Thought-Action Fusion, Scrupulosity and Afterlife Beliefs in Young Adults

1. INTRODUCTION

Religious beliefs and their implications have great importance in people’s lives.  Religion influences all aspects of believers’ lives and allows them to envision death through gratifying images of life after death. Religious beliefs about the afterlife can be positive or negative. Negative or unhealthy beliefs can cause irrational thoughts and behaviour about the religion and its role in one’s life. These irrational thoughts and behaviours constitute scrupulosity (Abramowitz, 2008).

Scrupulosity is usually considered a sub-type of OCD. In scrupulosity, individuals experience religious obsessions (repeated anxiety-provoking thoughts) like doubts about sins, arousal to commit sins, moral or sexual guilt and divine punishment etc. These obsessions produce anxiety or distress in the individual, which provoke them to perform compulsive behaviours like increased religious rituals, excessive praying, perfection in performing the religious tasks etc. in an effort to reduce that anxiety (Abramowitz, 2008). As stated earlier, different types of religious beliefs can have a significant effect on scrupulosity. In this regard, Noureen (2017) reported that afterlife beliefs are significantly positively correlated to scrupulosity. According to Simkus (2024), examples of scrupulous obsessions include doubts about one’s thoughts and words being offensive, while examples of scrupulous compulsions include excessive prayers and frequent confessing to religious leaders, etc.

Studies have identified different manifestations of scrupulosity, including cognitive, affective, behavioural, and social symptoms. Witzig (2005) presented different behavioural manifestations for clinical scrupulosity: the individual’s behaviour surpasses religious requirements; his/her beliefs and practices become much focussed on the exactness of rituals and usually lose the essence of religion interfering with normal religious practices. Abramowitz (2008) discussed some affective and social manifestations of scrupulosity. Anxiety is the most common emotional manifestation of scrupulosity and it refers to both uncertainty about future behaviours and frequent orientation towards past behaviours. Miller and Hedges (2008) presented several cognitive characteristics of scrupulosity asserting that patients have certain kinds of doubts in their minds regarding morality and religion leading to distress. They usually have negative and rigid cognitive styles when interpreting ambiguous stimuli. Scrupulous patients commonly show disturbed thinking patterns, as well as an excessive sense of guilt and personal responsibility regarding moral and religious issues.

These dysfunctional thought patterns and excessive sense of guilt are best expressed as thought-action fusion, in which a thought is considered equivalent to actions (Muris et al., 2001). For instance, someone with scrupulosity might have a fleeting sexual thought or urge that they didn't choose to have. They might feel intense guilt and believe they've committed a sexual sin, even though they never acted on it. This can lead them to confess repeatedly to a religious leader. Research suggests that thought-action fusion is an important causal factor of OCD symptoms which specifically triggers intrusive thoughts in a variety of anxiety-based disorders (Muris et al., 2001; Rassin & Koster, 2003). This aligns with the observation that individuals with scrupulosity, who hold strict moral standards and are highly vigilant about avoiding sin, may be particularly sensitive to intrusive sexual or sacrilegious thoughts that clash with their belief system (Nelson et al., 2006). Abramowitz and Deacon (2006) found that scrupulosity was correlated with all cognitive constructs of OCD, including thought-action fusion, moral, increased sense of responsibility etc.

The concept of Thought-Action Fusion (TAF) in clinical literature refers to the way people tend to mistake their thoughts for real-world actions. This can lead them to feel personally responsible for their intrusive thoughts as they assign special meaning them. They may also engage in self-blame for perceived harm caused to themselves or others (Salkovskis, 1985). TAF is a cognitive process in which thoughts are seen as equivalent to behaviours (Shafran & Rachman, 2004). Under the influence of TAF, intrusions transform into obsessions and individuals experience feelings of personal responsibility, guilt and hopelessness. Then, they try to neutralize these obsessions through compulsive behaviours such as increased religious deeds, saying certain type of words repeatedly and exhibiting certain reassurance seeking behaviours (Altin, 2009).

Numerous researchers have suggested that thought-action fusion and obsessive-compulsive symptoms are strongly correlated by checking their relationships on both clinical and non-clinical samples (Altin & Gençöz, 2011; Lee et al., 2020; Reuman et al., 2017; Yorulmaz et al., 2008). Previous research has revealed that TAF is also related to other psychopathologies like other anxiety disorders (Hezel et al., 2019; Thompson-Hollands et al., 2013), depression (Abramowitz, 2008), schizotypy (Lee et al., 2005), schizophrenia (Kabakcı et al., 2008) and eating disorders (Lee et al., 2020; Shafran & Rachman, 2004).

