Changes in Metacognition, Obsessional Beliefs, and OCD Severity over the Course of Treatment
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Changes in Metacognition, Obsessional Beliefs, and OCD Severity over the Course of Treatment

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Rachel C. Leonard, Ph.D.1, Chad T. Wetterneck, Ph.D. 2, Tannah Little, B.S. 2, & Bradley C. Riemann, Ph.D. 1...

Rachel C. Leonard, Ph.D.1, Chad T. Wetterneck, Ph.D. 2, Tannah Little, B.S. 2, & Bradley C. Riemann, Ph.D. 1



Both metacognitions (MC) and obsessional beliefs (OB) are related to OCD severity, however, only one study has compared them related to treatment outcome. Solem and colleagues (2009) found that changes in MC predicted changes in OCD severity above and beyond changes in depression and OB. Replication of this study is needed. Therefore, the present study examined whether changes in cognitions (OB about responsibility/threat estimation and perfectionism/certainty) and MC (including beliefs about the importance and need to control thoughts) predicted changes in OCD symptom severity following treatment. Results indicated that, when controlling for changes in depressive symptoms, neither changes in OB nor changes in MC significantly predicted changes in OCD symptom severity.

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Changes in Metacognition, Obsessional Beliefs, and OCD Severity over the Course of Treatment Changes in Metacognition, Obsessional Beliefs, and OCD Severity over the Course of Treatment Presentation Transcript

