Korean Clinical Psychology Association
[ Original Article ]
Korean Journal of Clinical Psychology - Vol. 40, No. 3, pp.258-268
ISSN: 1229-0335 (Print) 2733-4538 (Online)
Print publication date 30 Aug 2021
Received 20 May 2021 Revised 31 Jul 2021 Accepted 02 Aug 2021
DOI: https://doi.org/10.15842/kjcp.2021.40.3.007

불완전감과 강박신념이 강박증상에 미치는 영향: 마음챙김의 조절된 매개효과

조은주1 ; 임종민2 ; 장문선2,
2경북대학교 심리학과
The Effects of Incompleteness and Obsessive Beliefs on Obsessive-Compulsive Symptoms: The Moderated Mediating Effect of Mindfulness
Eunju Jo1 ; Jongmin Lim2 ; Mun-Seon Chang2,
1Affiliation Department of Clinical Psychology Intern, Daegu Catholic University College of Medicine, Daegu, Korea
2Affiliation Department of Psychology, Kyungpook National University, Daegu, Korea

Correspondence to: Mun-Seon Chang, Department of Psychology, Kyungpook National University, 80 Daehak-ro, Buk-gu, Daegu, Korea; E-mail: moonsun@knu.ac.kr

© 2021 Korean Clinical Psychology Association


본 연구는 불완전감과 강박증상 사이에서 강박신념의 매개효과 및 강박신념과 강박증상의 관계에서 마음챙김의 조절효과를 확인한 후, 이를 통합한 조절된 매개모형을 검증하고자 했다. 이를 위해 대학생 570명(남자 253명, 여자 317명)을 대상으로 연구에 대한 안내를 실시한 후 강박특질 핵심차원 질문지(OC-TCDQ), 강박신념 질문지(OBQ-44), Padua 강박질문지 워싱턴 주립대학 개정판(PI-WSUR), 마음챙김 척도(MS)로 구성된 설문지를 작성하도록 했고, 수집된 자료 중 결측치가 있는 15명의 자료를 제외하고 총 555명의 자료가 분석에 사용되었다. 수집된 자료는 IBM SPSS Statistics version 23.0 프로그램과 Hayes (2014)가 개발한 PROCESS macro for SPSS v2.11를 사용하여 분석했다. 연구 결과, 주요 변인 간 상관분석에서 불완전감은 강박신념과 강박증상과 높은 정적인 상관관계가 있는 것으로 나타났으며, 강박신념과 강박증상 사이에도 높은 정적 상관이 있음을 확인했다. 또한, 마음챙김과 강박증상은 부적상관을 나타냈다. 다음으로, 불완전감과 강박증상의 관계에서 강박신념의 매개효과를 확인했으며, 강박신념과 강박증상의 관계에서 마음챙김의 조절 효과를 확인했다. 최종적으로 불완전감이 강박증상에 영향을 미치는 경로에서 마음챙김에 의해 조절된 강박신념의 매개효과를 확인했다. 또한, 마음챙김의 어떤 하위 요소가 더욱 효과적인 개입인지 검증한 결과, 현재자각, 주의집중, 탈중심적 주의에서 유의한 결과를 나타냈으며, 특히 탈중심적 주의에서 높은 영향력을 확인했다. 본 연구의 결과는 불완전감을 특징으로 하는 강박장애의 효과적인 치료적 개입을 위한 근거를 제공한다.


The purpose of this study was to examine the moderated mediating effect of mindfulness through obsessive beliefs on the relationship between incompleteness and obsessive-compulsive symptoms. A total of 555 undergraduate students completed the Obsessive-Compulsive Trait Core Domains Questionnaire (OC-TCDQ), Obsessive Beliefs Questionnaire 44 (OBQ-44), the Padua Inventory-Washington State University Revision (PI-WSUR), and the Mindfulness Scale. Data were analyzed using SPSS 23.0 and its Macro. The main findings were as follows: First, the results of bootstrapping indicated that obsessive beliefs mediated the relationship between incompleteness and obsessive-compulsive symptoms. Second, hierarchical regression and slope analyses revealed the moderating effect of mindfulness on the relationship between obsessive beliefs and obsessive compulsive symptoms. Third, mindfulness moderated the mediating effect of incompleteness on obsessive-compulsive symptoms through obsessive beliefs. Finally, the results indicated that among several factors of mindfulness, present-moment awareness, concentration, and de-centered attention influence the relationship between obsession and obsessive-compulsive disorder, which is considered useful for future therapeutic interventions.


