Skip to main content
Top
Gepubliceerd in:

04-02-2021 | Original Article

Metacognitions and Obsessive Beliefs in Obsessive–Compulsive Disorder: A Study of Within- and Between-Person Effects on Long-Term Outcome

Auteurs: Tor Sunde, Sverre Urnes Johnson, Joseph A. Himle, Thomas Bjerregaard Bertelsen, Vegard Øksendal Haaland, Patrick A. Vogel, Liv Tveit Walseth, Åshild Tellefsen Haaland

Gepubliceerd in: Cognitive Therapy and Research | Uitgave 6/2021

Log in om toegang te krijgen
share
DELEN

Deel dit onderdeel of sectie (kopieer de link)

  • Optie A:
    Klik op de rechtermuisknop op de link en selecteer de optie “linkadres kopiëren”
  • Optie B:
    Deel de link per e-mail

Abstract

Background

This study extends previous research by exploring whether changes in obsessive beliefs and metacognitions that were associated with changes in obsessive–compulsive disorder (OCD) symptom severity over the course of group behavioral treatment were maintained at long-term follow-up.

Methods

Forty patients with a primary diagnosis of OCD participated. The between- and within-person effects were investigated with multilevel longitudinal models. Predictor variables were obsessive beliefs and metacognitions.

Results

Across the study period, with a mean 8-year follow-up, obsessive and metacognitive beliefs significantly declined. There were significant between-person effects for metacognition and obsessive beliefs on OCD symptom severity. When the overlap between the obsessive belief factors was controlled for, only changes in metacognitions emerged as an independent predictor of OCD symptom severity. A further analysis revealed that metacognitive beliefs regarding the need to control thoughts made a separate contribution at both the between- and within-person levels.

Conclusions

The results indicate that decreases in metacognitive beliefs during OCD treatment can also have important long-term consequences.
Voetnoten
1
Regional Committee for Medical and Health Research Ethics (REC) number; 2013/1210 Sør-Øst.
 
2
Using the method by Ahn et al. 2014 for power calculation of multilevel models, assuming ICC was 0.75, 65 participants at pre-treatment and 40 at long-term follow-up and an alpha level of 0.05, the power for our specified model to detect a within-person difference in magnitude of 0.5 d (Cohen’s d = \(\frac{{M1 {-} M2}}{{SD{\text{pooled}}}}\)) (Cohen 1988) was 26% and a between-person difference in magnitude of 0.5 d was 46%.
 
3
The use of additional treatment and pre-treatment depression severity [measured with Beck Depression Inventory (BDI; Beck and Steer 1987)] were entered into the analysis to investigate the robustness of the results. After controlling for depression and additional treatment there was still a between-person effect of MCT-30 and OBQ-44 total scores on OCD-symptoms.
 
