Thinking Differently - Metacognitive Therapy for Children and Adolescents with Obsessive-Compulsive Disorder: A Treatment Plan

Thinking Differently - Metacognitive Therapy for Children and Adolescents with Obsessive-Compulsive Disorder: A Treatment Plan The paper presents a metacognitive treatment manual for children and adolescents with obsessive-compulsive disorder. Adrian Wells developed his treatment manual for adult patients. Metacognitive therapy does not focus on the content of a single thought but on cognitive processes and the (metacognitive) over-importance of the obsessions. After a joint case formulation, patients learn a metacognitive way to respond to these thoughts ('detached mindfulness'). Thereafter, metacognitive beliefs regarding rituals and avoidance are challenged in order to reduce them. Exposure with response prevention is utilized to reappraise metacognitive beliefs; it does not aim at habituation and is therefore conducted for a much shorter duration than in traditional behavior therapy. Many interventions can be easily adapted to children. Role plays are helpful in making the abstract concept of metacognition more comprehensible to younger children.