J. Behav. Ther. & Exp. Psychiat. 46 (2015) 93e98
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Uncertainty, god, and scrupulosity: Uncertainty salience and priming god concepts interact to cause greater fears of sin Thomas A. Fergus*, Wade C. Rowatt Baylor University, USA
a r t i c l e i n f o
a b s t r a c t
Article history: Received 20 March 2014 Received in revised form 2 September 2014 Accepted 2 September 2014 Available online 10 September 2014
Background and objectives: Difficulties tolerating uncertainty are considered central to scrupulosity, a moral/religious presentation of obsessive-compulsive disorder (OCD). We examined whether uncertainty salience (i.e., exposure to a state of uncertainty) caused fears of sin and fears of God, as well as whether priming God concepts affected the impact of uncertainty salience on those fears. Method: An internet sample of community adults (N ¼ 120) who endorsed holding a belief in God or a higher power were randomly assigned to an experimental manipulation of (1) salience (uncertainty or insecurity) and (2) prime (God concepts or neutral). Results: As predicted, participants who received the uncertainty salience and God concept priming reported the greatest fears of sin. There were no mean-level differences in the other conditions. The effect was not attributable to religiosity and the manipulations did not cause negative affect. Limitations: We used a nonclinical sample recruited from the internet. Conclusions: These results support cognitive-behavioral models suggesting that religious uncertainty is important to scrupulosity. Implications of these results for future research are discussed. © 2014 Elsevier Ltd. All rights reserved.
Keywords: Fears of sin Intolerance of uncertainty God Obsessive-compulsive disorder (OCD) Scrupulosity
1. Introduction Researchers view difficulties tolerating uncertainty (i.e., intolerance of uncertainty) as being at the core of obsessive-compulsive disorder (OCD) (Grayson, 2010). Scrupulosity is a moral/religious presentation of OCD that is defined as “fearing sin where there is none’’ (Abramowitz & Jacoby, 2014, p. 140). The extant literature highlights the potential importance of uncertainty for understanding scrupulous fears. For example, within Abramowitz and Jacoby's (2014) cognitive-behavioral model, scrupulosity is marked by the tendency to misinterpret intrusive thoughts in ways that are not subject to assurance (e.g., Have I committed sin by mistake?). Uncertainty as to whether intrusive thoughts are sinful purportedly, in part, evokes fears about having committed sin or receiving punishment from God. In a separate line of research, uncertainty is viewed as leading to doubt or instability in one's sense of self (van den Bos, 2009) and this self-doubt causes anxiety (Echebarria-Echabe, 2013). Abramowitz and Jacoby (2014) highlighted the importance of self-doubt to scrupulosity, as they described commonly observed religious doubts that engender fears
* Corresponding author. Department of Psychology & Neuroscience, Baylor University, Waco, TX 76798, USA. Tel.: þ1 254 710 2651; fax: þ1 254 710 3033. E-mail address: [email protected] (T.A. Fergus). http://dx.doi.org/10.1016/j.jbtep.2014.09.003 0005-7916/© 2014 Elsevier Ltd. All rights reserved.
about sin or God (e.g., Am I pure enough?; Do I have sufficient faith in God?; Am I going to heaven when I die?). Taken together, these lines of research indicate that religious uncertainty may cause scrupulous fears. Some research suggests that religious priming (via God concept priming) provides a sense of order that reduces the emotional impact of uncertainty (Inzlicht & Tullet, 2010). As such, reflecting on God may mitigate the impact of uncertainty on scrupulous fears. Other research, though, has found that reflecting on God causes anxiety (Toburen & Meier, 2010), potentially because of evaluative concerns. For example, individuals who perceive that they are being watched by God may have concerns that their behavior will damage their standing in the eyes of God (McKay, Efferson, Whitehouse, & Fehr, 2011). This possibility is consistent with Shariff and Norenzayan's (2007) assertion that reflecting on God leads to perceptions that God is watching and wants individuals to behave, which has led researchers to conclude that moral impression management occurs as a result of reflecting on God (Preston & Ritter, 2013). Because scrupulosity is marked by concerns about morality and one's standing in relation to God (Abramowitz & Jacoby, 2014), reflecting on God would likely increase scrupulous fears. Interestingly, the available literature indicates a state of uncertainty may interact with reflecting on God to engender scrupulous
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fears. For example, reflecting on God could increase the saliency of religion (Inzlicht & Tullet, 2010), which, in the context of a state of uncertainty, might lead to religious uncertainty/doubt and scrupulous fears. This possibility is consistent with Abramowitz and Jacoby's (2014) cognitive-behavioral model of scrupulosity. Another explanation for an interaction between a state of uncertainty and reflecting on God comes from Gervais and Norenzayan (2012), who found that, among believers, priming God concepts caused public self-awareness. Public self-awareness is related to anxiety, with George and Stopa (2008) stating that “it may be the interaction between public self-awareness and negative images or impressions of self that creates the problem” (p. 68). Following from George and Stopa (2008), scrupulous fears may arise from a state of uncertainty, which is related to negative self-impressions, and the public self-awareness that results from reflecting on God. In sum, uncertainty is considered central to scrupulosity and yet its impact on scrupulous fears remains unexamined. In this study, we predicted that uncertainty salience (i.e., exposure to a state of uncertainty; van den Bos, 2009) and God concept priming would interact to cause scrupulous fears. We targeted fears of sin and fears of God, which are two central scrupulous fears (Abramowitz, Huppert, Cohen, Tolin, & Cahill, 2002). In an attempt to examine the specific importance of uncertainty salience to scrupulous fears, we used an insecurity salience control in which participants considered self-insecurity. Insecurity salience was used as a control because insecurity may best reflect the concept of uncertainty, within some models of this construct, among English-speaking respondents (McGregor, Prentice, & Nash, 2009). Using insecurity salience as a control was expected to provide a relatively stringent test as to the specific importance of uncertainty to scrupulous fears. Although it remains important to examine the targeted fears among patients with OCD, we used a group of community respondents. Our use of a nonclinical sample is informed by the purported continuous nature of scrupulosity (Abramowitz et al., 2002) and data indicating that obsessive-compulsive symptoms are dimensional (Olatunji, Williams, Haslam, Abramowitz, & Tolin, 2008). Nonclinical samples are frequently used in studies seeking to better understand scrupulosity and obsessive-compulsive symptoms (Abramowitz et al., 2014). An important methodological consideration is to account for the effects of religiosity when examining scrupulosity among nonclinical samples (Siev, Baer, & Minichiello, 2011). Religiosity was thus assessed as a covariate. Finally, uncertainty salience and reflecting on God are believed to increase specific forms of emotional distress (i.e., anxiety) rather than negative affect (Echebarria-Echabe, 2013; Toburen & Meier, 2010). We thus investigated whether uncertainty salience and God concept priming also impacted negative affect.
