The effectiveness of metacognitive therapy on experiential avoidance, uncertainty intolerance and positive metacognitive beliefs in women with obsessive-compulsive disorder

Document Type : Original Article


1 PhD student, Department of Psychology, Bushehr Branch, Islamic Azad University, Bushehr, Iran

2 Assistant Professor in the Department of Psychology, Busher Branch, Islamic Azad University, Bushehr, Iran

3 Assistant Professor, Department of Psychology and Counseling, Bushehr Branch, Islamic Azad University, Bushehr, Iran


Aim: The purpose of this research was the effectiveness of metacognitive therapy on experiential avoidance, uncertainty intolerance and positive metacognitive beliefs in women with obsessive-compulsive disorder. Methods: The current research method is semi-experimental and the design used in this research is a pre-test-post-test design with a control group and a follow-up period. The statistical population of the research was all women suffering from obsessive-compulsive disorder who referred to counseling and psychotherapy centers in Tehran in the months of February and March of 2021. The research sample included 30 women with obsessive-compulsive disorder who referred to counseling and psychotherapy centers in Tehran between February and March of 1400. Data were collected using the Yale-Brown Obsessive Compulsive Questionnaire (1989), the Experiential Avoidance Questionnaire by Bond et al. (2011), the Intolerance of Uncertainty Questionnaire by Friston et al. Obtained. In this research, the protocol of Wells (2000) was used to perform metacognitive therapy, which was performed once a week for 8 sessions of 90 minutes on the experimental group. The data was analyzed using the method of analysis of variance with repeated measurements and SPSS software. Results: The findings showed that metacognitive therapy on experiential avoidance (F=13.53, P<0.001), uncertainty intolerance (F=65.25, P<0.001), and positive metacognitive beliefs (F=75.86, P<0.001) was effective in women with obsessive compulsive disorder. Conclusion: It can be concluded that metacognitive therapy was effective on experiential avoidance, intolerance of uncertainty and positive metacognitive beliefs in women with obsessive compulsive disorder, and this therapy can be used to reduce the problems of obsessive-compulsive patients.


