The Efficacy of Metacognitive Therapy on Patients Suffering from Pure Obsession

By Andouz, Zahra; Dolatshahi, Behrouz et al. | Iranian Journal of Psychiatry, Winter 2012 | Go to article overview

The Efficacy of Metacognitive Therapy on Patients Suffering from Pure Obsession


Andouz, Zahra, Dolatshahi, Behrouz, Moshtagh, Nahaleh, Dadkhah, Asghar, Iranian Journal of Psychiatry


Objective: The present study aimed to examine the efficacy of metacognitive therapy in treatment of patients with pure obsession.

Method: Six patients suffering from pure obsession were selected using purposeful sampling method and were included after meeting the inclusion criteria of the study. Patients were assessed using the structured clinical interview for DSM- IV Axis I disorder - patient edition (SCID- I/P). The patients' main obsessions were present including sexual, aggressive and blasphemous thoughts. In response to these obsessions, all patients used covert rituals and compulsive behaviors. In this study, multiple baseline, a major type of single- subject empirical design, was employed. During the baseline (3-7 weeks) and treatment (14 weekly sessions) and follow-up (3 months) patients filled out the Obsessive Compulsive Inventory (Revised form) (OCI-R), Yale-Brown Obsessive- Compulsive Scale (Y-BOCS), Metacognitive Questionnaire (MCQ), Thought Fusion Inventory (TFI) and Beck Depression Inventory- II (BDIII). To implement metacognitive therapy, Well's theraputicimstruction for OCD was used .

Results: The results indicated that Metacognitive Therapy (MCT) is effective in reducing obsessive - compulsive symptoms and in modifying metacognitive beliefs and thought-fusion beliefs .

Conclusion: Metacognitive therapy is effective in treatment of pure obsession.

Keywords: Cognitive therapy, Obsessive compulsive disorder, Treatment outcome

Iran J Psychiatry 2012; 7:11-21

(ProQuest: ... denotes formula omitted.)

Obsessive-compulsive disorder with widespread rate of approximately 1-3% during 6 months (1-3), is considered as a relatively epidemic disorder and classified as the fourth widespread psychological disorder (4). According to the reported statistics by WHO, OCD is deemed as the tenth disabling factor (5) followed by loss of performance and poor quality of life for OCD patients. Mohammadi, et al. (6) reported that prevalence of obsessive-compulsive disorder in Iranian population is 1/8%. Study results show that despite the fact that OCD patients first refer to specialist beyond mental health field; they comprise about 10% of outpatients who refer to clinical centers of psychology (7). The important point lies in the fact that about 80% of OCD patients will not be recovered without receiving professional help ,OCD symptoms are rarely treated automatically (8,9). Meta analytic studies indicated that Exposure and Response Prevention (ERP) is considered as an effective therapy for OCD (10-14). Similarly, Research Group of American Association of Psychology classified ERP as an empirically verified therapy for OCD (15). The study results from ERP clinical research suggest that

about 25% of OCD patients do not accept ERP treatment and 3-12% do not complete their recovery

period (16, 17). These results reduce ERP effectiveness for OCD patients down to 63%. In other words, 36% of OCD patients achieve 70% reduction in their symptoms after therapy , 27% of these patients are recovered at the medium level (31-69% reduction of symptoms), and 7% have no access to any significant treatment (18). Moreover, it should be noted that in outcome research on ERP, the majority of OCD cases have compulsive washing and checking, while there are few findings about ERP effectiveness for other subtypes of OCD such as doubt, hoarding, ordering, slowness, and obsessions. ERP is usually appropriated for those who suffer from overt compulsions while it is not so effective for those suffering from obsessive thought without overt compulsions (pure obsession); ERP instruction is essentially varied for such patients (19-21).Thus, behavior therapists sounded for some effective interventions to treat obsessive thought without overt compulsions, including thought stopping, paradoxical intention, habituation (satiation) training and audiotaped habituation training techniques. In the meanwhile, thought stopping and habituation (satiation) training were more prevalent interventions for treating obsessive thoughts.

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