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Metacognition, Responsibility, and Perfectionism in Obsessive–Compulsive Disorder

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Abstract

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.

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References

  • 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.

    Article  PubMed  Google Scholar 

  • 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 

  • 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.

    Article  Google Scholar 

  • Brown, T. A., DiNardo, P. A., & Barlow, D. H. (1994). Anxiety disorders interview schedule (4th ed.). Boulder, CO: Graywind Publications.

    Google Scholar 

  • Cronbach, L. J., & Furby, L. (1970). How we should measure “change”: Or should we? Psychological Bulletin, 74, 68–80. doi:10.1037/h0029382.

    Article  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.

    Article  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Foa, E. B., & Kozak, M. J. (1997). Mastery of obsessive–compulsive disorder: Client workbook. New York: Graywind Publications.

    Google Scholar 

  • 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.

    Chapter  Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  Google Scholar 

  • Matthews, G., Deary, I. J., & Whiteman, M. C. (2003). Personality traits. Cambridge: The University Press.

    Book  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  Google Scholar 

  • Rachman, S. (1993). Obsessions, responsibility and guilt. Behaviour Research and Therapy, 31, 149–154. doi:10.1016/0005-7967(93)90066-4.

    Article  CAS  PubMed  Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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 

  • 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.

    Article  CAS  PubMed  Google 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.

    Article  Google Scholar 

  • 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.

    Article  Google 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  CAS  PubMed  Google 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., & 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.

    Article  PubMed  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 

  • 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.

    Article  CAS  PubMed  Google Scholar 

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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.

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Authors and Affiliations

  1. St. Olav University Hospital, Trondheim, Norway

    Torun Grøtte

  2. Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway

    Stian Solem & Patrick A. Vogel

  3. Division of Psychiatry, Department of Research and Development, St. Olav University Hospital, Trondheim, Norway

    Stian Solem & Ismail Cüneyt Güzey

  4. Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway

    Ismail Cüneyt Güzey

  5. Department of Psychiatry, Haukeland University Hospital, Bergen, Norway

    Bjarne Hansen

  6. Faculty of Psychology, University of Bergen, Bergen, Norway

    Bjarne Hansen

  7. Hadassah University Hospital, Jerusalem, Israel

    Samuel G. Myers

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  1. Torun Grøtte
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  2. Stian Solem
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  3. Patrick A. Vogel
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  4. Ismail Cüneyt Güzey
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  5. Bjarne Hansen
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  6. Samuel G. Myers
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Correspondence to Torun Grøtte.

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Grøtte, T., Solem, S., Vogel, P.A. et al. Metacognition, Responsibility, and Perfectionism in Obsessive–Compulsive Disorder. Cogn Ther Res 39, 41–50 (2015). https://doi.org/10.1007/s10608-014-9635-7

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  • DOI: https://doi.org/10.1007/s10608-014-9635-7

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