Change in metacognitions predicts outcome in obsessive–compulsive disorder patients undergoing treatment with exposure and response prevention
Abstract
Wells' (Wells, A. (1997). Cognitive therapy of anxiety disorders: a practice manual and conceptual guide. Chichester, UK: Wiley) metacognitive model of obsessive-compulsive disorder (OCD) predicts that metacognitions must change in order for psychological treatment to be effective. The aim of this study was to explore: (1) if metacognitions change in patients undergoing exposure treatment for OCD; (2) to determine the extent to which cognitive and metacognitive change predicts symptom improvement and recovery. The sample consisted of 83 outpatients with a diagnosis of OCD who completed exposure and response prevention treatment. The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), the Metacognitions Questionnaire (MCQ-30) and the Obsessive Beliefs Questionnaire (OBQ-44) were administered before treatment, after treatment, and at 12-month follow-up. Treatment resulted in significant changes in symptoms, metacognition score, responsibility and perfectionism. Regression analysis using post-treatment Y-BOCS as the dependent variable indicated that when the overlap between predictors was controlled for, only changes in metacognition were significant. Changes in metacognitions explained 22% of the variance in symptoms at post-treatment when controlling for pre-treatment symptoms and changes in mood. A further regression revealed that two MCQ-30 subscales made individual contributions. The patients had significantly higher scores compared to community controls on the MCQ-30. Patients who achieved clinical significant change had lower scores on the MCQ-30 compared to patients who did not change. The results did not change significantly from post-treatment to follow-up assessment. These findings provide further support for the importance of metacognitions in treating OCD.
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The need to control thoughts during exposure therapy predicted subsequent improvement in OC symptoms.
“Another study showed that the need to control thoughts during exposure therapy predicted a subsequent improvement in OC symptoms [18].”
From Metacognitive Training for Obsessive-Compulsive Disorder: A study protocol for a randomized controlled trial (2020) · cites this paper as [18]
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- Authors
- Solem, S., Håland, Å. T., Vogel, P. A., Hansen, B., & Wells, A.
- Affiliations
- Norwegian University of Science and Technology (NO)
- Sørlandet Sykehus (NO)
- Corresponding author
- Solem, Stian
- Venue
- Behaviour Research and Therapy
- Publisher
- Elsevier BV
- Published
- 2009-04
- Volume
- 47
- Issue
- 4
- Pages
- 301-307
- ISSN
- 0005-7967 (ISSN-L)
- OpenAlex
- W1983463944
- Cited by
- 152
- References
- 47
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 6 · 2023: 7 · 2022: 6 · 2021: 16 · 2020: 11 · 2019: 8 · 2018: 7 · 2017: 16 · 2016: 8 · 2015: 11 · 2014: 11 · 2013: 11 · 2012: 13
- FWCI
- 9.57
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Behaviour Research and Therapy (publishedVersion)
- PubMed (publishedVersion)
- Research Explorer (The University of Manchester) (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
- Keywords
- obsessive-compulsive disorder, metacognition, exposure and response prevention, metacognitive model, treatment outcome prediction, cognitive therapy, responsibility, perfectionism, obsessive beliefs, Yale-Brown Obsessive Compulsive Scale
- MeSH terms
- Adult, Cognition, Female, Humans, Male, Middle Aged, Obsessive-Compulsive Disorder, Patient Compliance, Prognosis, Psychiatric Status Rating Scales, Cognitive Behavioral Therapy, Treatment Outcome, Young Adult
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