Effectiveness of Metacognitive Therapy on Dysfunctional Beliefs, Inflated Sense of Responsibility, and Intolerance of Uncertainty in Patients with Obsessive-Compulsive Disorder

نوع مقاله: مقاله پژوهشی

نویسندگان

1 Department of General Psychology, Khomein Branch, Islamic Azad University, Khomein, Iran.

2 Assistant Professor, Department of clinical Psychology, Ashtian Branch, Islamic Azad University, Ashtian, Iran.

3 Associate Professor, Department of Counseling and Psychology, Khomein Branch, Islamic Azad University, Khomein, Iran.

4 Assistant Professor, Department of Counseling and Psychology, Khomein Branch, Islamic Azad University, Khomein, Iran.

چکیده

The present study aimed at investigating the effectiveness of metacognitive therapy on dysfunctional beliefs, inflated sense of responsibility, and intolerance of uncertainty in patients with obsessive compulsive-disorder (OCD). The design used in the present study is semi-experimental, pretest-posttest with control group and a tree-month follow-up stage. The statistical population consisted of all patients with OCD in Mahallat, a city located in Markazi province, Iran in 2018. The participants first screened by using inclusion and exclusion criteria. Then sixteen patients with OCD selected as the sample of the study through available sampling method and assigned randomly into two groups: one experimental group and one control group (eight patients in each group). Each participant in the experimental group received 12 treatment sessions according to Well's metacognitive therapy method for OCD. The participants were measured both before and after interventions as well as three months later in the follow-up phase by the Yale-Brown Obsessive-Compulsive Scale (Yale-BOCS; Goodman, 1989), the Obsessive Beliefs Questionnaire (OBQ-44; OCCWG, 2005), the Salkovskis Responsibility Attitude Scale (RAS; Salkovskis, 2000) and the Intolerance of Uncertainty Scale (IUS; Feriston, 1994). Data analyzed by multivariate co-variance analysis. The results indicated that metacognitive therapy had a significant effect on reducing dysfunctional beliefs, the inflated sense of responsibility and the variable intolerance of uncertainty (p˂0.050), and its effect remained three months after treatment (p˂0.050). The findings of the study support the effect of metacognitive therapy in improving the dysfunctional beliefs, inflated sense of responsibility and uncertainty of intolerance in patients with OCD.

کلیدواژه‌ها


عنوان مقاله [English]

Effectiveness of Metacognitive Therapy on Dysfunctional Beliefs, Inflated Sense of Responsibility, and Intolerance of Uncertainty in Patients with Obsessive-Compulsive Disorder (OCD)

نویسندگان [English]

  • Azam Nayebaghayee 1
  • Seyed Ali Aleyasin 2
  • Hassan Heidari 3
  • Hosein Davodi 4
1 Department of General Psychology, Khomein Branch, Islamic Azad University, Khomein, Iran.
2 Assistant Professor, Department of clinical Psychology, Ashtian Branch, Islamic Azad University, Ashtian, Iran.
3 Associate Professor, Department of Counseling and Psychology, Khomein Branch, Islamic Azad University, Khomein, Iran.
4 Assistant Professor, Department of Counseling and Psychology, Khomein Branch, Islamic Azad University, Khomein, Iran.
چکیده [English]

The present study aimed at investigating the effectiveness of metacognitive therapy on dysfunctional beliefs, inflated sense of responsibility, and intolerance of uncertainty in patients with obsessive compulsive-disorder (OCD). The design used in the present study is semi-experimental, pretest-posttest with control group and a tree-month follow-up stage. The statistical population consisted of all patients with OCD in Mahallat, a city located in Markazi province, Iran in 2018. The participants first screened by using inclusion and exclusion criteria. Then sixteen patients with OCD selected as the sample of the study through available sampling method and assigned randomly into two groups: one experimental group and one control group (eight patients in each group). Each participant in the experimental group received 12 treatment sessions according to Well's metacognitive therapy method for OCD. The participants were measured both before and after interventions as well as three months later in the follow-up phase by the Yale-Brown Obsessive-Compulsive Scale (Yale-BOCS; Goodman, 1989), the Obsessive Beliefs Questionnaire (OBQ-44; OCCWG, 2005), the Salkovskis Responsibility Attitude Scale (RAS; Salkovskis, 2000) and the Intolerance of Uncertainty Scale (IUS; Feriston, 1994). Data analyzed by multivariate co-variance analysis. The results indicated that metacognitive therapy had a significant effect on reducing dysfunctional beliefs, the inflated sense of responsibility and the variable intolerance of uncertainty (p˂0.050), and its effect remained three months after treatment (p˂0.050). The findings of the study support the effect of metacognitive therapy in improving the dysfunctional beliefs, inflated sense of responsibility and uncertainty of intolerance in patients with OCD.