The majority of the sample reported receiving a two-year college degree or higher (63.4%), being currently employed at least part-time (76.7%), and as currently non-married (59.2%). In terms of a current religious affiliation, 44.2% of the sample self-identified as Protestant, 18.3% as Catholic, 3.3% as Jewish, 2.5% as Buddhist, 1.7% as Muslim, and 10.8% as “other” religious affiliation. Approximately 23.3% of the sample reported having no current religious affiliation. Given that nearly 20% of individuals with scrupulosity report having no religious affiliation (Siev et al., 2011), participants reporting having no current religious affiliation were retained for subsequent analyses. As noted, analyses were run to ensure any observed effect was not attributable to religiosity. 2.2. Measures 2.2.1. Modified Penn Inventory of Scrupulosity (PIOS) The PIOS (Abramowitz et al., 2002) is a 19-item measure that assesses scrupulous fears, including fears of sin (e.g., I feel guilty about immoral thoughts I have had) and fears of God (e.g., I worry that God is upset with me), on a 0 to 4 scale. A 15-item reduced-item version of the PIOS that improves upon the factorial validity of the measure was used in this study (Olatunji, Abramowitz, Williams, Connolly, & Lohr, 2007). The revised PIOS (i.e., PIOS-R) total scale shares a near-perfect (r ¼ .99) correlation with the original PIOS total scale (Olatunji et al., 2007). Given the current study aims, we modified the original instructions to ensure state-like time instructions (“in this moment”) were used. We also modified the response options, such that item ratings were “very slightly or not at all,” “a little,” “moderately,” “quite a bit,” and “extremely.” Some of the PIOS items were reworded to reflect a state-like construct (e.g., “Immoral thoughts come into my head and I can't get rid of them” was reworded as “Immoral thoughts are in my head and I can't get rid of them”). The modified PIOS-R total (Cronbach's a ¼ .94), fears of sin scale (a ¼ .90), and fears of God scale (a ¼ .90) showed good internal consistency in this study. 2.2.2. General Religiousness Scale (GRS; Rowatt, LaBouff, Johnson, Froese, & Tsang, 2009) The GRS is a 4-item scale of religiosity. The four items are: (a) How religious do you consider yourself to be?; (b) How often do you attend religious services?; (c) How often do you read the Bible, Koran, Torah or other sacred book?; and (d) About how often do you pray or meditate outside of religious services?. Each item is rated using an ordered-category scale and the GRS items are best represented by a single-factor. The GRS showed good internal consistency in this study (a ¼ .85). Following Rowatt et al. (2009), we created a total scale by standardizing responses to each GRS item and summing the standardized scores.
2. Method 2.1. Participants Gervais and Norenzayan (2012) found inconsistent evidence for the impact of reflecting on God on public self-awareness among non-believers. Following from their findings, as part of our participant recruitment, we asked prospective participants if they believed in God or a higher power at the beginning of the study. The 58 prospective participants who denied belief in God or a higher power were excluded from participation. The total sample consisted of 120 adults. The mean age of the sample was 36.9 years (SD ¼ 13.2; range from 18 to 72) and respondents predominantly self-identified as female (62.5%). In terms of racial/ethnic identification, 76.7% of the sample self-identified as White, 9.2% as African American, 5.8% as Asian, 4.2% Latino, 2.5% as Native American, and 1.6% as bi-or multi-racial.
2.2.3. Positive and Negative Affect Schedule (PANAS; Watson, Clark, & Tellegen, 1988) The PANAS asks respondents to indicate to what extent singleword descriptors (e.g., distressed, scared) capture how they felt on a 1 to 5 scale. State-like time instructions (“in this moment”) were used in this study. The negative affect (NA) scale of the PANAS e the PANAS scale of interest in the present study e consists of 10 items. PANAS-NA has shown moderate to strong (rs ranging from .51 to .74) correlations with other measures of negative affect (Watson et al., 1988). PANAS-NA showed good internal consistency in this study (a ¼ .89). 2.3. Procedure Participants were recruited using Amazon's Mechanical Turk (MTurk), an internet-based platform that allows individuals to
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request the completion of tasks for monetary compensation. Respondents completing experiments through MTurk have been found to produce high quality data and are more demographically diverse than both standard internet samples and American undergraduate samples (Buhrmester, Kwang, & Gosling, 2011; Paolacci & Chandler, 2014; Shapiro, Chandler, & Mueller, 2013). The present study was approved by the local institutional review board. Recruitment was limited to MTurk workers over 18 years of age and located in the United States. In addition, participation was restricted to MTurk workers with approval ratings above 95%, a method shown to increase data quality (Peer, Vosgerau, & Acquisti, in press). Participants were required to provide electronic consent and there was no penalty for withdrawing from the study. Upon completion of the study, participants were debriefed and paid in full. Compensation was $1, an amount consistent with the compensation given to MTurk workers completing prior studies of similar length (Buhrmester et al., 2011). Participants initially completed a demographics questionnaire and the GRS. Participants were then randomly assigned to a salience manipulation. The uncertainty salience manipulation consisted of two standard open-ended questions (van den Bos, 2009). These two questions are: (1) Please briefly describe the emotions that the thought of you being uncertain arouses in you and (2) Please write down, as specifically as you can, what you think physically will happen to you as you feel uncertain. Prior research has found that uncertainty is made more salient in respondents who answer these two questions relative to respondents who answer parallel control open-ended questions (van den Bos, Poortvliet, Maas, Miedema, & van den Ham, 2005). The uncertainty salience manipulation has been used in prior studies using internet samples (van den Bos, van Ameijde, & van Gorp, 2006; McGregor et al., 2009). Participants in the salience control condition completed two parallel questions regarding insecurity (following McGregor et al., 2009). These two questions are: (1) Please briefly describe the emotions that the thought of you being insecure arouses in you and (2) Please write down, as specifically as you can, what you think physically will happen to you as you feel insecure. Next, participants were randomly assigned to complete a priming manipulation. Half of the participants received Shariff and Norenzayan's (2007) God concept priming manipulation. This manipulation consisted of a sentence unscrambling task, in which participants were required to unscramble 10 five-word sentences, dropping an extraneous word from each sentence to create a grammatical four-word sentence. All 10 sentences contained Godrelated words (e.g., spirit, divine, sacred, prophet). In the control priming condition, participants completed a parallel task that consisted of only neutral words unrelated to religion (following Shariff & Norenzayan, 2007). Shariff and Norenzayan's (2007) God concept priming manipulation is one of the most common manipulations of religious cognition and has been found to engender a broad array of outcomes (e.g., see Preston & Ritter, 2013). All participants then completed the PANAS and the modified PIOS-R.
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Table 1 Analysis of variance (ANOVA) results. Condition
Uncertainty Mean
PIOS-R total God 18.67 Neutral 10.70 Total 14.68 Fears of sin God 12.30 Neutral 6.97 Total 9.63 Fears of God God 6.37 Neutral 3.73 Total 5.05 PANAS-NA God 15.10 Neutral 12.67 Total 13.88
Insecurity
Total
(SD)
n
Mean
(SD)
n
Mean
(SD)
n
(11.32) (8.81) (10.83)
30 30 60
10.63 11.53 11.08
(9.30) (8.30) (8.75)
30 30 60
14.65 11.12
(11.04) (8.50)
60 60
(7.12) (5.67) (6.93)
30 30 60
7.07 7.77 7.42
(6.03) (5.37) (5.67)
30 30 60
9.68 7.37
(7.06) (5.49)
60 60
(4.78) (3.97) (4.56)
30 30 60
3.57 3.77 3.67
(3.66) (3.73) (3.67)
30 30 60
4.97 3.75
(4.45) (3.82)
60 60
(6.35) (4.10) (5.44)
30 30 60
12.87 12.23 12.55
(3.66) (3.94) (3.78)
30 30 60
13.98 12.45
(5.26) (3.99)
60 60
Note. PIOS-R ¼ Penn Inventory of Scrupulosity-Revised (Modified Version); PANASNA ¼ Negative Affect scale of Positive and Negative Affect Schedule (State Version).
significant difference (LSD) follow-up tests for differences between cell means (LSD ¼ 4.86) indicated that scrupulous fears was significantly higher in the uncertainty salience and God concept priming condition relative to the other three conditions. The magnitude of these cell mean differences was moderate-to-large in size (Cohen's ds ranged from .73 to .80). There were no significant differences among the other cell means. The salience prime interaction (F(1,115) ¼ 4.78, p ¼ .031) held when controlling for religiosity.