incompleteness, obsessive beliefs, OCD symptoms, mindfulness, moderated mediating effect


불완전감, 강박신념, 강박증상, 마음챙김, 조절된 매개효과

Author contributions statement

Eun Ju Jo, a graduate student at Kyungpook National University who is now a clinical psychology intern at Daegu Catholic University College of Medicine, designed the study and collected and analyzed data, and led manuscript preparation. Jongmin Lim, Lecturer at Kyungpook National University, assisted in data collection and analysis. Mun-Seon Chang, professor at Kyungpook National University, supervised the research process. All authors provided critical feedback, participated in revision of the manuscript, and approved the final submission.


  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders-5. Washington, DC: American Psychiatric Publishing. [https://doi.org/10.1176/appi.books.9780890425596]
  • Abramowitz, J. S., Deacon, B. J., & Whiteside, S. P. (2019). Exposure therapy for anxiety: Principles and practice. Guilford Publications.
  • Ball, S. G., Baer, L., & Otto, M. W. (1996). Symptom subtypes of obsessive–compulsive disorder in behavioral treatment studies: A quantitative review. Behaviour Research and Therapy, 34, 47-51. [https://doi.org/10.1016/0005-7967(95)00047-2]
  • Bear, R. (2003). Mindfulness training as a clinical intervention: A conceptual and empirical review. Clinical Psychology: Science and Practice, 10, 125-143. [https://doi.org/10.1093/clipsy/bpg015]
  • Bishop, S. R., Lau, M., Shapiro, S. L. (2004). Mindfulness: A proposed operational definition. Clinical Psychology: Science and Practice, 11, 230-241. [https://doi.org/10.1093/clipsy.bph077]
  • Bloch, M. H., Landeros-Weisenberger, A., Rosario, M. C., Pittenger, C., & Leckman, J. F. (2008). Meta-analysis of the symptom structure of obsessive-compulsive disorder. American Journal of Psychiatry, 165, 1532-1542. [https://doi.org/10.1176/appi.ajp.2008.08020320]
  • Bragdon, L. B., & Coles, M. E. (2017). Examining heterogeneity of obsessive-compulsive disorder: Evidence for subgroups based on motivations. Journal of Anxiety Disorders, 45, 64-71. [https://doi.org/10.1016/j.janxdis.2016.12.002]
  • Brown, K. W., & Ryan, R. M. (2003). The benefits of being present: Mindfulness and its role in psychological well-being. Journal of Personality and Social Psychology, 84, 822-848. [https://doi.org/10.1037/0022-3514.84.4.822]
  • Burns, G. L., Keortge, S. G., Formea, G. M., & Sternberger, L. G. (1996). Revision of the Padua Inventory of obsessive compulsive disorder symptoms: Distinctions between worry, obsessions, and compulsions. Behaviour research and therapy, 34, 163-173. [https://doi.org/10.1016/0005-7967(95)00035-6]
  • Clark, D. A. (2005). Lumping versus splitting: A commentary on subtyping in OCD. Behaviour Therapy, 36, 401-404. [https://doi.org/10.1016/S0005-7894(05)80122-4]
  • Cloninger, C. R., Zohar, A. H., Hirschmann, S., & Dahan, D. (2012). The psychological costs and benefits of being highly persistent: Personality profiles distinguish mood disorders from anxiety disorders. Journal of Affective Disorders, 136, 758-766. [https://doi.org/10.1016/j.jad.2011.09.046]
  • Coles, M. E., Frost, R. O., Heimberg, R. G., & Rheaume, J. (2003). “Not just right experiences”: Perfectionism, obsessive–compulsive features and general psychopathology. Behaviour Research and Therapy, 41, 681-700. [https://doi.org/10.1016/S0005-7967(02)00044-X]
  • Didonna, F. (2009). Mindfulness and obsessive-compulsive disorder: Developing a way to trust and validate one’s internal experience. In Didonna, F (Ed.), Clinical handbook of mindfulness (pp. 189-219). New York, NY, Springer. [https://doi.org/10.1007/978-0-387-09593-6_12]
