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Metacognitive Model of Obsessive Compulsive Disorder

Year 2012, Volume: 4 Issue: 3, 335 - 349, 01.09.2012
https://doi.org/10.5455/cap.20120420

Abstract

Several authors have suggested that not only appraisal of significance of external events and signals from the body, but also appraisal of the personal significance of thoughts are important, and emphasized the conceptual limitations of the schema approach in cognitive model and developed the integrative information processing model of emotional disorders. According to this approach, the assessment of the meaning of thought, rather than thought itself is more important in the development and maintenance of the psychopathology. In the metacognitive model of obsessive compulsive disorder, three types of metacognitive beliefs are emphasized. These are; thought-action fusion (thought-action, thought-event, thought-object), metacognitive beliefs on performing the rituals and metacognitive beliefs on the warning to stop to terminate the rituals. According to the model, targeting directly to change in metacognitive beliefs will increase success in therapy. In this article, the concept of metacognition in emotional disorders, the metacognitive model of obsessive compulsive disorder and the advances that the model introduced in conceptualization and treatment of obsessive compulsive disorder have been discussed.

References

  • Wells A, Matthews G. Attention and emotion: a clinical perspective. Hove, UK: Lawrence Erlbaum, 1994.
  • Fisher PL, Wells A. Experimental modification of beliefs in obsessive-compulsive disorder: a test of the metacognitive model. Behav Res Ther 2005; 43:821-829.
  • Sungur MZ. OKB’nin Anlaşılması ve Tedavisinde Bilişsel Davranışçı Yaklaşımlar. In Anksiyete Bozukluklarında Son Gelişmeler (Ed N Dilbaz). Ankara, Pozitif Matbaacı- lık, 2006.
  • Salzman L, Thaler FH. Obsessive compulsive disorders: a review of the literature. Am J Psychiatry 1981; 138:286-296.
  • Stanley MA, Turner SM. Current status of pharmacological and behavioral treatment of obsessive-compulsive disorder. Behav Ther 1995; 26:163-186.
  • Clark D. Cognitive behavioral treatment of obsessive compulsive disorders: a commentary. Cogn Behav Pract 1999; 6:408-415.
  • Rachman SJ, De Silva P. Abnormal and normal obsessions. Behav Res Ther 1978; 16:233-238.
  • Salkovskis PM, Harrison J. Abnormal and normal obsessions: a replication. Behav Res Ther 1984; 22:549-552.
  • Salkovskis PM. Obsessional-compulsive problems: a cognitive-behavioural analysis. Behav Res Ther 1985; 23:571-583.
  • Salkovskis EM, Westbrook D. Behaviour therapy and obsessional rumination: can failure be turned into success? Behav Res Ther 1989; 27:149-160.
  • Salkovskis EM. Cognitive-behavioural approaches to the understanding of obsessional problems. In Current Controversies in The Anxiety Disorders (Ed R Rapee):103-133. New York. Guilford Press, 1996.
  • Rachman S. Obsessions, responsibility and guilt. Behav Res Ther 1993; 31:149-154.
  • Rachman S. A cognitive theory of obsessions. Behav Res Ther 1997; 35:793-802.
  • Rachman S. A cognitive theory of obsessions: elaborations. Behav Res Ther 1998; 36:385-401.
  • Clark DA. Cognitive-Behavioral Therapy For OCD. New York, The Guilford Press, 2004.
  • Obsessive Compulsive Cognitions Working Group. Cognitive assessment of obsessive-compulsive disorder. Behav Res Ther 1997; 35:667-681.
  • Flavell JH. Metacognitive aspects of problem solving. In The Nature of Intelligence (Ed LB Resnick): 231-236. Hillsdale, NJ, Lawrence Erbaum, 1976.
  • Brown AL. Metacognitive development and reading. Theoretical Issues in Reading Comprehension: Perspectives From Cognitive Psychology, Linguistics, Artificial Intelligence, and Education (Eds RJ Spiro, BC Bruce, WF Brewer). Hillsdale, NJ, Lawrence Erbaum, 1980.