3. Results A 2 2 between-subjects analysis of variance (ANOVA) was used to examine the impact of salience (uncertainty versus insecurity) and prime (God concept versus neutral) on scrupulous fears. ANOVA results are presented in Table 1. As predicted, there was a main effect of salience (F(1,116) ¼ 4.31, p ¼ .040) and prime (F(1,116) ¼ 4.15, p ¼ .044) on scrupulous fears (modified PIOS-R total). However, these main effects were qualified by the predicted salience prime interaction (F(1,116) ¼ 6.53, p ¼ .012). This interaction is depicted in Fig. 1. Further analysis based on least
Fig. 1. Interaction between salience (uncertainty versus insecurity) and prime (God concept versus neutral) on modified Penn Inventory of Scrupulosity-Revised (PIOS-R) total scale and fears of committing sin scale. Mean scores presented along with standard error of the mean bars.
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Exploratory ANOVAs were completed to examine the potential differential impact of uncertainty salience, God concept priming, and their interaction on fears of sin, fears of God, and negative affect. There was a main effect of both salience (F(1,116) ¼ 3.98, p ¼ .048) and prime (F(1,116) ¼ 4.35, p ¼ .039) on fears of sin. However, these main effects were qualified by a significant salience prime interaction (F(1,116) ¼ 7.37, p ¼ .008). This interaction is depicted in Fig. 1. Further analysis based on LSD follow-up tests for differences between cell means (LSD ¼ 3.11) indicated that fears of sin were significantly higher in the uncertainty salience and God concept priming condition relative to the other three conditions. The magnitude of these cell mean differences was moderate-to-large in size (Cohen's ds ranged from .73 to .84). There were no other significant differences among the cell means. The salience prime interaction (F(1,115) ¼ 6.15, p ¼ .015) held when controlling for religiosity. There was no main effect of salience (F(1,116) ¼ 3.48, p ¼ .065) or prime (F(1,116) ¼ 2.69, p ¼ .104), as well as no salience prime interaction (F(1,116) ¼ 3.65, p ¼ .059), on fears of God. There was also no main effect of salience (F(1,116) ¼ 2.48, p ¼ .112) or prime (F(1,116) ¼ 3.28, p ¼ .073), as well as no salience prime interaction (F(1,116) ¼ 1.13, p ¼ .290), on negative affect. 4. Discussion Difficulties tolerating uncertainty are considered central to scrupulosity and yet the potential impact of uncertainty on scrupulous fears remained unexamined. As predicted, we found that uncertainty salience and God concept priming interacted to cause scrupulous fears, particularly fears sin. Uncertainty is closely aligned with self-doubt (van den Bos, 2009) and, as described, religious self-doubt contributes to scrupulous fears within Abramowitz and Jacoby's (2014) cognitive-behavioral model of scrupulosity. When faced with a state of uncertainty, individuals typically seek out self-certainty (McGregor, Zanna, Holmes, & Spencer, 2001). Abramowitz and Jacoby (2014) asserted that most individuals who are religious are buffered against developing scrupulosity because of their faith, which these researchers defined “as belief that is based on trust or confidence, as opposed to actual proof” (p. 145; emphasis in original). It is possible that faith surrounding participation in standard religious practice could be sufficient to achieve self-certainty for most individuals who are religious and experience religious doubts. However, some individuals desire absolute proof that their religious doubts are unfounded and experience scrupulous fears when sufficient proof cannot be obtained. According to Abramowitz and Jacoby (2014), this desire for absolute proof is a result of an intolerance of uncertainty. Interestingly, van den Bos et al. (2006) found that individual differences in emotional reactions to uncertainty potentiated the effect of uncertainty salience. Because intolerance of uncertainty is an individual difference variable (Carleton, 2012), future research could examine whether this variable potentiates the effect of religious uncertainty salience on scrupulous fears. As noted, in the present study, we found that God concept priming moderated the effect of uncertainty salience on scrupulous fears. We believe this finding can be interpreted in at least two ways. First, it is possible that priming God concepts led religion to be salient, which, in the context of a state of uncertainty, evoked religious uncertainty/doubt and scrupulous fears. This possibility closely aligns with Abramowitz and Jacoby's (2014) cognitivebehavioral model. It is important to note that even if priming God concepts led to the saliency of religion, religion salience by itself is likely insufficient to cause scrupulous fears because God concept priming was not found to increase scrupulous fears when coupled with insecurity salience in this study. However, given our use of a nonclinical sample, we are unable to disentangle whether the
observed elevations in fears of sin are best characterized as general religious concerns versus the scrupulous fears that mark scrupulosity per se. Another possibility is that God concept priming led to what Gervais and Norenzayan (2012) labeled supernatural monitoring, which consists of individuals perceiving that God is monitoring their behavior. Supernatural monitoring may lead to concerns about morality, as Gervais and Norenzayan (2012) asserted that critical to the process of supernatural monitoring is that individuals perceive themselves as being watched by supernatural agents who are capable of moral judgment. Fears of sin could be viewed as a type of moral impression management, whereby individuals draw close attention to potential signs of immorality (e.g., I fear I will act immorally; Abramowitz et al., 2002). Indeed, Preston and Ritter (2013) opined that “the perception of God as an all-seeing moral judge may motivate people to appear virtuous as a way to avoid punishment, and also, to adhere to the moral standards of a perfect God” (p. 1473). Fears of sin are likely to be especially high when individuals are also in a state of uncertainty, as the self-doubt that accompanies this state may lead individuals to become hypervigilant for signs that their demeanor could lead God to view them as immoral. It is important to note that the effect related to fears of God approached statistical significance in this study and thus no firm conclusions regarding the specificity of the effects to fears of sin should be drawn at this time. Moreover, although the manipulations did not increase negative affect, we did not assess anxiety or obsessive-compulsive symptoms and thus are unable to conclude that the combination of uncertainty salience and reflecting on God uniquely impacted scrupulous fears. Toburen and Meier's (2010) speculated that the impact of perceiving God as watching on emotional distress could depend on individual differences in how God is viewed. Kirkpatrick (2005) stated that perceived relationships with God tend to meet the principal five criteria for defining attachment relationships and thus function psychologically much like other attachments. The structure of attachment insecurities in relation to God parallel the structure of attachment insecurities in close interpersonal relationships, as represented by the orthogonal dimensions of attachment anxiety and attachment avoidance (Rowatt & Kirkpatrick, 2002). Fergus and Rowatt (2014) found that scrupulosity is related to attachment anxiety in relation to God, with attachment anxiety referring to concerns that attachment figures will be unavailable during times of need. Future research could examine whether attachment security in relation to God mitigates the impact of uncertainty salience and God concept priming on scrupulous fears. The present findings may have related treatment implications. For example, Abramowitz and Jacoby (2014) noted that one treatment aim for scrupulosity is to increase tolerance for doubt and uncertainty and the present results support this treatment aim. To increase faith in response to religious doubts, Abramowitz and Jacoby (2014) suggest that exposure-and-response prevention (ERP) for scrupulosity can be tailored to increase tolerance for doubt and uncertainty (e.g., using expectancy tracking). Expectancy tracking involves patients tracking expectancies of tolerating doubt and uncertainty during the course of exposures. Exposures continue until the maximum tolerance of doubt and uncertainty is surpassed. Through expectancy tracking, patients with scrupulosity can learn that they can tolerate uncertainties in daily living and accomplish tasks based on faith alone (Abramowitz & Jacoby, 2014). Study limitations must be acknowledged. We did not include manipulation checks in this study, in large part, because the manipulations used to evoke uncertainty and God concepts in this study are well-established (e.g., van den Bos, 2009; Gervais & Norenzayan, 2012; Inzlicht & Tullet, 2010; McGregor et al., 2009; Preston & Ritter, 2013). As reviewed, van den Bos et al. (2005)