پاشنگ، سارا.، و خوش لهجه صدق، انیس. (1398). مقایسه اثربخشی درمان مبتنی بر پذیرش و تعهد و درمان فرا شناختی برکاهش علایم، سرمایه روان‌شناختی و کیفیت زندگی بیماران مبتلا به سندرم روده تحریک‌پذیر. فصلنامه علوم پزشکی دانشگاه آزاد اسلامی تهران، ۲۹(۲):۱۹۰-۱۸۱.
عباسی، عاطفه.، آقایی، اصغر.، و ابراهیمی مقدم، حسین. (1398). اثربخشی درمان فراشناختی بر تاب‌آوری در افراد مبتلا به اضطراب فراگیر. مجله علوم روانشناسی، 18(78): 691-698.
Ali, S., & Souilm, N. (2021). Effects of Insight with Obsessive Beliefs and Metacognition Appraisal on Symptoms’ Severity Among Patients with Obsessive Compulsive Disorder.
Barua, N., Singh, S., Agarwal, V., & Arya, A. (2020). Executive functions, Metacognitive Beliefs, and Thought Control Strategies in Adolescents with Obsessive Compulsive Disorder.
Bottesi, G., Noventa, S., Freeston, M. H., & Ghisi, M. (2019). Seeking certainty about Intolerance of Uncertainty: Addressing old and new issues through the Intolerance of Uncertainty Scale-Revised. PloS one, 14(2), e0211929.‏
Browning, M. E., Van Kirk, N. P., & Krompinger, J. W. (2021). Examining depression symptoms within OCD: the role of experiential avoidance. Behavioural and Cognitive Psychotherapy, 1-14.‏
Cowan, E. (2020). Exploring the Role of Experiential Avoidance in the Relationship between Obsessive-Compulsive Disorder and Obsessive-Compulsive Personality (Doctoral dissertation, Kean University).‏
Dutta, R. (2019). Analyzing Obsessive-Compulsive Disorder Using Relational Frame Theory, Experiential Avoidance, and Emotion Regulation. Kean Quest, 2(1), 2.
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.‏
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 transdiagnostic construct with implications for phenomenology and treatment. Clinical psychology review, 60, 100-108.‏
Gushanas, K. L. (2019). The role of parental experiential avoidance (PEA) in the accommodation of pediatric obsessive-compulsive disorder (POCD) (Doctoral dissertation).‏
Haseth, S., Solem, S., Sørø, G. B., Bjørnstad, E., Grøtte, T., & Fisher, P. (2019). Group metacognitive therapy for generalized anxiety disorder: A pilot feasibility trial. Frontiers in psychology10, 290.
Hezel, D. M., Stewart, S. E., Riemann, B. C., & McNally, R. J. (2019). Clarifying the thought-action fusion bias in obsessive-compulsive disorder. Journal of Obsessive-Compulsive and Related Disorders, 20, 75-84.‏
Hood, H. K., Wilson, G. A., Koerner, N., McCabe, R. E., Rowa, K., & Antony, M. M. (2019). Poor insight in obsessive-compulsive disorder: Examining the role of cognitive and metacognitive variables. Journal of Obsessive-Compulsive and Related Disorders23, 100447.‏
Jensen, D., & Heimberg, R. G. (2015). Domain-specific intolerance of uncertainty in socially anxious and contamination-focused obsessive–compulsive individuals. Cognitive Behaviour Therapy, 44(1), 54-62.‏
Kim, S. T., Park, C. I., Kim, H. W., Jeon, S., Kang, J. I., & Kim, S. J. (2021). Dysfunctional Metacognitive Beliefs in Patients with Obsessive–Compulsive Disorder and Pattern of Their Changes Following a 3-Month Treatment. Frontiers in Psychiatry12.‏
Lee, S. W., Song, H., Jang, T. Y., Cha, H., Kim, E., Chang, Y., & Lee, S. J. (2020). Aberrant functional connectivity of neural circuits associated with thought-action fusion in patients with obsessive–compulsive disorder. Psychological Medicine, 1-10.‏
Mauzay, D., Spradlin, A., & Cuttler, C. (2016). Devils, witches, and psychics: The role of thought-action fusion in the relationships between obsessive-compulsive features, religiosity, and paranormal beliefs. Journal of Obsessive-Compulsive and Related Disorders, 11, 113-120.‏
McEvoy, P. M. (2019). Metacognitive therapy for anxiety disorders: a review of recent advances and future research directions. Current psychiatry reports21(5), 1-9.
Mellick, W., Vanwoerden, S., & Sharp, C. (2017). Experiential avoidance in the vulnerability to depression among adolescent females. Journal of Affective Disorders, 208, 497-502.‏
Meraj, M. B., Singh, S., Kar, S. K., Sharma, E., & Sarraf, S. R. (2020). Metacognitions in Symptomatic and Remitted Patients with Obsessive Compulsive Disorder: Preliminary Evidence for Metacognitive State and Trait Markers. Indian Journal of Psychological Medicine, 0253717620975295.‏
Miegel, F., Moritz, S., Hottenrott, B., Demiralay, C., & Jelinek, L. (2021). Metacognitive Training for Obsessive-Compulsive Disorder: A randomized controlled trial. Journal of Obsessive-Compulsive and Related Disorders30, 100647.‏
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 Disorders13, 1-6.‏
Normann, N., & Morina, N. (2018). The efficacy of metacognitive therapy: a systematic review and meta-analysis. Frontiers in psychology9, 2211.
Pascual-Vera, B., Belloch, A., Ghisi, M., Sica, C., & Bottesi, G. (2021). To achieve a sense of rightness: The joint role of Not Just Right Experiences and Intolerance of Uncertainty in Obsessive-Compulsive Disorder. Journal of Obsessive-Compulsive and Related Disorders, 29, 100627.‏
Reuman, L., Buchholz, J., Blakey, S., & Abramowitz, J. S. (2017). Uncertain and fused: cognitive fusion, thought-action fusion, and the intolerance of uncertainty as predictors of obsessive-compulsive symptom dimensions. Journal of Cognitive Psychotherapy, 31(3), 191-203.‏
Scherr, S. R., Herbert, J. D., & Forman, E. M. (2015). The role of therapist experiential avoidance in predicting therapist preference for exposure treatment for OCD. Journal of Contextual Behavioral Science, 4(1), 21-29.‏
Siwiec, S. G., Davine, T. P., Kresser, R. C., Rohde, M. M., & Lee, H. J. (2017). Modifying thought-action fusion via a single-session computerized interpretation training. Journal of Obsessive-Compulsive and Related Disorders, 12, 15-22.‏
van Oosterom, A. T. (2021). The influence of obsessions on the relationship between intolerance of uncertainty and drive for activity in anorexia nervosa (Master's thesis).‏
Wells A. Cognitive therapy of anxiety disorders: a practice manual and conceptual guide. Chichester, Sussex: Wiley; 1997.
Wells A. (2009). Metacognitive therapy for anxiety and depression. NewYork, London: Guilford Press.
Wetterneck, C. T., Steinberg, D. S., & Hart, J. (2014). Experiential avoidance in symptom dimensions of OCD. Bulletin of the Menninger Clinic, 78(3), 253-269.‏
Williams, B. M., & Levinson, C. A. (2021). Intolerance of uncertainty and maladaptive perfectionism as maintenance factors for eating disorders and obsessive‐compulsive disorder symptoms. European Eating Disorders Review, 29(1), 101-111.‏
Winter, L., Schweiger, U., & Kahl, K. G. (2020). Feasibility and outcome of metacognitive therapy for major depressive disorder: a pilot study. BMC psychiatry20(1), 1-7.
Yılmaz, O., Boyraz, R. K., Kurtulmuş, A., Parlakkaya, F. B., & Öztürk, A. (2020). The relationship of insight with obsessive beliefs and metacognition in obsessive compulsive disorder. Journal of Psychiatric Nursing11(1), 11-19.‏