  • Wells A, Matthews G. Modelling cognition in emotional disorder: the S-REF model. Behav Res Ther 1996; 34:881-888.
  • Fisher P, Wells A. Metacognitive Therapy: Distinctive Features. New York, Routledge, 2009.
  • Wells A. Metacognitive Therapy for Anxiety and Depression. New York, The Guilford Press, 2009.
  • Cartwright-Hatton S, Wells A. Beliefs about worry and intrusions: the metacognitions questionnaire and its correlates. J Anxiety Disord 1997; 11:279-296.
  • Janeck AS, Calamari JE, Riemann BC, Heffelfinger SK. Too much thinking about thinking?: metacognitive differences in obsessive compulsive disorder. J Anxiety Disord 2003; 17:181-195.
  • Cohen RJ. Calamari JE. Thought-focused attention and obsessive–compulsive symptoms: an evaluation of cognitive self-consciousness in a nonclinical sample. Cognit Ther Res 2004; 28:457-471.
  • De Bruin GO, Muris P, Rassin E. Are there specific meta-cognitions associated with vulnerability to symptoms of worry and obsessional thoughts? Pers Individ Dif 2007; 42:689-699.
  • Barahmand U. Meta-cognitive profiles in anxiety disorders. Psychiatry Res 2009; 169:240-243.
  • Myers SG, Fisher PL, Wells A. An empirical test of the metacognitive model of obsessive-compulsive symptoms: Fusion beliefs, beliefs about rituals, and stop signals. J Anxiety Disord 2009; 23:436-442.
  • Gwilliam PDH, Wells A, Cartwright-Hatton S. Does metacognition or responsibility predict obsessive-compulsive symptoms. A test of the metacognitive model. Clin Psychol Psychother 2004; 11:137-144.
  • Myers SG, Wells A. Obsessive–compulsive symptoms: the contribution of metacognitions and responsibility. J Anxiety Disord 2005; 19:806-817.
  • Myers SG, Fisher PL, Wells A. Belief domains of the Obsessive Beliefs Questionnaire- 44 (OBQ-44) and their specific relationship with obsessive–compulsive symptoms. J Anxiety Disord 2008; 22:475-484.
  • Myers SG, Fisher PL, Wells A. An empirical test of the metacognitive model of obsessive-compulsive symptoms: fusion beliefs, beliefs about rituals and stop signals. J Anxiety Disord 2009; 23:436-442.
  • Wells A. Cognitive Therapy of Anxiety Disorders: A Practice Manual and Conceptual Guide. Chichester, UK, Wiley, 1997.
  • Simons M, Schneider S, Herpertz-Dahlmann B. Metacognitive therapy versus exposure and response prevention for pediatric obsessive–compulsive disorder. Psychother Psychosom 2006; 75:257-264.
  • Fisher PL, Wells A. Metacognitive therapy for obsessive–compulsive disorder: a case series. J Behav Ther Exp Psychiatry 2008; 39:117-132.
  • Rees CS, van Koesveld KE. An open trial of group metacognitive therapy for obsessive-compulsive disorder. J Behav Ther Exp Psychiatry 2008; 39:451-458.
  • Solem S, Håland AT, Vogel PA, Hansen B, Wells A. Change in metacognitions predicts outcome in obsessive–compulsive disorder patients undergoing treatment with exposure and response prevention. Behav Res Ther 2009; 47:301-307.
  • Moritz S, Jelinek L, Hauschildt M, Naber D. How to treat the untreated: effectiveness of a self-help metacognitive training program (myMCT) for obsessive- compulsive disorder. Dialogues Clin Neurosci 2010; 12:209-220.
  • Ömer Şenormancı, Uzm.Dr., Bakırköy Prof. Dr. Mazhar Osman Ruh Sağlığı ve Sinir Hastalıkları Eğitim ve
  • Araştırma Hastanesi, İstanbul; Ramazan Konkan, Uzm.Dr., Bakırköy Prof. Dr. Mazhar Osman Ruh Sağlığı ve
  • Sinir Hastalıkları Eğitim ve Araştırma Hastanesi, İstanbul; Oya Gönüllü Güçlü, Uzm.Dr., Bakırköy Prof. Dr.
  • Mazhar Osman Ruh Sağlığı ve Sinir Hastalıkları Eğitim ve Araştırma Hastanesi, İstanbul; Mehmet Zihni
  • Sungur, Prof. Dr., Marmara Üniversitesi Tıp Fakültesi Psikiyatri Anabilim Dalı, İstanbul

Obsesif Kompulsif Bozukluğun Metakognitif Modeli

Year 2012, Volume: 4 Issue: 3, 335 - 349, 01.09.2012
https://doi.org/10.5455/cap.20120420

