The Need to Control Thoughts in Eating Disorder Outpatients: A Longitudinal Study on Its Modification and Association with Eating Disorder Symptom Improvement

The metacognition of needing to control thoughts has been implicated in eating disorders (EDs)—specifically, in association with the drive for thinness and over-control. To date, it has yet to be investigated longitudinally in ED outpatients undergoing CBT-based treatment. The current study aims to examine whether endorsing a need to control thoughts undergoes modifications during CBT-based treatment for EDs and whether its modification correlates with treatment response in terms of reduced ED symptomatology. Seventy female ED outpatients (34 with AN, 29 with BN, 7 with OSFED) were assessed at baseline and at the end of treatment with the Metacognitions Questionnaire (MCQ), the Eating Attitudes Test (EAT-40), and the General Health Questionnaire (GHQ). Post-treatment, significant reductions were observed in MCQ-need to control thoughts. Using hierarchical linear regression analyses such decreases significantly explained the variance in observed reductions in EAT-oral control and to a lesser extent, reductions in EAT-bulimia and food preoccupation and EAT-dieting. These results underscore the importance of metacognitive change in EDs and the potential utility of CBT-based treatment in its modification. Improving ED outcomes may warrant broadening the therapeutic target of over-control and a sense of loss of control beyond dysfunctional eating behaviors to include maladaptive metacognitions that concern the need to control thoughts.