کلیدواژه‌ها [English]

  • Obsessive-Compulsive Disorder (OCD)
  • Dysfunctional beliefs
  • Inflated sense of responsibility
  • Intolerance of uncertainty
  • Metacognitive Therapy

Ahadi, B., & Moradi, F. (2018). Psychological C Correlates of Intolerance of Uncertainty :( meta-analysis of Persian language Articles). Journal of Research in Psychological Health, 12(3), 91-105.

Akbari, M. (2017). The Comparison of the Efficacy of Intolerance Uncertainty Therapy, Buspirone and Combined Treatment in Improvement Symptom of Patients with Generalized Anxiety Disorder. Clinical Psychology Studies, 7(27), 89-115.

Almardani someeh, Narimani M, Mikaeeli N, Basharpoor S. (2017). The role of intolerance of uncertainty and emotion regulation in the prediction of marital satisfaction in OCD-pateints. Journal of Cultural Education of Women and Family, 11(37), 133-151.

Altın, M., & Karanci, A. N. (2008). How does locus of control and inflated sense of responsibility relate to obsessive-compulsive symptoms in Turkish adolescents? Journal of Anxiety Disorders, 22(8), 1303-1315.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub. Washington, DC: American Psychiatric Association. P. 235-295. [BOOK].

Arntz, A., Voncken, M., & Goosen, A. C. (2007). Responsibility and obsessive–compulsive disorder: An experimental test. Behaviour Research and Therapy, 45(3), 425-435. [Link]

Asaszadeh, I., Mahmoudalilou, M. (2018). The Study of the Effectiveness of Metacognitive Therapy on Depressive Symptoms and Life Expectancy of Women with Breast Cancer. Clinical Psychology Studies, 8(29), 69-95.

Bakhshipour, A., Alilou, M. M., & Pourfaraj Omran, M. (2016). Comparative study of cognitive factors in obsessive-compulsive, generalized anxiety, and major depression disorders. Journal of Shahrekord University of Medical Sciences, 18(6).

Calleo, J. S., Hart, J., Björgvinsson, T., & Stanley, M. A. (2010). Obsessions and worry beliefs in an inpatient OCD population. Journal of Anxiety Disorders, 24(8), 903-908.

Cheie, L., & Miu, A. C. (2016). Functional and dysfunctional beliefs in relation to adolescent health-related quality of life. Personality and Individual Differences, 97, 173-177.

Chiniforoushan, M., Sohrabi, F., Golzari, M., & Farokhi, N. (2017). Comparison of the Effectivness of Metacognitive therapy in a group and individual design patients with Obsessive-Compulsive Disorder.

Coles, M. E., & Schofield, C. A. (2008). Assessing the development of inflated responsibility beliefs: the Pathways to Inflated Responsibility Beliefs Scale. Behavior Therapy, 39(4), 322-335.

Conley, S. L., & Wu, K. D. (2018).­­ ­Experimental modification of dysfunctional interpretations in individuals with contamination concerns. Journal of behavior therapy and experimental psychiatry, 59, 56-64.

Counsell, A., Furtado, M., Iorio, C., Anand, L., Canzonieri, A., Fine, A., & Katzman, M. A. (2017). Intolerance of uncertainty, social anxiety, and generalized anxiety: Differences by diagnosis and symptoms. Psychiatry research, 252, 63-69.

Dugas, M. J., Schwartz, A., & Francis, K. (2004). Brief report: Intolerance of uncertainty, worry, and depression. Cognitive Therapy and Research, 28(6), 835-842.

Esfahani, S. R., Motaghipour, Y., Kamkari, K., Zahiredin, A., & Janbozorgi, M. (2012). Reliability and Validity of the Persian Version of the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). Iranian Journal of Psychiatry & Clinical Psychology, 17(4).

Faleer, H. E., Fergus, T. A., Bailey, B. E., & Wu, K. D. (2017). Examination of an experimental manipulation of intolerance of uncertainty on obsessive-compulsive outcomes. Journal of Obsessive-Compulsive and Related Disorders, 15, 64-73.

Fergus, T. A., & Wu, K. D. (2011). Searching for specificity between cognitive vulnerabilities and mood and anxiety symptoms. Journal of Psychopathology and Behavioral Assessment, 33(4), 446-458.