Literatuur
go back to reference Ahn, C., Heo, M., & Zhang, S. (2014). Sample size calculations for clustered and longitudinal outcomes in clinical research. New York: Chapman and Hall/CRC.CrossRef Ahn, C., Heo, M., & Zhang, S. (2014). Sample size calculations for clustered and longitudinal outcomes in clinical research. New York: Chapman and Hall/CRC.CrossRef
go back to reference American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Association. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Association.
go back to reference Brown, T. A., Campbell, L. A., Lehman, C. L., Grisham, J. R., & Mancill, R. B. (2001). Current and lifetime comorbidity of the DSM-IV anxiety and mood disorders in a large clinical sample. Journal of Abnormal Psychology, 110(4), 585–599.CrossRefPubMed Brown, T. A., Campbell, L. A., Lehman, C. L., Grisham, J. R., & Mancill, R. B. (2001). Current and lifetime comorbidity of the DSM-IV anxiety and mood disorders in a large clinical sample. Journal of Abnormal Psychology, 110(4), 585–599.CrossRefPubMed
go back to reference Beck, A. T., & Steer, R. A. (1987). BDI, beck depression inventory: manual. San Antonio, TX: Psychological Corp.; Harcourt Brace Jovanovich. Beck, A. T., & Steer, R. A. (1987). BDI, beck depression inventory: manual. San Antonio, TX: Psychological Corp.; Harcourt Brace Jovanovich.
go back to reference Clark, D. A. (2004). Cognitive-behavioral therapy for OCD. New York: Guilford Press. Clark, D. A. (2004). Cognitive-behavioral therapy for OCD. New York: Guilford Press.
go back to reference Clark, D. A., & Purdon, C. L. (1995). The assessment of unwanted intrusive thoughts: A review and critique of the literature. Behaviour Research and Therapy, 33(8), 967–976.CrossRefPubMed Clark, D. A., & Purdon, C. L. (1995). The assessment of unwanted intrusive thoughts: A review and critique of the literature. Behaviour Research and Therapy, 33(8), 967–976.CrossRefPubMed
go back to reference Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Lawrence Erlbaum Associates. Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Lawrence Erlbaum Associates.
go back to reference Corcoran, K. M., & Segal, Z. V. (2008). Metacognition in depressive and anxiety disorders: Current directions. International Journal of Cognitive Therapy, 1(1), 33–44.CrossRef Corcoran, K. M., & Segal, Z. V. (2008). Metacognition in depressive and anxiety disorders: Current directions. International Journal of Cognitive Therapy, 1(1), 33–44.CrossRef
go back to reference Diedrich, A., Sckopke, P., Schwartz, C., Schlegl, S., Osen, B., Stierle, C., & Voderholzer, U. (2016). Change in obsessive beliefs as predictor and mediator of symptom change during treatment of obsessive-compulsive disorder-A process-outcome study. BMC Psychiatry, 16, 1–10.CrossRef Diedrich, A., Sckopke, P., Schwartz, C., Schlegl, S., Osen, B., Stierle, C., & Voderholzer, U. (2016). Change in obsessive beliefs as predictor and mediator of symptom change during treatment of obsessive-compulsive disorder-A process-outcome study. BMC Psychiatry, 16, 1–10.CrossRef
go back to reference Falkenström, F., Finkel, S., Sandell, R., Rubel, J. A., & Holmqvist, R. (2017). Dynamic models of individual change in psychotherapy process research. Journal of Consulting and Clinical Psychology, 85(6), 537.CrossRefPubMed Falkenström, F., Finkel, S., Sandell, R., Rubel, J. A., & Holmqvist, R. (2017). Dynamic models of individual change in psychotherapy process research. Journal of Consulting and Clinical Psychology, 85(6), 537.CrossRefPubMed
go back to reference First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (1995). Structured clinical interview for DSM-IV axis I disorders – Patient edition (SCID I/P, version 2.0). New York: Biometrics research department. First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (1995). Structured clinical interview for DSM-IV axis I disorders – Patient edition (SCID I/P, version 2.0). New York: Biometrics research department.
