Metacognition, Responsibility, and Perfectionism in Obsessive–Compulsive Disorder
- 1.3k Downloads
In Wells’ (1997) metacognitive model of obsessive–compulsive disorder (OCD), two types of metacognitive beliefs are considered central: thought-fusion beliefs and beliefs about rituals. According to the model, non-metacognitive beliefs such as responsibility and perfectionism, linked to OCD in other theories, are by-products of the perseverative thinking and behaviors (the cognitive attentional syndrome) activated by metacognitive beliefs. If this is the case, changes in metacognition should be a better independent predictor of changes in obsessive–compulsive symptoms following treatment than changes in non-metacognitive beliefs. This study aimed to test this in a sample of 108 in-patients with OCD, who completed an intensive (3 weeks) multimodal treatment package consisting of behavioral, cognitive, and metacognitive ingredients. Results indicated that obsessive–compulsive symptoms, cognitive, and metacognitive beliefs were significantly reduced during treatment, and treatment responders had larger reductions in these beliefs than non-responders. Metacognitive belief change emerged as a better independent predictor of recovery than cognitive belief change. These results add to the growing body of empirical support for the importance of metacognitions in OCD.
KeywordsMetacognition Obsessive–compulsive disorder Perfectionism Responsibility
Conflict of Interest
Torun Grøtte, Stian Solem, Patrick A. Vogel, Ismail Cüneyt Güzey, Bjarne Hansen, and Samuel G. Myers declare that they have no conflict of interest.
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 (5). Informed consent was obtained from all patients for being included in the study.
No animal studies were carried out by the authors for this article.
- Baer, L., Brown-Beasley, M. W., Sorce, J., & Henriques, A. I. (1993). Computer-assisted telephone administration of a structured interview for obsessive–compulsive disorder. The American Journal of Psychiatry, 150, 1737–1738. http://ajp.psychiatryonline.org/journal.aspx?journalid=13.
- Beck, A. T. (1976). Cognitive therapy and the emotional disorders. New York: International University Press.Google Scholar
- Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression. New York: The Guilford Press.Google Scholar
- Brown, T. A., DiNardo, P. A., & Barlow, D. H. (1994). Anxiety disorders interview schedule (4th ed.). Boulder, CO: Graywind Publications.Google Scholar
- Emmelkamp, P. M. G., & Aardema, A. (1999). Metacognition, specific obsessive–compulsive beliefs and obsessive–compulsive behaviour. Clinical Psychology and Psychotherapy, 6, 139–145. doi: 10.1002/(SICI)1099-0879(199905)6:2<139:AID-CPP194>3.0.CO;2-9.CrossRefGoogle Scholar
- Foa, E. B., & Kozak, M. J. (1997). Mastery of obsessive–compulsive disorder: Client workbook. New York: Graywind Publications.Google Scholar
- Salkovskis, P. M., Wroe, A. L., Gledhill, A., Morrison, N., Forrester, E., Richards, C., et al. (2000). Responsibility attitudes and interpretations are characteristic of obsessive–compulsive disorder. Behaviour Research and Therapy, 38, 347–372. doi: 10.1016/S0005-7967(99)00071-6.PubMedCrossRefGoogle Scholar
- Sica, C., Steketee, G., Ghisi, M., Chiri, L. R., & Franceschini, S. (2007). Metacognitive beliefs and strategies predict worry, obsessive–compulsive symptoms and coping styles: A preliminary prospective study on an Italian non-clinical sample. Clinical Psychology and Psychotherapy, 14, 258–268. doi: 10.1002/cpp.520.CrossRefGoogle Scholar
- Solem, S., Håland, Å. T., Vogel, P. A., Hansen, B., & Wells, A. (2009a). Change in metacognitions predicts outcome in obsessive–compulsive disorder patients undergoing treatment with exposure and response prevention. Behaviour Research and Therapy, 47, 301–307. doi: 10.1016/j.brat.2009.01.003.PubMedCrossRefGoogle Scholar
- Wells, A. (1997). Cognitive therapy of anxiety disorders: A practice manual and conceptual guide. Chichester, UK: Wiley.Google Scholar
- Wells, A. (2009). Metacognitive therapy for anxiety and depression. New York: The Guilford Press.Google Scholar
- Wells, A., Gwilliam, P., & Cartwright-Hatton, S. (2001). The thought fusion instrument (unpublished self-report scale). UK: University of Manchester.Google Scholar
- Wells, A., & Matthews, G. (1994). Attention and emotion: A clinical perspective. Hove: Lawrence Erlbaum & Associates.Google Scholar
- Wells, A., & McNicol, K. (2004). The beliefs about rituals inventory (unpublished self-report scale). UK: University of Manchester.Google Scholar