An Evaluation of Metacognitive Functions in Obsessive-Compulsive Disorder

In metacognitive theory, thought fusion beliefs, beliefs about rituals, and beliefs about stop signals predict obsessive-compulsive symptoms. The number of controlled studies using specific scales to assess these three belief domains in different cultures is limited.

The comparison sample consisted of patients with obsessive-compulsive disorder (n: 106) and control (n: 200) group. Participants filled out the Obsessive-Compulsive Inventory-Revised form, Penn State Worry Scale, Obsessive Beliefs Scale-44, Thought Fusion Inventory, Beliefs about Rituals Inventory and Stop Signs Questionnaire. Correlation analysis of worry and OCD symptom severity levels, cognitions and metacognitions in OCD were performed between groups. Worry, cognition and metacognitive predictors of obsessive-compulsive symptoms were analyzed with a hierarchical linear regression model.

The metacognitive scale scores were significantly higher in the OCD group than in the control group except for hoarding (p<0.001). Obsessive-compulsive symptoms were statistically positively correlated (r: 0.17-0.53) with all three metacognitive functions in the OCD and control groups (except ordering in the control group). In addition to the three metacognitive domains, worry, perfectionism and intolerance of uncertainty predicted obsessive-compulsive symptoms (p<0.05). All three metacognitive domains contributed to the variance in the hierarchical regression model in addition to worry and cognitions (p<0.05).

All the three metacognitive domains were correlated with OCD symptom severity. Metacognitions explained additional variance above and beyond cognitions. Metacognitive assessment domains of OCD predicted OCD symptom severity when included in the hierarchical regression model.