Anger and aggressiveness in obsessive-compulsive disorder (OCD) and the mediating role of responsibility, non-acceptance of emotions, and social desirability

According to psychodynamic and cognitive models of obsessive-compulsive disorder (OCD), anger and aggression play an important role in the development and maintenance of the disorder. (Sub-) clinical samples with OCD have reported higher anger and anger suppression. Patients with checking-related symptoms of OCD showed a less aggressive self-concept as assessed by an Implicit Association Test (IAT). This study assessed anger and aggressiveness self-concepts in OCD as well as possible mediators of the link between OCD and aggressiveness. A total of 48 patients with OCD and 45 healthy controls were included. Measures included the State-Trait Anger Expression Inventory-II and an aggressiveness self-concept IAT (Agg-IAT). An inflated sense of responsibility, non-acceptance of emotions, and social desirability were tested as mediators. As expected, patients with OCD reported higher trait anger and anger suppression compared to healthy controls. Contrary to hypotheses, the aggressiveness self-concept (Agg-IAT) did not differ between groups. The inflated sense of responsibility mediated the relationship between group and anger suppression. Non-acceptance of negative emotions mediated the relationship between group and trait anger, as well as anger suppression. However, comorbidities and medication may account for some effect in anger suppression. Elevated trait anger and anger suppression in OCD patients could be explained by dysfunctional beliefs or maladaptive emotion regulation strategies. Emotion regulation therapy might help to enhance awareness and acceptance of emotions and possibly improve treatment outcomes

Session-specific effects of the Metacognitive Group Training for Obsessive-Compulsive Disorder: significant results for thought control

The investigation of the session-specific effects is central for the understanding of psychological interventions. For the present study, we investigated the session-specific effects of the Metacognitive Group Training for Obsessive-Compulsive Disorder (MCT-OCD), which was revised based on data of a pilot study. Thirty-four outpatients with OCD participated in the MCT-OCD once a week over 8 weeks. Different metacognitive beliefs (e.g., thought control) and cognitive beliefs (e.g., intolerance of uncertainty), OC symptoms, as well as associated comorbid symptoms were assessed before and after each session. Linear mixed effects models showed that patients' obsessions and compulsions, thought control, the belief of being well informed about the disorder, and action fusion improved over the course of the training. The only session-specific effect emerged for thought control, which improved immediately after the respective module. We were able to replicate the findings of the pilot study and thus corroborate the session-specific effect of the module targeting thought control. Moreover, we generated information on the mode of action of the individual modules of the MCT-OCD that allows a more in-depth evaluation of the intervention. Notably, we were able to eliminate the adverse effects of the pilot version of the MCT-OCD.Trial Registration: German Clinical Trials Register (Deutsches Register Klinischer Studien [DRKS];DRKS-ID: DRKS00013539;registration date: 22/02/2018)

Predictors of trajectories of obsessive-compulsive symptoms during the COVID-19 pandemic in the general population in Germany

The COVID-19 pandemic has been associated with an increase in obsessive-compulsive disorder/symptoms (OCD/OCS). However, knowledge is limited regarding the trajectories of OCS during the pandemic, as well as their predictors and mechanisms (e.g., experiential avoidance, EA). The aim of this study was to describe the trajectories of OCS and the identification of associated factors. We assessed 1207 participants of the general population in March 2020 (t1) and June 2020 (t2). Pre-pandemic data was available from March 2014 for a subsample (n=519). To define trajectories, we determined OCS status (OCS+/-). We performed a hierarchical multinomial logistic regression to investigate predictors of trajectories. Between t1 and t2, 66% of participants had an asymptomatic trajectory (OCS-/OCS-); 18% had a continuously symptomatic trajectory (OCS+/OCS+). Ten percent had a delayed-onset trajectory (OCS-/OCS+), and the recovery trajectory group (OCS+/OCS-) was the smallest group (6%). Higher education reduced the odds of an OCS+/OCS- trajectory. OCS in 2014 was associated with increased odds of showing an OCS+/OCS+ or OCS-/OCS+ trajectory. When EA at t1 and change in EA from t1 to t2 were added to the model, higher EA at t1 was associated with increased odds of scoring above the cut score on one or more of the assessments. A higher decrease in EA from t1 to t2 reduced the probability of showing an OCS+/OCS+ and an OCS-/OCS+ trajectory. While the current data supports a slight increase in OCS during the pandemic, trajectories differed, and EA seems to represent an important predictor for an unfavorable development

Letter to the Editor: Metacognitive training and metacognitive therapy. A reply to Lora Capobianco and Adrian Wells

