Cognitive Therapy and Research

, Volume 39, Issue 1, pp 41–50 | Cite as

Metacognition, Responsibility, and Perfectionism in Obsessive–Compulsive Disorder

  • Torun GrøtteEmail author
  • Stian Solem
  • Patrick A. Vogel
  • Ismail Cüneyt Güzey
  • Bjarne Hansen
  • Samuel G. Myers
Original Article


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.


Metacognition 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.

Informed Consent

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.

Animal Rights

No animal studies were carried out by the authors for this article.


  1. Abramowitz, J. S., & Deacon, B. J. (2006). Psychometric properties and construct validity of the Obsessive–Compulsive Inventory-Revised: Replication and extension with a clinical sample. Journal of Anxiety Disorders, 20, 1016–1035. doi: 10.1016/j.janxdis.2006.03.001.PubMedCrossRefGoogle Scholar
  2. 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.
  3. Beck, A. T. (1976). Cognitive therapy and the emotional disorders. New York: International University Press.Google Scholar
  4. Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression. New York: The Guilford Press.Google Scholar
  5. Beck, A. T., Steer, R. A., & Carbin, M. G. (1988). Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation. Clinical Psychology Review, 8, 77–100. doi: 10.1016/0272-7358(88)90050-5.CrossRefGoogle Scholar
  6. Brown, T. A., DiNardo, P. A., & Barlow, D. H. (1994). Anxiety disorders interview schedule (4th ed.). Boulder, CO: Graywind Publications.Google Scholar
  7. Cronbach, L. J., & Furby, L. (1970). How we should measure “change”: Or should we? Psychological Bulletin, 74, 68–80. doi: 10.1037/h0029382.CrossRefGoogle Scholar
  8. 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
  9. Fisher, P. L., & Wells, A. (2005a). Experimental modification of beliefs in obsessive–compulsive disorder: A test of the metacognitive model. Behaviour Research and Therapy, 43, 821–829. doi: 10.1016/j.brat.2004.09.002.PubMedCrossRefGoogle Scholar
  10. Fisher, P. L., & Wells, A. (2005b). How effective are cognitive and behavioral treatments for obsessive–compulsive disorder? A clinical significance analysis. Behaviour Research and Therapy, 43, 1543–1558. doi: 10.1016/j.brat.2004.11.007.PubMedCrossRefGoogle Scholar
  11. Fisher, P. L., & Wells, A. (2008). Metacognitive therapy for obsessive–compulsive disorder: A case series. Journal of Behavior Therapy and Experimental Psychiatry, 39, 117–132. doi: 10.1016/j.jbtep.2006.12.001.PubMedCrossRefGoogle Scholar
  12. Foa, E. B., Huppert, J. D., Leiberg, S., Langner, R., Kichic, R., Hajcak, G., et al. (2002). The Obsessive–Compulsive Inventory: Development and validation of a short version. Psychological Assessment, 14, 485–496. doi: 10.1037/1040-3590.14.4.485.PubMedCrossRefGoogle Scholar
  13. Foa, E. B., & Kozak, M. J. (1997). Mastery of obsessive–compulsive disorder: Client workbook. New York: Graywind Publications.Google Scholar
  14. Frost, R. O., Novara, C., & Rhéaume, J. (2002). Perfectionism in obsessive–compulsive disorder. In R. O. Frost & G. Steketee (Eds.), Cognitive approaches to obsessions and compulsions: Theory, assessment, and treatment (pp. 91–107). Oxford: Pergamon.CrossRefGoogle Scholar
  15. Frost, R. O., & Steketee, G. (1997). Perfectionism in obsessive–compulsive disorder patients. Behaviour Research and Therapy, 35, 291–296. doi: 10.1016/S0005-7967(96)00108-8.PubMedCrossRefGoogle Scholar
  16. Grabill, K., Merlo, L., Duke, D., Harford, K.-L., Keeley, M. L., Geffken, G. R., et al. (2008). Assessment of obsessive–compulsive disorder: A review. Journal of Anxiety Disorders, 22, 1–17. doi: 10.1016/j.janxdis.2007.01.012.PubMedCrossRefGoogle Scholar
