that may help to explain and possibly predict some of

the difference seen between victims and perpetrators of moral transgressions in their

sensitivity to mental contamination. A predictive role of responsibility in mental

contamination was suggested by Elliott and Radomsky (2013) who found appraisals of

personal responsibility accounted for a significant amount of mental contamination, measured

through the INE index. Moreover, Radomsky and Elliott (2009) found appraisals of personal

responsibility were a better and more significant predictor of mental contamination on its

indices of urges to wash and feelings of dirtiness, than contact contamination. This research

demonstrates that there is a role of responsibility in mental contamination and that this role

might be a predictive one.

Responsibility is defined here as “the belief that one has power that is pivotal to bring

about or prevent subjectively crucial negative outcomes. These outcomes may be actual, that

is having consequences in the real world, and/or at a moral level” (Salkovskis, Richards &

Forrester, 1995, p. 285). The fundamental act of an immoral behaviour suggests attributable

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differences between victims and perpetrators. Perpetrators are the instigators of immoral

behaviour and therefore intrinsically hold responsibility as the action is under their control.

This study will investigate general propensity for responsibility rather than measuring

responsibility appraisals after a recalled event. Investigating specific predictive factors, such

as responsibility, might help to tease apart some of the differences found between victims and

perpetrators in previous research. It could be hypothesised that those who experience higher

levels of responsibility might be more sensitive to experiencing mental contamination when

asked to recall a memory of being a perpetrator of a moral transgression. Therefore, when

asked to recall a memory of holding power and acting in an immoral way, it is possible they

would experience more negative emotions. Variability might therefore be expected in

individual’s sensitivity to mental contamination depending on how much responsibility they

generally feel for the outcome of events.

This is supported by research of both victims and perpetrators of real and imagined

moral transgressions, which found variability in whether individuals’ experienced mental

contamination. Fairbrother and Rachman (2004) found only 60% of women who had been the

victim of a sexual assault reported feelings of mental contamination. Similarly, whilst

Rachman et al. (2012) found perpetrators and victims experienced similar emotions in

response to immoral behaviour, some perpetrators reported experiencing no negative

symptoms at all. This suggests that there is not only variability between victims and

perpetrators in their sensitivity to mental contamination, but variability within groups. It is

possible therefore that how much responsibility a person feels might help to explain some of

this variability.

The Cognitive Theory of OCD (Salkovskis, 1985) adds support to this. It proposes

that negative appraisals may develop from assumptions learned in childhood as a way of

coping with early experiences. The theory suggests these assumptions shape the individual

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and their subsequent responses to critical incidents i.e. threat. Therefore, it is possible that

those who hold more assumptions around responsibility for harm, will be more likely to

appraise their role in events as holding more responsibility for its causation or prevention

(Salkovskis et al. 2000). This may then result in them being more sensitive to experiencing

mental contamination. It could be argued that if a person has a high general sense of personal

responsibility, they might be more likely to feel shame and guilt following perceived

immorality. When a person is then asked to recall an actual experience of immoral behaviour

(i.e. being a perpetrator), this predictive effect of responsibility on mental contamination is

likely to be stronger than when a person recalls an immorality perpetrated on them.

It is often these feelings of responsibility, which lead to an increase in the negative

emotions that are conceptualised in mental contamination. As a result, this study will measure

sensitivity to mental contamination through emotional response (i.e. the INE index), which

might include increased feelings of anxiety, shame, disgust and guilt (Veale 2007).

The conceptualisation of these emotions is important to state here to further explain

their relationship to each other and to responsibility. In the literature, trait and state shame

and guilt are usually highly correlated (Radomsky & Elliott, 2009). Shame, however,

has been conceptualised as a different construct from guilt due to its internal focus; the guilt

response is externally focused (Teroni & Deonna, 2008). Furthermore, shame and guilt are

shown to be part of the moral response with them being described as “self-conscious

emotions” (Tangney, Stuewig & Mashek, 2007 p. 346) that allow for self-reflection on

behaviour and a means of self-punishment for moral transgressions. This conceptual

difference suggests that shame is felt more in relation to the self, whereas guilt is experienced

in relation to a specific behaviour. This is an important distinction as it suggests that an

association might be expected between responsibility and shame that is different to the

relationship between responsibility and guilt.

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Salkovskis et al.’s (1995) definition of responsibility, stated above, stresses the

fundamental power of the individual in the causation or prevention of negative consequences.

Therefore, the conceptual differences between shame and guilt may relate to differences in

sensitivity to mental contamination observed between victims and perpetrators. This could be

due to power differences between the two groups in the immoral behaviour itself. Shame and

guilt are conceptualised as part of mental contamination. Therefore, it is likely that

responsibility appraisals that result from more general feelings of responsibility, will amplify

this sense of shame and/or guilt. Individuals may then blame themselves for the outcome of

the event, which therefore would increase the amount of mental contamination experienced.

Despite previous research focusing on the victims’ sensitivity to mental contamination

in response to moral transgressions, according to the literature outlined above, it might be

expected that perpetrators would be more sensitive to experiencing guilt, as they instigated

and were inherently responsible for the act. Conversely, victims may be more sensitive to

experiencing shame, as they did not hold the inherent responsibility and may direct the

negative emotions internally. Therefore, investigating an individuals’ general sense of

responsibility may be beneficial in understanding what makes some people more sensitive to

experiencing mental contamination and to try and explain some of the variability seen both

between and within groups.

The Measurement of Mental Contamination

Due to the internal focus of mental contamination, understanding more about its

measurement and the negative emotions evoked is important so that treatment can be

effective and valid. As stated previously, mental contamination is measured through the four

indices of: INE’s, ENE’s, feelings of dirtiness, and urge to wash (Elliott & Radomsky, 2009).

This study will focus on the measurement of mental contamination through its INE index.

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This is due to the importance of associated negative emotions in the definition of mental

contamination (Fairbrother, Newth & Rachman (2005) alongside feelings of dirtiness.

Shame and guilt were outlined in the previous section as important components of mental

contamination. Disgust propensity has also been found to be significantly and positively

related to mental contamination, measured as a whole construct (Badour, Feldner,

Blumenthal & Bujarski, 2013a), and through its urge to wash index (Carraresi et al., 2013;

Herba & Rachman, 2007; Radomsky & Elliott, 2009). Rachman et al. (2012) have

demonstrated the important role of disgust and shame in the conceptualisation of mental

contamination through the INE index, operationalizing disgust as part of the mental

contamination response. Disgust will therefore be included as a measure of mental

contamination in this research, along with shame and guilt, in order to replicate previous

findings and to further explore its relationship to other INE’s.

All of the emotions outlined so far in this paper are moral-focused emotions, meaning that

they are often triggered in response to immoral behaviour. For example, Eskine, Novreske

and Richards (2013) found both direct and indirect contact with an immoral person increased

participants’ level of state guilt. The amount of guilt felt was mediated by disgust sensitivity,

whereby those who were more sensitive to feelings of disgust experienced an increased

amount of guilt. The literature on sociomoral disgust is also relevant to mention here.

Sociomoral disgust refers to the apparent violation of social or moral boundaries. Examples

of this include rape, racism, hypocrisy and exploitation (Rozin, Haidt & McCauley, 2000). It

differs from core disgust through the additional element of human violations of the dignity of

another (Rozin, Haidt & McCauley, 1999). This therefore could relate directly to previous

examples in the literature of how mental contamination has been induced (Rachman, 2004,

2006; Elliott & Radomsky, 2009). Research by Simpson, Carter, Anthony and Overton

15

(2006) found that higher levels of anger were elicited when evoking sociomoral disgust as

opposed to core disgust. Despite anger being characterised as an ENE in the mental

contamination literature, it will be measured in this research given its relationship with

disgust in the sociomoral literature.

This paper has so far outlined the importance of measuring negative emotions

experienced in relation to a moral transgression, due to their role in the conceptualisation of

mental contamination. However, sensitivity to mental contamination can also be investigated

behaviourally by engaging in specific behaviours with the aim of reducing negative emotions.

Research by Zhong and Liljenquist (2006) looked at the effect of neutralising behaviour and

found exposure to unethical acts, whether the participants own, or those of others, promoted

this behaviour. Neutralising is defined as “voluntarily initiated activity, which is intended to

have the effect of reducing the perceived responsibility” (Salkovskis & McGuire, 2003, p.

64). However, research trying to replicate Zhong and Liljenquist’s (2006) findings have been

unsuccessful (Fayard, Bassi, Bernstein & Roberts, 2009; Waller & Boschen, 2015). Due to

these equivocal findings, this study will employ a behavioural measure of sensitivity to

mental contamination, rather than measuring it as a means of reducing mental contamination.

It would therefore be predicted that engagement in this measure would increase in the same

direction as the emotion variables already outlined in this paper. This will enable further

exploration of the impact of immoral behaviour on mental contamination.

Inducing Mental Contamination

Mental imagery has been demonstrated to be a core feature in contamination related OCD

(Coughtrey, Shafran & Rachman, 2013b). However, how mental imagery is utilised in mental

contamination needs further investigation. Research from both clinical and nonclinical

populations have found there to be a vivid use of imagery in relation to mental contamination,

evoking the feeling of needing to wash in some participants (Coughtrey, Shafran & Rachman,

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2015; Rachman, et al., 2012). However, one criticism of the paradigms currently used to

elicit mental contamination through imagery (e.g. “the dirty kiss” paradigm, Fairbrother et al,

2005), is that participants have to imagine themselves in a predetermined role developed by

the researchers. The effect of the manipulation therefore may not be as powerful. To address

this lower ecological validity, a more salient way to induce mental contamination would be

through the recall of the participants own autobiographical memories. This has been found to

be effective in nonclinical populations (Coughtrey, et al., 2014), and has been more widely

used in clinical populations, with participants recalling memories of sexual assault

(Badour, Feldner, Babson, Blumenthal & Dutton, 2013b; Fairbrother & Rachman, 2004); and

feelings of contamination (Coughtrey, et al. 2012b). 

In order to further develop how mental contamination is induced experimentally, it would

therefore seem beneficial to continue to explore how participants own autobiographical

memories can be used to elicit this. Whilst Coughtrey et al. (2014) found the approach to be

effective, they noted that the mental contamination induced was transient, decaying

spontaneously after three minutes; however, the effect could be repeatedly re-evoked. The

potential downfalls to using participants own autobiographical memories to induce mental

contamination, include the possibility of priming, decay of mental contamination response,

participants failing to recall an appropriate memory, in addition to other issues related to

control of the memories recalled. Despite this, there are gains in making the induction of

mental contamination more ecologically valid. Therefore, the possibility of eliciting more

pertinent memories has the potential to elicit a greater mental contamination response than

previous methods used. This has important clinical implications in how intrusive memories

and the resulting mental contamination experienced, can be understood and subsequently

treated. 

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Hypotheses 

Based on the literature outlined above, the following hypotheses will be tested within the

study: 

1) Scores indicating a higher sense of personal responsibility will be correlated with

higher sensitivity to mental contamination (defined as an increase in mental

contamination indices) following recall of a moral transgression.

2) In line with previous research, sensitivity to mental contamination will be higher in

participants who recall being the victim of a moral transgression than participants who

recall being a perpetrator of a moral transgression.

3) The effect of responsibility on sensitivity to mental contamination will be higher for

those who recall being a perpetrator than those who recall being a victim of a moral

transgression.

Method

Design

A between-subjects design was used in this study to assess the effect of participants’

feelings of responsibility (covariate) on participants’ sensitivity to mental contamination

(dependent variable (DV)). Sensitivity to mental contamination was measured through the

negative emotions of shame, guilt, disgust and anger. Happiness was also included as a DV to

check validity of responses i.e. to ensure that participants were not just responding to every

item in the same way. Happiness is a positively valenced emotion, therefore the opposite

response would be expected to the negative emotions. The inclusion of feelings of

contamination was to act as an overall measure of sensitivity to mental contamination.

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Participants were randomly allocated into one of two conditions (independent

variable): victim or perpetrator of a moral transgression. A behavioural measure of mental

contamination (DV) was also included at the end of study to assess participants’ intention to

neutralise the mental contamination.

Participants

Inclusion criteria required participants to be aged 18 years and over. No other

inclusion or exclusion criteria were stipulated. Both convenience and snowball sampling

methods were used to recruit participants. The hyperlink for the online survey was shared on

social media sites (e.g. Facebook, Twitter, Reddit, and LinkedIn). It was suggested that

participants who took part in the study forward the hyperlink onto other people whom they

thought might take part and who met the inclusion criteria.

A priori sample size calculations were conducted using G*Power (Faul, Erdfelder,

Buchner & Lang, 2009) for correlational analyses (n=111; effect size f=.3; α=.05;

power=.95); for analysis of variance (ANOVA) (n=84; effect size f=.4; α=.05; power=.95);

and for analysis of covariance (ANCOVA) with one interaction (n=84; effect size f=.4;

α=.05; power=.95). In addition to this, previous studies with similar designs (Radomsky &

Elliott, 2009; Elliott & Radomsky, 2013; Rachman et al. 2012) reported similar sample sizes

to the a priori calculations. The sample size included in this study of 121 participants

(Male=33; Female=87; Other=1) should therefore be large enough to reach a medium to large

effect size if the findings are significant.

Measures

Responsibility Attitudes Scale (RAS) (Salkovskis et al., 2000). The RAS was

administered in order to assess responsibility attitudes. The RAS is a 26-item questionnaire

19

measuring an individual’s general beliefs about responsibility (Appendix A). The items are

rated on a 7-point Likert scale where individuals state how strongly they agree or disagree

with each statement (1= “Totally Agree”, 7= “Totally Disagree”). The total score from the

RAS was calculated in line with Salkovskis et al.’s (2000) guidelines whereby each item

score is added together to create the Total Score. A higher Total Score equates to fewer

responsibility attitudes. It has high reliability and internal consistency (Cronbach’s α=.92)

and has demonstrated good concurrent and criterion validity (Salkovskis et al. 2000). A high

internal consistency was also found on the RAS for the sample used in this study (α=.924).

Visual Analogue Scales (VAS). VAS were used to measure the subjective experience

of mental contamination through the INE index. VAS are a useful tool when the variable is

difficult to objectively assess (Crichton, 2001). Furthermore, due to the subjectivity of what

they are measuring, they are more reliable when measuring change within an individual,

rather than between individuals (Crichton, 2001). Therefore, as emotion variables were

assessed at two time points in this study, the use of VAS seemed like the most appropriate

tool. The use of individual measures for each emotion was also considered. See Appendix B

for a comparison between using VAS and specific measures of emotion.

Participants were required to self-rate their feelings of shame, guilt, disgust, anger,

happiness and contamination on a scale of 0-100 (Appendix C). A rating of 0 meaning that

none of that particular emotion was felt at that time and 100 meaning the greatest amount of

that emotion was felt. The VAS were used before the induction of mental contamination as a

baseline measure (Time 1 (T1)) and then after the manipulation (Time 2 (T2)). To assess

amount of mental contamination experienced, the change from baseline score (T2-T1) for all

DV’s were calculated. VAS are widely used tools in both clinical and research settings, and

have been found to have high reliability (r=.94 (Henderson, Byrne & Duncan-Jones, 1981)

and validity (McCormack, Horne & Sheather, 1988).

20

Manipulation check. A manipulation check was developed for this study (Appendix

D) based upon the Mental Contamination Report (MCR) (Radomsky, Elliott, Rachman,

Fairbrother & Newth, 2006). It was used after the recall of the autobiographical memory to

check whether participants were able to both recall and hold in mind a salient memory for up

to 1 minute. The Manipulation Check involved participants answering 5 questions, on a scale

of 0 to 100, with the exception of a question about length of time spent visualising the

memory (0-120 seconds). Questions included participants reporting “How vividly were you

able to imagine the memory?” (0= not vividly at all to 100 = very vividly) and “How easy

was it to think of a memory that met the guidance given?” (0=Very Difficult to 100=Very

Easy). As an additional manipulation check, the memories recorded by each participant were

considered by the researcher to ensure they were the appropriate perspective for the group

they had been allocated to.

Procedure

The study was granted favourable ethical opinion by The University of Surrey Faculty

of Arts and Human Sciences Ethics Committee (Appendix E).

An online experimental paradigm was created and shared using Qualtrics software

(2015). The hyperlink for the study was shared online through social media websites

(Appendix F). Participants were able to gain access to the study by selecting the link, at

which point they were presented with the information sheet (Appendix G). Figure 1 outlines a

diagrammatic representation of the components of the online study.

Participants were informed if they only completed part of the study their data would

be deleted and interpreted as them withdrawing their data from the study. The information

sheet outlined what participation would entail and potential costs and benefits of taking part,

along with information about their right to withdraw from the research.

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Figure 1: Diagrammatic representation of the online protocol of the study.

MC=mental contamination; VAS = Visual Analogue Scale

22

The true nature of the study was not explicitly stated at this point, due to the potential to bias

the research; however, was described in full on the debriefing page. Participants were then

presented with a consent form (Appendix H) before being asked to complete demographic

information (Appendix I). Some of these questions were forced choice responses (e.g. age)

and some they were prompted, but not required, to complete (e.g. level of education).

Participants were then presented with the questionnaire measure (RAS), which had forced

choice questions due to it being a key variable in the study. They were then asked to complete

a pre-manipulation VAS (T1), subjectively rating how much of the 6 emotions being

measured they were currently experiencing.

At this point, participants were randomly allocated into one of two conditions (victim

or perpetrator), and asked to both recall and write down a memory of a time when they had

committed, or been the recipient of a moral transgression. Participants were provided with

examples of moral transgressions before this to prompt them with completing the task

(Appendix J). Those in the perpetrator condition received the instruction: “please write down

a memory that relates to a time when you have acted in an immoral way towards another

person”.

Conversely, those in the victim condition were requested to: “please write down a

memory that relates to a time when someone has acted in an immoral way towards you.”

Both groups then received the following information: “Please use the examples listed above

for a guide on the type of memories to recall. It may help to take a minute to think about this

memory before writing it down”. Examples provided included: lying to a friend, cheating on a

partner, or committing a minor transgression, amongst others. Once they had written down

the memory they were asked to “think about and visualise it for one minute”. They were then

asked to complete the manipulation check, to assess the salience of their memory and how

23

easy it was for them to recall a memory, before being required to complete the VAS again

(T2), rating the same 6 emotions.

Finally, participants were presented with the debriefing page, where they were

informed of the true nature of the study and provided with sources of support to access if they

wished to (Appendix K). Here, they were also asked if they would like to participate in any

further research and to leave their email address on the next page if they wanted to. This was

used as the behavioural measure of mental contamination; however, this was not made

explicit to the participants, to try and control for the introduction of bias.

Data Analysis

Data analysis was conducted using the Statistical Package for the Social Sciences

(SPSS) version 22.0 (IBM Corp. 2013). Descriptive statistics and frequency analyses were

initially produced to examine the distribution of the data at all levels (see Appendix L for

histograms of the residuals). Additional descriptive statistics were also produced to explore

the manipulation checks to ensure participants were able to recall an appropriate and salient

memory.

Correlational analyses and one-way between-groups analyses of variance (ANOVA’s)

were initially completed to assess hypotheses 1 and 2. To test hypothesis 3, a between

subject’s analysis of covariance (ANCOVA’s) was conducted for each emotion (shame,

disgust, guilt, anger, happiness, contamination) using a custom model to include the

interaction between the condition and responsibility. For each of the above analyses the

assumptions for validity were examined and are mentioned in the results section.