go back to reference Fisher, P. L., & Wells, A. (2005). How effective are cognitive and behavioral treatments for obsessive-compulsive disorder? A clinical significance analysis. Behaviour Research and Therapy, 43(12), 1543–1558.CrossRefPubMed Fisher, P. L., & Wells, A. (2005). How effective are cognitive and behavioral treatments for obsessive-compulsive disorder? A clinical significance analysis. Behaviour Research and Therapy, 43(12), 1543–1558.CrossRefPubMed
go back to reference Fitzmaurice, G. M., Laird, N. M., & Ware, J. H. (2004). Applied longitudinal analysis. Hoboken NJ: Wiley-Interscience. Fitzmaurice, G. M., Laird, N. M., & Ware, J. H. (2004). Applied longitudinal analysis. Hoboken NJ: Wiley-Interscience.
go back to reference Haaland, A. T., Vogel, P. A., Launes, G., Haaland, V. O., Hansen, B., Solem, S., & Himle, J. A. (2011). The role of early maladaptive schemas in predicting exposure and response prevention outcome for obsessive-compulsive disorder. Behaviour Research and Therapy, 49(11), 781–788.CrossRefPubMed Haaland, A. T., Vogel, P. A., Launes, G., Haaland, V. O., Hansen, B., Solem, S., & Himle, J. A. (2011). The role of early maladaptive schemas in predicting exposure and response prevention outcome for obsessive-compulsive disorder. Behaviour Research and Therapy, 49(11), 781–788.CrossRefPubMed
go back to reference Haaland, A. T., Vogel, P. A., Lie, B., Launes, G., Pripp, A. H., & Himle, J. A. (2010). Behavioural group therapy for obsessive-compulsive disorder in Norway. An open community-based trial. Behaviour Research and Therapy, 48(6), 547–554.CrossRef Haaland, A. T., Vogel, P. A., Lie, B., Launes, G., Pripp, A. H., & Himle, J. A. (2010). Behavioural group therapy for obsessive-compulsive disorder in Norway. An open community-based trial. Behaviour Research and Therapy, 48(6), 547–554.CrossRef
go back to reference Himle, J. A., Rassi, S., Haghighatgou, H., Krone, K. P., Nesse, R. M., & Abelson, J. (2001). Group behavioral therapy of obsessive-compulsive disorder: Seven vs. twelve-week outcomes. Depression and Anxiety, 13(4), 161–165.CrossRefPubMed Himle, J. A., Rassi, S., Haghighatgou, H., Krone, K. P., Nesse, R. M., & Abelson, J. (2001). Group behavioral therapy of obsessive-compulsive disorder: Seven vs. twelve-week outcomes. Depression and Anxiety, 13(4), 161–165.CrossRefPubMed
go back to reference Hoffart, A., & Johnson, S. U. (2017). Psychodynamic and cognitive-behavioral therapies are more different than you think: Conceptualizations of mental problems and consequences for studying mechanisms of change. Clinical Psychological Science, 5(6), 1070–1086.CrossRef Hoffart, A., & Johnson, S. U. (2017). Psychodynamic and cognitive-behavioral therapies are more different than you think: Conceptualizations of mental problems and consequences for studying mechanisms of change. Clinical Psychological Science, 5(6), 1070–1086.CrossRef
go back to reference Jacoby, R. J., & Abramowitz, J. S. (2016). Inhibitory learning approaches to exposure therapy: A critical review and translation to obsessive-compulsive disorder. Clinical Psychology Review, 49, 28–40.CrossRefPubMed Jacoby, R. J., & Abramowitz, J. S. (2016). Inhibitory learning approaches to exposure therapy: A critical review and translation to obsessive-compulsive disorder. Clinical Psychology Review, 49, 28–40.CrossRefPubMed
go back to reference Johnson, S. U., Hoffart, A., Nordahl, H. M., Ulvenes, P. G., Vrabel, K., & Wampold, B. E. (2018). Metacognition and cognition in inpatient MCT and CBT for comorbid anxiety disorders: A study of within-person effects. Journal of Counseling Psychology, 65(1), 86–97. https://doi.org/10.1037/cou0000226.CrossRefPubMed Johnson, S. U., Hoffart, A., Nordahl, H. M., Ulvenes, P. G., Vrabel, K., & Wampold, B. E. (2018). Metacognition and cognition in inpatient MCT and CBT for comorbid anxiety disorders: A study of within-person effects. Journal of Counseling Psychology, 65(1), 86–97. https://​doi.​org/​10.​1037/​cou0000226.CrossRefPubMed