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previously found that uncertainty was made more salient in respondents who answered the uncertainty questions used in this study relative to respondents who answered parallel control questions. Manipulation checks are rarely used following religious priming because priming techniques presumably operate outside of conscious awareness. Indeed, Shariff and Norenzayan (2007) found that the vast majority of respondents did not report that the God concept sentence unscrambling task reminded them of religious concepts. As reviewed, central to the predictions of this study was that the idea that God concept priming evokes public self-awareness. Shariff and Norenzayan's (2007) God concept priming task has been found to cause public self-awareness in prior studies (Gervais & Norenzayan, 2012). Prior studies support the use of the targeted experimental manipulations; however, we are unable to state that the manipulations functioned in their intended manner in this particular study. Future research may seek to replicate the present results while using manipulation checks. An additional limitation is that we created a modified version of the PIOS (Abramowitz et al., 2002) to assess scrupulous fears. It was deemed necessary to modify the PIOS in certain ways (i.e., item wording and response options) to help ensure a state-like construct was assessed. The modified PIOS demonstrated good internal consistency and the average inter-item correlation among the modified PIOS items (average inter-item r ¼ .50) was nearly identical to that observed in prior studies using the original version of the measure (e.g., average inter-item r ¼ .52; Olatunji et al., 2007). Based on these average inter-item correlations, the modified PIOS appears to assess a construct of similar breadth relative to the original measure. However, it is unknown whether the modified PIOS assesses the same construct as the original measure. Our use of a nonclinical sample is an additional limitation. It bears repeating that the purported continuous nature of scrupulosity (Abramowitz et al., 2002) and data indicating that obsessivecompulsive symptoms are dimensional (Olatunji et al., 2008) support our use of an nonclinical sample. Further, many experimental studies examining obsessive-compulsive symptoms conducted using nonclinical samples have been replicated using clinical samples (Abramowitz et al., 2014). With this information in mind, we believe the present findings meaningfully contribute to the existing literature. The generality of the present results, though, would be assured via replication among patients with OCD. It is important to acknowledge that the quality of data obtained via remote collection efforts remains an issue to be fully vetted in the psychopathology literature. Both experimental manipulations used in this study have been used in prior Internet studies (van den Bos et al., 2006; Preston & Ritter, 2012) and known methods shown to increase the quality of remotely collected data were used (e.g., use of only high reputation MTurk workers; Peer et al., in press). Research supports MTurk as a viable method for data collection when interested in clinical phenomena (Shapiro et al., 2013). Whereas MTurk samples tend to be more diverse than standard Internet samples or American undergraduate samples, MTurk samples should not be considered representative of the general population (Buhrmester et al., 2011; Paolacci & Chandler, 2014). The generality of these findings would be supported by examining other groups of nonclinical respondents with a greater diversity of religious affiliation. Finally, the present findings are likely only applicable to individuals who believe religious doctrine underlies their fear(s) rather than those individuals with secular moral scrupulous concerns (Huppert & Siev, 2010). 4.1. Conclusions Limitations notwithstanding, this study is the first known examination as to whether uncertainty causes scrupulous fears. The
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present results are in line with cognitive-behavioral models suggesting that difficulties tolerating uncertainty are important to scrupulosity, indicating that such difficulties are likely best understood within the context of religious doubt and/or moral impression management. Increasing tolerance for uncertainty could prove to be a promising intervention strategy for reducing scrupulous fears.
References Abramowitz, J. S., Fabricant, L. E., Taylor, S., Deacon, B. J., McKay, D., & Storch, E. A. (2014). The relevance of analogue studies for understanding obsessions and compulsions. Clinical Psychology Review, 34, 206e217. Abramowitz, J. S., Huppert, J. D., Cohen, A. B., Tolin, D. F., & Cahill, S. P. (2002). Religious obsessions and compulsions in a non-clinical sample: the Penn Inventory of Scrupulosity (PIOS). Behaviour Research and Therapy, 40, 825e838. Abramowitz, J. S., & Jacoby, R. J. (2014). Scrupulosity: a cognitive-behavioral analysis and implications for treatment. Journal of Obsessive-Compulsive and Related Disorders, 3, 140e149. van den Bos, K. (2009). Making sense of life: the existential self trying to deal with personal uncertainty. Psychological Inquiry, 20, 197e217. van den Bos, K., van Ameijde, J., & van Gorp, H. (2006). On the psychology of religion: the role of personal uncertainty in religious worldview defense. Basic and Applied Social Psychology, 28, 333e341. van den Bos, K., Poortvliet, P. M., Maas, M., Miedema, J., & van den Ham, E. (2005). An enquiry concerning the principles of cultural norms and values: the impact of uncertainty and mortality salience on reactions to violations and bolstering of cultural worldviews. Journal of Experimental Social Psychology, 41, 91e113. Buhrmester, M., Kwang, T., & Gosling, S. D. (2011). Amazon's Mechanical Turk: a new source of inexpensive, yet high-quality, data? Perspectives on Psychological Science, 6, 3e5. Carleton, R. N. (2012). The intolerance of uncertainty construct in the context of anxiety disorders: theoretical and practical perspectives. Expert Reviews of Neurotherapeutics, 12, 937e947. Echebarria-Echabe, A. (2013). Mortality salience and uncertainty: similar effects but different processes? European Journal of Social Psychology, 43, 185e191. Fergus, T. A., & Rowatt, W. C. (2014). Examining a purported association between attachment to God and scrupulosity. Psychology of Religion and Spirituality, 6, 230e236. George, L., & Stopa, L. (2008). Private and public self-awareness in social anxiety. Journal of Behavior Therapy and Experimental Psychiatry, 39, 57e72. Gervais, W. M., & Norenzayan, A. (2012). Like a camera in the sky? Thinking about God increases public self-awareness and socially desirable responding. Journal of Experimental and Social Psychology, 48, 298e302. Grayson, J. B. (2010). OCD and intolerance of uncertainty: treatment issues. Journal of Cognitive Psychotherapy, 24, 3e15. Huppert, J. D., & Siev, J. (2010). Treating scrupulosity in religious individuals using cognitive-behavioral therapy. Cognitive and Behavioral Practice, 17, 382e392. Inzlicht, M., & Tullet, A. M. (2010). Reflecting on God: religious primes can reduce neuropsychological response to errors. Psychological Science, 21, 1184e1190. Kirkpatrick, L. A. (2005). Attachment, evolution, and the psychology of religion. New York, NY: Guilford Press. McGregor, I., Prentice, M. S., & Nash, K. A. (2009). Personal uncertainty management by reactive approach motivation. Psychological Inquiry, 20, 225e229. McGregor, I., Zanna, M. P., Holmes, J. G., & Spencer, S. J. (2001). Compensatory conviction in the face of personal uncertainty: going to the extremes and being oneself. Journal of Personality and Social Psychology, 80, 472e488. McKay, R., Efferson, C., Whitehouse, H., & Fehr, E. (2011). Wrath of God: religious primes and punishment. Proceedings of the Royal Society B: Biological Sciences, 278, 1858e1863. Olatunji, B. O., Abramowitz, J. S., Williams, N. L., Connolly, K. M., & Lohr, J. M. (2007). Scrupulosity and obsessive-compulsive symptoms: confirmatory factor analysis and validity of the Penn Inventory of Scrupulosity. Journal of Anxiety Disorders, 21, 771e787. Olatunji, B. O., Williams, B. J., Haslam, N., Abramowitz, J. S., & Tolin, D. F. (2008). The latent structure of obsessive-compulsive symptoms: a taxometric study. Depression and Anxiety, 25, 956e968. Paolacci, G., & Chandler, J. (2014). Inside the Turk: understanding Mechanical Turk as a participant pool. Current Directions in Psychological Science, 23, 184e188. Peer, E., Vosgerau, J., & Acquisti, A. (2014). Reputation as a sufficient condition for data quality on Amazon Mechanical Turk. Behavior Research Methods. http:// dx.doi.org/10.3758/s13428-013-0434-y (in press). Preston, J. L., & Ritter, R. S. (2012). Cleanliness and godliness: mutual association between two kinds of personal purity. Journal of Experimental and Social Psychology, 48, 1365e1368. Preston, J. L., & Ritter, R. S. (2013). Different effects of religion and God on prosociality with the ingroup and outgroup. Personality and Social Psychology Bulletin, 39, 1471e1483. Rowatt, W. C., & Kirkpatrick, L. A. (2002). Two dimensions of attachment to God and their relation to affect, religiosity, and personality constructs. Journal for the Scientific Study of Religion, 41, 637e651.