© 2018 Elsevier. This manuscript version is made available under the CC-BY-NC-ND 4.0 license: http://creativecommons.org/licenses/by-nc-nd/4.0/ This author accepted manuscript is made available following 24 month embargo from date of publication (Jan 2018) in accordance with the publisher’s archiving policyTo the Editor: It is indeed unfortunate that our metacognitive treatment programs use a similar name as the psychotherapy developed by Adrian Wells. Nevertheless, we believe that our use of the term ‘metacognitive’ is justified. The term ‘metacognition’ is somewhat over-inclusive. Coined by Flavell (1979) it is usually understood as “thinking about one's thinking”. Yet, subsequent research used the term in various ways (Koriat, 2002). For example, confidence/doubt is at the heart of metacognition according to Asher Koriat (Koriat & Levy-Sadot, 1999). In neuropsychology, a discrepancy between subjective and objective performance is termed a deficit in metacognition (for an early study see Anderson-Parenté, 1994). Moreover, Flavell's definition of metacognitive knowledge about oneself versus others is quite close to the concept of social cognition, further blurring the boundaries (p. 906). The idea for metacognitive training for psychosis originated in the early 2000s based on research suggesting ‘cognitive biases’ in people with psychosis (Garety & Freeman, 1999), such as jumping to conclusions (JTC), incorrigibility and overconfidence (note that these are not “thought contents” as Capobianco and Wells write, but rather overarching distortions in the processing of information; see Pohl, 2004). Importantly, awareness of these biases is poor in many patients. The primary goal of our approach was to ‘straighten’ these cognitive biases (not to be confused with emotional distortions/biases proposed by Aaron Beck) and raise metacognitive awareness in a gentle, non-confrontational manner (e.g., through playful exercises that generate surprising outcomes [i.e., metacognitive experience] and through education regarding cognitive biases [i.e., metacognitive knowledge]). A recurring theme in MCT for psychosis is that patients should check whether their confidence in a given judgment is justified (metacognitive strategy, cf. Koriat, 2002) and to “sow the seeds of doubt”. Importantly, MCT exercises on cognitive biases use delusion-neutral material. Although the ultimate goal is to improve delusions, this is achieved indirectly, as the main emphasis of the intervention remains on the modification at a meta-level of processing (e.g., confidence in judgements). We therefore reject the claim by Capobianco and Wells that our program “is clearly a cognitive behavioral approach that deals with the content of negative thoughts." Over the years, we incorporated compatible elements from CBT, while the focus remained on metacognition. Why did we do this? Initially, we had the perhaps naive hope that our MCT would run alongside other psychotherapeutic programs in mental health institutions. However, as the literature shows, psychotherapy for psychosis is rarely provided. In order to address this problem within our low-threshold program, the newest versions of MCT and MCT + include additional modules with a CBT orientation, dealing with issues deemed by patients to be a priority in treatment, namely self-esteem and stigma. We have devised a number of MCT interventions for other disorders, which are clearly rooted in the setup and presentation mode of MCT for psychosis. These disorder-specific versions were developed as hybrids to amalgamate a cognitive and a metacognitive perspective, as we do not view working on a cognitive or metacognitive level as mutually exclusive. Wells' work dates back to the 1990s - however, to the best of our knowledge, the term ‘metacognitive therapy’ was introduced much later. When we became aware of its existence, MCT for psychosis was already available and used in many different languages (currently 33 languages). Therefore, changing its name would have created new confusion; however, we used slightly different names or acronyms (e.g., myMCT) to distinguish the two approaches

Unrealistic pessimism and obsessive‐compulsive symptoms during the COVID‐19 pandemic: two longitudinal studies

OBJECTIVE: Unrealistic pessimism (UP) is an aspect of overestimation of threat (OET) that has been associated with obsessive‐compulsive disorder/symptoms (OCD/OCS). During the COVID‐19 pandemic, UP may have played an important role in the course of OCD. To investigate the relationship, we conducted two longitudinal studies assuming that higher UP predicts an increase in OCS. METHOD: In Study 1, we investigated UP in the general population (N = 1,184) at the start of the pandemic asking about overall vulnerability to infection with SARS‐CoV‐2 and UP regarding infection and outcome of severe illness. Further, OCS status (OCS+/−) was assessed at the start of the pandemic and 3 months later. In Study 2, we investigated UP in individuals with OCD (N = 268) regarding the likelihood of getting infected, recovering, or dying from an infection with SARS‐CoV‐2 at the start of the pandemic and re‐assessed OCS 3 months later. RESULTS: In Study 1, UP was higher in the OCS+ compared to the OCS− group, and estimates of a higher overall vulnerability for an infection predicted a decrease in OCS over time. UP regarding severe illness predicted an increase in symptoms over time. In Study 2, UP was found for a recovery and death after an infection with SARS‐CoV‐2, but not for infection itself. CONCLUSIONS: Exaggeration of one’s personal vulnerability rather than OET per se seems pivotal in OCD, with UP being associated with OCD/OCS+ as well as a more negative course of symptomatology over the pandemic in a nonclinical sample. PRACTITIONER POINTS: Unrealistic optimism, a bias common in healthy individuals, is thought to be a coping mechanism promoting well‐being in the face of danger or uncertainty. The current study extends findings that its inversion, unrealistic pessimism, may play an important role in obsessive‐compulsive disorder and may also be involved in the development of the disorder. This study highlights the importance that prevention programs during a pandemic should include targeting unrealistic pessimism