  • Dugas, M. J., Buhr, K., & Ladouceur, R. (2004). The Role of Intolerance of Uncertainty in Etiology and Maintenance. In R. G. Heimberg, C. L. Turk, & D. S. Mennin (Eds.), Generalized anxiety disorder: Advances in research and practice (pp. 143-163). The Guilford Press.
  • Ecker, W., & Gönner, S. (2008). Incompleteness and harm avoidance in OCD symptom dimensions. Behaviour Research and Therapy, 46, 895-904. [https://doi.org/10.1016/j.brat.2008.04.002]
  • Ecker, W., Kupfer, J., & Gönner, S. (2014). Incompleteness as a link between obsessive-compulsive personality traits and specific symptom dimensions of obsessive compulsive disorder. Clinical Psychology & Psychotherapy, 21, 394-402. [https://doi.org/10.1002/cpp.1842]
  • Fairfax, H., & Barfield, J. (2010). A group-based treatment for clients with obsessive compulsive disorder (OCD) in a secondary care mental health setting: Integrating new developments within cognitive behavioural interventions—an exploratory study. Counselling and Psychotherapy Research, 10, 214-221. [https://doi.org/10.1080/14733140903171212]
  • Foa, E. B., Liebowitz, M. R., Kozak, M. J., Davies, S., Campeas, R., Franklin, M. E., . . . Tu, X. (2005). Randomized, placebo-controlled trial of exposure and ritual prevention, clomipramine, and their combination in the treatment of obsessive-compulsive disorder. American Journal of Psychiatry, 162, 151-161. [https://doi.org/10.1176/appi.ajp.162.1.151]
  • Freeston, M. (2006). Cognitive therapy in obsessive compulsive disorder, lecture given at the. Univeristy of Exeter.
  • Frost, R. O., & Steketee, G. (1997). Perfectionism in obsessive compulsive disorder patients. Behaviour Research and Therapy, 35, 291-296. [https://doi.org/10.1016/S0005-7967(96)00108-8]
  • Haslam, N., Williams, B. J., Kyrios, M., McKay, D., & Taylor, S. (2005). Subtyping obsessive-compulsive disorder: A taxometric analysis. Behavior Therapy, 36, 381-391. [https://doi.org/10.1016/S0005-7894(05)80120-0]
  • Hayes, A. F. (2014). The PROCESS macro for SPSS and SAS (version 2.11) [Software]. Available from http://www.processmacro.org/download.html
  • Jeon, H. S., & Son, C. N. (2010). The relationship among mindfulness, trait anger, and irrational beliefs. Korean Journal of Clinical Psychology, 29, 989-1007. [https://doi.org/10.15842/kjcp.2010.29.4.005]
  • Johnson, E. M. (2014). Not Just Right Exposure?: Exposure to Feelings of Incompleteness and Not Just Right Experiences Associated with OCD Symptoms (Doctoral dissertation). Binghamton University, State of New York, United States.
  • Kampman, O., Viikki, M., Järventausta, K., & Leinonen, E. (2014). Meta-analysis of anxiety disorders and temperament. Neuropsychobiology, 69, 175-186. [https://doi.org/10.1159/000360738]
  • Key, B. L., Rowa, K., Bieling, P., McCabe, R., & Pawluk, E. J. (2017). Mindfulness-based cognitive therapy as an augmentation treatment for obsessive-compulsive disorder. Clinical Psychology & Psychotherapy, 24, 1109-1120. [https://doi.org/10.1002/cpp.2076]
  • Kim, I. J., & Shin, M. S. (2017). Evidence-based treatment of obsessive-compulsive disorder. Korean Journal of Clinical Psychology, 36, 509-525. [https://doi.org/10.15842/kjcp.2017.36.4.005]
  • Kim, J. H. (2018). Understanding of meditation and mindfulness. Korean Society of Meditation, 8, 1-22. [https://doi.org/10.35184/kshce.2018.22.2.1]
  • Lee, E. H. (2005). Incompleteness and its relationship to OCD symptoms and personality characteristics (Unpublished master’s thesis). Seoul National University, Seoul, Korea.