24

Results

Preliminary Analysis

One hundred and twenty-one participants (Male=33; Female=87; Other=1) were

included in the analyses after the removal of incomplete data (n=107, 47%). This was in line

with information outlined to participants in the information sheet, which interpreted non-

completion of the survey as participants choosing to withdraw their data. These 107 cases

were not included in the analysis. See Table 1 for demographic information for participants.

For ethnicity, level of education and marital status, the highest two categories are presented.

Table 1: Key demographic information for participants

By condition

Demographic variables All data Victim Perpetrator

N 121 63 58

Gender M=33; F=87 M=13; F=50 M=20; F=37

Mean age in years (SD) 34.07 (11.69) 35.30 (12.24) 32.72 (11.01)

Ethnicity

White British 86% 84.1% 87.9%

Asian or Asian British 6.6% 6.3% 6.9%

Education

Postgraduate degree 45.5% 41.3% 50%

Undergraduate degree 25.6% 25.4% 25.9%

Marital status Maa=41.3% Sb=52.1%

Maa=41.3% Sb=50.8%

Maa=41.4% Sb=53.4%

N= number of participants; M=Male; F=Female; SD=Standard Deviation; Maa=Married; Sb=Single

Table 1 shows that, when split by condition, the two groups were similar in their key

demographic information. Overall the sample was largely White British and educated to an

undergraduate or postgraduate degree level. Despite slight differences being observed in the

gender ratio and Mean age of between groups, these were not significant.

25

Manipulation Checks

A manipulation check was conducted to assess the participants’ ability to think of and

hold in mind a relevant memory. There are no norms for this paradigm, but responses were

on a 0-100 scale, with the exception of Time, which was measured on a scale of 0-120

(seconds).

Therefore, where the Means for participants were more than 50, it could be argued the

tool was somewhat effective as reasonably realistic and vivid memories were recalled that

participants could hold in mind. Participants were asked to rate the ease at which they were

able to think of a memory (M=61.22, SD=33.38), how vivid the memory was (M=67.29,

SD=29.34), and also how realistic it seemed (M=68.08, SD=29.626). The mean amount of

time participants were able to visualise the memory for was M=52.97 seconds (SD=37.982).

These findings demonstrate that on average, participants were able to engage in the recall of

an appropriate memory and this memory was somewhat realistic and vivid.

Analysis of group differences, whilst smaller than those found in previous studies

(Radomsky & Elliott, 2009), still found a significant difference in the ability to recall an

appropriate memory (F (1, 119) =29.57, p<.001, d=.99), with perpetrators reporting this to be

more difficult (M=31.90, SD=25.99) than victims (M=62.98, SD=35.69). Furthermore, there

was a significant group difference in participants’ ability to visualise the memory (F (1, 119)

=4.06, p=.046, d=.37), with perpetrators finding this more difficult (M=45.81, SD=31.98)

than victims (M=59.56, SD=41.95). No other significant group differences were found.

26

Comparisons at Baseline

All variables were examined at the Time 1 (T1) level, before the induction of mental

contamination (see Table 2) to examine comparability at baseline. Between groups

comparisons were also made at T1 using an analysis of variance (ANOVA). This was to

assess if Means and variances were equal across groups for each variable to check the

randomisation of groups had worked. Assumptions of normality of residuals for ANOVA

were also assessed. Histograms of the variables and of the residuals were produced for each

model to assess whether the assumptions of each parametric test were met.

Table 2: Means & SD’s at T1, and by condition

By Condition

MCa Variable at T1

All data Victim Perpetrator

Mean

SD Mean

SD Mean

SD F statisti

c

P Valu

e

Cohen’s d

Contamination

9.51 19.98

13.10

23.85

5.62 13.87

4.34 .04* .38

Shame 16.09

23.01

17.49

24.61

14.57

21.24

.49 .49 .13

Disgust 11.08

20.85

11.98

22.12

10.10

19.52

.24 .62 .09

Guilt 17.00

23.88

18.78

25.46

15.07

22.09

.72 .39 .16

Anger 12.21

21.22

16.79

25.66

7.24 13.55

6.39 .01* .46

Happiness 55.17

26.26

55.67

25.67

54.62

27.10

.048 .83 .04

MCa=Mental contamination; SD=Standard Deviation; *= significant at p<.05 level.

No significant differences between groups were found for the variables of shame,

disgust, guilt, and happiness (see Appendix M for histograms of the residuals). However, a

significant difference was found on anger (F(1, 119)=6.39, p=.013) and contamination (F(1,

119)=4.34, p=.04). This suggests there might have been differential dropout for these

27

variables. Additionally, Levene’s test of equality of variances was violated for these two

variables, suggesting unequal variances.

Correlational analyses showed high positive correlations at T1 between shame and

disgust (r=.868, p<.001), shame and guilt (r=.891, p<.001), and disgust and guilt (r=.845,

p<.001). These high correlations suggest there may be some commonality in what these

variables are measuring. Previous research has highlighted high correlations between these

variables, yet frequently used in them in the literature and conceptualisation of mental

contamination (Radomsky & Elliott, 2009). They therefore will be included and examined as

separate DV in this analysis.

The change from baseline scores (T2-T1) were calculated as the dependent variable in

the analysis for each variable and compared between groups (see Table 3). Levene’s test

showed there was some heterogeneity of variance for the variables of anger (p<.001) and

guilt (p=.029) (see Appendix N for histograms of the residuals). Despite this, the decision

was made not to transform the data and to use parametric tests to analyse the data. This was

based upon the robustness of ANOVA for large samples (Field, 2009, pp155-156) where

group sizes are equal (Field, 2009, pp.359-360).

Main Analysis

The hypotheses that were being tested in the main analysis of the study were as

follows: 1) scores indicating a higher sense of personal responsibility will be correlated with

higher sensitivity to mental contamination (defined as an increase in mental contamination

indices) following recall of a moral transgression; 2) in line with previous research,

sensitivity to mental contamination will be higher in participants who recall being the victim

of a moral transgression than participants who recall being a perpetrator of a moral

transgression; and 3) the effect of responsibility on sensitivity to mental contamination will

28

be higher for those who recall being a perpetrator than those who recall being a victim of a

moral transgression.

Exploring the relationship between responsibility and mental contamination.

Correlational analyses (see Table 3) of responsibility and change from baseline scores in

variables that comprise mental contamination, showed mainly negative correlations.

However, these correlations were only significant for disgust and contamination, with

contamination showing the largest effect size and significance level (r=-.31; p<.001).

Significant positive correlation was found for happiness, therefore showing the less

responsible a person feels, the happier they report themselves to be. Happiness is a positive

emotion, whereas the other variables are negatively valenced emotions, therefore it might be

expected that happiness would be rated in the opposite direction to the negative emotions.

Table 3: Summary data and correlations between mental contamination variables using change from baseline

MCa Variables Mean change from baseline

SD Correlation between Responsibility and change from

baseline (r)

p values

Contamination 8.93 21.19 -.31 .00**

Shame 21.60 31.33 -.04 .63

Disgust 24.84 31.87 -.20 .03*

Guilt 20.17 34.23 -.03 .73

Anger 13.69 28.28 -.15 .104

Happiness -12.93 22.04 .24 .01*

MCa= Mental Contamination; *significant as p<.05 level; **significant at p<.001 level; SD=Standard Deviation

Disgust and happiness showed small to medium effect sizes and contamination

showed a medium effect size. Nonparametric correlations were also conducted using

Spearman’s Rank Correlation Coefficient (Appendix O), due to heterogeneity of variances

previously found. The results of the nonparametric test found significant correlations for

29

contamination. These findings provide support for hypothesis 1, as more responsibility was

related to more sensitivity to mental contamination, measured through feelings of

contamination.

Comparison of victim versus perpetrator groups. First a between groups one-way

analysis of variance (ANOVA) was conducted on each of the variables measuring mental

contamination once spilt into the 2 conditions of victim and perpetrator, to investigate the

hypothesis that sensitivity to mental contamination will be higher in the victim condition than

in the perpetrator condition (see Figure 1 for Means).

Figure 1. Means for each

dependent variable by each condition based upon the change from baseline data

The ANOVA showed significant group differences on shame (F(1,119)=17.54, p<.001,

d=.77), guilt (F(1,119)=20.052, p<.001, d=.81), and anger (F(1,119)=7.51, p=.007, d=.50).

Significantly higher levels of anger were reported in the victim group. Conversely, more

shame and guilt were experienced by perpetrators after remembering a time when they had

instigated an immoral behaviour.

Shame

Disgust

Guilt

Anger

Happiness

Contmaination

-20 -10 0 10 20 30 40

33.31

23.24

33.66

6.53

-9.74

7.22

10.81

26.33

7.75

20.27

-15.87

10.49

Change from baseline Means by Condition

Victim Condition Perpetrator Condition

30

To explore group differences in the behavioural measure, Crosstabulations were

calculated and a Fisher’s Exact test was conducted (see Table 4).

Table 4: Crosstabulation of behavioural measure of mental contamination

Neutralising Behaviour

Condition Count Did Not Complete Completed

Victim N 51 12

% within Experimental Condition 81% 19%

Perpetrator N 55 3

% within Experimental Condition 94.8% 5.2%

Total N 106 15

% of Total sample 87.6% 12.4%

N=number of participants

Table 4 shows that 19% of those in the victim condition intended to complete the

neutralising behaviour compared with 5.2% of perpetrators (p=.023). Therefore, despite the

overall completion of this measure being a small proportion of the total sample (12.4%), the

majority of those that did complete it were in the victim condition. This suggests that

participants who recalled a memory of being a victim of a moral transgression experienced

more sensitivity to mental contamination than those who recalled a memory of being a

perpetrator and may have wanted to neutralise this in some way. This adds support for

hypothesis 2.

The role of responsibility in mental contamination. To continue to explore both

hypotheses 1 and 2, a between groups analysis of covariance (ANCOVA) was conducted on

all of the mental contamination variables. Responsibility scores were included in the model as

a covariate (see Appendix P for histograms of the residuals). Significant differences between

the conditions continued to be found for shame (F(1, 118)=17.59, p<.001, d=.77), guilt (F(1,

118)=19.87, p<.001, d=.63) and anger (F(1, 118)=7.74, p=.01, d=.-.50). No significant

31

effects of the condition were found for disgust, happiness or contamination after adjusting for

responsibility (see Table 5).

Table 5: Summary statistics for an analysis of covariance model comparing the two groups and including responsibility scores as a covariate

Marginal Means (standard error)

By Covariate (Responsibility)

By condition

MCa Variable

Victim Perpetrator B

(SE)

F p F p d

Contamb 10.57 (2.55)

7.14

(2.66)

-.27 (.08)

13.01 .00 .86 .355 .17

Shame 10.82 (3.71)

33.30

(3.87)

-.05 (.11)

.22 .64 17.59 >.001** .76

Disgust 26.31 (3.96)

23.25

(4.13)

-.26 (.12)

4.99 .03 .29 .594 .09

Guilt 7.76 (4.02)

33.64

(4.19)

-.04 (.12)

.11 .75 19.87 >.001** .81

Anger 20.32 (3.44)

6.48

(3.59)

-.18 (.10)

2.94 .09 7.74 .006* .51

Happiness -15.93 (2.69)

-9.68

(2.80)

.22 (.08)

7.39 . 01 2.59 .110 .29

MCa= mental contamination; **=significant at <.001 level; *=significant at p<.05 level; contamb=contamination

Similar to the results of the previous ANOVA, when responsibility was not included

in the model, perpetrators experienced a greater change from baseline in the amount of shame

and guilt they were experiencing. Similarly again for anger, victims showed a greater change

from baseline. Additionally, Table 5 shows that after adjusting for experimental condition,

the covariate, responsibility, was significantly related to the change from baseline score for

disgust (F(1, 118)=4.99, p=.03), happiness (F,(1, 118)=7. 39, p=.01) and contamination (F,(1,

118) =13.01, p<.001). The effect of responsibility on disgust and contamination,

demonstrates that more responsibility is significantly related to increased sensitivity to mental

32

contamination. For happiness the effect was in the opposite direction, whereby less

responsibility was related to less sensitivity to mental contamination.

The analysis so far has shown that significant results with a medium effect sizes have

been found for anger in the victim condition, adding support for both hypotheses 1 and 2.

However, perpetrators were found to have significant results for shame and guilt with

medium to large effect sizes. This means that the direction of hypothesis 2 cannot be fully

supported.

To explore hypothesis 3; the effect of responsibility on sensitivity to mental

contamination will be higher in the perpetrator than in the victim condition, a between groups

ANCOVA was conducted using a custom model to include the interaction between the

condition and responsibility (see Table 6) (see Appendix Q for histograms of the residuals).

Table 6: Summary data from ANCOVA showing significance of interaction between condition and responsibility scores for each MC variable.

Interaction between condition and responsibility scores

MCa Variables F Statistic p Value

Contamination .43 .51

Shame 1.31 .26

Disgust .92 .34

Guilt .14 .71

Anger .71 .40

Happiness .78 .38

MCa=Mental contamination

Table 6 shows that none of the interaction terms were statistically significant and

therefore supply no evidence that associations with responsibility were higher in the

perpetrator group. Hypothesis 3 therefore cannot be supported. The best model for comparing

the conditions was therefore the model shown previously (see Table 5) with responsibility as

a covariate but not as an interaction term.

33

Overall, the analysis of group differences has found mixed results. Whilst group

differences were found, they were not always in the direction stated in the hypotheses. The

hypothesis stated that victims would experience more sensitivity to mental contamination

than perpetrators. This was found to be the case for the behavioural measure and for anger.

However, a greater sensitivity to mental contamination was found for the perpetrator group

on shame and guilt. Therefore, the hypothesis is not able to be supported fully.

Discussion

Main Findings

This study explored the relationship between responsibility and sensitivity to mental

contamination when recalling an autobiographical memory of being a victim or a perpetrator

of a moral transgression. It was hypothesised that: 1) scores indicating a higher sense of

personal responsibility would be correlated with higher sensitivity to mental contamination

(defined as an increase in mental contamination indices) following recall of a moral

transgression; 2) in line with previous research, sensitivity to mental contamination would be

higher in participants who recalled being the victim of a moral transgression than participants

who recalled being a perpetrator of a moral transgression; and 3) the effect of responsibility

on sensitivity to mental contamination would be higher for those who recalled being a

perpetrator than those who recalled being a victim of a moral transgression.

Correlational analyses showed a relationship between feelings of responsibility and

disgust and contamination. Here, the more responsibility a person felt, the more disgust and

contamination they experienced. Additionally, happiness showed a significant relationship

with responsibility, but in the opposite direction, suggesting the less responsibility a person

feels, the less sensitive they are to mental contamination. Hypothesis 1 can therefore be

supported. However, further investigation would be beneficial due to the lack of significant

34

findings with the other variables which are also conceptualised as part of mental

contamination in order to be able to fully assess whether mental contamination was evoked in

participants. Fairbrother, et al. (2005) report that associated negative emotions are needed in

order to define mental contamination, however, other factors must also be present, e.g. the

urge to wash or feelings of dirtiness. No including these indices of mental contamination is

therefore a limitation of this study.

Exploration of hypothesis 2 found overall, analyses of differences between the victim

and perpetrator groups was mixed. Whilst group differences were found, these were not

always in the direction stated in the hypothesis. Significant results with medium-large effect

sizes were present for shame, guilt, and anger. Group differences were also found on the

behavioural measure. However, the hypothesis stated that victims would experience more

sensitivity to mental contamination than perpetrators. This was found to be the case on the

behavioural measure and for anger. However, for shame and guilt, a greater change from

baseline score was seen for the perpetrator condition. Therefore, the hypothesis is not able to

be supported or rejected at this stage.

Contamination, which was found to be related to responsibility overall, showed a

medium to large effect size for perpetrators and a small to medium effect size for victims.

These findings add support to hypothesis 1, as more sensitivity to mental contamination was

shown to be related to higher amounts of reported responsibility. However, it does not

provide support for the direction of hypothesis 2, as victims did not show more sensitivity to

mental contamination when correlated with responsibility than perpetrators. Furthermore, the

ANCOVA conducted investigating the interaction between experimental condition and

responsibility, to test hypothesis 3, found no significant differences. Therefore, no evidence

was supplied to support the hypothesis that associations with responsibility were higher in the

35

perpetrator group. Responsibility therefore is effective as a covariate, but not as an

interaction. Consequently, hypothesis 3 can be rejected.

Victim versus Perpetrator Response

Previous research suggested that whilst both groups were sensitive to experiencing

mental contamination, victims experienced more than perpetrators in response to immoral

behaviour (Rachman et al., 2012). Yet the findings from this study contradict this as they

showed that for shame and guilt, perpetrators showed a greater increase in their sensitivity to

mental contamination compared to victims. It is possible therefore that sensitivity to mental

contamination may be comprised of different affective processes for victims and perpetrators

of moral transgressions. However, further research would be needed to explore this.

These disparate findings also raise the question of whether the underlying processes

involved in sensitivity to mental contamination for victims and perpetrators may not be as

similar as previously thought. This may lie in the conceptualisation of shame and guilt.

Research by Leith and Baumeister (1998) propose that guilt is a cognitive process, whereas

shame is an affective process. They postulated that guilt helps to develop empathy, due to

focusing on understanding the other person’s point of view. Conversely, shame focuses on

one’s own distress and is unlikely to have beneficial consequences. Therefore, feelings of

guilt can improve relationships, whereas shame can harm them. As both shame and guilt were

found to be significant for perpetrators in this study, there appears to be an incongruence for

this group. There may have been a desire to repair the relationship, seen through their

cognitive experience of guilt, however, their affective response of shame may prevent this

from occurring. Given the focus on cognitive appraisals in mental contamination, along with

guilt being postulated as a cognitive process here, it’s possible that measuring these emotions

in the same way is misleading. It may therefore be beneficial to explore additional cognitive

36

factors in the measurement of mental contamination. This may also help to explain some of

the variability seen between victims and perpetrators.

The one emotion where victims did show significantly more mental contamination to

perpetrators was anger. This suggests that anger may be more of a key response in victims

than previously considered. The finding also suggests that victims and perpetrators

experience mental contamination differently, given that different emotions were evoked by

each group. It is interesting that such a split was shown between internal and external

emotions between groups. This may relate to Rachman’s (2006) description of mental

contamination as having a “human contaminant”. It is possible that victims feel more of a

need to externalise their feelings about the immoral behaviour and direct their anger, for

example, to this external source. This could be due to them holding less power for the events

occurrence and a desire to attribute blame to the perpetrator. However, more information

about how participants experienced their anger in the study would be needed to determine if

this were the case. Further research, possibly using qualitative methodology would help to

understand this more.

One possibility for the difference found between groups on their experience of anger

could lie in how it was rated. It is possible that on the T2 VAS, participants could have rated

not only how angry they felt towards the perpetrator for instigating the event, but also how

angry they were at themselves for the being the “victim”. Therefore, anger may have been

interpreted as both an INE, when directed towards the self, and an ENE when directed

towards the perpetrator. This may account for the increased amount of anger reported by this

group. Additionally, despite this research not finding any significant effect on disgust when

investigating group differences, it is possible to conceptualise it in the same framework as

anger. This is possible due to them both having an internal and external focus, when related

to an immoral trigger. This relates to the literature on sociomoral disgust, where research by

37

Simpson, et al. (2006) found that higher levels of anger were elicited when evoking

sociomoral disgust as opposed to core disgust. If disgust towards a perpetrator can be

categorized as an ENE and disgust towards the self is categorised as an INE then this

hypothesis might be plausible. However, more research to tease out the disgust response

would be needed as the findings from this study were not sensitive enough to capture this.