  17. Gwilliam, P., Wells, A., & Cartwright-Hatton, S. (2004). Does meta-cognition or responsibility predict obsessive–compulsive symptoms: A test of the metacognitive model. Clinical Psychology and Psychotherapy, 11, 137–144. doi: 10.1002/cpp.402.CrossRefGoogle Scholar
  18. Matthews, G., Deary, I. J., & Whiteman, M. C. (2003). Personality traits. Cambridge: The University Press.CrossRefGoogle Scholar
  19. Myers, S. G., Fisher, P. L., & Wells, A. (2008). Belief domains of the Obsessive Beliefs Questionnaire-44 (OBQ-44) and their specific relationship with obsessive–compulsive symptoms. Journal of Anxiety Disorders, 22, 475–484. doi: 10.1016/j.janxdis.2007.03.012.PubMedCrossRefGoogle Scholar
  20. Myers, S. G., Fisher, P. L., & Wells, A. (2009a). An empirical test of the metacognitive model of obsessive–compulsive symptoms: Fusion beliefs, beliefs about rituals, and stop signals. Journal of Anxiety Disorders, 23, 436–442. doi: 10.1016/j.janxdis.2008.08.007.PubMedCrossRefGoogle Scholar
  21. Myers, S. G., Fisher, P. L., & Wells, A. (2009b). Metacognition and cognition as predictors of obsessive–compulsive symptoms: A prospective study. International Journal of Cognitive Therapy, 2, 132–142. doi: 10.1521/ijct.2009.2.2.132.CrossRefGoogle Scholar
  22. Myers, S. G., & Wells, A. (2005). Obsessive–compulsive symptoms: The contribution of metacognitions and responsibility. Journal of Anxiety Disorders, 19, 806–817. doi: 10.1016/j.janxdis.2004.09.004.PubMedCrossRefGoogle Scholar
  23. Myers, S. G., & Wells, A. (2013). An experimental manipulation of metacognition: A test of the metacognitive model of obsessive–compulsive symptoms. Behaviour Research and Therapy, 51, 177–184. doi: 10.1016/j.brat.2013.01.007.PubMedCrossRefGoogle Scholar
  24. OCCWG. (2005). Psychometric validation of the Obsessive Belief Questionnaire and the Interpretation of Intrusions Inventory—part 2: Factor analyses and testing of a brief version. Behaviour Research and Therapy, 43, 1527–1542. doi: 10.1016/j.brat.2004.07.010.CrossRefGoogle Scholar
  25. Rachman, S. (1993). Obsessions, responsibility and guilt. Behaviour Research and Therapy, 31, 149–154. doi: 10.1016/0005-7967(93)90066-4.PubMedCrossRefGoogle Scholar
  26. Rachman, S., Thordarson, D. S., Shafran, R., & Woody, S. R. (1995). Perceived responsibility: Structure and significance. Behaviour Research and Therapy, 33, 779–784. doi: 10.1016/0005-7967(95)00016-Q.PubMedCrossRefGoogle Scholar
  27. Rees, C. S., & van Koesveld, K. (2008). An open trial of group metacognitive therapy for obsessive–compulsive disorder. Journal of Behavior Therapy and Experimental Psychiatry, 39, 451–458. doi: 10.1016/j.jbtep.2007.11.004.PubMedCrossRefGoogle Scholar
  28. Rhéaume, J., Freeston, M. H., Dugas, M. J., Letarte, H., & Ladouceur, R. (1995). Perfectionism, responsibility and obsessive–compulsive symptoms. Behaviour Research and Therapy, 33, 785–794. doi: 10.1016/0005-7967(95)00017-R.PubMedCrossRefGoogle Scholar
  29. Richter, M. A., Cox, B. J., & Direnfeld, D. M. (1994). A comparison of three assessment instruments for obsessive–compulsive symptoms. Journal of Behavior Therapy and Experimental Psychiatry, 25, 143–147. doi: 10.1016/0005-7916(94)90007-8.PubMedCrossRefGoogle Scholar
  30. Salkovskis, P. M. (1985). Obsessional-compulsive problems: A cognitive-behavioural analysis. Behaviour Research and Therapy, 23, 571–583. doi: 10.1016/0005-7967(85)90105-6.PubMedCrossRefGoogle Scholar
  31. Salkovskis, P. M. (1999). Understanding and treating obsessive–compulsive disorder. Behaviour Research and Therapy, 37, S29–S52. doi: 10.1016/S0005-7967(99)00049-2.PubMedCrossRefGoogle Scholar
