Category: Obsessive Compulsive and Related Disorders

Symposium

Feasibility and Mechanisms of Actions of Metacognitive Therapy for OCD: A Pilot Trial

Friday, November 17
8:30 AM - 10:00 AM
Location: Sapphire Ballroom M & N, Level 4, Sapphire Level

Keywords: OCD (Obsessive Compulsive Disorder) | Cognitive Schemas / Beliefs | Clinical Trial
Presentation Type: Symposium

Although exposure with response prevention (ERP) is the treatment of choice for obsessive-compulsive disorder (OCD), a substantial number of patients refuse this method of treatment or do not profit sufficiently. Metacognitive therapy (MCT) has been proposed for some time as an alternative way of psychotherapy in OCD. MCT offers relief from obsessive-compulsive symptoms by fostering a different attitude of patients towards their thinking process rather than relying on prolonged exposure exercises. However, only small cases series have been published so far on the use of MCT in OCD. Controlled studies are still missing.


Feasibility of using MCT in the treatment of OCD was investigated in a pilot randomized trial, controlling efficacy and mechanisms of MCT to the established treatment protocol of ERP. Thirty-six outpatients with OCD according to DSM-IV criteria were randomly allocated to individual weekly therapy with either manualized MCT or ERP and completed on average 13 sessions. Primary outcome was the reduction of OCD symptom severity after treatment as indicated by the clinician rated Yale-Brown Obsessive Compulsive Scale. Metacognitions were investigated as a potential mediator (mechanism) of treatment success in MCT. Patient satisfaction and drop-out rates were obtained as indicators of acceptability to patients.


Results at post treatment assessment showed a significant reduction of OCD symptoms in both treatment conditions with more than 67% of patients reaching clinically significant improvement (Y-BOCS score of 14 or below) and no differences between MCT and ERP. There was also no difference between MCT and ERP in terms of attrition rates. Although only targeted by MCT metacognitive beliefs were reduced to a comparable degree in both conditions and were not related to treatment success. Satisfaction with therapy was equally high in both conditions. Results were stable at three months follow-up.


The pilot trial provides preliminary evidence that MCT might present a treatment alternative for OCD. The proposed mechanisms of actions are still not known, but reduction in metacognitive beliefs might occur in both MCT and ERP approach and might be less important for treatment success. More and larger controlled trials are required to confirm our findings.

Cornelia Exner

Professor
University of Marburg, Germany

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