The relationship between metacognitions and insight in obsessive–compulsive disorder Sinay Önen a , Görkem Karakaş Uğurlu b, ⁎ , Ali Çayköylü b a Bartın State Hospital, Department of Psychiatry, Bartın, Turkey b Yıldırım Beyazıt University Atatürk Training and Research Hospital, Department of Psychiatry, Ankara, Turkey Abstract This study aimed to determine the relationship between metacognitions and insight in obsessive compulsive disorder. One hundred individuals who had been diagnosed according to “Diagnostic and Statistical Manual of Mental Disorders Fourth Edition Text Revision” criteria as having obsessive compulsive disorder and 50 healthy controls are included in the study. A sociodemographic and clinical data form, the Yale–Brown Obsession and Compulsion Scale and the Beck Depression Inventory were given to the participants. Insight is assessed by the 11th item of the Yale–Brown Obsession and Compulsion Scale. The Metacognition Questionnaire-30 was administered to both the obsessive compulsive disorder and the control groups to assess metacognitions. We found that the metacognition scores were statistically different in all groups and that the metacognition scores were higher in the obsessive compulsive disorder with good insight group than in the obsessive compulsive disorder with poor insight and control groups. In the obsessive compulsive disorder with poor insight group, all of the metacognition subscale scores were lower than those in the obsessive compulsive disorder with good insight group. Our findings elucidate the relationship between metacognitions and insight in obsessive compulsive disorder. © 2012 Elsevier Inc. All rights reserved. 1. Introduction Several belief domains have been implicated in the deve- lopment of obsessive thoughts, images and impulses, including responsibility, metacognitive beliefs, and the importance of thoughts. Beck has emphasized that the cog- nitive processes, which emerge from experiences that activate catastrophic misinterpretations of one's intrusive thoughts, are useful in the treatment of obsessive compulsive disorder (OCD). However, it has been pointed out that most of the cognitive activities are based on metacognitive factors; therefore, metacognitions are essential for evaluating these processes [1–5]. Metacognition is defined as “cognition about cognition” or “knowing about knowing”, and it includes knowledge about the correctness and convenience of one's reactions to any stimulus. Metacognition encompasses the knowledge, processes and strategies that appraise, monitor or control thinking [3,4,6,7]. The importance of metacognitive pro- cesses, such as the appraisal of thoughts and beliefs about thinking, is emphasized in the formation and prolongation of intrusive thoughts [8–11]. It has been found that one's awareness about one's own thoughts and negative appraisals about intrusive thoughts predict obsessive thoughts, while efforts to control thought predict worry [12]. The meta- cognitive model of OCD, which is known as ‘Self- Regulatory Executive Function (S-REF)’, proposes that obsessive thoughts are negatively interpreted as a result of metacognitive beliefs about the meaning and/or dangerous consequences of having a specific thought or thoughts. According to these authors, the metacognitive system is designed to regulate the self by utilizing beliefs about the self. Thus, distortions in metacognitive beliefs affect the meanings and functioning of cognition and may promote ruminations and active worry [13]. Metacognitive beliefs about intrusive thoughts fall broadly into three domains: thought–action fusion (TAF) [14], thought–event fusion (TEF) [15] and thought–object fusion (TOF) [4]. In Wells' model, TAF refers to the fusion between thoughts and actions, TEF refers to the belief that a thought can cause an event or can be in itself evidence that an event has occurred, and TOF refers to the belief that thoughts, feelings or memories can be passed to other people or into objects. The Available online at www.sciencedirect.com Comprehensive Psychiatry xx (2013) xxx – xxx www.elsevier.com/locate/comppsych ⁎ Corresponding author. Tel.: +90 3122912525/3768. E-mail address: dr_gorkem@yahoo.com (G. Karakaş Uğurlu). 0010-440X/$ – see front matter © 2012 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.comppsych.2012.11.006