Fisher, P. L., & Wells, A. (2008). Metacognitive therapy for obsessive–compulsive disorder: A case series. Journal of behavior therapy and experimental psychiatry, 39(2), 117-132.

Foa, E. B., Amir, N., Bogert, K. V., Molnar, C., & Przeworski, A. (2001). Inflated perception of responsibility for harm in obsessive–compulsive disorder. Journal of Anxiety Disorders, 15(4), 259-275.

Frost, R. O., & Steketee, G. (Eds.). (2002). Cognitive approaches to obsessions and compulsions: Theory, assessment, and treatment. Elsevier.

Gillett, C. B., Bilek, E. L., Hanna, G. L., & Fitzgerald, K. D. (2018). Intolerance of uncertainty in youth with obsessive-compulsive disorder and generalized anxiety disorder: A Trans diagnostic construct with implications for phenomenology and treatment. Clinical psychology review, 60, 100-108.

Goodman, W. K., Price, L. H., Rasmussen, S. A., Mazure, C., Fleischmann, R. L., Hill, C. L., ... & Charney, D. S. (1989). The Yale-Brown obsessive-compulsive scale: I. Development, use, and reliability. Archives of general psychiatry, 46(11), 1006-1011.

Grøtte, T., Solem, S., Vogel, P. A., Güzey, I. C., Hansen, B., & Myers, S. G. (2015). Metacognition, responsibility, and perfectionism in obsessive–compulsive disorder. Cognitive Therapy and Research, 39(1), 41-50.

Halvaiepour, Z., & Nosratabadi, M. (2016). External criticism by parents and obsessive beliefs in adolescents: mediating role of beliefs associated with inflated responsibility. Global journal of health science, 8(5), 125.

Hamamcı, Z., & Esen-Coban, A. (2010). Dysfunctional relationship beliefs of late adolescence in adjustment to university. Procedia-Social and Behavioral Sciences, 2(2), 300-304.

Hansmeier, J., Exner, C., Rief, W., & Glombiewski, J. A. (2016). A test of the metacognitive model of obsessive-compulsive disorder. Journal of Obsessive-Compulsive and Related Disorders, 10, 42-48.

Kabirnezhad, S., MAHMOUD Alilo, A. M., & SHARIFI, M. A. (2010). Validity and reliability of the responsibility attitude scale (RAS). Psychological Research, 13(1):109-123.

Kazemi Rezaei, A., Saeidpoor, S., Samimi, Z., Parooi, M., & Afzoon, J. (2017). The Comparison of the Intolerance of Uncertainty and Short-Term Memory Capacity in Patients with Obsessive compulsive-disorder and Normal Individuals. Journal of Cognitive Psychology, 5(3).

Kim, S. K., McKay, D., Taylor, S., Tolin, D., Olatunji, B., Timpano, K., & Abramowitz, J. (2016). The structure of obsessive-compulsive symptoms and beliefs: A correspondence and biplot analysis. Journal of anxiety disorders, 38, 79-87.

Luppino, O. I., Tenore, K., Mancini, F., & Basile, B. (2018). A Theoretical Integration of Schema Therapy and Cognitive Therapy in OCD Treatment: Goals and Beliefs of the Obsessive Mind (Part I). Psychology, 9(09), 2261.

Mancini, F., D’Olimpio, F., & D’Ercole, S. (2001). Responsibility attitude, obsession and compulsion: further support in a nonclinical sample. Clinical Psychology and Psychotherapy, 8, 274–281.

Mantz, S. C., & Abbott, M. J. (2017). The relationship between responsibility beliefs, symptoms, and processes in obsessive-compulsive disorder: A systematic review. Journal of Obsessive-Compulsive and Related Disorders, 14, 13-26.

Mousavi Moghadam, S., Bairami, M., Bakhshipour, A., HamidPour, H. (2017). The Efficacy of Metacognitive Therapy on Reduction of Pathological Symptoms and Trait Anxiety Intensity in Patients with Generalized Anxiety Disorder. Clinical Psychology Studies, 7(27), 23-45.

Myers, S. G., Grøtte, T., Haseth, S., Guzey, I. C., Hansen, B., Vogel, P. A., & Solem, S. (2017). The role of metacognitive beliefs about thoughts and rituals: A test of the metacognitive model of obsessive-compulsive disorder in a clinical sample. Journal of Obsessive-Compulsive and Related Disorders, 13, 1-6.

Obsessive Compulsive Cognitions Working Group (OCCWG). (1997). Cognitive assessment of obsessive-compulsive disorder. Behavior Research and Therapy, 35(7), 667-681.