  • Lim, J. E. (2017). The Effect of Intolerance of Uncertainty and Perfectionism on Obsessive-Compulsive Symptoms: The Mediating Effect of Self-Compassion (Unpublished master’s thesis). Chosun University, Gwangju, Korea.
  • Radomsky, A. S., & Taylor, S. (2005). Subtyping OCD: Prospects and problems. Behavior Therapy, 36, 371-379. [https://doi.org/10.1016/S0005-7894(05)80119-4]
  • Ramel, W., Goldin, P. R., Carmona, P. E., & McQuaid, J. R. (2004). The effects of mindfulness meditation on cognitive processes and affect in patients with past depression. Cognitive Therapy and Research, 28, 433-455. [https://doi.org/10.1023/B:COTR.0000045557.15923.96]
  • Rosário. (2017). Symptom heterogeneity in OCD. Pittenger (Ed.), Obsessive-compulsive Disorder: Phenomenology, Pathophysiology, and Treatment (pp. 75-92). New York, NY, Oxford University Press.
  • McKay, D., Abramowitz, J. S., Calamari, J. E., Kyrios, M., Radomsky, A., Sookman, D., . . .Wilhelm, S. (2004). A critical evaluation of obsessive–compulsive disorder subtypes: Symptoms versus mechanisms. Clinical Psychology Review, 24, 283-313. [https://doi.org/10.1016/j.cpr.2004.04.003]
  • Meyer, V. (1966). Modification of expectations in cases with obsessive rituals. Behavior Research and Therapy, 4, 273-280. [https://doi.org/10.1016/0005-7967(66)90083-0]
  • Moon, H. M. (2005). The third wave of cognitive-behavioral therapy. Korean Journal of Counseling and Psychotherapy, 17, 15-33.
  • Obsessive Compulsive Cognitions Working Group. (2003). Psychometric validation of the obsessive beliefs questionnaire and the interpretation of intrusions inventory: Part 1. Behavior Research and Therapy, 41, 863-878. [https://doi.org/10.1016/S0005-7967(02)00099-2]
  • Obsessive Compulsive Cognitions Working Group. (2005). Psychometric validation of the obsessive belief questionnaire and interpretation of intrusions inventory–Part 2: Factor analyses and testing of a brief version. Behaviour Research and Therapy, 43, 1527-1542. [https://doi.org/10.1016/j.brat.2004.07.010]
  • Park, S. H. (2006). Development of the mindfulness scale (doctoral dissertation). The Catholic University of Korea, Gyeonggi, Korea.
  • Park, S. J. (2018). The effects of guilt on obsessive compulsive symptoms: not just right experiences as a mediator. Korean Journal of Clinical Psychology, 37, 145-155. [https://doi.org/10.15842/kjcp.2018.37.2.002]
  • Pallanti, S. (2017). Incompleteness and harm avoidance in OCD. C. Pittenger (Ed.), Obsessive-compulsive Disorder : Phenomenology, Pathophysiology, and Treatment (pp. 93-100). New York, NY: Oxford University Press. [https://doi.org/10.1093/med/9780190228163.003.0009]
  • Pietrefesa, A. S., & Coles, M. E. (2008). Moving beyond an exclusive focus on harm avoidance in obsessive compulsive disorder: Considering the role of incompleteness. Behavior Therapy, 39, 224-231. [https://doi.org/10.1016/j.beth.2007.08.004]
  • Pietrefesa, A. S., & Coles, M. E. (2009). Moving beyond an exclusive focus on harm avoidance in obsessive-compulsive disorder: Behavioral validation for the separability of harm avoidance and incompleteness. Behavior Therapy, 40, 251-259. [https://doi.org/10.1016/j.beth.2008.06.003]
  • Preacher, K. J., Rucker, D. D., & Hayes, A. F. (2007). Addressing moderated mediation hypotheses: Theory, methods, and prescriptions. Multivariate Behavioral Research, 42, 185-227. [https://doi.org/10.1080/00273170701341316]
  • Schwartz, J., Stoessel, P., Baxter, L., Martin, K., & Phelps, M. (1996). Systematic changes in cerebral glucose metabolic rate after successful behavior modification treatment of obsessive–compulsive disorder. Archives of General Psychiatry, 53, 109-113. [https://doi.org/10.1001/archpsyc.1996.01830020023004]