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Rowatt, W. C., LaBouff, J., Johnson, M., Froese, P., & Tsang, J. (2009). Associations among religiousness, social attitudes, and prejudice in a national random sample of American adults. Psychology of Religion and Spirituality, 1, 14e24. Shapiro, D. N., Chandler, J., & Mueller, P. A. (2013). Using Mechanical Turk to study clinical populations. Clinical Psychological Science, 1, 213e220. Shariff, A. F., & Norenzayan, A. (2007). God is watching you: priming God concepts increases prosocial behavior in an anonymous economic game. Psychological Science, 18, 803e809.
Siev, J., Baer, L., & Minichiello, W. E. (2011). Obsessive-compulsive disorder with predominantly scrupulous symptoms: clinical and religious characteristics. Journal of Clinical Psychology, 67, 1188e1196. Toburen, T., & Meier, B. P. (2010). Priming God-related concepts increases anxiety and task persistence. Journal of Social and Clinical Psychology, 29, 127e143. Watson, D., Clark, L. A., & Tellegen, A. (1988). Development and validation of brief measures of Positive and Negative Affect: the PANAS Scales. Journal of Personality and Social Psychology, 54, 1063e1070.
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Journal of Behavior Therapy and Experimental Psychiatry journal homepage: www.elsevier.com/locate/jbtep
Uncertainty, god, and scrupulosity: Uncertainty salience and priming god concepts interact to cause greater fears of sin Thomas A. Fergus*, Wade C. Rowatt Baylor University, USA
a r t i c l e i n f o
a b s t r a c t
Article history: Received 20 March 2014 Received in revised form 2 September 2014 Accepted 2 September 2014 Available online 10 September 2014
Background and objectives: Difficulties tolerating uncertainty are considered central to scrupulosity, a moral/religious presentation of obsessive-compulsive disorder (OCD). We examined whether uncertainty salience (i.e., exposure to a state of uncertainty) caused fears of sin and fears of God, as well as whether priming God concepts affected the impact of uncertainty salience on those fears. Method: An internet sample of community adults (N ¼ 120) who endorsed holding a belief in God or a higher power were randomly assigned to an experimental manipulation of (1) salience (uncertainty or insecurity) and (2) prime (God concepts or neutral). Results: As predicted, participants who received the uncertainty salience and God concept priming reported the greatest fears of sin. There were no mean-level differences in the other conditions. The effect was not attributable to religiosity and the manipulations did not cause negative affect. Limitations: We used a nonclinical sample recruited from the internet. Conclusions: These results support cognitive-behavioral models suggesting that religious uncertainty is important to scrupulosity. Implications of these results for future research are discussed. © 2014 Elsevier Ltd. All rights reserved.
Keywords: Fears of sin Intolerance of uncertainty God Obsessive-compulsive disorder (OCD) Scrupulosity
1. Introduction Researchers view difficulties tolerating uncertainty (i.e., intolerance of uncertainty) as being at the core of obsessive-compulsive disorder (OCD) (Grayson, 2010). Scrupulosity is a moral/religious presentation of OCD that is defined as “fearing sin where there is none’’ (Abramowitz & Jacoby, 2014, p. 140). The extant literature highlights the potential importance of uncertainty for understanding scrupulous fears. For example, within Abramowitz and Jacoby's (2014) cognitive-behavioral model, scrupulosity is marked by the tendency to misinterpret intrusive thoughts in ways that are not subject to assurance (e.g., Have I committed sin by mistake?). Uncertainty as to whether intrusive thoughts are sinful purportedly, in part, evokes fears about having committed sin or receiving punishment from God. In a separate line of research, uncertainty is viewed as leading to doubt or instability in one's sense of self (van den Bos, 2009) and this self-doubt causes anxiety (Echebarria-Echabe, 2013). Abramowitz and Jacoby (2014) highlighted the importance of self-doubt to scrupulosity, as they described commonly observed religious doubts that engender fears
* Corresponding author. Department of Psychology & Neuroscience, Baylor University, Waco, TX 76798, USA. Tel.: þ1 254 710 2651; fax: þ1 254 710 3033. E-mail address: [email protected] (T.A. Fergus). http://dx.doi.org/10.1016/j.jbtep.2014.09.003 0005-7916/© 2014 Elsevier Ltd. All rights reserved.
