Contents lists available at ScienceDirect Journal of Obsessive–Compulsive and Related Disorders journal homepage: www.elsevier.com/locate/jocrd The role of metacognitive beliefs about thoughts and rituals: A test of the metacognitive model of obsessive-compulsive disorder in a clinical sample Samuel G. Myers a, ⁎ , Torun Grøtte b , Svein Haseth c , Ismail C. Guzey b , Bjarne Hansen d , Patrick A. Vogel b , Stian Solem b a The Israel Center for the Treatment of Psychotrauma, Jerusalem, Israel b Norwegian University of Science and Technology, Trondheim, Norway c St. Olav University Hospital, Trondheim, Norway d University of Bergen, Bergen, Norway ARTICLE INFO Keywords: Obsessive-compulsive disorder Metacognitive model Beliefs ABSTRACT The metacognitive model of obsessive-compulsive disorder (OCD; Wells, 1997) emphasises the role of metacognitive beliefs about both thoughts and rituals. The current study tested hypotheses that emerge from the model concerning three domains of these metacognitive beliefs: though fusion beliefs, beliefs about rituals, and stop signals, in an OCD sample (N =210). Results showed that each type of metacognitive belief significantly and positively correlated with two different measures of obsessive-compulsive symptoms. Additionally, in hierarchical regressions, with worry, and non-metacognitive beliefs linked to OCD in other theories controlled, each of the metacognitive domains, when entered in their hypothesised order of activation, incrementally predicted each obsessive-compulsive symptom measure. Results provide further support for the role of these three metacognitive belief domains as hypothesised in the metacognitive model. 1. Introduction The metacognitive model of obsessive-compulsive disorder (OCD; Wells & Matthews, 1994; Wells, 1997, 2009) emphasises the role of two types of metacognitive beliefs: 1) metacognitive beliefs concerning thoughts and feelings and 2) metacognitive beliefs concerning rituals. The first domain consists of beliefs fusing thoughts and feelings with reality. Three forms of thought fusion are identified in the model: Thought-Event fusion (TEF) i.e. the belief that thoughts on their own can cause events to happen or signify that events have happened, Thought-Action Fusion (TAF) i.e. the belief that intrusive thoughts/ feeling/impulses can make a person carry out actions they do not want to commit and Thought-Object Fusion (TOF) which refers to beliefs that thoughts and/or feelings can pass into objects. These fusion beliefs lead intrusions to be appraised negatively, either as being dangerous in themselves or as having significant negative meaning. This activates the second domain: metacognitive beliefs concerning rituals, as the person attempts to regulate the distress caused by his/her negative appraisal. Metacognitive beliefs concerning rituals have two components: 1) beliefs concerning the need to carry out rituals e.g. “I have to carry out rituals otherwise I will never have peace of mind” and 2) a metacognitive plan that guides how rituals should be carried out. This plan includes a stop-signal, such as a feeling of calm, which indicates to the person that the ritual can be stopped. Although activated as a way of self-regulating, metacognitive beliefs about rituals lead to an exacerbation of symptoms. Beliefs about rituals reinforce beliefs that intrusions are important and need to be acted on while the metacognitive plan used to carry out rituals is often counterproductive and difficult to carry out. For example, the stop signals used are often internal or idiosyncratic criteria which are hard to achieve and lead to a prolongation of rituals (Wells, 2009). Evidence for the role of metacognitive beliefs about thoughts and rituals comes from a number of studies that have tested the model. These studies have tested three central hypotheses concerning these metacognitive beliefs: 1) They should be related to obsessive-compulsive (o-c) symptoms and OCD. 2) They should predict o-c symptoms independently of non-metacog- nitive beliefs linked to OCD in other models. According to the metacognitive model, non-metacognitive beliefs implicated in other models of OCD, such as responsibility (Salkovskis, 1985) and perfectionism (Frost & Steketee, 1997), may be present in OCD but are a by-product of the activation of metacognitive beliefs and http://dx.doi.org/10.1016/j.jocrd.2017.01.007 Received 16 November 2016; Received in revised form 22 December 2016; Accepted 9 January 2017 ⁎ Correspondence to: The Israel Center for the Treatment of Psychotrauma, Hasadna, 4, Talpiot, PO Box 3900, Jerusalem 91035, Israel. E-mail address: s.g.myers2013@gmail.com (S.G. Myers). Journal of Obsessive-Compulsive and Related Disorders 13 (2017) 1–6 Available online 02 February 2017 2211-3649/ © 2017 Elsevier Inc. All rights reserved. MARK