go back to reference Kart, A., BurchanSozer, B., & Turkcapar, H. (2020). Predictive values of obsessive beliefs and metacognitions in OCD symptom dimensions. Psychiatry and Behavioral Sciences, 10(3), 141–147.CrossRef Kart, A., BurchanSozer, B., & Turkcapar, H. (2020). Predictive values of obsessive beliefs and metacognitions in OCD symptom dimensions. Psychiatry and Behavioral Sciences, 10(3), 141–147.CrossRef
go back to reference Leckman, J. F., Bloch, M. H., & King, R. A. (2009). Symptom dimensions and subtypes of obsessive-compulsive disorder: A developmental perspective. Dialogues in Clinical Neuroscience, 11(1), 21.CrossRefPubMedPubMedCentral Leckman, J. F., Bloch, M. H., & King, R. A. (2009). Symptom dimensions and subtypes of obsessive-compulsive disorder: A developmental perspective. Dialogues in Clinical Neuroscience, 11(1), 21.CrossRefPubMedPubMedCentral
go back to reference Little, R. J. A., & Rubin, D. B. (2019). Statistical analysis with missing data (3rd ed.). Hoboken NJ: Wiley. Little, R. J. A., & Rubin, D. B. (2019). Statistical analysis with missing data (3rd ed.). Hoboken NJ: Wiley.
go back to reference McKay, D., Abramowitz, J. S., Calamari, J. E., Kyrios, M., Radomsky, A., Sookman, D., & Wilhelm, S. (2004). A critical evaluation of obsessive-compulsive disorder subtypes: Symptoms versus mechanisms. Clinical Psychology Review, 4(3), 283–313.CrossRef McKay, D., Abramowitz, J. S., Calamari, J. E., Kyrios, M., Radomsky, A., Sookman, D., & Wilhelm, S. (2004). A critical evaluation of obsessive-compulsive disorder subtypes: Symptoms versus mechanisms. Clinical Psychology Review, 4(3), 283–313.CrossRef
go back to reference Myers, S. G., Grøtte, T., Haseth, S., Guzey, I. C., Hansen, B., Vogel, P. A., & Solem, S. (2017). The role of metacognitive beliefs about thoughts and rituals: A test of the metacognitive model of obsessive-compulsive disorder in a clinical sample. Journal of Obsessive-Compulsive and Related Disorders, 13, 1–6. https://doi.org/10.1016/j.jocrd.2017.01.007.CrossRef Myers, S. G., Grøtte, T., Haseth, S., Guzey, I. C., Hansen, B., Vogel, P. A., & Solem, S. (2017). The role of metacognitive beliefs about thoughts and rituals: A test of the metacognitive model of obsessive-compulsive disorder in a clinical sample. Journal of Obsessive-Compulsive and Related Disorders, 13, 1–6. https://​doi.​org/​10.​1016/​j.​jocrd.​2017.​01.​007.CrossRef
go back to reference Nance, M., Abramowitz, J. S., Blakey, S. M., Reuman, L., & Buchholz, J. L. (2018). Thougts and thoughts about thoughts: The relative contribution of obsessive beliefs and metacognitive beliefs in predicting obsessive-compulsive symptom dimensions. International Journal of Cognitive Therapy, 11(2), 234–248.CrossRef Nance, M., Abramowitz, J. S., Blakey, S. M., Reuman, L., & Buchholz, J. L. (2018). Thougts and thoughts about thoughts: The relative contribution of obsessive beliefs and metacognitive beliefs in predicting obsessive-compulsive symptom dimensions. International Journal of Cognitive Therapy, 11(2), 234–248.CrossRef
go back to reference Olatunji, B. O., Rosenfield, D., Tart, C. D., Cottraux, J., Powers, M. B., & Smits, J. A. (2013b). Behavioral versus cognitive treatment of obsessive-compulsive disorder: An examination of outcome and mediators of change. Journal of Consulting and Clinical Psychology, 81(3), 415–428. https://doi.org/10.1037/a0031865.CrossRefPubMed Olatunji, B. O., Rosenfield, D., Tart, C. D., Cottraux, J., Powers, M. B., & Smits, J. A. (2013b). Behavioral versus cognitive treatment of obsessive-compulsive disorder: An examination of outcome and mediators of change. Journal of Consulting and Clinical Psychology, 81(3), 415–428. https://​doi.​org/​10.​1037/​a0031865.CrossRefPubMed