Understanding the Relationship between Shame, Guilt and Disgust

As outlined already in this paper, given the high correlations between shame, disgust

and guilt at baseline, measuring all of them may have been redundant. The analysis showed

that disgust failed to show any significant results when the data was analysed by group. This

may suggest it was essentially measuring the same thing and shame and/or guilt. However,

disgust did show an overall relationship with responsibility. Conversely, both shame and guilt

continued to show significant results with large effect sizes. This might not have been

expected if they were measuring the same thing.

Despite high correlations, shame and guilt are frequently measured and

conceptualised as part of the mental contamination (Radomsky & Elliott, 2009). They are

also conceptualised as different constructs due to their respective focus on the self (shame)

and on others (guilt) (Teroni & Deonna, 2008). However, this does raise the question of

possible methodological issues in regards to how these emotions are rated and understood

and if participants understand the conceptual differences. In this study, visual analogue scales

were used to ascertain participants’ feelings of disgust, shame and guilt. As similar wording

was used for each emotion, (e.g. “How disgusted do you feel right now”, “Extremely” to

“Not at all”; “How ashamed do you feel right now?”, “Extremely” to “Not at all; and

“How guilty do you feel right now?”, “Extremely” to “Not at all), it possible that

38

participants found it difficult to differentiate the conceptual differences between the emotions

and required more guidance.

This is possibly the case for shame and guilt in particular, which are often used

interchangeably (Tangney, 1990), due to the same action often giving rise to both emotions

e.g. immoral behaviour. However, given the wise use of VAS across a range of fields and it

being a relatively straightforward tool to administer and for participants to understand, it

seems like it would be beneficial to continue to use. It is therefore suggested that future

research employing VAS in the way this study has should include a definition of each

emotion rather than just stating the emotion. This would potentially give participants more of

a framework around identifying similar but different emotions.

Moreover, given how these emotions are all moral focused emotions (Tangney,

Stuewig & Mashek, 2007) and would all be likely to be elicited in the manipulation used to

induce mental contamination, it is not surprising that they are shown to be highly correlated

in this study. Shame is more often experienced when an individual has violated one of their

own values, whereas, guilt is felt more when a social norm has been violated (Deonna &

Teroni, 2012). As this study found that perpetrators experienced these emotions more so than

victims, it could be hypothesised that the process through which these emotions were elicited

was two-fold. Firstly, the immoral act they were recalling triggered feelings of guilt, due to

the recollection of breaking social norms. Secondly, writing down and reflecting upon the act

may have elicited feelings of shame if they appraised the behaviour as violating their core

beliefs.

Furthermore, this reflection may have also highlighted for them their power and

responsibility in the act they committed, which relates to Salkovskis’ et al.’s (1995) definition

of responsibility as “the belief that one has power that is pivotal to bring about or prevent

subjectively crucial negative outcomes. These outcomes may be actual, that is having

39

consequences in the real world, and/or at a moral level” (p. 285). Reflecting on this power

over the outcome of the event may have further increased their feelings of shame and guilt.

This hypothesis could therefore account for differences shown within the perpetrator group,

as well as in comparison to the victim group. Further exploration of this would therefore be

warranted.

Methodological Issues and Future Research

A surprising finding from the study was that at baseline (T1), there were significant

differences between groups on the variables of anger and contamination, suggesting

differential dropout. Participants were randomly allocated into the two conditions, therefore

this is an unusual finding. It is hypothesised that participants who felt higher levels of anger

at baseline and were then randomised into the perpetrator condition chose to withdraw from

the study. However, due to ethical considerations, the incomplete data could not be analysed

to understand this more as incomplete data was regarded to be a withdrawal of data from the

study. Replication of this study, with stipulation around allowing analysis of incomplete data

may therefore be helpful to understand this finding.

There was only a small number of people who completed the behavioural measure,

however, most of these were in the victim condition. This is interesting as the analysis found

both victims and perpetrators reported increased sensitivity to mental contamination,

therefore it could be hypothesised that victims felt they needed to complete an additional act

in order to feel in control again. An additional factor to consider is that the emotion victims

did experience significantly more than perpetrators was anger. Given the possibility that this

may have been directed externally towards the perpetrator, it may be that the experience of

this emotion felt uncomfortable for some and therefore the need to neutralise was greater.

40

How this measure was operationalised is important to consider. It was only a single

item behavioural measure of participants’ sensitivity to mental contamination. It drew upon

the idea that an individual might be more inclined to engage in altruistic behaviour as a

means of reducing or neutralising any mental contamination experienced. This was based on 

Zhong and Liljenquist (2006)’s research which found exposure to unethical acts promoted

neutralising behaviour. However, it is possible that after completing this study, participants

may not have wanted to subject themselves to any further psychological discomfit and

therefore may have chosen not to volunteer for participation in future research. Therefore,

how this measure was used in the study may have had limited plausibility. Zhong and

Liljenquist’s (2006) study was not online, therefore the researchers were able to provide

participants with a range of objects through which they might neutralise. This was more

difficult to operationalise using an online paradigm. One way might be to ask participants to

complete a questionnaire at the end of the study to assess whether they engaged in any

neutralisation, however, it would be expected that there would be a lot of variance between

participants as the researcher would be unable to control participants access to certain

neutralising objects. Therefore, further exploration is needed in order to operationalise this

most effectively.

Another important consideration around methodological issues involves thinking more

about how much control there was in the manipulation used to induce mental contamination.

As participants were asked to recall an autobiographical memory of a moral transgression, the

researcher had much less control in the study and it is relatively unknown how much the

participants chose to engage in the manipulation. The additional factor of this being an online

paradigm adds to the difficulty in assessing this. The manipulation checks aimed to try and

address this in part and found significant group differences, yet were smaller than found in

previous studies (Radomsky & Elliott, 2009; Rachman, et al. 2012).

41

Furthermore, it is possible that the requirement of writing down the memory made some

participants stop themselves from choosing their most valid and salient memory for fear that

writing this down may trigger difficult feelings about the event. This therefore, could be

related to the literature on Thought Action Fusion (TAF) beliefs (Salkovskis, 1985). In TAF,

a construct related to all anxiety disorders (Abramowitz, Whiteside, Lynam, & Kalsy, 2003),

people believe that “intrusive thoughts have moral and actual consequences” (Bailey, Wu,

Valentiner & McGrath, 2014, p.40). Therefore, whilst this study asked people to recall actual

events, rather than imagined, as is often the case with intrusive thoughts, it still may have

elicited feelings that the event could occur again if they recalled it in detail. This however, is

just one hypothesis that would need to be explored further to explore the impact of mental

contamination more widely in both general and clinical populations.

Despite these concerns, there were definite gains of using this method for inducing mental

contamination, due to the possibility of it being more effective at capturing differing

individual perceptions of what is immoral behaviour. As a result of this, it is possible that the

differences found in this study between victims and perpetrators could be account for by the

use of this paradigm for eliciting mental contamination due to the participants being in

control of what memory they chose to recall. It could be that the method used in previous

studies was not salient enough for all of the participants and therefore restricted the ability to

elicit certain emotions and find certain differences between groups.

This method therefore has the potential to be more valid and salient for each participant.

This has important clinical implications as it suggests that assessing imagery more in the

treatment of mental contamination and in anxiety disorders more widely may be beneficial in

understanding the nature of anxiety for each person which would enable a more person-

centred approach to treatment. It is therefore proposed that imagery be included as a key area

in assessment of people who may be presenting with contamination-related difficulties.

42

Additionally, the group differences found add to the literature and suggest that the

paradigm is relatively effective at inducing and sustaining memories for participants. As this

method is being used more widely in both research and clinical settings (Coughtrey, et al.,

2015; Rachman, et al., 2012), further research is warranted to continue to explore the

reliability of this method. One possible way of doing this may be in a comparison study using

different models of inducing mental contamination, for example the “dirty kiss” paradigm

(Fairbrother et al, 2005) and autobiographical memory to assess the effectiveness of the

different methods. Furthermore, using content analysis to explore the memories that

participants chose to recall and whether this was related to their sensitivity to mental

contamination would be an interesting line of research. For example, exploring at the

language used and the length of the memory that was record.

Conclusions

Overall, mixed results have been found in this study. Some of which add support to

the previous literature, some which contradict previous literature, and some which offer a

new insight into how sensitivity to mental contamination is understood in different

populations. General feelings of responsibility were not found to explain any of the

variability found between victims and perpetrators of moral transgressions as predicted.

However, it was found that whilst both victims and perpetrators experienced an increase in

their sensitivity to mental contamination after recalling a memory of immoral behaviour, the

specific way in which they experienced the mental contamination was different. It appears

that a difference was found in whether mental contamination was experienced internally

(perpetrators) or externally (victims) through participants’ emotional responses.

This suggests that whilst the recall of autobiographical memories of immoral

behaviour is a reliable way of evoking mental contamination, more research is needed to

43

understand how specific emotions are affected in different groups. It is possible that looking

at how individuals appraise an event (i.e. in regards to their responsibility for it) might be

more a pertinent way of understanding sensitivity to mental contamination than looking at

general feelings of responsibility. It is clear from this study however, that more research is

needed to further explore these group differences. Understanding more about the relationship

between victims and perpetrators and their experience of mental contamination could have

important clinical implications for targeting interventions of mental contamination

specifically, and OCD more generally.

44

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Appendix Contents Page

A. Responsibility Attitudes Scale (RAS)

B. Comparison table of VAS and individual emotion measures

C. Visual Analogue Scale (VAS)

D. Manipulation Check

E. Ethics approval letter

F. Advertising poster/online post

G. Information sheet

H. Consent form

I. Demographic form

J. Instruction for recalling memory

K. Debriefing page

L. Histograms for standardised residuals of variables using T1, T2 and change from baseline data

M. Standardised residuals for analysis of variance (ANOVA) using T1 data

N. Standardised residuals for analysis of covariance (ANCOVA) using change from baseline data

O. Non parametric correlation coefficients for change from baseline data and responsibility

P. Standardised residuals for analysis of covariance (ANCOVA) using change from baseline data

Q. Standardised residuals for analysis of covariance (ANCOVA) with interaction model using change from baseline data

R. Target journal: guide for authors

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Appendix A) Responsibility Attitudes Scale

Responsibility Attitudes Scale

This questionnaire lists different attitudes or beliefs which people sometimes hold. Read each statement carefully and decide how much you agree or disagree with it. For each of the attitudes, show your answer by putting a circle round the words which BEST DESCRIBE HOW YOU THINK. Be sure to choose only one answer for each attitude. Because people are different, there is no right answer or wrong answer to these statements. To decide whether a given attitude is typical of your way of looking at things, simply keep in mind what you are like MOST OF THE TIME.

1. I often feel responsible for things which go wrong.

TOTALLY AGREE AGREE NEUTRAL DISAGREE DISAGREE TOTALLYAGREE VERY MUCH SLIGHTLY SLIGHTLY VERY MUCH DISAGREE

2. If I don’t act when I can foresee danger, then I am to blame for any consequences if it happens.

TOTALLY AGREE AGREE NEUTRAL DISAGREE DISAGREE TOTALLYAGREE VERY MUCH SLIGHTLY SLIGHTLY VERY MUCH DISAGREE

3. I am too sensitive to feeling responsible for things going wrong.

TOTALLY AGREE AGREE NEUTRAL DISAGREE DISAGREE TOTALLYAGREE VERY MUCH SLIGHTLY SLIGHTLY VERY MUCH DISAGREE

4. If I think bad things, this is as bad as doing bad things.

TOTALLY AGREE AGREE NEUTRAL DISAGREE DISAGREE TOTALLYAGREE VERY MUCH SLIGHTLY SLIGHTLY VERY MUCH DISAGREE

5. I worry a great deal about the effects of things which I do or don’t do.

TOTALLY AGREE AGREE NEUTRAL DISAGREE DISAGREE TOTALLYAGREE VERY MUCH SLIGHTLY SLIGHTLY VERY MUCH DISAGREE

6. To me, not acting to prevent danger is as bad as making disaster happen.

TOTALLY AGREE AGREE NEUTRAL DISAGREE DISAGREE TOTALLYAGREE VERY MUCH SLIGHTLY SLIGHTLY VERY MUCH DISAGREE

7. If I know that harm is possible, I should always try to prevent it, however unlikely it seems.

TOTALLY AGREE AGREE NEUTRAL DISAGREE DISAGREE TOTALLYAGREE VERY MUCH SLIGHTLY SLIGHTLY VERY MUCH DISAGREE

8. I must always think through the consequences of even the smallest actions.

TOTALLY AGREE AGREE NEUTRAL DISAGREE DISAGREE TOTALLYAGREE VERY MUCH SLIGHTLY SLIGHTLY VERY MUCH DISAGREE

54

9. I often take responsibility for things which other people don’t think are my fault.

TOTALLY AGREE AGREE NEUTRAL DISAGREE DISAGREE TOTALLYAGREE VERY MUCH SLIGHTLY SLIGHTLY VERY MUCH DISAGREE

10. Everything I do can cause serious problems.TOTALLY AGREE AGREE NEUTRAL DISAGREE DISAGREE TOTALLYAGREE VERY MUCH SLIGHTLY SLIGHTLY VERY MUCH DISAGREE

11. I am often close to causing harm.

TOTALLY AGREE AGREE NEUTRAL DISAGREE DISAGREE TOTALLYAGREE VERY MUCH SLIGHTLY SLIGHTLY VERY MUCH DISAGREE

12. I must protect others from harm.

TOTALLY AGREE AGREE NEUTRAL DISAGREE DISAGREE TOTALLYAGREE VERY MUCH SLIGHTLY SLIGHTLY VERY MUCH DISAGREE

13. I should never cause even the slightest harm to others.

TOTALLY AGREE AGREE NEUTRAL DISAGREE DISAGREE TOTALLYAGREE VERY MUCH SLIGHTLY SLIGHTLY VERY MUCH DISAGREE

14. I will be condemned for my actions.

TOTALLY AGREE AGREE NEUTRAL DISAGREE DISAGREE TOTALLYAGREE VERY MUCH SLIGHTLY SLIGHTLY VERY MUCH DISAGREE

15. If I can have even a slight influence on things going wrong, then I must act to prevent it.

TOTALLY AGREE AGREE NEUTRAL DISAGREE DISAGREE TOTALLYAGREE VERY MUCH SLIGHTLY SLIGHTLY VERY MUCH DISAGREE

16. To me, not acting where disaster is a slight possibility is as bad as making that disaster happen.

TOTALLY AGREE AGREE NEUTRAL DISAGREE DISAGREE TOTALLYAGREE VERY MUCH SLIGHTLY SLIGHTLY VERY MUCH DISAGREE

17. For me, even slight carelessness is inexcusable when it might affect other people.

TOTALLY AGREE AGREE NEUTRAL DISAGREE DISAGREE TOTALLYAGREE VERY MUCH SLIGHTLY SLIGHTLY VERY MUCH DISAGREE

18. In all kinds of daily situations, my inactivity can cause as much harm as deliberate bad intentions.

TOTALLY AGREE AGREE NEUTRAL DISAGREE DISAGREE TOTALLYAGREE VERY MUCH SLIGHTLY SLIGHTLY VERY MUCH DISAGREE

55

19. Even if harm is a very unlikely possibility, I should always try to prevent it at any cost.

TOTALLY AGREE AGREE NEUTRAL DISAGREE DISAGREE TOTALLYAGREE VERY MUCH SLIGHTLY SLIGHTLY VERY MUCH DISAGREE

20. Once I think it is possible that I have caused harm, I can’t forgive myself.

TOTALLY AGREE AGREE NEUTRAL DISAGREE DISAGREE TOTALLYAGREE VERY MUCH SLIGHTLY SLIGHTLY VERY MUCH DISAGREE

21. Many of my past actions have been intended to prevent harm to others.

TOTALLY AGREE AGREE NEUTRAL DISAGREE DISAGREE TOTALLYAGREE VERY MUCH SLIGHTLY SLIGHTLY VERY MUCH DISAGREE

22. I have to make sure other people are protected from all of the consequences of things I do.TOTALLY AGREE AGREE NEUTRAL DISAGREE DISAGREE TOTALLYAGREE VERY MUCH SLIGHTLY SLIGHTLY VERY MUCH DISAGREE

23. Other people should not rely on my judgement.

TOTALLY AGREE AGREE NEUTRAL DISAGREE DISAGREE TOTALLYAGREE VERY MUCH SLIGHTLY SLIGHTLY VERY MUCH DISAGREE

24. If I cannot be certain I am blameless, I feel that I am to blame.

TOTALLY AGREE AGREE NEUTRAL DISAGREE DISAGREE TOTALLYAGREE VERY MUCH SLIGHTLY SLIGHTLY VERY MUCH DISAGREE

25. If I take sufficient care then I can prevent harmful accidents.

TOTALLY AGREE AGREE NEUTRAL DISAGREE DISAGREE TOTALLYAGREE VERY MUCH SLIGHTLY SLIGHTLY VERY MUCH DISAGREE

26. I often think that bad things will happen if I am not careful enough.

TOTALLY AGREE AGREE NEUTRAL DISAGREE DISAGREE TOTALLYAGREE VERY MUCH SLIGHTLY SLIGHTLY VERY MUCH DISAGREE

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Appendix B) Comparison Table

Comparison of the use of Visual Analogue Scales (VAS) to assess emotions compared to standardised measures for each emotion e.g. Test of Self-Conscious Affect (TOSCA) (Tangney et al. 1989) to assess shame and guilt, or The Disgust Scale (DS; Haidt et al., 1994).

Table Appendix B: Comparison of VAS and other measures

VAS Other Emotion Measures Participants able to provide a

subjective rating of their felt emotion

Quick and easy tool to use

Can be used to compare participant’s response at different time points (e.g. before and after the manipulation) to assess change in emotion.

Participants might need more guidance around how an emotion is conceptualised, e.g. how to assess the difference between guilt and shame

Using standardised measures can provide a more objective view of a specific emotion

The rating/ score would be more valid and reliable as it would be based upon more than one question

It would take longer for participants to complete the measure. If a different measure was provided for each emotion this would be a large amount of questionnaires for participants to complete which may lead to attrition

As negative emotions are associated with mental contamination, it seemed unnecessary to focus so much on each specific emotion measured in the study by completing separate measures. Furthermore, emotions were experienced would be expected to vary between individuals.

57

Appendix C) Visual analogue scales

Visual Analogue Scales (pre and post experimental task)

Please click on the line for each of the questions below to indicate how you feel in response to the question right now.

1) How ashamed do you feel right now?

Extremely Not at all

2) How disgusted do you feel right now?

Extremely Not at all

3) How guilty do you feel right now:

Extremely Not at all

4) How angry do you feel right now?

Extremely Not at all

5) How happy do you feel right now?

Extremely Not at all

6) How much do you feel contaminated right now?

Extremely Not at all

58

Appendix D) Manipulation Check

59

Appendix E) Ethics committee conformation

60

Appendix F) Recruitment poster

61

Appendix G) Information Sheet for participants

How does recalling an unpleasant memory impact upon our emotions?