about sin or God (e.g., Am I pure enough?; Do I have sufficient faith in God?; Am I going to heaven when I die?). Taken together, these lines of research indicate that religious uncertainty may cause scrupulous fears. Some research suggests that religious priming (via God concept priming) provides a sense of order that reduces the emotional impact of uncertainty (Inzlicht & Tullet, 2010). As such, reflecting on God may mitigate the impact of uncertainty on scrupulous fears. Other research, though, has found that reflecting on God causes anxiety (Toburen & Meier, 2010), potentially because of evaluative concerns. For example, individuals who perceive that they are being watched by God may have concerns that their behavior will damage their standing in the eyes of God (McKay, Efferson, Whitehouse, & Fehr, 2011). This possibility is consistent with Shariff and Norenzayan's (2007) assertion that reflecting on God leads to perceptions that God is watching and wants individuals to behave, which has led researchers to conclude that moral impression management occurs as a result of reflecting on God (Preston & Ritter, 2013). Because scrupulosity is marked by concerns about morality and one's standing in relation to God (Abramowitz & Jacoby, 2014), reflecting on God would likely increase scrupulous fears. Interestingly, the available literature indicates a state of uncertainty may interact with reflecting on God to engender scrupulous
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fears. For example, reflecting on God could increase the saliency of religion (Inzlicht & Tullet, 2010), which, in the context of a state of uncertainty, might lead to religious uncertainty/doubt and scrupulous fears. This possibility is consistent with Abramowitz and Jacoby's (2014) cognitive-behavioral model of scrupulosity. Another explanation for an interaction between a state of uncertainty and reflecting on God comes from Gervais and Norenzayan (2012), who found that, among believers, priming God concepts caused public self-awareness. Public self-awareness is related to anxiety, with George and Stopa (2008) stating that “it may be the interaction between public self-awareness and negative images or impressions of self that creates the problem” (p. 68). Following from George and Stopa (2008), scrupulous fears may arise from a state of uncertainty, which is related to negative self-impressions, and the public self-awareness that results from reflecting on God. In sum, uncertainty is considered central to scrupulosity and yet its impact on scrupulous fears remains unexamined. In this study, we predicted that uncertainty salience (i.e., exposure to a state of uncertainty; van den Bos, 2009) and God concept priming would interact to cause scrupulous fears. We targeted fears of sin and fears of God, which are two central scrupulous fears (Abramowitz, Huppert, Cohen, Tolin, & Cahill, 2002). In an attempt to examine the specific importance of uncertainty salience to scrupulous fears, we used an insecurity salience control in which participants considered self-insecurity. Insecurity salience was used as a control because insecurity may best reflect the concept of uncertainty, within some models of this construct, among English-speaking respondents (McGregor, Prentice, & Nash, 2009). Using insecurity salience as a control was expected to provide a relatively stringent test as to the specific importance of uncertainty to scrupulous fears. Although it remains important to examine the targeted fears among patients with OCD, we used a group of community respondents. Our use of a nonclinical sample is informed by the purported continuous nature of scrupulosity (Abramowitz et al., 2002) and data indicating that obsessive-compulsive symptoms are dimensional (Olatunji, Williams, Haslam, Abramowitz, & Tolin, 2008). Nonclinical samples are frequently used in studies seeking to better understand scrupulosity and obsessive-compulsive symptoms (Abramowitz et al., 2014). An important methodological consideration is to account for the effects of religiosity when examining scrupulosity among nonclinical samples (Siev, Baer, & Minichiello, 2011). Religiosity was thus assessed as a covariate. Finally, uncertainty salience and reflecting on God are believed to increase specific forms of emotional distress (i.e., anxiety) rather than negative affect (Echebarria-Echabe, 2013; Toburen & Meier, 2010). We thus investigated whether uncertainty salience and God concept priming also impacted negative affect.
The majority of the sample reported receiving a two-year college degree or higher (63.4%), being currently employed at least part-time (76.7%), and as currently non-married (59.2%). In terms of a current religious affiliation, 44.2% of the sample self-identified as Protestant, 18.3% as Catholic, 3.3% as Jewish, 2.5% as Buddhist, 1.7% as Muslim, and 10.8% as “other” religious affiliation. Approximately 23.3% of the sample reported having no current religious affiliation. Given that nearly 20% of individuals with scrupulosity report having no religious affiliation (Siev et al., 2011), participants reporting having no current religious affiliation were retained for subsequent analyses. As noted, analyses were run to ensure any observed effect was not attributable to religiosity. 2.2. Measures 2.2.1. Modified Penn Inventory of Scrupulosity (PIOS) The PIOS (Abramowitz et al., 2002) is a 19-item measure that assesses scrupulous fears, including fears of sin (e.g., I feel guilty about immoral thoughts I have had) and fears of God (e.g., I worry that God is upset with me), on a 0 to 4 scale. A 15-item reduced-item version of the PIOS that improves upon the factorial validity of the measure was used in this study (Olatunji, Abramowitz, Williams, Connolly, & Lohr, 2007). The revised PIOS (i.e., PIOS-R) total scale shares a near-perfect (r ¼ .99) correlation with the original PIOS total scale (Olatunji et al., 2007). Given the current study aims, we modified the original instructions to ensure state-like time instructions (“in this moment”) were used. We also modified the response options, such that item ratings were “very slightly or not at all,” “a little,” “moderately,” “quite a bit,” and “extremely.” Some of the PIOS items were reworded to reflect a state-like construct (e.g., “Immoral thoughts come into my head and I can't get rid of them” was reworded as “Immoral thoughts are in my head and I can't get rid of them”). The modified PIOS-R total (Cronbach's a ¼ .94), fears of sin scale (a ¼ .90), and fears of God scale (a ¼ .90) showed good internal consistency in this study. 2.2.2. General Religiousness Scale (GRS; Rowatt, LaBouff, Johnson, Froese, & Tsang, 2009) The GRS is a 4-item scale of religiosity. The four items are: (a) How religious do you consider yourself to be?; (b) How often do you attend religious services?; (c) How often do you read the Bible, Koran, Torah or other sacred book?; and (d) About how often do you pray or meditate outside of religious services?. Each item is rated using an ordered-category scale and the GRS items are best represented by a single-factor. The GRS showed good internal consistency in this study (a ¼ .85). Following Rowatt et al. (2009), we created a total scale by standardizing responses to each GRS item and summing the standardized scores.
2. Method 2.1. Participants Gervais and Norenzayan (2012) found inconsistent evidence for the impact of reflecting on God on public self-awareness among non-believers. Following from their findings, as part of our participant recruitment, we asked prospective participants if they believed in God or a higher power at the beginning of the study. The 58 prospective participants who denied belief in God or a higher power were excluded from participation. The total sample consisted of 120 adults. The mean age of the sample was 36.9 years (SD ¼ 13.2; range from 18 to 72) and respondents predominantly self-identified as female (62.5%). In terms of racial/ethnic identification, 76.7% of the sample self-identified as White, 9.2% as African American, 5.8% as Asian, 4.2% Latino, 2.5% as Native American, and 1.6% as bi-or multi-racial.
