Comparison Between Obsessive Compulsive Disorder and Panic Disorder on Metacognitive Beliefs, Emotional Schemas, and Cognitive Flexibility
We aimed to investigate the similarities and differences between patients with OCD and PD, and healthy control subjects (NPC) on their metacognitive beliefs, emotional schemas, and cognitive flexibility. We hypothesized that the clinical groups would score higher than the NPC group on their dysfunctional metacognitive beliefs and negative beliefs about emotional schemas, and lower than the control subjects on their cognitive flexibility. Regarding the metacognitive beliefs, the clinical groups scored higher than the NPC group on the scores of the uncontrollability and danger, the need to control thoughts subscales, and on the total score of the MCQ-30. On the uncontrollability, comprehensibility, rumination, dissimilarity, dangerousness, and guilt dimensions, and on the total score of the LESS, the clinical groups scored significantly higher than the NPC group. The NPC group obtained higher scores than the clinical groups on the Cognitive Flexibility Inventory. Focusing on the psychological concepts that differentiate patients with OCD and PD from healthy controls might help identify potential targets for psychotherapy.
KeywordsCognitive flexibility Emotional schema Metacognition Obsessive-compulsive disorder Panic disorder
Compliance with Ethical Standards
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee, and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants involved in the study.
Conflict of Interest
The authors declare that they have no conflicts of interest.
- Allen, L. B., McHugh, R. K., & Barlow, D. H. (2008). Emotional disorders: A unified protocol.Google Scholar
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.Google Scholar
- Aydın, O., Balıkçı, K., Çökmüş, F. P., & Ünal Aydın, P. (2019). The evaluation of metacognitive beliefs and emotion recognition in panic disorder and generalized anxiety disorder: Effects on symptoms and comparison with healthy control. Nordic Journal of Psychiatry, 1-9. https://doi.org/10.1080/08039488.2019.1623317.
- Barlow, D. H. (2001). Anxiety and its disorders, The Nature and Treatment of Anxiety and Panic (second ed.): Guilford Press.Google Scholar
- Batmaz, S., & Özdel, K. (2015). Psychometric properties of the Turkish version of the Leahy Emotional Schema Scale-II. Anatolian Journal of Psychiatry/Anadolu Psikiyatri Dergisi, 16(Supplement 1): 23–30.Google Scholar
- Clark, D. A. (2004). Intrusive thoughts in clinical disorders: Theory, research and treatment. New York: The Guilford Press.Google Scholar
- Cucchi, M., Bottelli, V., Cavadini, D., Ricci, L., Conca, V., Ronchi, P., & Smeraldi, E. (2012). An explorative study on metacognition in obsessive-compulsive disorder and panic disorder. Comprehensive Psychiatry, 53(5), 546–553. https://doi.org/10.1016/j.comppsych.2011.09.008.CrossRefPubMedGoogle Scholar
- de Jonge, P., Roest, A. M., Lim, C. C., Florescu, S. E., Bromet, E. J., Stein, D. J., et al. (2016). Cross-national epidemiology of panic disorder and panic attacks in the world mental health surveys. Depression and Anxiety, 33(12), 1155–1177. https://doi.org/10.1002/da.22572.CrossRefPubMedPubMedCentralGoogle Scholar
- Gloster, A. T., Sonntag, R., Hoyer, J., Meyer, A. H., Heinze, S., Strohle, A., Eifert, G., & Wittchen, H. U. (2015). Treating treatment-resistant patients with panic disorder and agoraphobia using psychotherapy: A randomized controlled switching trial. Psychotherapy and Psychosomatics, 84(2), 100–109. https://doi.org/10.1159/000370162.CrossRefPubMedGoogle Scholar
- Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2011). Acceptance and commitment therapy: The process and practice of mindful change. New York: Guilford Press.Google Scholar
- Hayes, S. C., Strosahl, K. D., & Wilson. (2012). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.). New York: Guilford Press.Google Scholar
- Hisli, N. (1989). Beck Depresyon Envanterinin üniversite öğrencileri için geçerliği, güvenirliği. Psikoloji dergisi, 7(23), 3–13.Google Scholar
- Leahy, R. L. (2018). Emotional schema therapy: Distinctive features. Routledge.Google Scholar
- Levin, M. E., MacLane, C., Daflos, S., Seeley, J. R., Hayes, S. C., Biglan, A., & Pistorello, J. (2014). Examining psychological inflexibility as a transdiagnostic process across psychological disorders. Journal of Contextual Behavioral Science, 3(3), 155–163.CrossRefPubMedPubMedCentralGoogle Scholar
- Lieberman, L., Gorka, S. M., Sarapas, C., & Shankman, S. A. (2017). Cognitive flexibility mediates the relation between intolerance of uncertainty and safety signal responding in those with panic disorder. Cognition & Emotion, 1–9. https://doi.org/10.1080/02699931.2015.1067189.