Participant Information Sheet

I would like to invite you to take part in my study, which is looking at the impact of recalling unpleasant memories on our emotions. Please take the time to read the following information before deciding whether you would like to take part in this study.

Who is conducting the research?

This research is being conducted by Katie Piggott, a Trainee Clinical Psychologist at the University of Surrey and forms part of my doctoral training. The research is supervised by Dr Jason Spendelow, a Chartered Clinical Psychologist and Senior Teaching Fellow at the University of Surrey. The research has received a favourable opinion from the Faculty of Arts and Human Sciences Ethics Committee at the University of Surrey.

Am I eligible to take part?

Anyone aged over 18 years of age is eligible to take part in this research

Do I have to take part?

Participation in this research is entirely voluntary. You are under no obligations to take part and have a right to withdraw from the study at any point up until competition of the online survey; if you choose to withdraw your data will be deleted. After completion of the study, as all of the data is anonymised, your responses will not be able to be removed, but you will not be able to be identified from your data. To withdraw from the research during the survey simply close the browser by clicking on the X in the top right hand corner of the window.

What will I have to do?

You will be asked to complete an online survey. During the survey you will be asked to complete some questionnaires. You will then be asked to think of a memory, which may be unpleasant, that relates to an immoral act, for example, lying to someone or stealing something. You will be given more guidance as to the type of memory to think about, but the memory you choose will be your choice. You will be asked to think about this memory for one minute, after which you will be asked to complete some further questions.

The survey will take approximately 30 minutes to complete.

What will happen to my data?

Your responses will remain confidential, and anonymous upon completion of the survey. There will be no way to identify you or your responses. The data will be handled by the researcher and shared with the supervisor. In line with the Data Protection Act 1998, all data will be securely stored and will be destroyed after 5 years.

The study will be completed and submitted to the University in March 2016. It is usual practice for researchers to publish their findings in professional journals so that research can be shared within the profession. Again, your anonymity will be upheld throughout this process.

What are the benefits and downsides of taking part in this research?

62

Whilst there may be no direct benefits to you taking part in this research you will be contributing to the development of the field of clinical psychology and how we understand the impact of memories on emotions. This will be beneficial in developing our understanding of the treatment of some mental health disorders, which has wide-reaching benefits for society.

Due to potentially some memories being unpleasant, there is the possibility that you might be left with some feelings of distress. If you find some of the questions too upsetting or personal then you do not have to answer them and can leave the survey at any point. As we are aware of the possibility that some people may be caused upset upon completion of the survey, you will receive a full debriefing at the end of the survey and will be signposted to appropriate sources of support if you feel that you need to discuss things further.

Thank you for taking the time to read this information sheet.

If you would like to continue to take part in the research then select the “next” button at the bottom of the page. If you have decided not to take part, then please close the browser

Who can I contact about this research?

Researcher:

Katie Piggott

Trainee Clinical Psychologist

PsychD Clinical Psychology Programme

School of Psychology

Elizabeth Fry Building

University of Surrey

Guildford

GU2 7XH

Email: k.piggott@surrey.ac.uk

Supervisor:

Dr Jason Spendelow

Senior Teaching Fellow & Chartered Clinical Psychologist

PsychD Clinical Psychology Programme

School of Psychology

Elizabeth Fry Building

University of Surrey

Guildford

GU2 7XH

Email: j.spendelow@surrey.ac.uk

63

Appendix H) Consent form for participants

Consent form

I voluntarily agree to take part in the study. I have read and understood the Information Screen and I have been given am explanation of

the nature, purpose, and likely duration of the study, and of what I will be expected to do. I have been advised that participation in this research may cause me some distress and I have

been advised of that sources of support will be provided that I can contact if that occurs. I have been given the researcher’s details and have had the opportunity to contact them and to

ask questions on all aspects of the study. I understand that if I do not wish to proceed I can close the browser window at any time. I agree to comply with any instruction given to me during the study and to co-operate fully

with the researcher. I am happy for the reseracher to write about and publish my responses given in the survey on

the understanding that my data will remain anaoymous. I understand that all personal data relating to participants is held and processed in the strictest

confidence, and in accordance with the Data Protection Act 1998. I understand that I am free to withdraw from the study up until the point of completing the

surevy, without needing to justify my decision and without prejudice.

I confirm that I have read and understood the above and freely consent to participating in this study. I have been given adequate time to consider my participation and agree to comply with the instructions and restrictions of the study.

By clicking the below arrow you consent to taking part in this study. If you do not wish to take part, close your web browser now.

https://surreyfahs.eu.qualtrics.com/SE/?SID=SV_0V4FtpFGsXFeCkl

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Appendix I) Demographic Information Sheet

To begin, I’d like to get some basic information about you (such as your age, education and occupation). The reason that I’d like this information is so that I can ensure that I have obtained the views of a cross-section of people in society. The information that you give will never be used to identify you in any way because this research is entirely confidential.

1) Are you: (Select the appropriate answer) Male Female

2) How old are you? years

3) How would you describe your ethnic origins? (Choose one section from (a) to (e) and then select the appropriate category to indicate your ethnic background).

(a) WhiteEnglish/Welsh/Scottish/Northern Irish/British __Irish __Gypsy or Irish Traveller __

Any other White background, please write in below

_________________________________________

(b) Mixed/multiple ethnic groupsWhite and Black Caribbean __White and Black African __White and Asian __

Any other mixed background, please write in below

__________________________________________

(c) Asian or Asian BritishIndian __Pakistani __Bangladeshi __Chinese __

Any other Asian background, please write in below_________________________________________

(d) Black/African/Caribbean/Black BritishAfrican __Caribbean __

Any other Black/African/Caribbean background, please write in below

_________________________________________

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(e) Other ethnic groupArab __

Any other ethnic group, please write in below

_________________________________________

1) What is your highest educational qualification? (select the appropriate answer)

None __GCSE(s)/O-level(s)/CSE(s) __A-level(s)/AS-level(s) __Diploma (HND, SRN, etc.) __Undergraduate Degree __Postgraduate degree/diploma __

2) What is your current occupation (or, if you are no longer working, what was your last occupation?)

__________________________________________

3) What is your current legal marital status? (select the appropriate answer)

Single __Married __Civil partnership __Divorced/separated __Widowed __

4) How many children do you have? [ ]

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Appendix J) Instructions regarding the recall unpleasant memories

In a moment you will be asked to recall an unpleasant memory related to an immoral act. The following examples are given to help guide you as to the type of memory that you might recall.

Betraying a friend or hurting someone’s feelings Revealing a secret Lying to a friend or at work Cheating on a partner Committing minor transgressions Committing a more serious crime

These are given as a guideline only and you can recall a memory outside of these examples if it is an immoral act.

(*the participant will then receive one of the following descriptions based on which condition that they have been randomised into)

Condition A:

In the box below, please write down a memory that relates to a time when you have acted in an immoral way towards another person. Please use the examples listed above for a guide on the type of memories to recall. It may help to take a minute to think about this memory before writing it down.

(* a text box will be inserted here so that the participant can write down their memory)

Now that you have written down the memory, please think about and visualise it for one minute.

Condition B:

In the box below, please write down a memory that relates to a time when someone has acted in an immoral way towards you. Please use the examples listed above for a guide on the type of memories to recall. It may help to take a minute to think about this memory before writing it down

(* a text box will be inserted here so that the participant can write down their memory)

Now that you have written down the memory, please think about and visualise it for one minute.

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Appendix K) Debriefing page for particiants

Thank you for participating in this research. The survey is nearly complete. Below is some further infomration about the nature of the study.

Post-survey Infomration Sheet

You were told on the information sheet that this research was investigating the impact of recalling unpleasant memories on our emotions. Whilst this is true, the research was also assessing other factors which we were ubnable to inform you of at the start of the study due to the potential that you knowing beforehand may bias the results. This included looking at whether people who feel more responsible report more unpleasant emotions, especially in relation to shame, guilt and disgust.

Previous research has found that recalling such unpleasant memories can lead people to experiencing “mental contamination”, where you might feel increased amounts of the emotions listed above. Mental contamination is related to Obsessive Comulsive Disorder (OCD) and it is where people feel a sense of contamination in the absence of physical contact. It can be measured in a number of different ways, with emotions being one of these, which this researched focussed on.

Also, you were randomlly allocated into one of two conditions when asked to recall your memory. These were: people who had done an immoral act, and people who had been the recipient of an immoral act. Previous research has demonstrated that people who commit an immoral act experinece that same emotions as someone who is the recipient of an immoral act, but to a lesser extent. Including this in this research was intended to try and see if these findings can be replicated, which will help to further our understanding of the impact of moral transgressions on our emotions from both perspectives, helping to inform how we work clinically with people affected by these issues.

If any issues have arisen for you throughout the completion of this survey or you have been left feeling upset or distressed and would like to talk to someone then please contact one of the following support charities:

Mental Health Charities:SANE: http://www.sane.org.uk/ or helpline: 0845 767 8000MIND: http://www.mind.org.uk/OCD UK: http://www.ocduk.org/ - online support and discussion forumsOCD Action: http://www.ocdaction.org.uk/ or helpline: 0845 390 6232

Alternatively, you can also contact your GP to discuss any concerns or questions that you may have about mental health.

If you have any further questions about the research then please do not hesitate to contact Katie on k.piggott@surrey.ac.uk.

If you know any other people who you think would also like to take part in this study then I would be grateful of you could forward the hyperlink for this survey on to them.

Finally, if you would like to participate in any future research, please leave your email address in the box on the next page. If you do not wish to participate in any future research then you can close the survey.

Thank you again for you participation.

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Appendix L) Histograms for standardised residuals of variables at baseline

Responsibility variable

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Dependent variables at Time 1 level

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Dependent variables at Time 2 level

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Dependent variables using change from baseline

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Appendix M) Standardised residuals for analysis of variance (ANOVA) using T1 data

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Appendix N) Standardised residuals for analysis of variance (ANOVA) using change from

baseline data

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Appendix O) Non parametric correlation coefficients

Table Appendix O: Spearman’s Rho correlations between mental contamination variables using change from baseline Table for

Responsibility P value

Contamination -.25 .01*

Shame -.04 .70

Disgust -.16 . 07

Guilt -.07 . 42

Anger -.18 .05*

Happiness .17 .07

*p<.05

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Appendix P) Standardised residuals for analysis of covariance (ANCOVA) using change

from baseline data

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Appendix Q) Standardised residuals for analysis of covariance (ANCOVA) with interaction model using change from baseline data

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Appendix R) Target journal: guide for authors

BEHAVIOUR RESEARCH AND THERAPY

AUTHOR INFORMATION PACK

DESCRIPTION

Behaviour Research and Therapy encompasses all of what is commonly referred to as cognitive behaviour therapy (CBT). The focus is on the following: theoretical and experimental analyses of psychopathological processes with direct implications for prevention and treatment; the development and evaluation of empirically-supported interventions; predictors, moderators and mechanisms of behaviour change; and dissemination and implementation of evidence-based treatments to general clinical practice. In addition to traditional clinical disorders, the scope of the journal also includes behavioural medicine. The journal will not consider manuscripts dealing primarily with measurement, psychometric analyses, and personality assessment.

The Editor and Associate Editors will make an initial determination of whether or not submissions fall within the scope of the journal and/or are of sufficient merit and importance to warrant full review.

Benefits to authors

We also provide many author benefits, such as free PDFs, a liberal copyright policy, special discounts on Elsevier publications and much more. Please click here for more information on our author services.

Please see our Guide for Authors for information on article submission. If you require any further information or help, please visit our support pages: http://support.elsevier.com

AUDIENCE

For clinical psychologists, psychiatrists, psychotherapists, psychoanalysts, social workers, counsellors, medical psychologists, and other mental health workers.

IMPACT FACTOR

2012: 3.471 © Thomson Reuters Journal Citation Reports 2013

GUIDE FOR AUTHORS

INTRODUCTION

Behaviour Research and Therapy encompasses all of what is commonly referred to as cognitive behaviour therapy (CBT). The focus is on the following: theoretical and experimental analyses of psychopathological processes with direct implications for prevention and treatment; the development and evaluation of empirically-supported interventions; predictors, moderators and mechanisms of behaviour change; and dissemination and implementation of evidence-based treatments to general clinical practice. In addition to traditional clinical disorders, the scope of the journal also includes behavioural medicine. The journal will not consider manuscripts dealing primarily with measurement, psychometric analyses, and personality assessment.

The Editor and Associate Editors will make an initial determination of whether or not submissions fall within the scope of the journal and/or are of sufficient merit and importance to warrant full review.

Contact details

Any questions regarding your submission should be addressed to the Editor in Chief: Professor G. T. Wilson

Psychological Clinic at Gordon Road

Rutgers

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The State University of New Jersey

41C Gordon Road

Piscataway

New Jersey

08854-8067

USA

Email: brat@rci.rutgers.edu

BEFORE YOU BEGIN

Ethics in publishing

For information on Ethics in publishing and Ethical guidelines for journal publication see http://www.elsevier.com/publishingethics and http://www.elsevier.com/journal-authors/ethics.

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All authors are requested to disclose any actual or potential conflict of interest including any financial, personal or other relationships with other people or organizations within three years of beginning the submitted work that could inappropriately influence, or be perceived to influence, their work. See also http://www.elsevier.com/conflictsofinterest. Further information and an example of a Conflict of Interest form can be found at: http://help.elsevier.com/app/answers/detail/a_id/286/p/7923.

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Before the accepted manuscript is published in an online issue: Requests to add or remove an author, or to rearrange the author names, must be sent to the Journal Manager from the corresponding author of the accepted manuscript and must include: (a) the reason the name should be added or removed, or the author names rearranged and (b) written confirmation (e-mail, fax, letter) from all authors that they agree with the addition, removal or rearrangement. In the case of addition or removal of authors, this includes confirmation from the author being added or removed. Requests that are not sent by

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After the accepted manuscript is published in an online issue: Any requests to add, delete, or rearrange author names in an article published in an online issue will follow the same policies as noted above and result in a corrigendum.

Article transfer service

This journal is part of our Article Transfer Service. This means that if the Editor feels your article is more suitable in one of our other participating journals, then you may be asked to consider transferring the article to

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one of those. If you agree, your article will be transferred automatically on your behalf with no need to reformat. More information about this can be found here: http://www.elsevier.com/authors/article-transfer-service.

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Subscription articles please see http://www.elsevier.com/journal-authors/author-rights-and-responsibilities.

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This journal offers authors a choice in publishing their research:

Open Access

• Articles are freely available to both subscribers and the wider public with permitted reuse

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Subscription

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• Articles are made available to subscribers as well as developing countries and patient groups through our access programs (http://www.elsevier.com/access)

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All articles published Open Access will be immediately and permanently free for everyone to read and download. Permitted reuse is defined by your choice of one of the following Creative Commons user licenses:

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Submit your article

Please submit your article via http://ees.elsevier.com/brat/

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Article structure

Subdivision - unnumbered sections

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Divide your article into clearly defined sections. Each subsection is given a brief heading. Each heading should appear on its own separate line. Subsections should be used as much as possible when cross- referencing text: refer to the subsection by heading as opposed to simply 'the text'.

Appendices

If there is more than one appendix, they should be identified as A, B, etc. Formulae and equations in appendices should be given separate numbering: Eq. (A.1), Eq. (A.2), etc.; in a subsequent appendix, Eq. (B.1) and so on. Similarly for tables and figures: Table A.1; Fig. A.1, etc.

Essential title page information

• Title. Concise and informative. Titles are often used in information-retrieval systems. Avoid abbreviations and formulae where possible.

• Author names and affiliations. Where the family name may be ambiguous (e.g., a double name), please indicate this clearly. Present the authors' affiliation addresses (where the actual work was done) below the names. Indicate all affiliations with a lower-case superscript letter immediately after the author's name and in front of the appropriate address. Provide the full postal address of each affiliation, including the country name and, if available, the e-mail address of each author.

• Corresponding author. Clearly indicate who will handle correspondence at all stages of refereeing and publication, also post-publication. Ensure that phone numbers (with country and area code) are provided in addition to the e-mail address and the complete postal address. Contact details must be kept up to date by the corresponding author.

• Present/permanent address. If an author has moved since the work described in the article was done, or was visiting at the time, a 'Present address' (or 'Permanent address') may be indicated as a footnote to that author's name. The address at which the author actually did the work must be retained as the main, affiliation address. Superscript Arabic numerals are used for such footnotes.

Abstract

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Graphical abstract

A Graphical abstract is optional and should summarize the contents of the article in a concise, pictorial form designed to capture the attention of a wide readership online. Authors must provide images that clearly represent the work described in the article. Graphical abstracts should be submitted as a separate file in the online submission system. Image size: Please provide an image with a minimum of 531 × 1328 pixels (h × w) or proportionally more. The image should be readable at a size of 5 × 13 cm using a regular screen resolution of 96 dpi. Preferred file types: TIFF, EPS, PDF or MS Office files. See http://www.elsevier.com/graphicalabstracts for examples.

Authors can make use of Elsevier's Illustration and Enhancement service to ensure the best presentation of their images also in accordance with all technical requirements: Illustration Service.

Highlights

Highlights are mandatory for this journal. They consist of a short collection of bullet points that convey the core findings of the article and should be submitted in a separate file in the online submission system. Please use 'Highlights' in the file name and include 3 to 5 bullet points (maximum 85 characters, including spaces, per bullet point). See http://www.elsevier.com/highlights for examples.

Keywords

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Immediately after the abstract, provide a maximum of 6 keywords, to be chosen from the APA list of index descriptors. These keywords will be used for indexing purposes.

Abbreviations

Define abbreviations that are not standard in this field in a footnote to be placed on the first page of the article. Such abbreviations that are unavoidable in the abstract must be defined at their first mention there, as well as in the footnote. Ensure consistency of abbreviations throughout the article.

Acknowledgements

Collate acknowledgements in a separate section at the end of the article before the references and do not, therefore, include them on the title page, as a footnote to the title or otherwise. List here those individuals who provided help during the research (e.g., providing language help, writing assistance or proof reading the article, etc.).

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Artwork Electronic artwork General points

• Make sure you use uniform lettering and sizing of your original artwork.

• Embed the used fonts if the application provides that option.

• Aim to use the following fonts in your illustrations: Arial, Courier, Times New Roman, Symbol, or use fonts that look similar.

• Number the illustrations according to their sequence in the text.

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A detailed guide on electronic artwork is available on our website:

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You are urged to visit this site; some excerpts from the detailed information are given here.

Formats

If your electronic artwork is created in a Microsoft Office application (Word, PowerPoint, Excel) then please supply 'as is' in the native document format.

Regardless of the application used other than Microsoft Office, when your electronic artwork is finalized, please 'Save as' or convert the images to one of the following formats (note the resolution requirements for line drawings, halftones, and line/halftone combinations given below):

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Please do not:

• Supply files that are optimized for screen use (e.g., GIF, BMP, PICT, WPG); these typically have a low number of pixels and limited set of colors;

• Supply files that are too low in resolution;

• Submit graphics that are disproportionately large for the content.

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Number tables consecutively in accordance with their appearance in the text. Place footnotes to tables below the table body and indicate them with superscript lowercase letters. Avoid vertical rules. Be sparing in the use of tables and ensure that the data presented in tables do not duplicate results described elsewhere in the article.

