Compare the efficacy of Well’s Metacognitive Therapy (MCT) and Exposure and Response Prevention (ERP) for the treatment of Thought Fusion symptoms in women with Obsessive-Compulsive Disorder (OCD)

Obsessive-compulsive disorder (OCD) is a psychological disorder with debilitating impacts on many aspects of daily functioning, including relationships and quality of life. Exposure to ritual prevention (ERP) is the psychotherapeutic treatment of choice for obsessive-compulsive disorder. Also metacognitive therapy (MCT) based on Wells’ metacognitive model of OCD aims to modify the maladaptive metacognitive beliefs and processes implicated in the disorder, to alleviate symptoms. The aim of the present study was to compare the efficacy of Well’s Metacognitive Therapy (MCT) and Exposure and Response Prevention (ERP) for the treatment of Thought Fusion symptoms in women with Obsessive-Compulsive Disorder (OCD).  

The study was semi-experimental research done through a pretest-posttest design, using a control group. The statistical population included all OCD patients who were referred to the counseling centers in Shiraz during 2015-2016. The 60 patients who had been diagnosed as having OCD by the psychiatrist or clinical psychologist were selected and divided into two groups of 20 people (MCT and ERP) and a 20-member as control group. The experimental group1 experienced Wells’ Metacognitive Therapy in 8 sessions and the experimental group 2 experienced ERP in 14 sessions of 1. 5 hours during two months. Both experimental and control groups received equal doses of medicine during the study. Participants completed the thought fusion instrument as a research scale. It is a 14 item self-report measure assessing metacognitive beliefs about the meaning and power of thoughts. It is designed to measure the three types of thought fusion implicated in the metacognitive model: TAF (eg. ‘‘if I have thoughts about harming someone I will act on them”), TEF (eg. “my thoughts alone have the power to change the course of events”) and TOF (eg. “my feelings can be transferred into objects.”). Gwilliam et al. reported good internal consistency with a Cronbach’s alpha of 0.89 for the scale. Khorramdel et al. (2010). in their final investigation about internal consistency found the alpha coefficients for the general factor index were 0.87, and for the first, second, third factors, and split-half coefficient, it was 0.77, 0.82, 0.80, and 0.73, respectively. Data were analyzed by covariance analysis, using the 21st version of SPSS software.

The results indicated that the MCT group had a significant reduction (more efficacy) in two factors of thought-action and thought-event fusion in comparison to the ERP group (p<0. 001). No significant difference was observed in the thought fusion of the experimental groups. ERP group, on the other hand, showed significant reduction in all factors in comparison to the control group (p<0. 001).

Despite some methodological limitations, results showed that MCT proved to be a promising psychotherapeutic alternative to the well-established ERP in the treatment of Obsessive-Compulsive Disorder. Further investigations into the efficacy of MCT are necessary to answer questions as to the working mechanisms underlying therapy for Obsessive-Compulsive Disorder.