There is some evidence in research studies that examines how TAF relates to obsessive-compulsive symptoms and religiosity. For example, Williams et al. (2013) found that TAF acted as a mediator between religiosity and obsessive-compulsive symptoms.  Assigning connotation to intrusive thoughts can add to the increase or cause of OCD symptoms; i.e., obsessions and compulsions (Abramowitz, 2008). If these obsessions are severe, they can also affect the beliefs of a person, one of which is the belief of life after death.

Afterlife belief refers to an individual’s beliefs in life after death; in other words, the believer may think that the physical body is meant to be resurrected and reunited with one’s soul after death. The major religions of the world provide some form of beliefs about afterlife which vary from religion to religion (Obayashi, 1992). Hinduism, Sikhism, and Buddhism (Pearson, 1998) present the concept of reincarnation to their believers in the form of birth, death and rebirth cycle. The process of reincarnation is a continuous journey aimed at achieving freedom, which entails recognizing one's authentic self (Ghayas & Batool, 2016) and obtaining liberation from the cycle of rebirth along with the suffering it involves (Reynolds, 1992).

In Islam, afterlife belief is one of the major themes, the lack of which excludes a person from the religion (Abdel-Khalek, 2014). There are numerous verses in the Holy Quran as well as the Hadiths of Prophet (PBUH) on the topic of life after death. Islam also offers rewards and ranks in heaven as the afterlife compensation for a person’s religious and moral actions in this world. This engenders the believers to bring out the best in them with respect to religion, motivating them not to be limited to mere prayer halls, urging them to extend the teachings of Islam to every aspect of their lives (Maududi, 1984). Islam has taught people two types of afterlife beliefs: positive afterlife beliefs and negative afterlife beliefs. Individuals with positive afterlife beliefs hope that their lives after death would be happy, satisfied and rewarded, while, individuals with negative afterlife beliefs believe that their life after death will be unhappy, unsatisfied, regretful, fearful, and punished (Ghayas & Batool, 2016).

Afterlife belief serves many functions for human beings. For example, it satisfies the human need for striving towards a meaningful life (Hood et al., 2005). Secondly, it equips individuals to deal with the existential anxiety of their own death and bereavement (Benore & Park, 2004). A research study was conducted on the relationship between religiosity, death anxiety and aging. Its results revealed that individuals with high levels of religiosity tend to have low levels of death anxiety and vice versa (Amjad, 2014).

Another study conducted by Flannelly et al. (2008) evaluated the relationship between afterlife belief and psychiatric symptoms. They reported that individuals with positive afterlife belief had little to no psychiatric symptoms while individuals with negative afterlife belief had more psychiatric symptoms. In another study, both positive afterlife beliefs and negative afterlife beliefs significantly positively predicted religious manifestation of OCD, named scrupulosity; however, negative afterlife belief was a more powerful predictor of scrupulosity. Moreover, afterlife belief acted as a mediator in the relationship of religiosity and scrupulosity (Noureen, 2017).

An individual’s religious inclinations and beliefs constitute their life decisions and drive their choices. During the last few years, there has been an increased interest in the scientific study of religion and belief systems. Thus, the nature of the current study also lies in this criterion; it aims to examine how the belief about God and belief about life after death affects a person’s obsessional tendencies regarding religion and morality. A vast majority of the previous studies regarding religion and moral beliefs has been carried out in Western and Christian contexts. Very few researches have been carried out in Muslim cultures.

In Pakistan, there are very few researches about the link between religious beliefs and scrupulosity. Recently, Noureen (2017) has examined the role of religiosity in psychopathological symptomology among university students. Her findings revealed that in university student’s religiosity, positive afterlife beliefs and negative afterlife beliefs were significant positive predictors of scrupulosity. Thus, the current study aims to examine these relationships in a sample of young adults to analyse how thought-action fusion predicts scrupulosity and the effect of afterlife beliefs in these relationships.

The significance and impact of the current study is that it provides clinicians and counsellors a way to understand the development of scrupulosity with the help of religious beliefs and thought-action fusion. The study aims to bridge the gap in the psychological literature, linking mental issues (scrupulosity, TAF) with a person’s religious beliefs (afterlife beliefs). In addition, the study indicates the general patterns of religious beliefs (afterlife beliefs, and also TAF) in younger adults further highlighting unhealthy patterns of these beliefs. Furthermore, this study identifies how these beliefs can trigger the religious obsessions and compulsions (scrupulosity) of people.

