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

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.

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Notes

  1. 1.

    Regional Committee for Medical and Health Research Ethics (REC) number; 2013/1210 Sør-Øst.

  2. 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. 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.

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Funding

This work was supported by Sørlandet Hospital in Norway and the Norwegian extrafoundation for health and rehabilitation, Reference Number 2013/FOM5661. The founders had no further involvement in planning, data analysis, writing of the manuscript or decision to publish.

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Sunde, T., Johnson, S.U., Himle, J.A. et al. Metacognitions and Obsessive Beliefs in Obsessive–Compulsive Disorder: A Study of Within- and Between-Person Effects on Long-Term Outcome. Cogn Ther Res (2021). https://doi.org/10.1007/s10608-021-10210-y

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Keywords

  • Metacognition
  • Obsessive beliefs
  • Cognition
  • Obsessive–compulsive disorder
  • Exposure
  • Follow-up