Abstract

Çeşitli araştırmacılar tarafından bilişsel modeldeki şema yaklaşımının kavramsal sınırlılıklarını vurgulanarak dış olayların ve bedensel duyumların anlamlarının değerlendirilmesinin ötesinde düşüncelerin kişisel anlamlarının değerlendirilmesinin önemini gündeme getirilmiş ve duygusal bozuklukların işlemleme modeli geliştirilmiştir. Bu yaklaşıma göre, psikopatolojinin oluşumu ile sürmesinde kişinin sahip olduğu düşüncelerden çok böyle düşünüyor olmanın anlamlarına yönelik değerlendirmeler daha önemlidir. Obsesif kompulsif bozukluğun metakognitif modelinde üç tip metakognitif inanca vurgu yapılır. Bunlar; düşünce-eylem kaynaşmaları (düşünce-eylem, düşünce-olay, düşünce-nesne), ritüelleri gerçekleştirme ihtiyacına dair ve ritüelleri sonlandırılması için durma uyarısına dair metakognitif inançlardır. Modele göre, obsesif kompulsif bozukluk tedavisinde başarılı olmak için doğrudan metakognitif inançlardaki değişikliğin hedeflenmesi tedavi başarısını arttıracaktır. Bu makalede duygusal bozukluklarda metakognisyon kavramı, obsesif kompulsif bozukluğun metakognitif modeli, bu modelin bozukluğun kavramsallaştırılmasına ve tedavisine getirdiği yenilikler tartışılmıştır.