go back to reference Ong, C. W., Clyde, J. W., Bluett, E. J., Levin, M. E., & Twohig, M. P. (2016). Dropout rates in exposure with response prevention for obsessive-compulsive disorder: What do the data really say? Journal of Anxiety Disorders, 40, 8–17.CrossRefPubMed Ong, C. W., Clyde, J. W., Bluett, E. J., Levin, M. E., & Twohig, M. P. (2016). Dropout rates in exposure with response prevention for obsessive-compulsive disorder: What do the data really say? Journal of Anxiety Disorders, 40, 8–17.CrossRefPubMed
go back to reference Purdon, C., & Clark, D. A. (1999). Metacognition and obsessions. Clinical Psychology & Psychotherapy, 6(2), 102–110.CrossRef Purdon, C., & Clark, D. A. (1999). Metacognition and obsessions. Clinical Psychology & Psychotherapy, 6(2), 102–110.CrossRef
go back to reference Purdon, C., & Clark, D. A. (2002). The need to control thoughts. In R. O. Frost & G. Steketee (Eds.), Cognitive approaches to obsessions and compulsions: Theory, assessment, and treatment (pp. 29–43). Oxford: Elservier.CrossRef Purdon, C., & Clark, D. A. (2002). The need to control thoughts. In R. O. Frost & G. Steketee (Eds.), Cognitive approaches to obsessions and compulsions: Theory, assessment, and treatment (pp. 29–43). Oxford: Elservier.CrossRef
go back to reference Raudenbush, S. W., & Bryk, A. S. (2002). Hierarchical linear models: Applications and data analysis methods (2nd ed.). Thousand Oaks, CA: Sage. Raudenbush, S. W., & Bryk, A. S. (2002). Hierarchical linear models: Applications and data analysis methods (2nd ed.). Thousand Oaks, CA: Sage.
go back to reference Ruscio, A. M., Stein, D. J., Chiu, W. T., & Kessler, R. C. (2010). The epidemiology of obsessive-compulsive disorder in the national comorbidity survey replication. Molecular Psychiatry, 15(1), 53–63.CrossRefPubMed Ruscio, A. M., Stein, D. J., Chiu, W. T., & Kessler, R. C. (2010). The epidemiology of obsessive-compulsive disorder in the national comorbidity survey replication. Molecular Psychiatry, 15(1), 53–63.CrossRefPubMed
go back to reference Sunde, T., Walseth, L. T., Himle, J. A., Vogel, P. A., Launes, G., Haaland, V. Ø., & Haaland, Å. T. (2017). A long-term follow-up of group behavioral therapy for obsessive-compulsive disorder in a general outpatient clinic in Norway. Journal of Obsessive-Compulsive and Related Disorders, 14, 59–64. https://doi.org/10.1016/j.jocrd.2017.06.002.CrossRef Sunde, T., Walseth, L. T., Himle, J. A., Vogel, P. A., Launes, G., Haaland, V. Ø., & Haaland, Å. T. (2017). A long-term follow-up of group behavioral therapy for obsessive-compulsive disorder in a general outpatient clinic in Norway. Journal of Obsessive-Compulsive and Related Disorders, 14, 59–64. https://​doi.​org/​10.​1016/​j.​jocrd.​2017.​06.​002.CrossRef
go back to reference Taylor, S., Abramowitz, J. S., McKay, D., Calamari, J. E., Sookman, D., Kyrios, M., & Carmin, C. (2006). Do dysfunctional beliefs play a role in all types of obsessive-compulsive disorder? Journal of Anxiety Disorders, 20(1), 85–97.CrossRefPubMed Taylor, S., Abramowitz, J. S., McKay, D., Calamari, J. E., Sookman, D., Kyrios, M., & Carmin, C. (2006). Do dysfunctional beliefs play a role in all types of obsessive-compulsive disorder? Journal of Anxiety Disorders, 20(1), 85–97.CrossRefPubMed
go back to reference Tumkaya, S., Karadag, F., HanciYenigun, E., Ozdel, O., & Kashyap, H. (2018). Metacognitive beliefs and their relation with symptoms in obsessive-compulsive disorder. NoropsikiyatriArsivi, 55(4), 358–363. Tumkaya, S., Karadag, F., HanciYenigun, E., Ozdel, O., & Kashyap, H. (2018). Metacognitive beliefs and their relation with symptoms in obsessive-compulsive disorder. NoropsikiyatriArsivi, 55(4), 358–363.