In order to achieve the objectives of the present study, following hypotheses are articulated in light of previous studies:

1. Thought action fusion, positive afterlife belief and negative afterlife belief would be significantly positively correlated with scrupulosity.
2. Positive afterlife belief and negative afterlife belief would mediate the relationship between thought-action fusion and scrupulosity.

The conceptual diagram of current study is given below.

Methodology

The convenience sample of the present study comprised of two hundred adults with an age range of 18-35 years. Correlational research design was used in the study. All the participants were healthy young adults that were approached in universities. Severe mentally disturbed patients and non-religious individuals were excluded from the study.

The demographic sheet comprised of several characteristics to define the sample, including gender, age, profession, and marital status.

The scale was developed by Ghayas and Batool (2016), having 15 items and 3 subscales including positive afterlife beliefs, negative afterlife beliefs, and extinction. High score on each subscale indicates high belief on that dimension. Response format is Likert-type 5-point ranging from 1 = never to 5 = always. The authors of the scale reported that Cronbach’s alpha coefficient for positive afterlife belief dimension was .78 and that for negative afterlife belief dimension was .70. In the present study, only positive and negative afterlife beliefs subscales were used.

In the present study, TAFS was translated into Urdu language after getting permission from the original authors and a standardized procedure of translation was used. The scale consists of 19 items with 5-point Likert-type scale. The reliability of the scale came to be .95 (Shafran et al., 1996).

In the present study, Urdu translation of PIOS-R was used to measure scrupulosity. Its Urdu translation was done by Noureen (2017) and it has a total of 15-items. Response format was 5-point Likert-type scale ranging from 1 = never to 5 = constantly. High score indicates high level of scrupulosity and vice versa. Its Cronbach’s alpha, as reported by Olatunji et al. (2007) is .91

Procedure

After selection of topic and finalization of scales, for the purpose of data collection, participants were approached directly in different universities of the Punjab province. The heads of psychology departments were approached in these universities who were briefed about the research and were requested participation. After obtaining informed consent, participants were individually briefed about the study's objectives and nature. They were informed that their confidentiality would be maintained. Participants then received a test booklet containing anxiety scales, thought-action fusion measures, and a demographic sheet. They were instructed to complete all sections honestly and sincerely. No time limit was imposed. Data from a sample of 200 participants was then entered into SPSS software. Different statistical analyses were run to test the proposed hypotheses. After analysis, results were compiled and discussed.

Results

Table 1 shows the frequency and percentage of individuals with respect to gender, profession, marital status, and educational status.

Table 2 shows the psychometric properties of study variables. Reliability analysis of all the scales encapsulates the good internal consistency of each scale. The values of skewness and kurtosis for all the scales and sub-scales are less than 1 which indicates that univariate normality is not problematic.

Table 3 manifests inter-correlations of the study variables. The table demonstrates that scrupulosity is significantly positively correlated with TAF, positive afterlife belief and negative afterlife belief. TAF has significant positive relationship with negative afterlife belief. Positive afterlife belief has significant positive relationship with negative afterlife belief. TAF has non-significant relationship with positive afterlife belief.

***p < .001. **p < .01. *p < .05.

Table 4 shows the total, direct, and indirect effects of Thought-Action Fusion on scrupulosity through negative afterlife beliefs. In case of scrupulosity, TAF (independent variable) has direct effect on it (β = .25, t = 2.92, p < .001), whereas afterlife beliefs (mediating variable) have direct effect on it (β = .56, t = 6.08, p < .001). Furthermore, the R² value of .071 indicates that total model explains 7.1% variance in scrupulosity with F (1, 198) = 15.18, p < .001, which is statistically significant. TAF has indirect effect through afterlife beliefs on scrupulosity (β = .07, CI =.01, .13), which is statistically significant. The statistical diagram of mediation is given below along with path co-efficient.

Discussion

The present study investigated the mediating role of afterlife beliefs between thought action fusion and scrupulosity. Correlation analysis revealed the nature of relationships between study variables (see Table 3). Subscales of afterlife belief scale for Muslims included positive afterlife beliefs and negative afterlife beliefs which were significantly positively correlated with each other. The reason for significant positive correlation between positive and negative afterlife beliefs is that in the religion of Islam, it is obligatory to hold faith on both positive and negative afterlife beliefs and both these beliefs are explained in numerous verses of the Quran and different sayings of the Prophet (PBUH). For example, in the Holy Quran, Allah stated, “… and they (believers) hold faith on life after death” (Surah Baqarah). In another Surah, Allah stated, “then as for those whose scales (of good deeds) are heavy, they shall be in a state of pleasure. And as for those whose scales are light, so his refuge will be the deep pit (of Hell)” (Surah Al-Qariyah). Regarding Paradise (positive afterlife belief) and hell (negative afterlife belief), Prophet (PBUH) said, “Paradise is surrounded by adversity and hellfire is surrounded by lusts” (Sahih Muslim, 2823). So, Muslims, tend to maintain beliefs on both positive and negative aspects of the afterlife. The original authors of the scale also reported a significant positive correlation between these two aspects (Ghayas & Batool, 2016).