References

Citation in text

Please ensure that every reference cited in the text is also present in the reference list (and vice versa). Any references cited in the abstract must be given in full. Unpublished results and personal communications are not recommended in the reference list, but may be mentioned in the text. If these references are included in the reference list they should follow the standard reference style of the journal and should include a substitution of the publication date with either 'Unpublished results' or 'Personal communication'. Citation of a reference as 'in press' implies that the item has been accepted for publication.

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This journal has standard templates available in key reference management packages EndNote (http://www.endnote.com/support/enstyles.asp) and Reference Manager (http://refman.com/support/rmstyles.asp). Using plug-ins to wordprocessing packages, authors only need to select the appropriate journal template when preparing their article and the list of references and citations to these will be formatted according to the journal style which is described below.

Reference style

Text: Citations in the text should follow the referencing style used by the American Psychological Association. You are referred to the Publication Manual of the American Psychological Association, Sixth Edition, ISBN 978-1-4338-0561-5, copies of which may be ordered from http://books.apa.org/books.cfm?id=4200067 or APA Order Dept., P.O.B. 2710, Hyattsville, MD

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List: references should be arranged first alphabetically and then further sorted chronologically if necessary. More than one reference from the same author(s) in the same year must be identified by the letters 'a', 'b', 'c', etc., placed after the year of publication.

Examples:

Reference to a journal publication:

Van der Geer, J., Hanraads, J. A. J., & Lupton, R. A. (2010). The art of writing a scientific article.

Journal of Scientific Communications, 163, 51–59. Reference to a book:

Strunk, W., Jr., & White, E. B. (2000). The elements of style. (4th ed.). New York: Longman, (Chapter 4).

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Reference to a chapter in an edited book:

Mettam, G. R., & Adams, L. B. (2009). How to prepare an electronic version of your article. In B. S. Jones, & R. Z. Smith (Eds.), Introduction to the electronic age (pp. 281–304). New York: E-Publishing Inc.

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Ensure that the following items are present:

One author has been designated as the corresponding author with contact details:

• E-mail address

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All necessary files have been uploaded, and contain:

• Keywords

• All figure captions

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• All tables (including title, description, footnotes) Further considerations

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Use of the Digital Object Identifier

The Digital Object Identifier (DOI) may be used to cite and link to electronic documents. The DOI consists of a unique alpha-numeric character string which is assigned to a document by the publisher upon the initial electronic publication. The assigned DOI never changes. Therefore, it is an ideal medium for citing a document, particularly 'Articles in press' because they have not yet received their full bibliographic information. Example of a correctly given DOI (in URL format; here an article in the journal Physics Letters B):

http://dx.doi.org/10.1016/j.physletb.2010.09.059

When you use a DOI to create links to documents on the web, the DOIs are guaranteed never to change.

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87

Major Research Project Proposal

Do appraisals of personal responsibility affect how much mental contamination

individuals experience in a comparison between ‘victims’ and ‘perpetrators’ of

moral transgressions.

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Introduction

Background and Theoretical Rationale

Mental contamination is defined by Rachman (1994) as “a sense of internal

uncleanness which can and usually does arise and persist regardless of the presence or

absence of external, observable dirt”. The construct was borne out of Obsessive Compulsive

Disorder (OCD), whereby the distinction was made between contact contamination and

mental contamination when it was observed that occasionally there was a continuing fear of

contamination despite the absence of a physical stimulus. Much of the research to date has

focused upon defining contact and mental contamination as distinct constructs. Now that

there is agreement within the literature that they are separate constructs (Herba & Rachman,

2007; Coughtrey, et al., 2012a; Radomsky, et al., 2013), the field is now able to begin

developing its understanding of mental contamination in other directions.

An area where this is occurring is in understanding how morality and more

specifically moral transgressions, can impact upon mental contamination. Moral

transgressions can be defined as the idea that “the individual being evaluated has violated a

sense of right and wrong” (Tilghman-Osborne, et al., 2010). For example, this could involve

behaviours such as lying, stealing or betrayal.

How individuals appraise moral transgressions is an important consideration as

appraisals impact upon the subsequent response of the individual. One factor potentially

influencing an individual’s appraisal of a situation is the amount of responsibility they feel,

both for the event and intrinsically. Elliott and Radomsky (2013) found the appraisal

variables of personal responsibility accounted for a significant amount of mental

89

contamination measured through its internal negative emotions (INE’s) index (e.g. shame). In

addition, Radomsky and Elliott (2009) found that responsibility could significantly predict

mental contamination on its indices of urges to wash and feelings of dirtiness, thus

demonstrating the association between mental contamination and personal responsibility.

Ishikawa, et al. (2014) add support to this by suggesting that the greater the degree of

responsibility an individual might feel in response to a contaminating event, the greater the

level of mental contamination they experience.

Most research to date on moral transgressions and mental contamination has focused

on the victims’ response. However, Rachman, et al. (2012) found that whilst victims of

negative interactions, such as a non-consensual kiss, experienced more mental contamination

than perpetrators, perpetrators did still experience mental contamination. This was measured

through INE’s of anxiety, guilt, shame and anger. They postulated that the mechanisms

underlying the generation of distressing intrusive thoughts might be similar with each group.

This idea is supported by Evans, et al. (2007) who found that psychological distress was

subsequently experienced by both participants who had committed a violent crime, and also

those who were victims of assault.

Moral transgressions are especially evident in the literature on defining and measuring

guilt, with one definition of guilt stating that it “involves a sense of moral transgression”

(Harder & Greenwald (1999) p. 271). Guilt has been found to be a key factor involved in

mental contamination and is one of the many INE’s frequently measured as part of the

construct. Rachman et al. (2012) found that participants experienced more guilt, along with

disgust and shame in comparison to anxiety, anger and urges to wash, in response to

committing a non-consensual act. This therefore highlights the important role of guilt in both

mental contamination and in relation to moral transgressions. Furthermore, it could be

postulated that the role of responsibility appraisals is involved here as the participants own

90

feelings of personal responsibility could have been affecting the amount of INE’s they

experienced. However, this needs further investigation.

Alongside guilt, Rachman et al. (2012) have also demonstrated the important role of

disgust and shame in the conceptualisation of mental contamination through the INE index.

Disgust has been consistently and significantly found to be associated with metal

contamination and is perhaps the most well-researched emotion in relation to the construct. It

has been found that disgust propensity is significantly and positively related to mental

contamination measured as a whole construct (Badour, et al., 2013a), and through its urge to

wash index (Carraresi et al., 2013; Herba & Rachman, 2007; Radomsky & Elliott, 2009). It

will be included as a measure of mental contamination in this research in order to replicate

previous findings.

Similarly, shame is also a commonly found to be part of the INE’s experienced by

participants in response to negative events, such as a non-consensual kiss (Fairbrother, et al.,

2005). Radomsky and Elliott (2009) found that younger participants experienced greater

levels of INE’s, such as shame, in comparison to older participants. Shame has been

conceptualised as a different construct from guilt due to its focus on the self, whereas guilt

focuses on others (Teroni & Deonna, 2008). This is important as it suggests that those who

are more internally focused may be more sensitive to experiencing shame. Therefore, an

association might be expected between personal responsibility appraisals and amount of

shame experienced.

To assess the behavioural impact of mental contamination induced through moral

transgressions, an opportunity to neutralise mental contamination will be included in this

study. This follows on from research by Zhong and Liljenquist (2006) who found that

exposure to immoral acts, whether the participant’s own or those of others, promoted

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neutralising behaviour. This study will aim to replicate and extend these findings by

measuring the behavioural intention of participants.

The induction of mental contamination in experimental paradigms to date has been

approached in a number of ways. Perhaps the most successful of these has been through the

“dirty kiss” paradigm (Fairbrother et al., 2005), which was developed from literature on the

association between sexual assault and mental contamination (Gershuny, et al., 2003). The

replication of the “dirty kiss” paradigm across a number of studies (Elliott & Radomsky,

2009; Elliott & Radomsky, 2013; Herba & Rachman, 2007; Ishikawa et al., 2014; Rachman

et al., 2012; Radomsky & Elliott, 2009) has demonstrated it is a reliable way to induce and

explore the construct. The success of this paradigm appears to centre on participants’ ability

to place themselves within the scenario and their use of mental imagery in doing this. Most

studies have assessed participants’ ability to do this through questions on the Mental

Contamination Report (MCR) (Radomsky et al. 2006).

However, it could be argued that as participants are imagining themselves in a

predetermined role, the effect of the manipulation is potentially not as powerful. Another,

more salient way that mental contamination could be induced would be through the recall of

autobiographical memories. This has been found to be effective in nonclinical populations

(Coughtrey, et al., 2014a) and has been more widely used in clinical populations, with

participants recalling memories of sexual assault (Badour, et al., 2013b; Fairbrother &

Rachman, 2004) and for those with OCD, feelings of contamination (Coughtrey, et al.

2012b).

In order to further develop how mental contamination is induced experimentally it

would seem reasonable to continue to explore how participants own autobiographical

memories can be used to elicit this. Whilst Coughtrey et al. (2014a) found the approach to be

92

effective, they noted that the mental contamination induced was transient, decaying

spontaneously after three minutes. However, the effect could be repeatedly re-evoked.

Despite the potential downfalls to this approach (the possibility of priming, decay of mental

contamination response, participants failing to recall an appropriate memory, and other issues

related to control of the memories recalled), the gains in ecological validity are substantial.

Therefore, the possibility of creating more pertinent memories has the potential to elicit a

greater mental contamination response than previous methods used. This has important

clinical implications in how intrusive memories and the resulting mental contamination

experienced can be understood.

Main Hypotheses

Based on the literature outlined above, the following hypotheses will be tested within the

study:

There will be a positive association between recalling an autobiographical memory of

a moral transgression and mental contamination, measured through the change in

scores of INE’s.

The effect of the autobiographical memory, measured through the amount of mental

contamination experienced, will be more powerful in the “victim” condition than in

the “perpetrator” condition.

A positive association will be found between personal responsibility and mental

contamination.

There will be a positive association between mental contamination and behavioural

intention to neutralise.

Method

93

Design

An experimental paradigm will be employed to examine the influence of

responsibility appraisals (predictor variable) on feelings of mental contamination (outcome

variable). Mental contamination will be measured through the amount of increase in the

INE’s of shame, guilt and disgust. Behavioural intention to neutralise mental contamination

will also be measured (outcome variable). A between-groups analysis will be conducted to

explore group differences and correlations to explore associations between variables.

Participants

G*Power (Faul et al., 2009) calculations were conducted to determine sample size

requirements. To measure group differences with a medium effect size a sample size of 84 is

recommended. For correlational analyses a sample of 111 would be required. Therefore,

approximately 120 participants will be recruited for the study. This figure is larger than

samples sizes used in previous studies with similar designs and good effect sizes (Radomsky

& Elliott, 2009; Elliott & Radomsky, 2013; Rachman et al. 2012).

The previous use of mainly female samples across many studies has made

generalizability of the research findings difficult due to the potential for gender bias within

the literature. The inclusion of a more gender-balanced sample will enable greater inferences

to be made about mental contamination and the impact of appraisals. Similarly, most studies

report a younger adult sample (18-30 years). To enable further generalizability a broader

range of ages within the nonclinical adult field will be obtained. The use of an online

experimental paradigm will help to access a greater age range of participants and a more

balanced mix of gender as data collection will not be confined to the university laboratory. A

snowball sampling method through social media sites such as Facebook, Twitter, and Reddit,

would help to facilitate this. One potential flaw is that the demographic of social media sites

94

are largely younger adults. However, the use of a snowballing sampling method would

hopefully counteract this as older participants might be more likely to pass the hyperlink onto

people of a similar age.

Measures

Responsibility Attitudes Scale (RAS) (Salkovskis et al., 2000). The RAS will be

administered in order to assess responsibility appraisals. The RAS is a 26-item questionnaire

that measures an individual’s general beliefs about responsibility (Appendix B). The items

are listed on a 7-point Likert scale where individuals state how strongly they agree or

disagree with each statement. It has high reliability and internal consistency (Cronbach’s

α=.92) and has demonstrated good concurrent and criterion validity (Salkovskis et al. 2000).

Visual Analogue Scales (VAS). VAS will be used to measure the subjective

experience of mental contamination by participants self-rating their INE’s of shame, guilt and

disgust. These will be measured before the induction of mental contamination as a baseline

and then after, to assess amount of mental contamination experienced. VAS are widely used

tools in both clinical and research settings, and have been found to have high reliability and

validity (McCormack, et al., 1988).

Mental Contamination Report (MCR) (Radomsky et al. 2006). An adapted version

of the MCR will be used as a manipulation check after the participant has recalled their

autobiographical memory. It will be adapted so that it is relevant for this study. The MCR is a

29-item measure of the indices of mental contamination. Its inclusion of appraisal questions,

such as the inclusion of how personally responsible the participant feels for the event will be

appropriate for this study. All questions are based on a scale of 0 (“not at all”) to 100

(“completely”). A Cronbach’s α=.41has been found (Radomsky & Elliott, 2009).

Procedure

95

An online experimental paradigm will be created. The hyperlink for the study will be

shared through social media sites. Participants will be able to select the link and gain access

the study, which will take approximately 20 minutes to complete. They will then see the

following screens (See Figure 1). All data will be anonymised from the start of the study.

Participants will be given an information sheet outlining the experiment and their

right to withdraw. They will be asked to consent to participate before completing

demographic information. They will then be presented with the RAS to complete before

being asked to complete VAS to subjectively rate their levels of shame, guilt and disgust. At

this point participants will be randomly allocated to either the “victim” or “perpetrator”

condition. These conditions will differ only in whether they will be asked to recall an

autobiographical memory of being a “victim” or a “perpetrator” of a moral transgression,

which they will be asked to write down.

Next, participants will be required to complete the adapted MCR to assess the salience

of the recalled memory before completing the VAS of their emotions again. Finally, they will

be presented with the debriefing page. Here participants will be informed of the nature of the

study and offered sources of support. They will also be asked to complete a behavioural

measure of intention to neutralise, which will be a question about how much they would like

to find out about a charity. They will be asked to respond to this on a Likert scale.

Ethical Considerations

Ethical approval will be sought from the Faculty of Arts and Human Sciences (FAHS)

at the University of Surrey.

Participants will be required to give informed consent before completing the study.

They will be told that they will be asked to recall memories about moral transgressions and

96

will be given the option to not participate. This will help to reduce the impact of any

psychological distress that might be caused through completion of the study.

97

Figure 1: Diagrammatic representation of the experimental paradigm

They will not be informed that the study will be measuring mental contamination in response

to the memory, but there will be no deception involved in this. The full nature of the study

will be provided on completion to help to control for participant bias. Participants will also be

informed of their right to withdraw from the research at any point up until they have

submitted the form online, by which point, all the data is anonymous and indistinguishable

from each other.

In order to reduce the impact of any harm that may be caused, participants will be

fully debriefed via a debriefing page at the end of the study. They will be signposted to

appropriate sources of support if they feel they have been left feeling distressed after

completion of the research. These will include: to contact their GP, details of a mental health

charity helpline/email address and an OCD charity helpline, included because of the clinical

focus of the research.

There is also the potential for risk of harm to researcher due to reading some

potentially distressing memories recorded by participants. In an effort to reduce the impact of

harm in this instance, appropriate supervision will be sought throughout the process.

Project Costing

As the study will be conducted online, advertised through social media sites, and by

using measures that are freely available, there are no potential costs involved in the project

that can be identified at this stage.

Proposed Data Analysis

Data analysis will be conducted using the Statistical Package for the Social Sciences

(SPSS). Descriptive statistics will be initially produced to assess whether parametric

assumptions have been met. In order to measure group differences, a repeated measures

Multivariate Analyses of Variance (MANOVA) will be conducted, due to measuring multiple

99

independent, and multiple dependent variables. To assess the impact of responsibility on the

group differences, a Multivariate Analyses of Covariance (MANCOVA) may be used to

factor out the noise this variable may create in the data. Correlational analyses will also be

conducted to test the hypotheses outlined that predict associations between variables. If,

during the initial descriptive analysis, the data is found to not meet parametric assumptions,

non-parametric methods of analyses will be implemented.

The autobiographical memories recorded by each participant will be analysed using

content analysis (Mayring, 2000) which will enable the data to be grouped and analysed as a

whole. This will help to assess the pertinence of the memories, in terms of their induction of

mental contamination.

Involving/ Consulting Interested Parties

Consultation with service-users and carers through the University of Surrey has been

sought to ensure the design and procedure appeared feasible and to highlight any potential for

associated distress. As a general population sample will be recruited for this study, a

heterogeneous group of service users and carers were consulted as they are more reflective of

the sample that will be recruited. The option to contact a more homogenous group, for

example people with OCD, was considered, however, it was felt that this was not necessary

due to not using a clinical population within the study itself.

After this initial consultation period, the study will be piloted to further ensure the

accessibility of the online study. A general population sample will be recruited for this stage,

using the same recruitment strategy that will be implemented in the main study. This will

help to assess the effectiveness of this strategy also.

100

Contingency Plan

If after piloting, it is found that participants struggle to identify memories that

effectively elicit mental contamination, then a vignette could be given (one for each

experimental group). Participants would be asked to imagine themselves within the role

outlined in the vignette. This would still be in keeping with previous literature as a means of

eliciting mental contamination through participants placing themselves in the role of another

person (e.g. the “dirty kiss” scenario, Fairbrother, et al., 2005).

Dissemination Strategy

The paper will be submitted for publication to a peer-reviewed journal on completion.

Also, due to the potential clinical implications of the research on the construct of mental

contamination, it may be beneficial to submit an executive summary of the research to OCD

websites, such as OCD-UK. Summaries are often published on the research section of their

website. Other websites, such as OCDfoundation.org, accept summaries for inclusion on their

newsletters and could therefore also be contacted.

101

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105

Major Research Project Literature Review

What is mental contamination and how is it related to

psychological distress?

106

Abstract

Mental contamination refers to the feeling of being contaminated that occurs in the

absence of physical contact. Recent research in the field has begun conceptualising mental

contamination as a separate construct to contact contamination. This has potentially important

clinical implications in the treatment of anxiety disorders, and specifically in Obsessive

Compulsive Disorder (OCD), where the construct was first identified. In light of the current

interest in this field, this review aims to narratively synthesise the research to date in order to

consolidate how mental contamination is defined, understood, and also its relationship to

psychological distress. An extensive search of the literature was conducted incorporating

electronic databases (PsychINFO, CINAHL, Science Direct, EBSCO and Cochrane Library)

and by hand searching. After the removal of duplicates, 23 papers met the eligibility criteria

and were included in the review. It was found that there is consensus across the literature that

contact and mental contamination are distinct constructs and that they can both be induced

empirically. The role of appraisals in mental contamination was also emphasised as an

important factor in the level contamination that was experienced. However, it was identified

that there are sampling limitations across the studies, with mainly females in their early 20’s

being recruited as participants. This needs to be addressed in order to develop understanding

in the field and increase generalizability of findings.

Keywords: Mental contamination, Contact Contamination, Anxiety Disorders, OCD,

Appraisals.

