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Background The recommended psychological treatment of choice for obsessive-compulsive disorder (OCD) is exposure with response prevention (ERP). However, recovery rates are relatively modest, so better treatments are needed. This superiority study aims to explore the relative efficacy of metacognitive therapy (MCT), a new form of cognitive therapy based on the metacognitive model of OCD. Design and method In a randomized controlled trial, we will compare MCT with ERP. One hundred patients diagnosed with OCD will be recruited in an outpatient mental health center in Rotterdam (the Netherlands). The primary outcome measure is OCD severity, measured by the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). Data are assessed at baseline, after treatment, and at 6 and 30 months follow-up. Discussion By comparing MCT with ERP we hope to provide an indication whether MCT is efficacious in the treatment of OCD and, if so, whether it has the potential to be more efficacious than the current “gold standard” psychological treatment for OCD, ERP. Trial registration Dutch Trial Register, NTR4855 . Registered on 21 October 2014. Electronic supplementary material The online version of this article (10.1186/s13063-019-3381-9) contains supplementary material, which is available to authorized users.

Objectives: Although metacognitive therapy and intolerance-of-uncertainty therapy are considered efficacious treatments for generalized anxiety disorder, little is known about the long-term course in patients who engaged in treatment studies. Method: We conducted a continuation study of patients with GAD who had participated in a randomized, delayed treatment controlled trial in which the relative efficacy of MCT and IUT were compared.Results: Of the original 85 patients who completed the study, 34 were available for assessment of worry severity at 30-month follow-up. Both treatment groups showed maintenance of treatment gains from 6-month to 30-month follow-up assesment. However, MCT produced better results at long-term follow-up, which was reflected in statistically and clinically significant differences, and in terms of sustained efficacy (i.e., the degree in which patients who improved with treatment remained improved).Conclusion: Both MCT and IUT may be associated with long-term benefits for patients diagnosed with GAD, with MCT performing significantly better than IUT, and showing greater sustained efficacy.

Obsessive-compulsive disorder (OCD) is a common and disabling disorder. The most effective psychological treatment for OCD is currently exposure with response prevention (ERP). Although ERP is an effective therapy, recovery rates are relatively modest, so there is room for improvement. Metacognitive therapy (MCT) for OCD focuses primarily on modifying metacognitive beliefs about obsessions and compulsions, instead of their actual content. Based on a few small preliminary studies, there are some indications for the effectiveness of MCT for OCD. In the present article, the metacognitive model and treatment are discussed, as well as empirical support for its efficacy. Because detailed descriptions of the application of this treatment modality for patients with OCD are scarce, the authors report a case study to illustrate the content of this form of therapy.