  • Seo, Y. S. (2010). Testing medicator and moderator effects in counseling psychology research: Conceptual distinction and statistical considerations. The Korean Journal of Counseling and Psychotherapy, 22, 1147-1168.
  • Shapiro, S. L., Schwartz, G. E., & Santerre, C. (2002). Meditation and positive psychology. In C. R. Snyder & S. J. Lopez (Eds.), Handbook of positive psychology. New York, NY, Oxford University Press.
  • Shapiro, S. L., Carlson, L. E., Astin, J. A., & Freedman, B. (2006). Mechanisms of mindfulness. Journal of Clinical Psychology, 62, 373-386. [https://doi.org/10.1002/jclp.20237]
  • Seol, S. H., Kwo, S. M., & Shin, M. S. (2007). Cognitive appraisals and control strategies on worry and obsession. Korean Journal of Clinical Psychology, 26, 125-144. [https://doi.org/10.15842/kjcp.2007.26.1.008]
  • Shin, M. S., Seol, S. H., & Kwon, J. S. (2008). Cognitive therapy for obsessive-compulsive disorder: A guide for professionals. Seoul, Sigmapress.
  • Shrout, P. E., & Bolger, N. (2002). Mediation in experimental and nonexperimental studies: New procedures and recommendations. Psychological Methods, 7, 422-445. [https://doi.org/10.1037/1082-989X.7.4.422]
  • Storch, E. A., Merlo, L. J., Larson, M. J., Bloss, C. S., Geffken, G. R., Jacob, M. L., . . . Goodman, W. K. (2008). Symptom dimensions and cognitive‐behavioural therapy outcome for pediatric obsessive‐compulsive disorder. Acta Psychiatrica Scandinavica, 117, 67-75.
  • Summerfeldt, L. J., Richter, M. A., Antony, M. M., & Swinson, R. P. (1999). Symptom structure in obsessive-compulsive disorder: A confirmatory factor-analytic study. Behaviour Research and Therapy, 37, 297-311. [https://doi.org/10.1016/S0005-7967(98)00134-X]
  • Summerfeldt, L. J. (2004). Understanding and treating incompleteness in obsessive compulsive disorder. Journal of Clinical Psychology, 60, 1155-1168. [https://doi.org/10.1002/jclp.20080]
  • Summerfeldt, L. J., Kloosterman, P. H., Antony, M. M., & Swinson, R. P. (2014). Examining an obsessive-compulsive core dimensions model: Structural validity of harm avoidance and incompleteness. Journal of Obsessive-Compulsive and Related Disorders, 3, 83-94. [https://doi.org/10.1016/j.jocrd.2014.01.003]
  • Szechtman, H., & Woody, E. (2004). Obsessive-compulsive disorder as a disturbance of security motivation. Psychological Review, 111, 111-127. [https://doi.org/10.1037/0033-295X.111.1.111]
  • Taboas, W. R. (2017). The Treatment of Incompleteness as a Core Dimension of Obsessive-Compulsive Symptoms (Doctoral dissertation thesis). Fordham University, New York.
  • Taylor, S., McKay, D., Crowe, K. B., Abramowitz, J. S., Conelea, C. A., Calamari, J. E., & Sica, C. (2014). The sense of incompleteness as a motivator of obsessive-compulsive symptoms: An empirical analysis of concepts and correlates. Behavior Therapy, 45, 254-262. [https://doi.org/10.1016/j.beth.2013.11.004]
  • Tellegen, A., & Atkinson, G. (1974). Openness to absorbing and self-altering experiences (“absorbing”), a trait related to hypnotic susceptibility. Journal of Abnormal Psychology, 83, 268-277. [https://doi.org/10.1037/h0036681]
  • Van Schalkwyk, G. I., Bhalla, I. P., Griepp, M., Kelmendi, B., Davidson, L., & Pittenger, C. (2016). Toward understanding the heterogeneity in obsessive-compulsive disorder: Evidence from narratives in adult patients. Australian & New Zealand Journal of Psychiatry, 50, 74-81. [https://doi.org/10.1177/0004867415579919]