Scrupulosity was positively correlated with thought-action fusion. The previous line of research also suggested that thought-action fusion is a significant predictor of OCD symptoms (just as scrupulosity) and specifically triggers intrusive thoughts in a variety of anxiety-based disorders (Muris et al., 2001; Rassin & Koster, 2003). Miller and Hedges (2008) suggested that ethical patients most characteristically exhibit dysfunctional thought patterns regarding moral issues and religious themes. These dysfunctional patterns correspond to thought-action fusion, hence both have a positive relationship with each other. Moreover, through the study, it can be observed that scrupulosity is significantly positively correlated with positive afterlife beliefs and negative afterlife beliefs. TAF has a significant positive correlation with negative afterlife belief, but it has a non-significant correlation with positive afterlife belief. These findings can be explained in this way: if a person has more negative afterlife beliefs, then under the action of thought-action fusion, he/she will perceive the negative afterlife expectations as significant and likely to happen after death, so it may cause distress in the individual. Such negative expectation and distress get transformed into obsessions, making the patient anxious and scared.  Consequently, people tend to neutralize these obsessions and anxiety through compulsive behaviour such as increased religious rituals, forgiveness seeking behaviour, fears from sin and fear from God. Hence, negative afterlife beliefs are correlated with thought action fusion; and both are correlated with scrupulosity.

In Pakistani context, Noureen (2017) reported that afterlife beliefs were significantly positively correlated to scrupulosity. As stated earlier, a Muslim has both positive and negative afterlife beliefs (although one can be higher than the other). Negative afterlife belief is correlated with scrupulosity, however, while positive afterlife belief also has a relationship with scrupulosity, its magnitude is low compared to negative afterlife belief. The reason for this difference can be viewed in the light of a research study by Flannelly et al. (2008). They proposed that beliefs affect threat assessment systems in the brain by modulating their sensitivity or threshold about the assessment of encountered stimuli. This results in enhancement or reduction of the psychiatric symptoms (involving scrupulosity). Hence in the study, negative afterlife beliefs increased the perception of threat in the afterlife, higher than the positive afterlife beliefs, which in turn increased the symptom of scrupulosity more as compared to its enhancement by positive afterlife beliefs (Flannelly et al., 2008).

In mediation analysis, afterlife belief mediated the relationship of thought-action fusion and scrupulosity (see Table 4 and Figure 2). This can be justified as Islam offers afterlife beliefs to its believers which engenders the believers to bring out the best in them in regard to religion and morality. To achieve this motive, believers try to live their lives with higher religious standards and moral perfectionism. Such religious adherence may turn into scrupulous fears; fear of God's rejection due to not following God’s rules and fears of committing sins or immoral actions. So, afterlife beliefs mediate the relationship between scrupulosity and thought-action fusion.

There were some limitations in the current study. The sample of the present study was taken from a limited area (i.e., some universities of Punjab province) in a limited time with a limited number of participants, hence the findings cannot be generalized to every culture. It is recommended to future researchers to increase the sample size for better generalization of findings. The study was conducted on the Muslim population. People belonging to other religions were not included in the study, which might limit the generalizability of these findings. Certain demographics like home environment, number of prayers being offered in a day, etc. were not controlled even though they might be relevant to the constructs of the present study. Number of prayers being offered depicts an individual’s high level of religious commitment, home environment also keeps a significant role in shaping one’s religious beliefs; hence, these variables might be relevant to the relationships of the present study. Despite these limitations, the findings add to fill the gaps in the research literature.

The study will help mental health practitioners, and counsellors in dealing with patients with OCD, particularly scrupulosity. Psychologists and Islamic scholars should play an active role in developing the understanding of scrupulosity in general people and relate it with afterlife beliefs and thought action fusion.

CONFLICT OF INTEREST

The author of the manuscript has no financial or non-financial conflict of interest in the subject matter or materials discussed in this manuscript

DATA AVAILABILITY STATEMENT

The data associated with this study will be provided by the corresponding author upon request.

FUNDING DETAILS

No funding has been received for this research.