A randomized controlled trial to evaluate the efficacy of metacognitive training for older adults with depression (MCT-Silver) in Portugal: study protocol

First publication by Frontiers MediaDepression is one of the most common psychological disorders in later life. Although psychological interventions are recommended by treatment guidelines, most older adults with depression remain untreated. The aim of this study is to evaluate the efficacy of the Portuguese version of Metacognitive Training for Depression in later life (MCT-Silver)

Treatments used for obsessive-compulsive disorder-An international perspective

© 2019 John Wiley & Sons, Ltd.OBJECTIVE: The objective of this study was to characterise international trends in the use of psychotropic medication, psychological therapies, and novel therapies used to treat obsessive-compulsive disorder (OCD). METHODS: Researchers in the field of OCD were invited to contribute summary statistics on the characteristics of their samples. Consistency of summary statistics across countries was evaluated. RESULTS: The study surveyed 19 expert centres from 15 countries (Argentina, Australia, Brazil, China, Germany, Greece, India, Italy, Japan, Mexico, Portugal, South Africa, Spain, the United Kingdom, and the United States) providing a total sample of 7,340 participants. Fluoxetine (n = 972; 13.2%) and fluvoxamine (n = 913; 12.4%) were the most commonly used selective serotonin reuptake inhibitor medications. Risperidone (n = 428; 7.3%) and aripiprazole (n = 415; 7.1%) were the most commonly used antipsychotic agents. Neurostimulation techniques such as transcranial magnetic stimulation, deep brain stimulation, gamma knife surgery, and psychosurgery were used in less than 1% of the sample. There was significant variation in the use and accessibility of exposure and response prevention for OCD. CONCLUSIONS: The variation between countries in treatments used for OCD needs further evaluation. Exposure and response prevention is not used as frequently as guidelines suggest and appears difficult to access in most countries. Updated treatment guidelines are recommended.Peer reviewe

A randomized controlled trial to evaluate the efficacy of metacognitive training for older adults with depression (MCT-Silver) in Portugal: study protocol

IntroductionDepression is one of the most common psychological disorders in later life. Although psychological interventions are recommended by treatment guidelines, most older adults with depression remain untreated. The aim of this study is to evaluate the efficacy of the Portuguese version of Metacognitive Training for Depression in later life (MCT-Silver).MethodsThis is a study protocol of an observer-blind, parallel-group, randomized controlled trial to compare the efficacy of MCT-Silver with a treatment as usual (TAU) control group among older adults (age 65 years and older) with depressive symptoms according to the Montgomery-Asberg Depression Scale. Participants will be tested at three assessment time points (baseline, immediately following the intervention [8 weeks], and 3 months after the intervention). The primary outcome is change in self-rated depression symptoms assessed by the Beck Depression Inventory (BDI-II). Secondary outcomes include clinician-rated depression, self-esteem, dysfunctional beliefs, metacognitive beliefs, ruminations, attitudes toward aging and quality of life. A self-designed subjective appraisal rating scale consisting of 21-items will be used to assess participant acceptance of MCT-Silver.DiscussionMCT-Silver is an innovative intervention, which aims to reduce dysfunctional thoughts as well as depression-related behaviors and coping strategies through the metacognitive perspective. Until now, the training has only been tested in Germany. It is expected that after 8 weeks of treatment and 3 months later, the experimental group will demonstrate significant reductions in depressive symptoms, metacognitive beliefs, dysfunctional attitudes and ruminative responses compared to the TAU group. Moreover, quality of life, self-esteem, and attitudes towards aging will be significantly improved in MCT-Silver compared to the TAU group.Clinical trial registrationClinicalTrials.gov, NCT05640492