  • Changes in Metacognition, Obsessional Beliefs, and OCD Severity over the Course of Treatment Rachel C. Leonard, Ph.D.1, Chad T. Wetterneck, Ph.D. 2, Tannah Little, B.S. 2, & Bradley C. Riemann, Ph.D. 1 1 Rogers Memorial Hospital, Oconomowoc, WI 2 University of Houston – Clear Lake, Houston, TXAbstract Methods Results ConclusionsBoth metacognitions (MC) and obsessional beliefs Participants In order to examine changes over the course of treatment, These results did not replicate the finding by Solem et(OB) are related to OCD severity, however, only one Participants included 55 individuals between the ages of 18 residual gain scores (RG) were calculated, which corrects for al. (2009) that changes in MC predicted symptomstudy has compared them related to treatment and 70 (M = 30.55, SD= 12.22; males = 30, 54.5%). All problems in using raw change scores (see Steketee & change above and beyond changes in depressiveoutcome. Solem and colleagues (2009) found that participants had a primary diagnosis of OCD established by a Chambless, 1992). symptoms and changes in OB. In fact, the final stepchanges in MC predicted changes in OCD severity psychiatrist who specializes in anxiety disorder diagnosis and was not significant in either regression equation, Initial examination of the data using paired-samples t-testsabove and beyond changes in depression and OB. treatment and had a Y-BOCS-SR score of 16 or higher. indicating that metacognitive variables did not revealed that scores on the BDI-II, OBQ44 subscales, MCQ-30Replication of this study is needed. Therefore, the Comorbidity was common, with 81.8% of participants having at significantly predict OCD symptom severity change and Y-BOCS-SR significantly decreased from admission topresent study examined whether changes in least one additional diagnosis and 47.3% having at least two above and beyond change in depressive symptoms and discharge, indicating less severe symptom severity.cognitions (OB about responsibility/threat estimation additional diagnoses. changes in OB. The reverse was also true – change inand perfectionism/certainty) and MC (including beliefs 80 OB did not significantly predict change in OCDabout the importance and need to control thoughts) Treatment 72.67 symptom severity above and beyond change in MCQ-30predicted changes in OCD symptom severity following All patients were in a residential treatment center (RTC) for 70 69.53 depressive symptoms and change in MC. This istreatment. Results indicated that, when controlling for OCD. Treatment primarily consisted of exposure and response 59.87 despite the fact that all variables significantly decreased 60 BDI-IIchanges in depressive symptoms, neither changes in prevention (ERP), cognitive restructuring and medication 62.45 from admission to discharge. Additional research isOB nor changes in MC significantly predicted changes management. Participants received staff-assisted ERP seven 55.75 necessary to further explore the role of OB and MC in 50 Y-BOCS-in OCD symptom severity. days per week and were responsible for additional self-directed OCD symptom change following treatment. 46.55 SR exposures every day as well. Participants admitted between 40 37.64 OBQ44-Introduction May 19, 2008 and November 24, 2010 and had an average 27.13 RT Limitations and Future Directions length of stay of 69.86 days (SD = 32.26, range = 13 – 166 30 28.38 This study has several limitations. Most importantly, our OBQ44-The metacognitive model (Wells, 1997) suggests that days). Participants were not required to receive a specific dose 27.75 findings are limited by a small sample size of 55 20 PCOCD results from over-importance given to thoughts of treatment in order to be included in the study. 15.45 participants. Therefore, it is possible that the pattern of OBQ44-due to underlying MC. According to this model, 10 15.76 IC findings would differ with a larger sample size andintrusive thoughts or doubts activate meta-beliefs Measures greater statistical power. In fact, MCQ RG approachedregarding the meaning, importance, and harmful Beck Depression Inventory-II (BDI-II; Beck, Steer, & Brown, 0 significance, which suggests that perhaps it wouldconsequences associated with specific thoughts, which 1996). The BDI-II is a 21 item measure of severity of Admission Discharge emerge as a significant predictor with a larger sampleleads to attempts to control these thoughts through a depressive symptoms. Items are rated from 0-4, with total size. Future investigations with larger samples mayvariety of suppression or neutralization techniques, scores ranging from 0-63. Higher scores indicate greater In order to more fully examine these relationships, a multiple yield a different pattern of findings, and perhaps oneincluding rituals. Thus, according to this model, depression severity. regression analysis was conducted with the BDI-II RG entered more consistent with Solem and colleages (2009).metacognitive change is necessary for successful in Step 1 to control for depressive symptoms, cognitive Obsessive Beliefs Questionnaire-44 (OBQ44; OCCQG, 2005).treatment of OCD. In contrast to the metacognitive The OBQ-44 is a 44-item self-report measure of obsessive variables (OBQ44-RT RG, OBQ44-PC RG) entered in Step 2, Referencesmodel, the cognitive model suggests that successful and metacognitive variables (OBQ44-IC RG, MCQ30 RG) Baer, L., Brown-Beasley, M.W., Sorce, J., & Henriques, A. (1993). belief domains associated with OCD: responsibility/threattreatment requires changing the content of the entered in Step 3, with Y-BOCS-SR RG as the outcome Computer-assisted telephone administration of a structured estimation (OBQ44-RT), perfectionism/certainty (OBQ44-PC), interview for obsessive-compulsive disorder. American Journalthoughts, such as irrational beliefs about being variable. None of the predictors other than BDI-II RG were and importance/control of thoughts (OBQ44-IC). To replicate of Psychiatry, 150, 1737-1738.responsible for causing harm or a need for significant in Step 2 or Step 3. We also conducted an additional Solem and colleagues (2009), OBQ44-IC will be considered a Beck, A.T., Steer, R.A., & Brown, G.K. (1996). Manual for the Beckperfectionism. Solem, Håland, Vogel, Hansen, & Wells regression analysis with Steps 2 and 3 reversed. In this model, Depression Inventory, 2nd ed. San Antonio, TX: The metacognitive variable (see OCCQG, 1997) whereas OBQ44-(2009) examined the role of metacognitive and adding the metacognitive variables in Step 2 resulted in a Psychological Corporation. RT and OBQ44-PC will be considered cognitive variables. Obsessive Compulsive Cognitions Working Group. (1997). Cognitivecognitive changes in OCD symptom change using significant change, F change (2,51) = 5.504, p = .007, with Metacognitions Questionnaire 30 (MCQ-30; Wells & assessment of obsessive-compulsive disorder. Behaviourregression analyses within a sample of 83 outpatients MCQ RG a significant predictor, t = 2.126, p = .038. None of Research and Therapy, 35, 667-681.who received exposure and response prevention with Cartwright-Hatton, 2004). The MCQ-30 is a 30-item measure the predictors other than the BDI-II RG, however, was Obsessive Compulsive Cognitions Working Group (2005).or without additional cognitive techniques, such as that assesses metacognitive processes regarding focus and significant in the final step. The final step from this second Psychometric validation of the Obsessive Beliefs Questionnairecognitive restructuring. They found that changes in MC attention on thoughts, beliefs about worry, and beliefs about regression equation is presented below. and the Interpretation of Intrusions Inventory: part 2: factor intrusive thoughts. Specific domains assessed include positive analyses and testing of a brief version. Behaviour Research andwas a better predictor of symptom change than change Therapy, 43, 1527-1542.in OB (beliefs about responsibility and perfectionism). beliefs about worry, negative beliefs about thoughts regarding R2 β t p Solem, S., Håland, A. T., Vogel, P.A., Hansen, B., & Wells, A. (2009).For the present study, we sought to replicate this study uncontrollability and danger, cognitive confidence, negative DV: Y-BOCS-SR RG .510 Change in metacognitions predicts outcome in obsessive-in a sample of participants who received intensive beliefs about the consequences of not controlling thoughts, compulsive disorder patients undergoing treatment with BDI-II RG .416 3.267 .002 exposure and response prevention. Behaviour Research andoutpatient (IOP) or residential treatment for OCD. We and cognitive self-consciousness. OBQ44-IC RG .219 1.512 .137, ns Therapy, 47, 301-307.hypothesized that changes in MC would significantly Yale-Brown Obsessive-Compulsive Scale-Self Report (Y- Steketee, G., & Chambless, D. L. (1992). Methodological issues inpredict changes in OCD symptom severity above and BOCS-SR; Baer, Brown-Beasley, Sorce, & Henriques, 1993). MCQ-30 RG .249 1.987 .053, ns prediction of treatment outcome. Clinical Psychology Review,beyond changes in depressed mood and OB regarding The Y-BOCS-SR consists of 10 items rated from 0 to 4 for a OBQ44-RT RG .098 .598 .553, ns 12, 387-400.responsibility and perfectionism. Wells, A. (1997). Cognitive Therapy of anxiety disorders: a practice total score ranging from 0 to 40, with higher scores OBQ44-PC RG -.103 -.618 .539, ns manual and conceptual guide. Chichester, UK: Wiley. representing greater OCD symptom severity. 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. Rogers Memorial Hospital | Wisconsin | 800-767-4411 | rogershospital.org