107

Introduction

Mental contamination denotes any contamination that occurs in the absence of

physical contact with a contaminant. It was first identified as a distinct difficulty observed in

clinical settings by Rachman (1994), where it was noticed that for some people who

presented with Obsessive Compulsive Disorders (OCD), there was a persistent fear of

contamination even in the absence of a physical, external stimulus. The notion of a fear of

contamination arising from an internal stimulus had been acknowledged in the literature for

some time however, (Rachman & Hodgson, 1980, p. 113); and even before this, examples

(both real and fictional) throughout history have often been portrayed, with the most

commonly referred to example being that of Lady Macbeth and her efforts to rid herself of

guilt by repeated washing. However, whilst this notion was recognised, it was often thought

that contamination in response to an external stimulus (contact contamination) was more

commonly experienced and therefore historically the literature has predominantly followed

this direction.

The exploration of contamination in terms of the differentiation between contact and

mental contamination and the potential clinical implications of this, has only begun to be

studied relatively recently. This paper will synthesise and critically evaluate the research in

the field of mental contamination in order to consolidate how it is defined and understood.

Due to the field of research developing from investigation into OCD initially, this review will

also investigate the relationship between mental contamination and psychological distress.

For the purpose of this review “mental contamination” will refer to all references of internal

or inward contamination, or mental pollution and “contact contamination” will refer to

contamination, both direct and indirect, from a tangible source.

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Whilst contact and mental contamination are proposed to be distinct constructs, there

is large amount of overlap between the two fears (Coughtrey, Shafran, Lee & Rachman,

2012). The “internal sense of dirtiness” that is experienced in mental contamination is similar

to the ‘external dirtiness’ experienced in contact contamination in terms of both inducing

discomfort and distress in the sufferer. Rachman (2004, 2006) outlined the main differences

between these two types of contamination to be: (i) the process through which contamination

occurs (with or without physical contact); (ii) the effectiveness of washing behaviour (to

relieve distress); (iii) the perceived source of the contamination (internal or external) (iv) the

type of source (inanimate or human); (v) the persons vulnerable to contamination (self or self

and others); and (vi) the provocation of contamination (germs and dirt or thoughts and

memories). It is these differences that have led to the differentiation of contact and mental

contamination as distinct constructs of contamination fear (Rachman, 2004).

As stated above, the investigation of mental contamination as a separate construct

from contact contamination developed out of clinical observations and treatment of people

predominantly with OCD, where approximately 50% of people report a fear of contamination

(Rachman & Hodgson, 1980). It was found that for some people, feelings of contamination

could be induced even when there was no physical contact with a perceived “dirty” stimulus.

The feelings of contamination could be induced or intensified by thoughts, feelings or images

that had no tangible source, such as humiliations, betrayal and insults (Rachman, 2010).

The field has now moved on from the initial clinical observations of mental

contamination (Rachman, 1994) to investigate the construct empirically; with different

methods being introduced to induce and measure it in experimental paradigms. Coughtrey,

Shafran and Rachman (2014a) found that mental contamination could be induced in

nonclinical participants via the recall of negative autobiographical memories. However, the

biggest research base to date has involved the use of the non-consensual kiss scenario

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(Fairbrother, Newth & Rachman, 2005). In this scenario, participants listen to an audio

recording of an immoral act; the level of mental contamination they then experience as a

result of this is measured. The induction of mental contamination in this way is an important

development as it has widened the field from clinical observations, to empirical, objective

research. This has, and will continue to allow for further investigation into the construct and

its relationship with psychological distress.

Whilst the majority of the research has focused on investigating the role of mental

contamination in OCD (Cougle et al., 2008) the relationship between mental contamination

and other forms of psychological distress has also been investigated, but to a lesser extent.

The main area of research has focussed on mental contamination and posttraumatic stress

disorder (PTSD), especially in relation to those who have experienced sexual assault

(Fairbrother & Rachman, 2004; Gershuny et al. 2003). This has been an interesting

development in the research as it demonstrates the possibility that mental contamination may

be a factor in other psychological disorders; suggesting the potential to think of mental

contamination transdiagnostically, as a factor underlying a number of other anxiety disorders.

The aim of this study therefore is to narratively synthesise and critically evaluate the

research on mental contamination in an attempt to understand more about how the construct

relates to psychological distress and what the implications are of this for future research and

treatment.

Methods

Data Sources

To obtain relevant studies, five databases (Science Direct; EBSCO; Cochrane Library;

CINAHL; and PsychInfo) were searched in February 2014, using the search terms of:

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"mental contagion" OR "mental contamination" OR "mental pollution". No date range was

imposed upon the database search. The search terms were broad due to the limited amount of

literature in the field, which was determined after a preliminary database search. A manual

search of reference lists of papers that met the eligibility criteria was also conducted.

Eligibility Criteria

Inclusion and exclusion criteria were given broad parameters, again due to the limited

literature in the field. Studies were included if they: (i) were peer reviewed publications; (ii)

were English language papers; (iii) included reference specifically to mental contamination

and not just contact contamination or contamination; (v) the definition of mental

contamination was not primarily based upon attentional processes; (vi) the study employed an

experimental, correlational or qualitative research design; (vii) were only primary sources.

See Figure 1 for full screening process.

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Figure 1: Summary of study selection process

Data Extraction

The data extracted from the studies was two-fold. Firstly specific demographic

information was extracted, where reported, including: (i) sample size; (ii) percentage of

female participants that were included in the sample; (iii); the mean age of the sample; (iv)

the population (students or community); (v) whether the sample was clinical or nonclinical;

(vi) ethnicity of the sample; and (vii) the age range. Alongside this, the country the research

was conducted in was extracted and also the definition of mental contamination that the study

included.

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Secondly, specific information regarding methodology, statistics and findings were

extracted. These included: (i) design; (ii) predictor variable; (iii) outcome variable; (iv)

measures used, including specific measures of mental contamination; and (v) test statistics

and effect sizes. Extracting this information from all studies, where reported, was beneficial

in ensuring that a consistent and comprehensive synthesis was conducted across all studies.

Data Analysis

A narrative synthesis of the studies was conducted due to the heterogeneity of the

research included in this review. A meta-analytic synthesis requires that there is homogeneity

within the results to ensure that the findings of the synthesis are coherent. Therefore due to

the diversity in the studies, a qualitative synthesis would better describe the data. The

heterogeneity in the studies is largely due to the inclusion of a vast number of measures

across the studies, and also the inclusion of both experimental and correlation designs, which

leads to a disparity within the results.

Results

Description of Studies

The 23 studies that were included in this synthesis were published between 2004 and

2014 and assessed 2501 participants in total on the construct of mental contamination. The

main characteristics and results of these studies are summarised in Tables 1 and 2

respectively.

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Table 1: Demographic variables of all studies

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Article Country % Femal

e

Sample Size

Clinical/ nonclinical Population Mean Age Age range

Herba & Rachman (2007)

Canada 100% 120 Nonclinical Students 20.73 (SD= 4.73)

Radomsky & Elliot (2009)

Canada 100% 70 Nonclinical Students 23.30 (SD= 4.77) 18-43yrs

Coughtrey, Shafran & Rachman (2014a)

- 70% 40 Nonclinical Students 22.60 (SD= 5.33) 18-44yrs

- 82% 60 Clinical (scores >10 on VOCI) Students 20.53 (SD=

4.30)

18-38yrs

Coughtrey, Shafran & Rachman (2014b)

- 82% 60 Nonclinical Students 20.53 (SD= 4.30) 18-38yrs

Lee et al (2013) UK 83% 60 Nonclinical Students 22.25 (SD= 8.22) 18-57yrs

Berman et al (2012) US 72% 265 Nonclinical Students 19.46 (SD= 2.75) -

Coughtrey et al (2012a)

UK 73% 177 Clinical (high OC symptoms) Community 34.40 (SD= 11.43) -

UK 65% 54 Clinical (formal diagnosis using the ADIS-IV or structured interview)

Community 33.39 (SD= 10.89) -

Carraresi et al (2013) Italy 45% 83 Clinical (ADIS-IV) Community 32.6 (SD=9.6) -

Badour et al (2013a) US 100% 38 Clinical (history of at least one DSM-IV defined sexual assault)

Community 32.34 (SD= 13.55) -

Badour et al (2013b) US 100% 40 Clinical (positive history of traumatic event exposure as 

defined by meeting criterion A of the DSM-IV)

Community 28.18 (SD= 13.93) -

Cougle et al (2008)

(info from study 3)

US 75.3% 84 Nonclinical Students 19.45 (SD=5.3) 19-29yrs

Melli et al (2014) Italy 49.2% 63 Clinical (OCD diagnosed using the ADIS) (scored above 4.5 on the 

DOCS)

Community 33.4 (SD= 10.3) -

Olatunji et al (2008) US 100% 48 Nonclinical Students 19.52 (SD= 1.23) -

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SD=Standard Deviation; VOCI= Vancouver Obsessional Compulsive Inventory; OC=Obsessive Compulsive; OCD=Obsessive Compulsive Disorder; DSM-IV=Diagnostic and Statistical Manual of Mental Disorders; ADIS-IV=Anxiety Disorder Interview Schedule; DOCS=Dimensional Obsessive-Compulsive Scale.

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An average of 77% females were used across all study samples, with only one study

(Rachman, Radomsky, Elliott & Zysk., 2012) using a solely male sample. The average age

across all study samples was 25.03 years (SD=6.75). Age range was only reported in 13

studies, and for these studies, there was a range of 15-57 years old. This therefore,

demonstrates that a largely adult sample has been used, to date, in the investigation of mental

contamination. Of the 4 studies that included participants under the age of 18 years

(Fairbrother & Rachman, 2004; Elliot & Radomsky, 2009; Rachman et al., 2012; Fairbrother,

Newth & Rachman, 2005), the study that reported the lowest age (15 years) in their sample

(Fairbrother et al., 2005), also reported a mean age of 20.51 years (SD=3.17) across their

entire sample, thus suggesting that the majority of their participants were adults.

Twelve of the studies were conducted in North America (Canada and the USA), 5 in

Europe (UK and Italy), 1 study was conducted in Asia (Japan) and 5 studies failed to report

where they collected their data (Coughtrey, Shafran & Rachman, 2014a; Coughtrey, Shafran

& Rachman, 2014b; Radomsky, Rachman, Shafran, Coughtrey & Barber, in press; Rachman,

Radomsky, Elliott & Zysk, 2012). University student samples were used in 14 studies (61%),

8 studies (35%) used solely community samples and one study (Radomsky et al., in press)

used both a student and community sample. Only 6 studies reported ethnicity within their

sample. Of those that did, there was a majority of Caucasian participants across the samples

(64.3-90%), with Hispanic (Average 8.7%) and African American (Average 6.9%)

participants being the next highest populations respectively. Both clinical and nonclinical

samples were included in the review, with 14 studies reporting a nonclinical sample, 7 using

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clinical samples, and 2 using both clinical and nonclinical samples in their studies. Of those

studies that used clinical samples, the majority (75%) had a diagnosis of OCD.

Definitions of mental contamination varied across the studies. 14 studies reported the

word “internal” as part of or as the focus of their definition; 20 studies describe how mental

contamination occurs “without” or in “absence” of any physical contaminant; and 6 studies

refer to mental contamination as involving “psychological” processes or feelings. Whilst

there was this variation, it appears that the majority based their definition upon Rachman’s

(1994) definition of mental contamination as “a sense of internal uncleanness which can and

usually does arise and persist regardless of the presence or absence of external, observable

dirt”. However, only 4 studies directly use this quotation as part of their description

(Berman, Wheaton, Fabricant & Abramowitz, 2012; Cougle, Lee, Horowitz, Wolitzky-Taylor

& Telch, 2008; Fairbrother et al., 2005; and Elliot & Radomsky, 2013).

Quality Assessment

The studies in this review that employed quantitative analyses were assessed based

upon the checklist proposed by Kmet, Lee and Cook (2004). There were clear rationale, aims

and hypotheses reported across all studies. Both experimental and correlation paradigms were

included in the review. Whilst the experimental designs offer a more robust approach, there

was a lack of information across the majority of studies about the allocation of participants to

specific groups. This was only clear in studies that utilised both clinical and nonclinical

populations. Measures used to assess both mental contamination and other variables were

well defined and reported appropriately. All studies provided clear and appropriate analysis

of results and reported these in sufficient detail; conclusions were supported by the results.

Overall, all studies were found to meet the criteria for inclusion in the review.

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The Critical Appraisal Skills Programme (CASP) checklist was used to evaluate the

one paper that employed qualitative methodology appraised in this review. Following the 10

questions outlined, it was found there were clear aims, findings, and valuable clinical

implications that justified the research. Limitations were found regarding a lack of detail in

the explanation of the methodology used and also in the omission of researcher assumptions

throughout the process. However, overall, the paper was deemed appropriate for inclusion in

this review.

Description of the Results

Measures. Forty-nine different measures were used across all studies, with 10 of

those specifically measuring mental contamination (Mental Contamination Report (MCR)

Cronbach’s α=.41to .88 (Elliott & Radomsky, 2009); Mental Contamination Interview (α not

reported) (Rachman, 2006); Mental Pollution Questionnaire (MPQ) α=.86 for the washing

subscale and α=.85 for inward contamination subscale (Cougle et al. 2008); the Vancouver

Obsessional Compulsive Inventory – Mental Contamination Scale (VOCI-MC) α=.94 

(Rachman, 2006); Thought-Action Fusion- Mental Contamination Scale (TAF-MC) α=.92

(Rachman, 2006); Sexual Assault and Rape Appraisals (SARA) α=.80 (Fairbrother &

Rachman, 2004); Obsessive Compulsive Inventory – Short Version (OCI-R) α=.57 to .93

(Foa et al., 2002); Contamination Sensitivity Scale (CSS) α not reported (Rachman, 2005b);

Contamination Thought-Action Fusion Scale (CTAF) α not reported (Rachman, 2005c); and

the Unwanted Sexual Experiences Study Questionnaire (USES) α not reported (Fairbrother,

Newth & Rachman, 2005), which includes questions specific to mental contamination). Some

of these measures were adapted from other OCD and contamination specific measures to

include explicit questions on mental contamination. Not all of the studies reported the internal

consistency or reliability data for the measures used. It is therefore difficult to be confident

that they are all reliable and valid measures of mental contamination.

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Whilst the majority of those that did state Cronbach’s alpha (α) figures report good to

excellent amounts of internal consistency within the measures, the OCI-R and MCR reported

ranges of internal consistency with the lowest point showing poor to unacceptable levels. As

well as these standardised measures used to measure mental contamination, Visual analogue

scales (Coughtrey et al., 2014a; Coughtrey et al., 2014b; Lee et al., 2013), Appraisal/ Mental

pollution interviews (Radomsky & Elliot, 2009), and Likert Scales (Rachman et al., 2012),

were also used to assess the levels of mental contamination felt by participants.

Alongside the large number of different measures of mental contamination used

across studies, it is also important to note that mental contamination itself was assessed in

different ways, in terms of its specific properties. For example, in 32% of studies it was

measured as a whole construct (mental contamination), failing to specify the specific

components of the construct being measured. In 50% of studies it was broken down into its

indices and measured in this way (feelings of dirtiness, urges to wash, internal negative

emotions, external negative emotions). 6 studies measured mental contamination on all of

these indices (27%), whilst 23% of studies chose the two most prominent ones to measures

(feelings or dirtiness and urges to wash).

Outcome variables. It was expected that, due to the nature of the studies reviewed in

this paper, mental contamination would be the outcome variable in all experimental and

correlational studies. However, on investigation, it was found that whilst this was the case for

the majority of studies (86%), not all studies chose to explore the relationship between mental

contamination and other variables in this way (see Table 2). For example, mental

contamination was also used in mediation models, as both the predictor and mediatory

variable (mainly in studies on PTSD or OCD symptom severity (Badour, Fldner, Blumenthal

& Bujarski, 2013; Carraresi, Bulli, Melli & Stopani, 2013; Melli, Bulli, Carraresi & Stopani,

2014; Olatunji, Elwood, William & Lohr 2008). This therefore demonstrates how mental

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contamination has been investigated relatively widely, which is important in developing the

field and furthering our understanding of the construct. However, as the literature is fairly

small to date, it makes it difficult to make any clear assertions about its role in relation to

other constructs.

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Table 2: Findings extracted from all studies

Article Design Predictor variable Outcome variable Effect size and Significance

Herba & Rachman (2007)

Cross-sectional Disgust, anxiety, contact contamination, fear of negative evaluation from others, sexual attitudes, prior experience with unwanted sexual contact

Mental Contamination indices (Dirtiness; Urge to wash; Rinsing)

Urge to wash & Contact contamination r=.36***. Dirtiness: & Contact contamination r=.33***; & Disgust r=.29***; & Anxiety r=.28***. Rinsing & BFNE r=.26***; Rinsing & Prior experience r=.20*

Radomsky & Elliot (2009)

Cross-sectional Contact contamination, anxiety, disgust, fear of negative evaluation, neuroticism. Appraisal variables (responsibility, violation, post-kiss immorality)

MC indices (dirtiness & Urge to wash) Internal negative emotions (shame), & external negative emotions (anger)

Dirtiness: & Responsibility r=.39***; & Violation, r=.41***; & Immorality

r=.28***; & contact contamination r=.32***. Urge to wash: & Responsibility r=.37***; & Violation r=.31***; & Immorality r=.36***; & Contact Contamination r=.25*; & Anxiety r=.26*. INE’s: & Responsibility r=.55***; & Violation r=.44***; & Immorality r=.24*; & Contact Contamination r=.33***; & Anxiety r=.26*. ENE’s: & Violation r=.37***; & Immorality r=.31***; & Contact Contamination r=.26*; & Anxiety r=.29***.

Coughtrey, Shafran & Rachman (2014a)

(i) Experimental Negative Memories MC (dirtiness, urge to wash), state anxiety

Increase in: General dirtiness d=1.07***, Internal dirtiness d=1.24***, Urge to wash d=.79***, and State anxiety d=1.29***

(ii) Experimental

Negative Memories MC (dirtiness, urge to wash), state anxiety

General dirtiness n²=.35***; Internal dirtiness  n²=.19**; Urge to wash n²=.20**; and Anxiety  n²=.30***

Coughtrey, Shafran & Rachman (2014b)

Experimental & correlational

Contamination

Disgust, TAF, OCD symptoms

Contact Contamination & Mental Contamination

n.s. correlations

Contamination rating increased in no-contact condition d=.71***, but more so in contact condition d=1.09***

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Lee et al (2013)

Experimental & Correlational

Contamination (contact versus mental)

Internal dirtiness, disgust, anxiety, urge to wash

Increase disgust np²=.66***; Internal dirtiness np²=.11**; Anxiety np²=.17***;  Urge to wash np²=.16*** (no effect of condition in any)

Changes in OCI-R score: & Urge to wash r=.68***; & Internal dirtiness r=.55**. Changes VOCI-MC scores & Internal dirtiness in mental contamination condition r=.56***.

Berman et al (2012)

Cross-sectional Christian Religiosity, intrinsic motivation toward the Christian religion, parental guilt induction, childhood trauma

Mental contamination (washing rituals & inward contamination)

Washing Rituals: & Extrinsic social d=.69***; & Guilt disparagement d=1.07*I*; & Sexual abuse d=.52***. Inward contamination & Guilt f²=.06*

Coughtrey et al (2012a)

Cross-sectional OC symptoms,

TAF

Mental contamination VOCI-MC: & TAF total r=.36***; & TAF Moral r=.36***; & OCI-R Total r=.61***; & OCI-R Washing r=.70***. 