go back to reference Twohig, M. P., Abramowitz, J. S., Smith, B. M., Fabricant, L. E., Jacoby, R. J., Morrison, K. L., & Ledermann, T. (2018). Adding acceptance and commitment therapy to exposure and response prevention for obsessive-compulsive disorder: A randomized controlled trial. Behaviour Research and Therapy, 108, 1–9.CrossRefPubMed Twohig, M. P., Abramowitz, J. S., Smith, B. M., Fabricant, L. E., Jacoby, R. J., Morrison, K. L., & Ledermann, T. (2018). Adding acceptance and commitment therapy to exposure and response prevention for obsessive-compulsive disorder: A randomized controlled trial. Behaviour Research and Therapy, 108, 1–9.CrossRefPubMed
go back to reference van Buuren, S. (2018). Flexible imputation of missing data. Boca Raton (FL): CRC Press.CrossRef van Buuren, S. (2018). Flexible imputation of missing data. Boca Raton (FL): CRC Press.CrossRef
go back to reference Vogel, P. A., & Solem, S. (2017). Assessment of cognitive distortions and cognitive biases. The Wiley handbook of obsessive compulsive disorders (pp. 138–154). Chichester: Wiley.CrossRef Vogel, P. A., & Solem, S. (2017). Assessment of cognitive distortions and cognitive biases. The Wiley handbook of obsessive compulsive disorders (pp. 138–154). Chichester: Wiley.CrossRef
go back to reference Wells, A. (1997). Cognitive therapy of anxiety disorders: A practice manual and conceptual guide. Chichester, UK: Wiley. Wells, A. (1997). Cognitive therapy of anxiety disorders: A practice manual and conceptual guide. Chichester, UK: Wiley.
go back to reference Wells, A. (2000). Emotional disorders and metacognition: Innovative cognitive therapy. Chichester, UK: Wiley. Wells, A. (2000). Emotional disorders and metacognition: Innovative cognitive therapy. Chichester, UK: Wiley.
go back to reference Wells, A. (2009). Metacognitive therapy for anxiety and depression. New York: Guildford Press. Wells, A. (2009). Metacognitive therapy for anxiety and depression. New York: Guildford Press.
go back to reference Wells, A., & Matthews, G. (1994). Attention and emotion: A clinical perspective. Hove, UK: Lawrence Erlbaum & Associates. Wells, A., & Matthews, G. (1994). Attention and emotion: A clinical perspective. Hove, UK: Lawrence Erlbaum & Associates.
go back to reference Wheaton, M. G., Abramowitz, J. S., Berman, N. C., Riemann, B. C., & Hale, L. R. (2010). The relationship between obsessive beliefs and symptom dimensions in obsessive-compulsive disorder. Behaviour Research and Therapy, 48(10), 949–954.CrossRefPubMed Wheaton, M. G., Abramowitz, J. S., Berman, N. C., Riemann, B. C., & Hale, L. R. (2010). The relationship between obsessive beliefs and symptom dimensions in obsessive-compulsive disorder. Behaviour Research and Therapy, 48(10), 949–954.CrossRefPubMed
go back to reference Whittal, M. L., Robichaud, M., Thordarson, D. S., & McLean, P. D. (2008). Group and individual treatment of obsessive-compulsive disorder using cognitive therapy and exposure plus response prevention: A 2-year follow-up of two randomized trials. Journal of Consulting and Clinical Psychology, 76(6), 1003–1014. https://doi.org/10.1037/a0013076.CrossRefPubMed Whittal, M. L., Robichaud, M., Thordarson, D. S., & McLean, P. D. (2008). Group and individual treatment of obsessive-compulsive disorder using cognitive therapy and exposure plus response prevention: A 2-year follow-up of two randomized trials. Journal of Consulting and Clinical Psychology, 76(6), 1003–1014. https://​doi.​org/​10.​1037/​a0013076.CrossRefPubMed
Metagegevens
Titel
Metacognitions and Obsessive Beliefs in Obsessive–Compulsive Disorder: A Study of Within- and Between-Person Effects on Long-Term Outcome
Auteurs
Tor Sunde
Sverre Urnes Johnson
Joseph A. Himle
Thomas Bjerregaard Bertelsen
Vegard Øksendal Haaland
Patrick A. Vogel
Liv Tveit Walseth
Åshild Tellefsen Haaland
Publicatiedatum
04-02-2021
Uitgeverij
Springer US
Gepubliceerd in
Cognitive Therapy and Research / Uitgave 6/2021
Print ISSN: 0147-5916
Elektronisch ISSN: 1573-2819
DOI
https://doi.org/10.1007/s10608-021-10210-y

Andere artikelen Uitgave 6/2021

Cognitive Therapy and Research 6/2021 Naar de uitgave