Metacognitive therapy has two main metacognition changes. And for this, in therapy;
- How the person relates to his thoughts
- How he experiences his thoughts
- Focus on what he believes about his thoughts.
In order to achieve successful treatment results in the metacognitive therapy of OCD, an average of 12 sessions per week lasting 45-60 minutes is sufficient. (1)
Metacognitive therapy in OCD has some differences from traditional cognitive behavioral therapy
Differences of Metacognitive Therapy in Cognitive Behavioral Therapy in OCD
- Metacognitive therapy describes obsessive compulsive disorder with a specific metacognitive model. It can be applied to all subtypes of OCD.
- Metacognitive therapy focuses on metacognitive beliefs about obsessions and compulsions.
- It does not regulate other areas of belief, such as exaggerated responsibility, intolerance, or perfectionism.
- Metacognitive therapy does not benefit from familiarization strategies or does not require extended exercises in the session.
- The main purpose of metacognitive therapy in obsessive compulsive disorder is to treat the obsessional stimulus and to develop a functional plan for directing behaviors.
Metacognitive therapy of OCD consists of 7 stages. In the first stage, the case formulation is followed by a specific sequence.
- Firstly, it is asked about the formation of obsessional thought, impulse or neutralization (removing the trigger).
- Asking questions about feelings that accompany the trigger (emotion extraction).
- Evaluations of the patient about stubborn repeaters
- Questioning of metacognitive beliefs about stubborn repeaters.
In the case formulation, the therapist finally asks questions about the patient’s responses to stubborn repeaters, about the nature of their open or implicit neutralization, and their beliefs about their need to deal with these responses (rituals and beliefs about stop signals).
In the next step, in the socialization, the therapist explains to the patient that the problem is actually the obsessional thoughts / doubts / emotions rather than the responses to them and the meanings for the patient, and some behavioral experiments are performed to demonstrate this. Then the treatment is presented rationally.
Some obsessions cause embarrassment and are perceived as threatening. To avoid this situation, the therapist normalizes the content of obsessions.
The first step in the regulation of metacognitions in OCD is the detached mindfulness education, which is provided by means of distance-setting. Instead of struggling with the patient’s stubborn repetitive thoughts in the awareness provided by distance-setting, alternative and more functional pathways are planned to accept stubborn repeaters, and to be observers only.
The metacognitive mode of processing is strengthened.
There are four components of awareness provided through spacing.
The first is awareness. Awareness is the state of being objectively aware of emotion and thought. From person to opinion
not to be involved in a conceptual or coping process or activity.
The second is the awareness provided by the distance setting. In order to reach the awareness provided by the distance setting, practices are performed to show that obsessions are only a mental event and not an important part of the patient.
The third is the exercise and the response commission (ERC), which means that the patients perform their rituals, but instead the rituals are carried out in order to maintain the awareness of obsessional thoughts along with rituals, instead of reducing the danger or getting rid of the idea. This application makes it easy to distance the person.
The fourth is metacognitive exercise and ritual prevention. Unlike traditional cognitive behavioral therapy approaches, it is a shorter exercise than traditional exercise and reaction to reduce cognitive attention focus syndrome under the patients’ exaggerated threat perception and to question the beliefs of fusion. As a result of repetitive practices, the person learns the skill of awareness through which distance is created instead of the obsession.
I am studying in Florida about Dialectic Behavioral Therapy and Cognitive Behavioral Therapy. I’m doing research on Neuro-Emotional Technique (NET), Cognitive psychology, Metacognitive Therapy.