References

  • Wells A, Matthews G. Attention and emotion: a clinical perspective. Hove, UK: Lawrence Erlbaum, 1994.
  • Fisher PL, Wells A. Experimental modification of beliefs in obsessive-compulsive disorder: a test of the metacognitive model. Behav Res Ther 2005; 43:821-829.
  • Sungur MZ. OKB’nin Anlaşılması ve Tedavisinde Bilişsel Davranışçı Yaklaşımlar. In Anksiyete Bozukluklarında Son Gelişmeler (Ed N Dilbaz). Ankara, Pozitif Matbaacı- lık, 2006.
  • Salzman L, Thaler FH. Obsessive compulsive disorders: a review of the literature. Am J Psychiatry 1981; 138:286-296.
  • Stanley MA, Turner SM. Current status of pharmacological and behavioral treatment of obsessive-compulsive disorder. Behav Ther 1995; 26:163-186.
  • Clark D. Cognitive behavioral treatment of obsessive compulsive disorders: a commentary. Cogn Behav Pract 1999; 6:408-415.
  • Rachman SJ, De Silva P. Abnormal and normal obsessions. Behav Res Ther 1978; 16:233-238.
  • Salkovskis PM, Harrison J. Abnormal and normal obsessions: a replication. Behav Res Ther 1984; 22:549-552.
  • Salkovskis PM. Obsessional-compulsive problems: a cognitive-behavioural analysis. Behav Res Ther 1985; 23:571-583.
  • Salkovskis EM, Westbrook D. Behaviour therapy and obsessional rumination: can failure be turned into success? Behav Res Ther 1989; 27:149-160.
  • Salkovskis EM. Cognitive-behavioural approaches to the understanding of obsessional problems. In Current Controversies in The Anxiety Disorders (Ed R Rapee):103-133. New York. Guilford Press, 1996.
  • Rachman S. Obsessions, responsibility and guilt. Behav Res Ther 1993; 31:149-154.
  • Rachman S. A cognitive theory of obsessions. Behav Res Ther 1997; 35:793-802.
  • Rachman S. A cognitive theory of obsessions: elaborations. Behav Res Ther 1998; 36:385-401.
  • Clark DA. Cognitive-Behavioral Therapy For OCD. New York, The Guilford Press, 2004.
  • Obsessive Compulsive Cognitions Working Group. Cognitive assessment of obsessive-compulsive disorder. Behav Res Ther 1997; 35:667-681.
  • Flavell JH. Metacognitive aspects of problem solving. In The Nature of Intelligence (Ed LB Resnick): 231-236. Hillsdale, NJ, Lawrence Erbaum, 1976.
  • Brown AL. Metacognitive development and reading. Theoretical Issues in Reading Comprehension: Perspectives From Cognitive Psychology, Linguistics, Artificial Intelligence, and Education (Eds RJ Spiro, BC Bruce, WF Brewer). Hillsdale, NJ, Lawrence Erbaum, 1980.
  • Wells A, Matthews G. Modelling cognition in emotional disorder: the S-REF model. Behav Res Ther 1996; 34:881-888.
  • Fisher P, Wells A. Metacognitive Therapy: Distinctive Features. New York, Routledge, 2009.
  • Wells A. Metacognitive Therapy for Anxiety and Depression. New York, The Guilford Press, 2009.
  • Cartwright-Hatton S, Wells A. Beliefs about worry and intrusions: the metacognitions questionnaire and its correlates. J Anxiety Disord 1997; 11:279-296.
  • Janeck AS, Calamari JE, Riemann BC, Heffelfinger SK. Too much thinking about thinking?: metacognitive differences in obsessive compulsive disorder. J Anxiety Disord 2003; 17:181-195.
  • Cohen RJ. Calamari JE. Thought-focused attention and obsessive–compulsive symptoms: an evaluation of cognitive self-consciousness in a nonclinical sample. Cognit Ther Res 2004; 28:457-471.
  • De Bruin GO, Muris P, Rassin E. Are there specific meta-cognitions associated with vulnerability to symptoms of worry and obsessional thoughts? Pers Individ Dif 2007; 42:689-699.
  • Barahmand U. Meta-cognitive profiles in anxiety disorders. Psychiatry Res 2009; 169:240-243.
  • Myers SG, Fisher PL, Wells A. An empirical test of the metacognitive model of obsessive-compulsive symptoms: Fusion beliefs, beliefs about rituals, and stop signals. J Anxiety Disord 2009; 23:436-442.
  • Gwilliam PDH, Wells A, Cartwright-Hatton S. Does metacognition or responsibility predict obsessive-compulsive symptoms. A test of the metacognitive model. Clin Psychol Psychother 2004; 11:137-144.
  • Myers SG, Wells A. Obsessive–compulsive symptoms: the contribution of metacognitions and responsibility. J Anxiety Disord 2005; 19:806-817.
  • Myers SG, Fisher PL, Wells A. Belief domains of the Obsessive Beliefs Questionnaire- 44 (OBQ-44) and their specific relationship with obsessive–compulsive symptoms. J Anxiety Disord 2008; 22:475-484.
  • Myers SG, Fisher PL, Wells A. An empirical test of the metacognitive model of obsessive-compulsive symptoms: fusion beliefs, beliefs about rituals and stop signals. J Anxiety Disord 2009; 23:436-442.
  • Wells A. Cognitive Therapy of Anxiety Disorders: A Practice Manual and Conceptual Guide. Chichester, UK, Wiley, 1997.
  • Simons M, Schneider S, Herpertz-Dahlmann B. Metacognitive therapy versus exposure and response prevention for pediatric obsessive–compulsive disorder. Psychother Psychosom 2006; 75:257-264.
  • Fisher PL, Wells A. Metacognitive therapy for obsessive–compulsive disorder: a case series. J Behav Ther Exp Psychiatry 2008; 39:117-132.
  • Rees CS, van Koesveld KE. An open trial of group metacognitive therapy for obsessive-compulsive disorder. J Behav Ther Exp Psychiatry 2008; 39:451-458.
  • Solem S, Håland AT, Vogel PA, Hansen B, Wells A. Change in metacognitions predicts outcome in obsessive–compulsive disorder patients undergoing treatment with exposure and response prevention. Behav Res Ther 2009; 47:301-307.
  • Moritz S, Jelinek L, Hauschildt M, Naber D. How to treat the untreated: effectiveness of a self-help metacognitive training program (myMCT) for obsessive- compulsive disorder. Dialogues Clin Neurosci 2010; 12:209-220.
  • Ömer Şenormancı, Uzm.Dr., Bakırköy Prof. Dr. Mazhar Osman Ruh Sağlığı ve Sinir Hastalıkları Eğitim ve
  • Araştırma Hastanesi, İstanbul; Ramazan Konkan, Uzm.Dr., Bakırköy Prof. Dr. Mazhar Osman Ruh Sağlığı ve
  • Sinir Hastalıkları Eğitim ve Araştırma Hastanesi, İstanbul; Oya Gönüllü Güçlü, Uzm.Dr., Bakırköy Prof. Dr.
  • Mazhar Osman Ruh Sağlığı ve Sinir Hastalıkları Eğitim ve Araştırma Hastanesi, İstanbul; Mehmet Zihni
  • Sungur, Prof. Dr., Marmara Üniversitesi Tıp Fakültesi Psikiyatri Anabilim Dalı, İstanbul
There are 42 citations in total.

Details

Primary Language Turkish
Journal Section Review
Authors

Ömer Şenormancı This is me

Ramazan Konkan This is me

Oya Gönüllü Güçlü This is me

Mehmet Zihni Sungur This is me

Publication Date September 1, 2012
Published in Issue Year 2012 Volume: 4 Issue: 3

Cite

AMA Şenormancı Ö, Konkan R, Güçlü OG, Sungur MZ. Obsesif Kompulsif Bozukluğun Metakognitif Modeli. Psikiyatride Güncel Yaklaşımlar - Current Approaches in Psychiatry. September 2012;4(3):335-349. doi:10.5455/cap.20120420

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