  32. Salkovskis, P. M., Richards, H. C., & Forrester, E. (1995). The relationship between obsessional problems and intrusive thoughts. Behavioural and Cognitive Psychotherapy, 23, 199–281. doi: 10.1017/S1352465800015885.Google Scholar
  33. 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
  34. 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
  35. Smári, J., & Hólmsteinsson, H. E. (2001). Intrusive thoughts, responsibility attitudes, thought-action fusion, and chronic thought suppression in relation to obsessive–compulsive symptoms. Behavioural and Cognitive Psychotherapy, 29, 13–20. doi: 10.1017/S1352465801001035.CrossRefGoogle Scholar
  36. 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
  37. Solem, S., Hansen, B., Vogel, P. A., & Kennair, L. E. O. (2009b). The efficacy of teaching psychology students exposure and response prevention for obsessive–compulsive disorder. Scandinavian Journal of Psychology, 50, 245–250. doi: 10.1111/j.1467-9450.2008.00703.x.PubMedCrossRefGoogle Scholar
  38. Solem, S., Myers, S. G., Fisher, P. L., Vogel, P. A., & Wells, A. (2010). An empirical test of the metacognitive model of obsessive–compulsive symptoms: Replication and extension. Journal of Anxiety Disorders, 24, 79–86. doi: 10.1016/j.janxdis.2009.08.009.PubMedCrossRefGoogle Scholar
  39. Steketee, G., Frost, R., & Bogart, K. (1996). The Yale–Brown Obsessive Compulsive Scale: Interview versus self-report. Behaviour Research and Therapy, 34, 675–684. doi: 10.1016/0005-7967(96)00036-8.PubMedCrossRefGoogle Scholar
  40. Wells, A. (1997). Cognitive therapy of anxiety disorders: A practice manual and conceptual guide. Chichester, UK: Wiley.Google Scholar
  41. Wells, A. (2009). Metacognitive therapy for anxiety and depression. New York: The Guilford Press.Google Scholar
  42. Wells, A., & Cartwright-Hatton, S. (2004). A short form of the metacognitions questionnaire: properties of the MCQ-30. Behaviour Research and Therapy, 42, 385–396. doi: 10.1016/S0005-7967(03)00147-5.PubMedCrossRefGoogle Scholar
  43. Wells, A., Gwilliam, P., & Cartwright-Hatton, S. (2001). The thought fusion instrument (unpublished self-report scale). UK: University of Manchester.Google Scholar
  44. Wells, A., & Matthews, G. (1994). Attention and emotion: A clinical perspective. Hove: Lawrence Erlbaum & Associates.Google Scholar
  45. Wells, A., & McNicol, K. (2004). The beliefs about rituals inventory (unpublished self-report scale). UK: University of Manchester.Google Scholar
  46. Wu, K. D., & Cortesi, G. T. (2009). Relations between perfectionism and obsessive–compulsive symptoms: Examination of specificity among the dimensions. Journal of Anxiety Disorders, 23, 393–400. doi: 10.1016/j.janxdis.2008.11.006.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Torun Grøtte
    • 1
    Email author
  • Stian Solem
    • 2
    • 3
  • Patrick A. Vogel
    • 2
  • Ismail Cüneyt Güzey
    • 3
    • 4
  • Bjarne Hansen
    • 5
    • 6
  • Samuel G. Myers
    • 7
  1. 1.St. Olav University HospitalTrondheimNorway
  2. 2.Department of PsychologyNorwegian University of Science and TechnologyTrondheimNorway
  3. 3.Division of Psychiatry, Department of Research and DevelopmentSt. Olav University HospitalTrondheimNorway
  4. 4.Department of Neuroscience, Faculty of MedicineNorwegian University of Science and TechnologyTrondheimNorway
  5. 5.Department of PsychiatryHaukeland University HospitalBergenNorway
  6. 6.Faculty of PsychologyUniversity of BergenBergenNorway
  7. 7.Hadassah University HospitalJerusalemIsrael

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