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.

1. 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, TX
Abstract Methods Results Conclusions
Both 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 symptom
study 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 depressive
outcome. 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 step
changes 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-tests
above 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-30
Replication 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 to
present 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 in
and perfectionism/certainty) and MC (including beliefs 80 OB did not significantly predict change in OCD
about the importance and need to control thoughts) Treatment 72.67 symptom severity above and beyond change in
MCQ-30
predicted 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 is
treatment. 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-II
changes in depressive symptoms, neither changes in prevention (ERP), cognitive restructuring and medication 62.45 from admission to discharge. Additional research is
OB 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 PC
OCD 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 and
intrusive thoughts or doubts activate meta-beliefs Measures
greater statistical power. In fact, MCQ RG approached
regarding the meaning, importance, and harmful Beck Depression Inventory-II (BDI-II; Beck, Steer, & Brown, 0 significance, which suggests that perhaps it would
consequences 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 sample
leads to attempts to control these thoughts through a depressive symptoms. Items are rated from 0-4, with total size. Future investigations with larger samples may
variety 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 one
including 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, References
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