Cross-sectional Psychopathology (anxiety, depression, TAF, OCD, sensitivity to contamination)

Mental contamination VOCI-MC: & BDI-II r=.47***; S-CTN r=.56***; & CTN-TAF r=.49***; & OCI-R r=.48***. 

Carraresi et al (2013)

Cross-sectional Disgust propensity

Mental contamination (mediator)

Fear of contamination

Mental contamination

Mental contamination: & Fear of contamination r=.60***; & Disgust propensity r=.29**. Disgust propensity & Fear of contamination r=.35**

Mediation: Boot=.03 (SE=.02; BCa-CI 95%, p=.006-.006)

Badour et al (2013a)

Cross-sectional Disgust Sensitivity (DS)

Mental contamination (Mediator)

Posttraumatic stress symptoms severity

DS & Mental Contamination r=.43**. Mental Contamination & PTS symptoms r=.66***.Mediation: β =.31, SE=.14, BC 95% CI [.09, .67], k2=.30) 

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Posttraumatic stress (PTS) symptoms severity (Mediator)

Mental contamination

Badour et al (2013b)

Experimental OC symptoms, main effect of assault type (physical or sexual), PTS symptoms, contamination

Feelings of dirtiness, urges to wash, disgust ratings, anxiety ratings

Change in: dirtiness d=.77***; urge to wash d=.77***; & disgust d=.62***. No change in anxiety. PTS symptoms: & dirtiness (assault condition) r=.39*; urge to wash (assault) r=.34*; disgust (assault) r=.46**; anxiety (assault) r=.37*. PTS predicts dirtiness: sr²=.32***; PTS predicts urge to wash: sr²=.26***

Cougle et al (2008)

Cross sectional Mental contamination, guilt, disgust, TAF

OCD symptoms (washing and obsessions)

MPQ-ideation & Guilt r=.59***. MPQ-ideation predicted OCI-R obsessing d=.65**; MPQ-washing predicted OCI-R washing d=1.24***

Melli et al (2014)

Cross sectional Disgust propensity

Mental contamination (Mediator)

Contamination related OCD symptoms

Disgust & Mental contamination r=.37**, Mental contamination & OCD r=.67***

Mental contamination mediates disgust & OCD: Boot=(β =.04, SE=.01, BCa-CI 95%: .013-0.68).

Olatunji et al (2008)

Cross sectional Mental contamination

PTSD cognitions (mediator)

PTS symptom severity Mental contamination: & PTSD-avoidance r=.49**; & PTSD-self-blame r=.52**; & PPTS-R total r=.40**; PTCI r=.45**. No bootstrap reported for mediation.

Radomsky et al (in press)

Cross sectional OCD symptoms

OCD beliefs

Contamination VOCI-MC: & VOCI Total r=.78***; & VOCI contamination r=.70***. CSS & VOCI contamamination r=.74***. CTAF & TAF r=.74***. VOCI-MC significant predictor of OCD symptoms in students d=.51***; & in OCD patients d=.76*.

Coughtrey (2012b)

Qualitative – thematic analysis

- - -

Fairbrother, Newth &

Experimental Contamination, immoral act Mental contamination (feeling: cheap or 

Consensual condition vs. Non-consensual condition: feelings of dirtiness d=3.12***; dirty in non-physical terms d=2.84***; dirty 

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Rachman (2005)

sleazy, ashamed, immoral, urges to wash), Avoidance behaviour

on the inside d=2.74**; ashamed d=1.89***; immoral d=.94***; urge to wash d=4.09***

Rachman et al (2012)

Experimental

(4 conditions)

Betrayal, unacceptable thoughts/images

Mental contamination (feelings of dirtiness, urges to wash, & associated negative emotions)

Consensual condition vs. Non-consensual condition: shame d=1.27***; guilt d=1.08***; disgust d=1.74***. Anxiety np²=.12*; Shame np²=.29***; Guilt np²=.25***; Anger np²=.26***; Sadness np²=.20**

Elliot & Radomsky (2009)

Experimental (4 conditions – CM, CI, NCM, NCI)

morality (Consensual/ non-consensual act), disgust, anxiety, depression, desirability of the act

Mental contamination (feelings of dirtiness, urges to wash, negative internal emotions, negative external emotions)

Main effect of: desirability of the kiss n²=.34***; morality n²=.04*; & the interaction between them n²=.07***. Differences in: dirtiness n²=.26***;  urges to wash n²=.32***; INE’s n²=.20***; and ENE’s n²=.53***

Elliot & Radomsky (2012)

Experimental (4 conditions)

-Consensual/ non-consensual act

-physically dirty/ clean

Mental contamination (feelings of dirtiness, urges to wash, negative internal emotions, negative external emotions)

Main effect: desirability of the kiss np²=.39***; physicality of the man np²=.37***; & an interaction between them np²=.06**. Group Differences: feelings of dirtiness np²=.54***; urges to wash np²=.37***; INE’s np²=.27***; and ENE’s np²=.61***

Fairbrother & Rachman (2004)

Experimental Evoking memories/ images of assault, PTSD symptoms

Mental pollution (feelings of dirtiness, urge to wash)

Anxiety, Depression

Urge to wash following assault & mental pollution d=1.19***. Mental pollution: & CAPS r=.59***; & PSS-SR r=.53***; & feelings of dirtiness r=.45***. Evoking memory of assault vs pleasant memory d=1.86***. Urge to wash after memory d=1.22***.

Ishikawa et al (2014)

Experimental Washing behaviour, contamination

Mental contamination indices (dirtiness, urge 

Main effect of: time np²= .743***; group np²= .101 n.s.. Time: feelings of dirtiness np²= .446***; urge to wash np²= .452***; 

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to wash, INE’s and ENE’s)

INE’s np²= .413***; and ENE’s np²= .447***.

Elliot & Radomsky (2013)

Experimental Disgust, appraisals (personal responsibility, perceived violation, physically dirty stimulus), anxiety, contamination

Mental contamination (feelings of dirtiness, urges to wash, INE’s, ENE’s)

Dirtiness: & VOCI-CTN r=.25*; & DS r=.24*; & post kiss man is dirty r=.31*. Urges to wash: & ASI  r=.25*; & DS r=.24*. INE’s &: VOCI-CTN r=.26*; responsibility r=.37**; violation r=.22*; post-kiss man is dirty r=.25*. ENE’s: & Violation r=.49**; & post kiss man is dirty r=.26**.

Coughtrey, Shafran & Lee (2013)

Experimental -Time (pre & post treatment) Mental contamination Pre to post-treatment: Y-BOCS d=1.55*; OCI-R d=1.84***; VOCI-MC d=1.42***; TAF d=2.24***; BDI-II d=.79**; BAI d=.60***

* p<.05, ** p<.01, *** p<.001

TAF=Thought-Action Fusion; BFNE=Brief Fear of Negative Evaluation; INE=internal negative emotions; ENE=external negative emotions; DV’s=dependent variables; OC=Obsessive Compulsive; DS=disgust sensitivity; BDI-II=Beck Depression Inventory; ASI=Anxiety Sensitivity Inventory; Y-BOCS=Yale–Brown Obsessive Compulsive Scale; CAPS=Clinician-Administered PTSD Scale; CTAF=Contamination Thought-Action Fusion Scale ; CSS=Contamination Sensitivity Scale ; PPTS-R= Purdue PTSD Scale-Revised; PTCI= Posttraumatic Cognitions Inventory; S-CTN=Sensitivity to Contamination Scale; CTN-TAF=Thought-Action Fusion – Mental Contamination Scale

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Predictor variables. A vast array of predictor variables (see Table 2) were found

across the studies. Due to this, the variables were grouped into 5 categories and the number of

studies that looked at each of these categories was calculated. The five categories were: (1)

Dispositional Variables (which includes personality and appraisal variables, and morality);

(2) Anxiety; (3) Psychological Distress (e.g. psychopathology); (4) Behavioural Variables

(including contamination and safety behaviours); and (5) Emotion Variables (e.g. Disgust and

Fear of negative evaluation).

Dispositional variables. Nine studies reported using predictor variables within the

category of dispositional variables. This category included predictor variables of:

neuroticism, appraisal variables (which include feelings of responsibility, violation,

immorality and perceptions of a stimulus as physically dirty or clean), sensitivity to

contamination, Christian religiosity, intrinsic motivation toward the Christian religion, and

feelings of betrayal. Both experimental and correlational designs were employed with this

variable and therefore different effect size measures were reported. For the correlational

analyses (5 studies) effect sizes ranged from r=.22 to r=.59, which represents a small to large

effect size. Radomsky and Elliot (2009) used three appraisal variables in their study and

found that appraisals could significantly predict mental contamination on the two indices of

feeling of dirtiness (responsibility r=.39; violation r=.41; immorality r=.28 all at p<.001) and

urge to wash (responsibility r=.37; violation r=.31; and immorality r=.36 all at p<.001) better

than contact contamination (dirtiness r=.32, p<.001; urge to wash r=.25, p<.05). They also

found that physical contamination fear could predict mental contamination as measured by

the indices of internal (β=.92, t=2.50, p=.015) and external negative emotions (β=.71, t=2.20,

p=.03). In support of this finding, Elliot and Radomsky (2013) also found that appraisal

variables accounted for a significant amount of variance in mental contamination through

predicting the amount of internal negative emotions experienced (responsibility r=.37, p<.01;

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violation r=.22, p<.05) and also by predicting the external negative emotions felt (violation

r=.49, p<.01)

The experimental designs used Cohen’s d (d), Eta-squared (n²), and Partial Eta-

Squared (np²) to report effect sizes. Cohen’s d effect size was reported by 2 studies, ranging

from d=.69 to d=1.89, which represents a medium-large to very large effect size. Only 1

study (Elliot & Radomsky, 2009) reported n² (n²=.04 to n²=.53), demonstrating that the

personality variable can explain 4%-53% of the variance in contamination scores. This

suggests that the amount that dispositional variables are contributing to the relationship with

mental contamination is quite variable. However, this is only an estimate of the sample, not

the population and as a result, is likely to be inflated due to the study that reported this effect

size only having 148 participants. Elliot and Radomsky (2009) found that there were

significant group differences between participants who had heard an audio recording of a

consensual kiss and those that heard a recording of a non-consensual kiss, for the four indices

of mental contamination (feelings of dirtiness (F(1,136)=15.65, p<.001, n²=.26); urges to

wash (F(1,136)=20.90, p<.001, n²=.32); internal negative emotions (F=(1,136)=11.19,

p<.001, n²=.20); and external negative emotions (F(1,136)=50.76, p<.001, n²=.53)). They

also found that there was a main effect of the desirability of the kiss (F(1,136)=71.42, p<.001,

n²=.34), whereby the less desirable the kiss was perceived to be by the participant, the greater

the amount of mental contamination was experienced. These findings were supported by

Fairbrother, Newth and Rachman (2005) who found that participants in the non-consensual

kiss condition felt more angry, upset and anxious and had more associated features, such as

feeling ashamed, cheap and sleazy.

Anxiety variables. Only 2 studies reported using anxiety as a predictor variable.

Variables were only included in this category if they were specific measures of anxiety,

whether that be state or trait anxiety, sensitivity to anxiety, or not specified. Formal diagnoses

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of anxiety disorders (e.g. OCD) were included in the Psychological Distress category due to

their diagnostic properties. Both of these studies employed a correlational design (Herba &

Rachman, 2007; Radomsky & Elliot, 2009) and found that that there was a positive

relationship between anxiety sensitivity and feelings of dirtiness. However, effect sizes only

ranged from r=.26 to r=.28 (small effect), suggesting that whilst there is consistency within

the reported effect of the relationship, as the reported effect size is only small, the

relationship is not as strong as may have been previously predicted.

Psychological distress. The category of psychological distress, which includes

diagnoses such as depression, OCD and PTSD; as well as trauma and abuse, is made up of 11

predictor variables across all of the studies. Coughtrey et al. (2012) found that mental

contamination had a strong relationship with OCD symptom severity (r=.61, p<.001) and also

that it was positively correlated with the construct of Thought Action Fusion (TAF) which is

commonly presented in those with OCD (r=.49, p<.001). In the experimental studies, effect

sizes ranged from d=.35 to d=1.22 (small-medium to large). Fairbrother and Rachman

(2004) found large effect sizes and a significant effect of evoking a memory of a previous

sexual assault versus evoking a pleasant memory (F(4) =37.22, p<.001). They also found that

there was a stronger urge to wash in the study for those women who reported washing after

the initial assault (t(12.93)=-2.94, p=.006). Similarly, Badour et al. (2013) found that there

was a significant change in feelings of dirtiness (F(5,34)=5.89, p=.001) after an

individualised traumatic event script, and also changes in urges to wash (F(5,34) =6.90,

p<.001). In this study, the effect size was expressed as the Semi-Partial correlation squared

(sr²), which is a measure of variance. Here there was a range of sr²=.26 to sr²=.32, which

represents the predictor variable, (posttraumatic stress (PTS) symptoms) explaining 26%-

32% of the variance in the mental contamination indices (feelings of dirtiness and urges to

wash).

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Behavioural variables. The majority of studies (86.4%) included at least one

behavioural predictor variable. For the purpose of this review, these predictor variables were

categorised as those that included safety behaviours (e.g. washing behaviour, avoidance) and

also contact contamination. Again, there was a wide range of effect sizes reported across the

studies. 3 studies used correlational analyses and reported effect sizes of r=.20 to r=.52 (small

to large). 2 of these studies found that fear of contact contamination could significantly

predict mental contamination (Herba & Rachman, 2007 (urge to wash r=36, p<.01; feelings

of dirtiness r=.33, p<.01); Radomsky & Elliot, 2009 (urge to wash r=, p<.05; feelings of

dirtiness r=.25, p<.001)). Conversely, Elliot and Radomsky (2013) found that symptoms of

contact contamination fear were unable to consistently predict indices of mental

contamination.

Studies reporting the Cohen’s d effect size (7 studies) all reported large effect sizes,

however there was a vast range between these (d=.71 to d=3.34). The study which reported

the highest effect size (d=3.34) was Fairbrother et al. (2005), who found that a large

difference in reported urge to wash between consensual and non-consensual kiss conditions

(t(104.45)=19.44, p<.001), which demonstrates that the experimental paradigm was

successful in inducing mental contamination. Effect size expressed as amount of variance

was reported by 5 studies; with np² values ranging from np²=.10 to np²=.74 (10%-74%

variance); and n² reported values ranging from n²=.19 to n²=.35 (19%-35% variance). These

studies primarily focused on washing behaviour and its relationship with mental

contamination. Ishikawa, Kobori, Komuro and Shimizu (2014) found that mental

contamination could be reduced by washing behaviour (F(12,35)=11.31, p<.001, np²=.74) in

a nonclinical sample, although it is no more effective than waiting without washing for

feelings of dirtiness, urge to wash, and external negative emotions to reduce (F(4, 43)=1.08,

p=.09, np²=.109). Similarly, Lee et al. (2013) found that in comparison, groups who had

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contact contamination and mental contamination induced respectively, all experienced

increased feelings of internal dirtiness and urges to wash, as well as actual washing or

neutralising behaviour. Whilst this behaviour was more prevalent in the contact

contamination group, there were no significant differences in actual washing behaviour

across the groups. In addition to this, Coughtrey et al. (2014a) found that re-evoking thoughts

that are likely to induce mental contamination and engaging in subsequent washing

behaviour, prevents mental contamination from spontaneously decaying

Emotions and other vulnerabilities. This category includes predictor variables that

were predominately emotions, emotional responses, or other potential vulnerabilities.

Examples of these variables are: disgust propensity/sensitivity, guilt, fear of negative

evaluation from others, sexual attitudes, and prior experience with unwanted sexual contact.

10 studies reported predictor variables within this category. Effect sizes ranges from: r=.24 to

r=.60 (small-medium to large) for correlational designs. The majority of studies reported in

this category identify disgust propensity as a variable related to mental contamination.

Carraresi et al. (2013), Herba and Rachman (2007) and Radomsky and Elliot (2009) all report

small-medium effect sizes for the relationship between urges to wash and disgust sensitivity

(r=.29, r=.29, and r=.28 respectively). Badour et al. (2013a) however, found a larger

correlation of r=.43 between mental contamination and disgust sensitivity. These studies

show that disgust propensity appears to be a variable that is consistently and significantly

related to mental contamination.

For experimental paradigms, a range of different effect sizes were reported, which

included: d=.45 to d=1.07 (medium to large). Amount of variance of the variable was also

reported by Elliot and Radomsky (2009) (n²=.20 to n².53, 20%-53% of variance explained);

and Berman, Wheaton, Fabricant and Abramowitz (2012) (f²=.06, small effect). Berman et al.

(2012) measured the effect of guilt on inward contamination, which was being used as a

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subscale measure of mental contamination. They found that sexual abuse emerged as a

significant predictor of washing rituals (β=.25, t=3.31, p<.001) and emotional abuse emerged

as a predictor of inward contamination (β=.28, t=2.36, p<.05); however, guilt induction was

the strongest independent predictor of inward contamination (R²=.06, p<.05) and as a

significant predictor of washing rituals (R²=27, p<.001).

Whilst the majority of the studies in this review investigated behavioural predictor

variables in order to understand mental contamination, only 2 studies examined anxiety as a

predictor variable, which is an unexpected finding. It was noted however, that anxiety was

also used as an outcome variable in 5 studies (Badour, Feldner, Babson, Blumenthal &

Dutton, 2013b; Coughtrey, Shafran & Lee, 2013; Coughtrey, Shafran & Rachman, 2014a;

Fairbrother & Rachman, 2004; Lee et al., 2013), therefore suggesting that there is a

relationship between anxiety and mental contamination, but it may be that is more of an

associated construct that results from mental contamination, rather than predicting it.

Mental contamination in mediation models. Four studies investigated the role of

mental contamination in mediation models. In these studies, mental contamination was used

as both a mediator and a predictor variable. Olatunji, Elwood, William and Lohr (2008)

examined the relationship between mental contamination, PTSD cognitions, and PTSD

symptom severity. They found that PTSD cognitions mediated the relationship between

feelings of mental contamination and PTSD symptom severity (change in R²=.40 to .14). No

Bootstrap analysis was reported in this study. Carraresi, Bulli, Melli and Stopani (2013)

found that mental contamination partially mediated the relationship between disgust

propensity and fear of contamination (Bootstrap=.03 (SE=.02; BCa-CI 95%, p=.006-.006)).

Badour, Fldner, Blumenthal and Bujarski (2013) found a significant effect of disgust

sensitivity on mental contamination (β =.31, SE=.14, BC 95% CI [.09, .67], k2=.30), which

accounted for 71.77% of the variance in the model. They also found that mental

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contamination mediated the relationship between disgust sensitivity and PTSD symptom

severity (β =.23, SE=.46, BC 95% CI [.001, 1.79], k2=.30), accounting for 44.9% of the

variance in the model. Furthermore, Melli, Bulli, Carraresi and Stopani (2014) found that

mental contamination partially mediated the relationship between disgust propensity and

contamination-related OCD symptoms (Bootstrap: (β =.04, SE=.01, BCa-CI 95%: .013-

0.68)), with this indirect effect of mental contamination accounting for 53% of total effect in

the model.

