Religiosity, Thought Action Fusion, and Obsessive-Compulsive Disorder in the UK and Malaysia

Abstract

Over decades, many authors have suggested that religiosity is related to obsessive symptoms and cognitive model of OCD (Steketee, Quay, &White, 1991; Shafran, Thordarson, & Rachman, 1996; Shafran, Watkins, & Charman, 1996; Abramowitz, Huppert, Cohen, Tolin, & Cahill, 2002; Yorulmaz, et al., 2009; Williams, et al., 2013) but the relationship is unclear and the evidence to date is weak. The lack of scales to adequately assess religiosity/spirituality among individuals may have affected the findings to date. Therefore, the present study primarily aimed to investigate the relationship between religiosity, Thought Action Fusion (TAF), and OCD among two multicultural samples, namely 1) in the United Kingdom and 2) Malaysia. For the purpose of the main study, a multidimensional measure of religiosity/spirituality was developed in order to be used for a range of religions and cultures. The existing definitions of religiosity and spirituality in academic literature have yet to achieve universal consensus, as they are influenced by various disciplinary viewpoints and research environments. Additionally, discrepancies in the conceptualization and measurement of these constructs may diminish the significance of studies in this field. In response to this challenge, the Newcastle Spirituality and Religiosity Scale (NSRS) was developed as a multidimensional instrument that can be applied across different religious traditions, non religious groups, and cultural contexts. This scale consists of eighty-two items, organized into eight dimensions: Religious Behavior, Non-Theistic Spirituality, Theistic Spirituality, Intrinsic Religiosity, Personal Extrinsic Religiosity, Social- Family Extrinsic Religiosity, Religious Fundamentalism, and Quest. In the beginning, multiple steps were conducted in the development of 82 items of the Newcastle Religiosity and Spirituality Scale (NSRS). Results of Exploratory Factor Analysis (EFA) showed consistencies in terms of factor structures in both samples, with a few differences in the factor structure. The NSRS subscales showed excellent internal consistency and validity in both samples. A previous study has investigated the internal consistency and construct validity of the Newcastle Spirituality and Religiosity Scale (NSRS) through Exploratory Factor Analysis (EFA). Nonetheless, the absence of studies confirming the scale's reliability and validity, coupled with varying results, has prompted significant inquiries in both the United Kingdom and Malaysia. Consequently, the present study aims to further examine the psychometric properties of both the original and Short Versions of the NSRS. The initial phase concentrates on the convergent and divergent reliability of the NSRS-Short Version, utilizing a sample of 130 participants from Malaysia. The findings revealed consistent results that affirm the convergent and divergent validity of the NSRS SV. Although some unexpected and noteworthy outcomes were noted, the majority of the subscales exhibited correlations that met expectations, indicating strong convergent and divergent validity. The second phase evaluated the test-retest reliability among a sample of 130 individuals in Malaysia over four weeks, employing Pearson correlation and Intraclass Correlation. The results, derived from Pearson correlation and the Intraclass Correlation Coefficient (ICC), demonstrated a high degree of reliability. In the final phase, Confirmatory Factor Analysis (CFA) was utilized to assess the original version of the NSRS with a sample of 564 individuals from the United Kingdom. The CFA was based on three models developed from the EFA findings from the previous study (Alias, Freeston, & Rosenkranz, 2012): (a) Model 1 - an eight correlated factor model, (b) Model 2 - a seven correlated factor model based on the UK sample identified in EFA, and (c) Model 3 - a seven correlated factor model based on the Malaysian sample identified in EFA. It is crucial to acknowledge that the samples in this study differed in ethnicity, religion, cultural dimensions, and other characteristics. However, none of the models assessed achieved an optimal goodness of fit, highlighting the need for further investigation. This is especially crucial in heterogeneous samples that encompass particular religious or non-religious demographics. Although the optimal models for the samples were not identified and some discrepancies among the models were noted, the findings from the CFA indicated that the eight factors of the scale exhibited an adequate goodness of fit following the requisite modifications. Additionally, the findings consistently supported the factor structures and the removal of certain items, which aligned with the shortened version of the NSRS. Next, the relationship between the key components of the main study (i.e., religiosity/spirituality variables, Thought Action Fusion (TAF), and OCD) was investigated among 493 participants in the UK and 581 participants in Malaysia. In both samples, participants were recruited through both paper and pencil and Internet-based methods. Five measures were used in the studies, namely the Obsessive-Compulsive Inventory- Revised (OCI-SV), the Depression Anxiety Stress Scale (DASS-21), the Student Thought-Action Fusion Questionnaire (STAF-Q), the Vancouver Index of Acculturation Revised (VIA-R), and the new religiosity measure, Newcastle Religiosity and Spirituality Scale (NSRS). Further, Thought Action Fusion (TAF) variables were examined as a mediator in understanding how religiosity/spirituality relates to OC symptoms. Next, the role of Religious Fundamentalism as a moderator was examined in the indirect effect relationship. The studies in the UK and Malaysia found several consistent findings with a few inconsistent findings. First, there were positive correlations between TAF and OCD in both samples. Second, religiosity/spirituality was indirectly related to OC symptoms through TAF Likelihood in both studies, but in opposite directions (i.e., positive direction in the UK study and negative direction in the Malaysian study). Third, results of the conditional indirect effect showed that Religious Fundamentalism did moderate the indirect effect of religiosity/spirituality on OC symptoms in both samples. This finding also suggests that Religious Fundamentalism may potentially be a protective factor against the development of obsessions by the direction of the direct and indirect effects of religiosity/spirituality on obsessions through TAF Likelihood in the Malaysian sample. The consistent findings across the two samples may be due to the similarities, such as age group, young, educated, and with a modern outlook, while the differing findings are perhaps understandable considering different sample characteristics, religions, and cultures. In terms of the cognitive model of OCD, the present results provide some support for theoretical proposals and empirical findings that suggest TAF Likelihood is related to OCD in the expected direction (i.e., higher TAF with higher OCD) in both studies. Although future studies are needed to replicate this finding in different samples, there is some support that some aspects of the cognitive model of OCD may be universal in both Western and non-Western countries. In sum, although subsequent studies are required in order to increase our understanding of cognitive models of OCD and vulnerability factors in OCD, these studies can contribute to a 6better understanding of religiosity, thought-action fusion, and OCD. There are also implications for cognitive therapy that addresses beliefs and appraisals of thoughts across countries and cultures.