Skip to main content

Table 1 Detailed Description of All MCT-OCD Modules and Exercises

From: Metacognitive Training for Obsessive-Compulsive Disorder: a study protocol for a randomized controlled trial

Description of all modules Example exercises (homework)
1. False assumptions about OCD 1. Write down your personal obsessions, compulsions, and avoidance as well as safety behaviors and develop your own cognitive model for OCD.
False assumptions about OCD (e.g., OCD is very rare) are corrected, the cognitive model of OCD [60] is introduced, and alternative behavior strategies (e.g., asking their family not to react to their reassurance seeking) are suggested.
2. Compose a goodbye letter to your obsessions.
2. Perfectionism 1. Nobody’s perfect. Pay attention to the failures or imperfections of people you admire.
The advantages and disadvantages of doing something accurately as well as the right balance of accuracy and errors are discussed. Acceptance strategies are displayed in order to learn how to handle “imperfections.”
2. Deliberately be imperfect, observe the consequences, and write them down.
3. Intolerance of uncertainty  
Advantages and disadvantages of intolerance of uncertainty and the role of negative emotions during the experience of obsessions are discussed. The use of sentences that create a distance between an obsession and reality are suggested (e.g., “This is an obsessive thought, not reality”). Additional slides regarding depressive thought patterns are included that address, for example, overgeneralization (e.g., “I always do everything wrong”).
1. Find alternative evaluations of an incident where you were prone to overgeneralization.
2. Write down your strengths as well as explicit situations where you displayed them.
4. Action fusion 1. Try to influence someone else’s actions, an object, or an incident with your thoughts and use a checklist to see if you were successful.
It is explained that everybody is sometimes prone to thought-action fusion. The role of emotions during the occurrence of thought-action fusion is discussed, a thought behavioral exercise is practiced, and the difference between (aggressive) thoughts and actions is highlighted.
2. Try to influence an incident only with your thoughts and write down what happens.
(The goal is for the patients to learn that thoughts cannot influence actions, objects, or incidents.)
5. Control of thoughts 1. Try one of the imagination exercises presented in group (e.g., imagine clouds passing by) and write down what you experience.
The impossibility of completely controlling one’s thoughts is addressed (e.g., thought suppression). The vicious circle of aggression, guilt, and disappointment is explained, and patients are encouraged to let aversive thoughts pass by—like clouds, for example— in an imagination exercise.
2. Find sentences that help to create a distance from your obsessions (e.g., “This is an obsessive thought, not reality”).
6. Overestimation of threat 1. Write down your personal obsessional fear, the estimated possibility that it will occur, new information about your fear, alternative thoughts, and the converse probability.
Reasons for overestimation of threat are displayed (e.g., unrealistic pessimism). Calculating the statistical likelihood of a feared incident is practiced. Additional slides on rumination help patients to differentiate between rumination and normal problem-solving and provide a behavioral exercise that helps them to disengage from rumination.
2. Calculate the likelihood that your obsessional fear will occur.
7. Inflated sense of responsibility 1. Practice and write down your experiences while actively changing your perspective.
The relevance of an exaggerated sense of responsibility in OCD is highlighted. An active change of perspective is suggested. Patients practice finding more diverse reasons for particular events (i.e., others, coincidence, oneself) and are encouraged to counter attributing causations solely to themselves.
2. Write down three reasons for the occurrence of an event that fall into the categories “others,” “coincidence,” and “oneself” in order to counter attributing causation solely to oneself.
8. Biased attention/biased cognitive networks 1. Practice guiding your attention to a stimulus and write down what you experience.
Patients are encouraged to guide their attention purposely to certain stimuli in order to disengage from biased attention toward their feared stimuli. Patients learn how cognitions are associatively linked. The technique of “association splitting” is introduced in order for patients to form new associations and weaken obsessive ones.
2. Write down an OCD-relevant word and then write down new neutral or positive associations. Practice these associations for 10 min a day in order to weaken old OCD-relevant associations and form new ones.