2.2.3. Positive and Negative Affect Schedule (PANAS; Watson, Clark, & Tellegen, 1988) The PANAS asks respondents to indicate to what extent singleword descriptors (e.g., distressed, scared) capture how they felt on a 1 to 5 scale. State-like time instructions (“in this moment”) were used in this study. The negative affect (NA) scale of the PANAS e the PANAS scale of interest in the present study e consists of 10 items. PANAS-NA has shown moderate to strong (rs ranging from .51 to .74) correlations with other measures of negative affect (Watson et al., 1988). PANAS-NA showed good internal consistency in this study (a ¼ .89). 2.3. Procedure Participants were recruited using Amazon's Mechanical Turk (MTurk), an internet-based platform that allows individuals to
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request the completion of tasks for monetary compensation. Respondents completing experiments through MTurk have been found to produce high quality data and are more demographically diverse than both standard internet samples and American undergraduate samples (Buhrmester, Kwang, & Gosling, 2011; Paolacci & Chandler, 2014; Shapiro, Chandler, & Mueller, 2013). The present study was approved by the local institutional review board. Recruitment was limited to MTurk workers over 18 years of age and located in the United States. In addition, participation was restricted to MTurk workers with approval ratings above 95%, a method shown to increase data quality (Peer, Vosgerau, & Acquisti, in press). Participants were required to provide electronic consent and there was no penalty for withdrawing from the study. Upon completion of the study, participants were debriefed and paid in full. Compensation was $1, an amount consistent with the compensation given to MTurk workers completing prior studies of similar length (Buhrmester et al., 2011). Participants initially completed a demographics questionnaire and the GRS. Participants were then randomly assigned to a salience manipulation. The uncertainty salience manipulation consisted of two standard open-ended questions (van den Bos, 2009). These two questions are: (1) Please briefly describe the emotions that the thought of you being uncertain arouses in you and (2) Please write down, as specifically as you can, what you think physically will happen to you as you feel uncertain. Prior research has found that uncertainty is made more salient in respondents who answer these two questions relative to respondents who answer parallel control open-ended questions (van den Bos, Poortvliet, Maas, Miedema, & van den Ham, 2005). The uncertainty salience manipulation has been used in prior studies using internet samples (van den Bos, van Ameijde, & van Gorp, 2006; McGregor et al., 2009). Participants in the salience control condition completed two parallel questions regarding insecurity (following McGregor et al., 2009). These two questions are: (1) Please briefly describe the emotions that the thought of you being insecure arouses in you and (2) Please write down, as specifically as you can, what you think physically will happen to you as you feel insecure. Next, participants were randomly assigned to complete a priming manipulation. Half of the participants received Shariff and Norenzayan's (2007) God concept priming manipulation. This manipulation consisted of a sentence unscrambling task, in which participants were required to unscramble 10 five-word sentences, dropping an extraneous word from each sentence to create a grammatical four-word sentence. All 10 sentences contained Godrelated words (e.g., spirit, divine, sacred, prophet). In the control priming condition, participants completed a parallel task that consisted of only neutral words unrelated to religion (following Shariff & Norenzayan, 2007). Shariff and Norenzayan's (2007) God concept priming manipulation is one of the most common manipulations of religious cognition and has been found to engender a broad array of outcomes (e.g., see Preston & Ritter, 2013). All participants then completed the PANAS and the modified PIOS-R.
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Table 1 Analysis of variance (ANOVA) results. Condition
Uncertainty Mean
PIOS-R total God 18.67 Neutral 10.70 Total 14.68 Fears of sin God 12.30 Neutral 6.97 Total 9.63 Fears of God God 6.37 Neutral 3.73 Total 5.05 PANAS-NA God 15.10 Neutral 12.67 Total 13.88
Insecurity
Total
(SD)
n
Mean
(SD)
n
Mean
(SD)
n
(11.32) (8.81) (10.83)
30 30 60
10.63 11.53 11.08
(9.30) (8.30) (8.75)
30 30 60
14.65 11.12
(11.04) (8.50)
60 60
(7.12) (5.67) (6.93)
30 30 60
7.07 7.77 7.42
(6.03) (5.37) (5.67)
30 30 60
9.68 7.37
(7.06) (5.49)
60 60
(4.78) (3.97) (4.56)
30 30 60
3.57 3.77 3.67
(3.66) (3.73) (3.67)
30 30 60
4.97 3.75
(4.45) (3.82)
60 60
(6.35) (4.10) (5.44)
30 30 60
12.87 12.23 12.55
(3.66) (3.94) (3.78)
30 30 60
13.98 12.45
(5.26) (3.99)
60 60
Note. PIOS-R ¼ Penn Inventory of Scrupulosity-Revised (Modified Version); PANASNA ¼ Negative Affect scale of Positive and Negative Affect Schedule (State Version).
significant difference (LSD) follow-up tests for differences between cell means (LSD ¼ 4.86) indicated that scrupulous fears was significantly higher in the uncertainty salience and God concept priming condition relative to the other three conditions. The magnitude of these cell mean differences was moderate-to-large in size (Cohen's ds ranged from .73 to .80). There were no significant differences among the other cell means. The salience prime interaction (F(1,115) ¼ 4.78, p ¼ .031) held when controlling for religiosity.
3. Results A 2 2 between-subjects analysis of variance (ANOVA) was used to examine the impact of salience (uncertainty versus insecurity) and prime (God concept versus neutral) on scrupulous fears. ANOVA results are presented in Table 1. As predicted, there was a main effect of salience (F(1,116) ¼ 4.31, p ¼ .040) and prime (F(1,116) ¼ 4.15, p ¼ .044) on scrupulous fears (modified PIOS-R total). However, these main effects were qualified by the predicted salience prime interaction (F(1,116) ¼ 6.53, p ¼ .012). This interaction is depicted in Fig. 1. Further analysis based on least
Fig. 1. Interaction between salience (uncertainty versus insecurity) and prime (God concept versus neutral) on modified Penn Inventory of Scrupulosity-Revised (PIOS-R) total scale and fears of committing sin scale. Mean scores presented along with standard error of the mean bars.
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Exploratory ANOVAs were completed to examine the potential differential impact of uncertainty salience, God concept priming, and their interaction on fears of sin, fears of God, and negative affect. There was a main effect of both salience (F(1,116) ¼ 3.98, p ¼ .048) and prime (F(1,116) ¼ 4.35, p ¼ .039) on fears of sin. However, these main effects were qualified by a significant salience prime interaction (F(1,116) ¼ 7.37, p ¼ .008). This interaction is depicted in Fig. 1. Further analysis based on LSD follow-up tests for differences between cell means (LSD ¼ 3.11) indicated that fears of sin were significantly higher in the uncertainty salience and God concept priming condition relative to the other three conditions. The magnitude of these cell mean differences was moderate-to-large in size (Cohen's ds ranged from .73 to .84). There were no other significant differences among the cell means. The salience prime interaction (F(1,115) ¼ 6.15, p ¼ .015) held when controlling for religiosity. There was no main effect of salience (F(1,116) ¼ 3.48, p ¼ .065) or prime (F(1,116) ¼ 2.69, p ¼ .104), as well as no salience prime interaction (F(1,116) ¼ 3.65, p ¼ .059), on fears of God. There was also no main effect of salience (F(1,116) ¼ 2.48, p ¼ .112) or prime (F(1,116) ¼ 3.28, p ¼ .073), as well as no salience prime interaction (F(1,116) ¼ 1.13, p ¼ .290), on negative affect. 4. Discussion Difficulties tolerating uncertainty are considered central to scrupulosity and yet the potential impact of uncertainty on scrupulous fears remained unexamined. As predicted, we found that uncertainty salience and God concept priming interacted to cause scrupulous fears, particularly fears sin. Uncertainty is closely aligned with self-doubt (van den Bos, 2009) and, as described, religious self-doubt contributes to scrupulous fears within Abramowitz and Jacoby's (2014) cognitive-behavioral model of scrupulosity. When faced with a state of uncertainty, individuals typically seek out self-certainty (McGregor, Zanna, Holmes, & Spencer, 2001). Abramowitz and Jacoby (2014) asserted that most individuals who are religious are buffered against developing scrupulosity because of their faith, which these researchers defined “as belief that is based on trust or confidence, as opposed to actual proof” (p. 145; emphasis in original). It is possible that faith surrounding participation in standard religious practice could be sufficient to achieve self-certainty for most individuals who are religious and experience religious doubts. However, some individuals desire absolute proof that their religious doubts are unfounded and experience scrupulous fears when sufficient proof cannot be obtained. According to Abramowitz and Jacoby (2014), this desire for absolute proof is a result of an intolerance of uncertainty. Interestingly, van den Bos et al. (2006) found that individual differences in emotional reactions to uncertainty potentiated the effect of uncertainty salience. Because intolerance of uncertainty is an individual difference variable (Carleton, 2012), future research could examine whether this variable potentiates the effect of religious uncertainty salience on scrupulous fears. As noted, in the present study, we found that God concept priming moderated the effect of uncertainty salience on scrupulous fears. We believe this finding can be interpreted in at least two ways. First, it is possible that priming God concepts led religion to be salient, which, in the context of a state of uncertainty, evoked religious uncertainty/doubt and scrupulous fears. This possibility closely aligns with Abramowitz and Jacoby's (2014) cognitivebehavioral model. It is important to note that even if priming God concepts led to the saliency of religion, religion salience by itself is likely insufficient to cause scrupulous fears because God concept priming was not found to increase scrupulous fears when coupled with insecurity salience in this study. However, given our use of a nonclinical sample, we are unable to disentangle whether the