Overall, these studies demonstrate that the relationship between mental contamination

and psychological distress is not only being investigated; but that it is being explored in a

number of different ways. They show that mental contamination has a definite relationship to

psychological disorders such as OCD and PTSD and that emotion may be playing a role here

too, with the inclusion of disgust propensity in OCD. Mental contamination appears to impact

upon the symptom severity of these disorders, which is an important finding as it has

important clinical implications on the treatment of these disorders.

Qualitative studies. Whilst the majority of the studies included in this review are

quantitative (22), 1 study used qualitative analysis to investigate the construct of mental

contamination (Coughtrey, Shafran, Lee & Rachman, 2012). The study found that mental

contamination often has a human source and that it can take a number of forms, including

induction following a violation, association with immorality, and morphing fear.

Interestingly, they also found that self-generated contamination occurred with 60% of their

participants reporting feeling contaminated when they had violated their own moral standards

by doing something they felt was bad or sinful. This suggests therefore that whilst mental

contamination is induced by a human source, that source can be internal as well as external.

This study therefore provides evidence for the role of self-contamination in OCD,

highlighting the important role of appraisals in treatment.

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Discussion

The present review examined the construct of mental contamination across 23 studies

and 2501 participants, which reported investigation into the relationship between mental

contamination and a range of other variables. The aim of this review was to understand how

mental contamination is defined and understood and the relationship it has to other forms of

psychological distress. The synthesis was conducted with studies across 3 continents (North

America, Europe and Asia) and included both student and community samples. Both clinical

and nonclinical samples were included in the review, with the majority of those studies that

used clinical samples focusing on participants with a diagnosis of OCD. A predominantly

female sample was used across the studies (77%) with an average age of 25.03 years

(SD=6.75). The inclusion of mainly female samples creates difficulty in the generalizability

of the findings; further research should aim to address this gender bias in the research in order

to gain a more balanced picture of mental contamination and its relationship to psychological

distress. Moreover, whilst there is relative consistency across the studies in regards to the age

range of participants. Solely adult samples were included, which indicates that again

generalising the findings is difficult. Further research therefore should address this also,

through the investigation of the construct with both older adult, and child and adolescent

populations.

It was found that there was some consistency across all studies in terms of their

definitions of mental contamination. This relatively high consistency in the conceptualisation

of mental contamination allows for a clear understanding of the construct and enables

findings to be comparable. This therefore helps to ensure that future research is consistent in

their investigations of the construct. The main reference for definition of mental

contamination is Rachman’s (1994) “a sense of internal uncleanness which can and usually

does arise and persist regardless of the presence or absence of external, observable dirt”.

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Mental Contamination and Contact Contamination

The main focus of the research to date has been investigating the relationship between

contact and mental contamination. This is a logical progression, due to the recognition of

mental contamination developing naturally from contact contamination, as observed in

clinical case studies (Coughtrey, Shafran & Lee, 2013; Gershuny et al., 2003). However, it

appears that in a bid to fully understand the construct the research field has moved in very

different directions, resulting in a confusing picture.

A consensus was reached across many of the studies that there is a definite association

between mental contamination and contact contamination, but that they are separate

constructs. Coughtrey et al. (2012) reported similar levels of mental and contact

contamination and concluded that whilst mental contamination is related to contact

contamination, it is in fact a distinct construct. Similarly, Herba and Rachman (2007) found

that contact contamination was a significant predictor of mental contamination, and

Radomsky et al. (in press) postulated that contamination occurs in the absence of contact,

therefore adding to support to the argument that mental contamination and contact

contamination are separate constructs.

Moreover, fear of contamination was found to have a significant relationship with

mental contamination across many of the studies. Radomsky and Elliot (2009) found that

physical contamination fear could predict mental contamination; specifically on the indices of

internal negative emotions and external negative emotions. Similarly, Carraresi et al. (2013)

found a relationship between mental contamination and fear of contamination, but in the

opposite direction, whereby mental contamination partially mediated the relationship between

disgust propensity and fear of contamination. This is supported by Melli et al. (2014), who

also found this link between mental contamination and fear of contamination, when

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controlling for depression and generalised anxiety. They further developed their findings to

suggest that this provides evidence for a theoretical framework, in which the manifestation of

contamination related OCD symptoms depend upon both mental contamination and disgust

propensity. These findings demonstrate that whilst it is clear that there is an association

between mental and contact contamination, the direction of that association remains

uncertain.

Measurement and Interpretation of Mental Contamination

This synthesis found that a range of predictor variables have been used in the

measurement of mental contamination. Whilst this demonstrates that the field is extremely

varied and wide-reaching in endeavouring to enhance our understanding of mental

contamination; due to the small amount of literature in this field at present, it is difficult to

make clear assertions about the construct and its relationship to psychological distress and

related psychopathology. However, this variation is partly a function of methodological

quality and the limited replication of most findings. Consequently, further research should

aim to replicate existing findings to ensure consistency and allow for firmer assertions to be

made.

Additionally, across all 23 studies, 10 different measures of mental contamination

were used to assess the feelings of mental contamination experienced by the participants.

This lack of consistency in measurement makes it difficult to draw any firm conclusions from

the literature, due to the lack of consistency across studies. In addition, there is a lack of

reported figures of internal consistency and reliability of some measures of mental

contamination that were used, and variation in those figures that were reported. Again this

makes it difficult to assess not only if the measures are in fact consistently measuring mental

contamination, but also which aspects of mental contamination each of them are addressing.

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A comparison of the measures has not been conducted to date; therefore when reviewing

studies that have used this vast range of measures it makes it very difficult to draw

comparisons as it is impossible to be certain that they are all in fact measuring the same

aspects of mental contamination. In addition, some studies reported the specific indices of

mental contamination that were being measured within their study (e.g. feelings of dirtiness,

urges to wash), but not all studies reported this. Therefore, whilst it would be expected that

these would be the aspects of mental contamination that would be focused upon in any

measurement of the construct, due to definitions of the construct being very similar; this

assertion cannot be made due to unavailability of the data.

To facilitate the presentation of review findings, predictor variables were placed in

broad categories. Whilst this was beneficial in being able to analyse the variables with some

consistency, the findings from the category groupings displayed wide ranging effect sizes;

which still meant a lack of consensus across variables remained. This was especially evident

in the psychological distress category. Whilst it was a logical step to group these diagnoses in

order to effectively review the studies, it could be argued that due to their differing

presentations, grouping them could be a fairly reductionist approach and could be insufficient

in capturing the specific nuances within each variable’s relationship with mental

contamination. However, due to majority of disorders included in the category of

psychological distress having anxiety at their core (PTSD, OCD), or being a closely linked

construct to anxiety (e.g. depression), it would be expected that the individual variables in

this category share similarities in their relationship with mental contamination, therefore

adding support to the decision to group the variables in order to analyse them more

effectively. Whilst it could be argued that the arbitrary approach of categorising the variables

limits the ability to interpret, it could also be argued that without the categories it would be

extremely difficult to try and compare the literature on mental contamination in any kind of

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way due to the vast number of variables covered to date. Therefore, whilst there are

limitations to the approach taken, until there is more consensus within the literature, it

appears to be the more conservative approach.

Similarly, a number of different effect sizes were reported in the data, and whilst a

comparison was able to be made, it was found that there was a lot of variation within the

category variables, with effect sizes ranging from small to large in most instances. This again

makes it difficult to make any clear assertions and highlights the need for more consistency

within the data.

The Role of Appraisals

A theme that appeared across many of the studies was of the role of appraisals in the

development and maintenance of mental contamination; with Elliot and Radomsky (2103)

finding that appraisal variables accounted for a significant amount of variance in mental

contamination. In addition to this, Radomsky and Elliot (2009) found that appraisals were a

better and more significant predictor of mental contamination than both fear of physical

contamination and, even more so than specific and general vulnerabilities. Alongside this,

Coughtrey (2012) found a relationship between mental contamination and violation of moral

standards, with 60% of participants reporting more contamination when they felt they had

done something “bad” or “sinful”. Coughtrey (2012) posits that this provides evidence for the

role of self-contamination in OCD and also highlights the important role of appraisals in

treatment.

The influence of morality on mental contamination was also found in relation to the

source of contamination. Elliot and Radomsky (2012) found that when participants were

given moral information about the source (in this instance a person), this was overridden

when the act the source performed was immoral. However, a neutral act did not override

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immoral information. This suggests that the appraisal of immorality, whether seen through

behaviour or heard as information, is experienced as more contaminating and potentially

dangerous than either neutral or moral information. Ishikawa et al. (2014) propose that

cognitive factors, such as personal responsibility, may be playing a role here, whereby the

greater degree of responsibility an individual might feel in regards to a contaminating event,

the greater the level of mental contamination they experience. However, further investigation

would be needed in this area to determine any characteristics or personality variables, for

example, introspection, which may make people more vulnerable to rationalising a

contaminating event in a self-blaming way.

Methodological issues

There were some limitations identified across the studies. For example, as mentioned

previously in this review, the lack of consistency across the studies and within the data

produced has made it difficult to draw out any firm conclusions about the relationship

between mental contamination and psychological distress. Whilst each study produced clear

findings, the difference between their methodological approaches has made it difficult to

analyse as a whole. Moreover, 5 studies failed to report where they collected their data. This

therefore raises issues of generalizability as the study would not be replicable because of this

lack of information.

Another key reflection in the analyses of the studies is that many (8) have their

methodology based upon the consensual/ non-consensual kiss scenario for inducing mental

contamination (Elliot & Radomsky, 2009; Elliot & Radomsky, 2012; Elliot & Radomsky,

2013; Fairbrother, Newth & Rachman, 2005; Herba & Rachman, 2007; Ishikawa et al., 2014;

Rachman et al., 2012; Radomsky & Elliot, 2009). In terms of consistency, this is a positive

step as it allows for firm assertions to be made about the findings that are being reported.

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These studies found that participants who imagined a non-consensual kiss experienced more,

and a broader range, of negative emotions and that internal negative emotions, such as shame,

were experienced to a greater degree in younger participants (Radomsky & Elliott, 2009).

Stronger urges to wash and increased feelings of dirtiness were also reported by those in the

non-consensual kiss conditions.

This specific scenario gives the field a good base for exploration of other variables

and constructs that are related to mental contamination by having a scenario for inducing

mental contamination that has been found to be reliable. However, on investigation, it

appears that many of the studies that have used this scenario have all come out of the same

research group, which could lead to a publication bias within the literature. Nevertheless, this

is just a consideration at present and due to the current limited research in the field, this is

less of a concern, although further research by other groups would be encouraged to ensure

reliability of findings achieved.

Future Directions

This synthesis has demonstrated that the majority of studies in the field of mental

contamination, to date, have focused on behavioural predictor and outcome variables when

investigating contamination. This demonstrates that whilst the construct is being looked at

from many viewpoints (highlighted by the large number of predictor variables used across the

studies) the focal point of research remains on distinguishing the construct of mental

contamination as a being separate construct from contact contamination. This is not a

surprising finding due to the relative novelty of the research in this area. Understanding that

mental contamination and contact contamination are in fact separate constructs was an

important area of research in defining and increasing understanding of mental contamination.

However, it would be suggested that more exploratory research in the field is now conducted

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in order to replicate findings from studies that are focused on other variables that may have a

significant relationship with the construct.

The recent research focusing on issues of morality and betrayal have found that these

are important areas for further investigation in the field due to the role of self-contamination

and appraisals that has been highlighted in other research (Coughtrey, Shafran, Lee &

Rachman, 2012). This has important clinical implications, in terms of how sensitivity to

associated internal negative emotions, such as guilt and shame, could affect a person’s

likelihood to feel mentally contaminated when faced with a stimulus that could induce these

feelings. It is therefore hypothesised that the propensity people have for these negative

emotions could demonstrate an underlying vulnerability for anxiety disorders such as OCD

and PTSD.

This line of research could be especially evident in the investigation of mental

contamination within different age groups. Radomsky and Elliott (2009) identified that

internal negative emotions were experienced to a greater degree in younger participants in

their study; however, this finding has not been reported in any other study, and it appears that

this hypothesis has yet to be tested. This synthesis has demonstrated that the majority of

research to date has used adult samples. With a potential future direction of the research area

focusing on the importance of appraisals with the construct, a crucial direction to follow

would be measuring mental contamination in young people. This would have the advantage

of assessing if there is a propensity for mental contamination in this age group and whether

this is comparable to the results from the adult samples. This could help to identify whether

mental contamination is a potential indicator for underlying vulnerability to other anxiety

disorders, such as OCD. Investigating a younger population would also enable further

investigation of the indices of mental contamination and whether there are any differences in

susceptibility to these, as observed in Radomsky and Elliott’s (2009) study.

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Likewise, focusing clinical work on appraisals specifically, could be an important

future direction to take due to this seeming to be a theme across the studies that this paper

reviewed. Studies have found that an adapted CBT focusing on directly addressing mental

contamination was more effective for some participants (Coughtrey, Shafran & Lee, 2013)

and that appraisals played a key role in this. This therefore highlights the importance of

investigating the role of appraisals further as research is beginning to demonstrate that they

seem to have a significant impact upon mental contamination, which could have important

clinical implications.

Conclusions

This synthesis has systematically and critically evaluated the research to date in the

field of mental contamination. It has found that the majority of the research has focused, in

some part, on adding to the evidence base that mental contamination is a separate construct

from contact contamination. Now that a consensus has been reached on this point, the field

has begun to move in different directions in an aim to further explore and understand the

construct. Whilst this is promising in terms of widening the knowledge base, it has led to a

confusing picture in the literature as there is less reliability between studies because of the

lack of replication of findings. This therefore means that it is difficult to make any clear

assertions about the relationship between mental contamination and psychological distress in

a more specific manner. There does however, seem to be some promising findings emerging

from the research into mental contamination and morality and associated negative emotions

(such as shame and guilt). Whilst the research in this area remains in its infancy, replicable

results across studies are being found, therefore warranting further investigation. Research in

this area also has potential important clinical implications for the treatment of patients

presenting with OCD as understanding how these associated negative emotions interact with

mental contamination could help to identify specific vulnerabilities to the construct in the

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future and therefore direct clinicians to modified CBT approaches for OCD, which taken into

account the clients propensity for mental contamination.

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Clinical Experience: a brief overview

Detailed below is a summary of each of the placements I completed during the three

years of my training. I have outlined the main models used for each placement and

experiences gained.

Community Mental Health Recovery Service (CMHRS), November 2013 – September

2014

I worked mainly within a Cognitive Behavioural Therapy (CBT) framework across a

range of presentations and ages. I also developed my interest in integrative working by

completing CBT for psychosis family work alongside another psychologist. I completed

neuropsychological assessments and contributed to a neuropsychological case study, which

was published. I gained experience in using Dialectical Behaviour Therapy (DBT) through

co-facilitating a weekly DBT group within the service alongside another psychologist. I had

the opportunity to work on complex cases and had to liaise with many different services as

part of this role. This enabled me to gain a better insight into how services work and to

strengthen my skills in communicating with other professionals and group formulation. I also

completed a service evaluation within the service which I presented the findings of to the

MDT.

Child and Adolescent Mental Health Service (CAMHS), October 2014 – March 2015

This placement enabled me to develop my skills in working with young people. I was

able to work both individually and in group settings with a variety of ages and presentations,

often working systemically with parents alongside the young person. I continued to develop

my CBT skills, alongside learning new skills in narrative therapy, working with children

from 8-18 years old. I continued to develop my skills in neuropsychological assessment,

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learning to adapt my communication style to meet the needs of the young person and family.

I also completed ASD and developmental assessments.

Memory Assessment Service (MAS), April 2015 – September 2015

My role was split between providing psychological invention for people recently

diagnosed with dementia and their family and conducting neuropsychological assessments

and diagnoses of dementia. This role enabled me to develop my strong interest in

neuropsychology. Under the supervision of a neuropsychologist I developed many strengths

in this area, in both my ability to work in a hypothesis-driven way during assessment and also

in how to communicate the results of assessments in a sensitive way, whilst also making the

information accessible to the individual. The therapeutic part of this placement enabled me to

continue working within a systemic framework, thinking about the wider systems involved

around a person who has been diagnosed with dementia.

Specialist Pediatric Neurorehabilitation Service, October 2015 – March 2016

I developed my skills in neuropsychological assessment and learned more about

neuroanatomy and brain-behaviour relationships. I assessed young people with a range of

acquired brain injuries (ABI). I also worked therapeutically, in a narratively informed way

with young people and their families. All of the experiences I gained on this placement were

systemically informed due to the nature of working with children and young people with an

ABI. I worked alongside the wider MDT in delivering interventions to young people and

their families. I developed skills in consultation to staff teams and also did service delivery

work through the development of training workshops for staff on understanding the wider

impact of ABI and working with behaviour that challenges. This included delivering training

on the neuroanatomy involved in emotional response and distress. I also completed specific

cognitive rehabilitation work with young people.

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Community Team for People with Learning Disabilities (CTPLD), April 2016 –

September 2016

I continued to develop skills in neuropsychology and systemic practice on this

placement, but with a learning disability population. I therefore learned to adapt materials and

communication style to meet the needs of and to make them accessible for each client. I

developed skills Cognitive Analytic Therapy (CAT), using this model for a piece of

individual work and also receiving weekly supervision using this model. I also worked in an

integrative way with other therapeutic cases using CBT, systemic and narrative ideas to

inform the intervention. I gained experience of using Positive Behavioural Support (PBS)

working with behaviour that challenges. I also gained a lot of experience in consultation work

and supervision of assistant psychologists.

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Table of Assessments Completed During Training

Year I AssessmentsASSESSMENT TITLE

WAIS-IV WAIS Interpretation ReportService-Related Project How effective is the Coping Skills Group? A service

evaluation of care coordinators views on a CBT group within a Community Mental Health Recovery Service

Practice Case Report Cognitive behavioural therapy assessment and formulation of a man in his early forties with Bipolar disorder presenting with low mood and negative thinking patterns

Problem Based Learning – Reflective Account

PBL Reflective Account

Major Research Project Literature Review

What is mental contamination and how is it related to psychological distress?

Adult – Case Report 1 Assessment and intervention of a man in his early seventies with Bipolar disorder presenting with low mood and anxiety

Adult – Case Report 2 Neuropsychological assessment of a man in his mid-forties with a history of multiple head traumas and depression

Major Research Project Proposal

Do appraisals of personal responsibility affect how much mental contamination individuals experience in a comparison between ‘victims’ and ‘perpetrators’ of moral transgressions.

Year II AssessmentsASSESSMENT TITLE

Professional Issues Essay

How as a clinical psychologist could you help service users/ carers manage the transition from one age-related service to another (e.g. from CAMHS to AMH or from AMH to OA services)?

Problem Based Learning – Reflective Account

Problem Based Learning Reflective Account

Child and Family– Case Report

An integrative formulation and intervention of an 8-year-old boy presenting with anxiety and intrusive thoughts.

Personal and Professional Learning Discussion Groups – Process Account

PPLDG Process Account

Older People – Oral Presentation of Clinical Activity

Oral Case Report: Communicating Sensitive Information

Year III Assessments

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ASSESSMENT TITLE

Major Research Project Empirical Paper

Do appraisals of responsibility affect the amount of mental contamination experienced in a comparison between ‘victims’ and ‘perpetrators’ of moral transgressions?

Personal and Professional Learning – Final Reflective Account

On becoming a clinical psychologist: A retrospective, developmental, reflective account of the experience of training

Specialist – Case Report

An integrative formulation and intervention of girl in early adolescence with an acquired brain injury in the context of a neurorehabilitation service.