"The more you try to control them, the more they control you": positive meta-cognitions about control of unwanted thoughts predict catastrophic worry in patients with first psychotic episode

Purpose. Previous research suggested that catastrophic worry could be a process involved into delusions. Obsessive beliefs, previously identified as a maintenance factor also in acute symptoms of psychosis, could predict worry in patients after a first psychotic episode (FEP). No research examined this aspect. The present study investigated which obsessive beliefs predicted more severe worry in a sample of patients with FEP. Materials and methods: Thirty patients with a FEP (mean age= 23.90, SD= 3.37, 73.30%= males) completed the Obsessive Beliefs Questionnaire-46 (OBQ-46) as a measure of obsessive beliefs about thoughts (Importance of thoughts control, Thought Action Fusion, Inflated responsibility for harm, Inflated responsibility for omission, Perfectionism/Intolerance for uncertainty) and the Penn State Worry Questionnaire (PSWQ) as a measure of worry. Multiple linear regression analysis was conducted entering OBQ-87 scores as predictors and PSWQ scores as outcomes. Results: Higher scores on the OBQ-46 Importance of thoughts control scale were the only significant predictors of higher scores on the PSWQ (β= 0.68, t= 4.94, p<.001, R2= 47%). The other beliefs had no significant effect on worry. Conclusion: Positive meta-cognitions about control of unwanted thoughts could have a role after FEP impeding recovery and leading to subsequent psychotic episodes. Case conceptualizations could address this aspect and require the integration of meta-cognitive and Acceptance and Commitment therapy interventions in the treatment of cases after FEP. Future prospective research should examine whether these beliefs predict the FEP in high risk individuals.