observed elevations in fears of sin are best characterized as general religious concerns versus the scrupulous fears that mark scrupulosity per se. Another possibility is that God concept priming led to what Gervais and Norenzayan (2012) labeled supernatural monitoring, which consists of individuals perceiving that God is monitoring their behavior. Supernatural monitoring may lead to concerns about morality, as Gervais and Norenzayan (2012) asserted that critical to the process of supernatural monitoring is that individuals perceive themselves as being watched by supernatural agents who are capable of moral judgment. Fears of sin could be viewed as a type of moral impression management, whereby individuals draw close attention to potential signs of immorality (e.g., I fear I will act immorally; Abramowitz et al., 2002). Indeed, Preston and Ritter (2013) opined that “the perception of God as an all-seeing moral judge may motivate people to appear virtuous as a way to avoid punishment, and also, to adhere to the moral standards of a perfect God” (p. 1473). Fears of sin are likely to be especially high when individuals are also in a state of uncertainty, as the self-doubt that accompanies this state may lead individuals to become hypervigilant for signs that their demeanor could lead God to view them as immoral. It is important to note that the effect related to fears of God approached statistical significance in this study and thus no firm conclusions regarding the specificity of the effects to fears of sin should be drawn at this time. Moreover, although the manipulations did not increase negative affect, we did not assess anxiety or obsessive-compulsive symptoms and thus are unable to conclude that the combination of uncertainty salience and reflecting on God uniquely impacted scrupulous fears. Toburen and Meier's (2010) speculated that the impact of perceiving God as watching on emotional distress could depend on individual differences in how God is viewed. Kirkpatrick (2005) stated that perceived relationships with God tend to meet the principal five criteria for defining attachment relationships and thus function psychologically much like other attachments. The structure of attachment insecurities in relation to God parallel the structure of attachment insecurities in close interpersonal relationships, as represented by the orthogonal dimensions of attachment anxiety and attachment avoidance (Rowatt & Kirkpatrick, 2002). Fergus and Rowatt (2014) found that scrupulosity is related to attachment anxiety in relation to God, with attachment anxiety referring to concerns that attachment figures will be unavailable during times of need. Future research could examine whether attachment security in relation to God mitigates the impact of uncertainty salience and God concept priming on scrupulous fears. The present findings may have related treatment implications. For example, Abramowitz and Jacoby (2014) noted that one treatment aim for scrupulosity is to increase tolerance for doubt and uncertainty and the present results support this treatment aim. To increase faith in response to religious doubts, Abramowitz and Jacoby (2014) suggest that exposure-and-response prevention (ERP) for scrupulosity can be tailored to increase tolerance for doubt and uncertainty (e.g., using expectancy tracking). Expectancy tracking involves patients tracking expectancies of tolerating doubt and uncertainty during the course of exposures. Exposures continue until the maximum tolerance of doubt and uncertainty is surpassed. Through expectancy tracking, patients with scrupulosity can learn that they can tolerate uncertainties in daily living and accomplish tasks based on faith alone (Abramowitz & Jacoby, 2014). Study limitations must be acknowledged. We did not include manipulation checks in this study, in large part, because the manipulations used to evoke uncertainty and God concepts in this study are well-established (e.g., van den Bos, 2009; Gervais & Norenzayan, 2012; Inzlicht & Tullet, 2010; McGregor et al., 2009; Preston & Ritter, 2013). As reviewed, van den Bos et al. (2005)
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previously found that uncertainty was made more salient in respondents who answered the uncertainty questions used in this study relative to respondents who answered parallel control questions. Manipulation checks are rarely used following religious priming because priming techniques presumably operate outside of conscious awareness. Indeed, Shariff and Norenzayan (2007) found that the vast majority of respondents did not report that the God concept sentence unscrambling task reminded them of religious concepts. As reviewed, central to the predictions of this study was that the idea that God concept priming evokes public self-awareness. Shariff and Norenzayan's (2007) God concept priming task has been found to cause public self-awareness in prior studies (Gervais & Norenzayan, 2012). Prior studies support the use of the targeted experimental manipulations; however, we are unable to state that the manipulations functioned in their intended manner in this particular study. Future research may seek to replicate the present results while using manipulation checks. An additional limitation is that we created a modified version of the PIOS (Abramowitz et al., 2002) to assess scrupulous fears. It was deemed necessary to modify the PIOS in certain ways (i.e., item wording and response options) to help ensure a state-like construct was assessed. The modified PIOS demonstrated good internal consistency and the average inter-item correlation among the modified PIOS items (average inter-item r ¼ .50) was nearly identical to that observed in prior studies using the original version of the measure (e.g., average inter-item r ¼ .52; Olatunji et al., 2007). Based on these average inter-item correlations, the modified PIOS appears to assess a construct of similar breadth relative to the original measure. However, it is unknown whether the modified PIOS assesses the same construct as the original measure. Our use of a nonclinical sample is an additional limitation. It bears repeating that the purported continuous nature of scrupulosity (Abramowitz et al., 2002) and data indicating that obsessivecompulsive symptoms are dimensional (Olatunji et al., 2008) support our use of an nonclinical sample. Further, many experimental studies examining obsessive-compulsive symptoms conducted using nonclinical samples have been replicated using clinical samples (Abramowitz et al., 2014). With this information in mind, we believe the present findings meaningfully contribute to the existing literature. The generality of the present results, though, would be assured via replication among patients with OCD. It is important to acknowledge that the quality of data obtained via remote collection efforts remains an issue to be fully vetted in the psychopathology literature. Both experimental manipulations used in this study have been used in prior Internet studies (van den Bos et al., 2006; Preston & Ritter, 2012) and known methods shown to increase the quality of remotely collected data were used (e.g., use of only high reputation MTurk workers; Peer et al., in press). Research supports MTurk as a viable method for data collection when interested in clinical phenomena (Shapiro et al., 2013). Whereas MTurk samples tend to be more diverse than standard Internet samples or American undergraduate samples, MTurk samples should not be considered representative of the general population (Buhrmester et al., 2011; Paolacci & Chandler, 2014). The generality of these findings would be supported by examining other groups of nonclinical respondents with a greater diversity of religious affiliation. Finally, the present findings are likely only applicable to individuals who believe religious doctrine underlies their fear(s) rather than those individuals with secular moral scrupulous concerns (Huppert & Siev, 2010). 4.1. Conclusions Limitations notwithstanding, this study is the first known examination as to whether uncertainty causes scrupulous fears. The
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present results are in line with cognitive-behavioral models suggesting that difficulties tolerating uncertainty are important to scrupulosity, indicating that such difficulties are likely best understood within the context of religious doubt and/or moral impression management. Increasing tolerance for uncertainty could prove to be a promising intervention strategy for reducing scrupulous fears.
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