Pugh, K., Luzon, O., & Ellett, L. (2018). Responsibility beliefs and persecutory delusions. Psychiatry research, 259, 340-344.

Purdon, C., & Clark, D. A. (1999). Metacognition and obsessions. Clinical Psychology & Psychotherapy: An International Journal of Theory & Practice, 6(2), 102-110. [Link]

Rahimi, C., & Haghighi, M. (2015). Responsibility attitudes in obsessive-compulsive patients: the contributions of meta-cognitive beliefs and worry. Iranian Journal of Medical Sciences, 35(3), 195-200.

Raines, A. M., Carroll, M. N., Mathes, B. M., Franklin, C. L., Allan, N. P., & Constans, J. I. (2019). Examining the Relationships between Perfectionism and Obsessive-Compulsive Symptom Dimensions Among Rural Veterans. Journal of Cognitive Psychotherapy, 33(1), 58-70.

Salkovskis, P. M. (1985). Obsessional-compulsive problems: a cognitive-behavioural analysis. Behaviour Research and Therapy, 23, 571–583.

Salkovskis, P. M. (2007). Psychological treatment of obsessive–compulsive disorder.  Psychiatry, 6(6), 229-233.

Salkovskis, P. M., Wroe, A. L., Gledhill, A., Morrison, N., Forrester, E., Richards, C. ... & Thorpe, S. (2000). Responsibility attitudes and interpretations are characteristic of obsessive-compulsive disorder. Behaviour research and therapy, 38(4), 347-372.

Salkovskis, P., Shafran, R., Rachman, S., & Freeston, M. H. (1999). Multiple pathways to inflated responsibility beliefs in obsessional problems: Possible origins and implications for therapy and research. Behaviour Research and Therapy, 37(11), 1055-1072.

Salmani, B., Hasani, J. (2016). The role of intolerance of uncertainty and positive metacognitive beliefs in obsessive-compulsive disorder and depression. Razi Journal of Medical Sciences, 23(142), 64-72.

Samuels, J., Bienvenu, O. J., Krasnow, J., Wang, Y., Grados, M. A., Cullen, B.… & Rasmussen, S. A. (2017). An investigation of doubt in obsessive–compulsive disorder. Comprehensive psychiatry, 75, 117-124.

Shahjoee, T., Mahmood Aliloo, M., Bakhshipour Roodsari, A., & Fakhari, A. (2012). Intolerance of uncertainty and worry among patients with generalized anxiety disorder and obsessive-compulsive disorder. Iranian Journal of Psychiatry and Clinical Psychology, 17(4), 304-312.

Shams, G., Karamghadiri, N., ESMAELI, T. Y., & Ebrahimkhani, N. (2004). Validation and Reliability assessment of the Persian version of obsessive beliefs questionnaire, 44(32), 23-36.

Solem, S., Håland, Å. T., Vogel, P. A., Hansen, B., & Wells, A. (2009). Change in metacognitions predicts outcome in obsessive–compulsive disorder patients undergoing treatment with exposure and response prevention. Behaviour Research and Therapy, 47(4), 301-307.

Tolin, D. F., Abramowitz, J. S., Brigidi, B. D., & Foa, E. B. (2003). Intolerance of uncertainty in obsessive-compulsive disorder. Journal of anxiety disorders, 17(2), 233-242.

Tolin, D. F., Worhunsky, P., Brady, R. E., & Maltby, N. (2007). The relationship between obsessive beliefs and thought-control strategies in a clinical sample. Cognitive Therapy and Research, 31(3), 307-318.

Van der Heiden, C., van Rossen, K., Dekker, A., Damstra, M., & Deen, M. (2016). Metacognitive therapy for obsessive–compulsive disorder: A pilot study. Journal of Obsessive-Compulsive and Related Disorders, 9, 24-29.

Wells, A. (2007). Cognition about cognition: Metacognitive therapy and change in generalized anxiety disorder and social phobia. Cognitive and Behavioral Practice, 14(1), 18-25.Wells, A. (2009).

Wells, A. (2009). Metacognitive therapy for anxiety and depression. Guilford press.

Wells, A. (2011). Metacognitive therapy for anxiety and depression. Guilford press.

Wolters, L. H., Prins, P. J., Garst, G. J. A., Hogendoorn, S. M., Boer, F., Vervoort, L., & de Haan, E. (2019). Mediating Mechanisms in Cognitive Behavioral Therapy for Childhood OCD: The Role of Dysfunctional Beliefs. Child Psychiatry & Human Development, 50(2), 173-185.