Metacognition, Responsibility, and Perfectionism in Obsessive-Compulsive Disorder

In Wells' (1997) metacognitive model of obsessive-compulsive disorder (OCD), two types of metacognitive beliefs are considered central: thought-fusion beliefs and beliefs about rituals. According to the model, non-metacognitive beliefs such as responsibility and perfectionism, linked to OCD in other theories, are by-products of the perseverative thinking and behaviors (the cognitive attentional syndrome) activated by metacognitive beliefs. If this is the case, changes in metacognition should be a better independent predictor of changes in obsessive-compulsive symptoms following treatment than changes in non-metacognitive beliefs. This study aimed to test this in a sample of 108 in-patients with OCD, who completed an intensive (3 weeks) multimodal treatment package consisting of behavioral, cognitive, and metacognitive ingredients. Results indicated that obsessive-compulsive symptoms, cognitive, and metacognitive beliefs were significantly reduced during treatment, and treatment responders had larger reductions in these beliefs than non-responders. Metacognitive belief change emerged as a better independent predictor of recovery than cognitive belief change. These results add to the growing body of empirical support for the importance of metacognitions in OCD.