- Meuret, A. E., Twohig, M. P., Rosenfield, D., Hayes, S. C., & Craske, M. G. (2012). Brief acceptance and commitment therapy and exposure for panic disorder: A pilot study. Cognitive and Behavioral Practice, 19(4), 606–618.Google Scholar
- Myers, S. G., Fisher, P. L., & Wells, A. (2009). An empirical test of the metacognitive model of obsessive-compulsive symptoms: Fusion beliefs, beliefs about rituals, and stop signals. Journal of Anxiety Disorders, 23(4), 436–442. https://doi.org/10.1016/j.janxdis.2008.08.007.CrossRefPubMedGoogle Scholar
- Sharp, K. (2012). A review of acceptance and commitment therapy with anxiety disorders. International Journal of Psychology and Psychological Therapy, 12(3), 359–372.Google Scholar
- Sighvatsson, M. B., Salkovskis, P. M., Sigurdsson, E., Valdimarsdottir, H. B., Thorsdottir, F., & Sigurdsson, J. F. (2019). ‘You should always look at the washing machine without actually being in it!’ Thematic framework analysis of patients’ understanding of transdiagnostic cognitive behaviour therapy and its mechanisms. Psychology and Psychotherapy: Theory, Research and Practice. https://doi.org/10.1111/papt.12220.
- Tek, C., Uluǧ, B., Rezaki, B. G., Tanriverdi, N., Mercan, S., Demir, B., & Vargel, S. (1995). Yale-Brown obsessive compulsive scale and US National Institute of Mental Health global obsessive compulsive scale in Turkish: Reliability and validity. Acta Psychiatrica Scandinavica, 91(6), 410–413.CrossRefPubMedGoogle Scholar
- Twohig, M. P., Abramowitz, J. S., Smith, B. M., Fabricant, L. E., Jacoby, R. J., Morrison, K. L., Reuman, L., Blakey, S. M., & 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. https://doi.org/10.1016/j.brat.2018.06.005.CrossRefPubMedGoogle Scholar
- Twohig, M. P., Hayes, S. C., Plumb, J. C., Pruitt, L. D., Collins, A. B., Hazlett-Stevens, H., & Woidneck, M. R. (2010). A randomized clinical trial of acceptance and commitment therapy versus progressive relaxation training for obsessive-compulsive disorder. Journal of Consulting and Clinical Psychology, 78(5), 705–716. https://doi.org/10.1037/a0020508.CrossRefPubMedPubMedCentralGoogle Scholar
- Twohig, M. P., Lewin, M. P. (2017). Acceptance and commitment therapy as a treatment for anxiety and depression: A review. Retrieved Utah State University, DigitalCommons@USU, from psychology faculty publications.Google Scholar
- Ulusoy, M., Şahin, N., & Erkman, H. T. (1998). Turkish version of the beck anxiety inventory: Psychometric properties. Journal of Cognitive Psychoterapy, 12, 28–35.Google Scholar
- Ulusoy, S., Yavuz, K. F., Kara, T., Karadere, M. E. (2015). The role of metacognitive processes and emotional schemas in obsessive compulsive disorder. Journal of Cognitive-Behavioral Psychotherapy and Research, 4 (3), 173-183. Turkish. https://doi.org/10.5455/JCBPR.211991
- Vakili, Y., Gharaee, B., & Habibi, M. (2015). Acceptance and commitment therapy, selective serotonin reuptake inhibitors and their combination in the improvement of obsessive-compulsive symptoms and experiential avoidance in patients with obsessive-compulsive disorder. Iranian journal of psychiatry and behavioral sciences, 9(2).Google Scholar
- Wells, A. (2009). Metacognitive therapy for anxiety and depression. New York: The Guildford 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(4), 385–396Google Scholar
- Yavuz, K. F., Türkçapar, M. H., Demirel, B., & Karadere, E. (2011). Üniversite Öğrencileri ve Çalışanları Örnekleminde Leahy Duygusal Şema Ölçeği'nin Türkçe Uyarlaması, Geçerlilik ve Güvenilirliği. Düşünen Adam Psikiyatri ve Nörolojik Bilimler Dergisi, 24, 273–282.Google Scholar