Metacognitive therapy for obsessive–compulsive disorder: A pilot study

•MCT produced significant reductions in both OCD-symptoms and comorbid depressive symptoms.•MCT resulted in high proportions of clinically significant change on the Y-BOCS.•Recovery rates appeared at least comparable to those reported for ERP.

The first-line psychological treatment for OCD, exposure and response prevention (ERP), has been shown to lead to statistically significant improvements in 75% of patients. However, as only about 60% of treatment completers achieve recovery, and 25% of patients are asymptomatic following treatment, there is room for improvement. One promising approach is metacognitive therapy, which targets metacognition, a key cognitive process involved in the development and maintenance of OCD. This open trial examined the effectiveness of MCT among 25 consecutively referred outpatients with OCD. At posttreatment and follow-up, MCT produced significant and large reductions across all outcome variables, with high proportions of clinically significant change (patients recovered at posttreatment, 74%; at follow-up, 80%) on the Y-BOCS. In addition, the majority of patients (63% and 80% respectively) no longer fulfilled the diagnostic criteria for OCD. The encouraging results from this open trial justify a controlled trial in which the effectiveness of MCT is evaluated against ERP.