Metacognitive therapy versus exposure and response prevention for obsessive-compulsive disorder: study protocol for a randomized controlled trial

Abstract

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.

Clinical advances in obsessive-compulsive disorder: a position statement by the International College of Obsessive-Compulsive Spectrum Disorders

“…However, the strength of efficacy for both treatments appeared to be less than that generally found with ERP (Rupp et al, 2019). Despite promising results for metacognitive therapy in patients with OCD in case series, a full controlled trial has yet to be performed (Melchior et al, 2019).…”

Metacognitive Therapy in Patients with ObsessiveCompulsive Disorder: A review

“…Despite CBT providing significant benefits in the treatment of OCD, treatment remains below optimal levels in a significant proportion of patients. 16 Furthermore, it has been reported that in reality, only 25% of the patients remain completely asymptomatic. 17 …”

“…According to Wells’s model, 2 metacognitive steps lead to the occurrence and continuation of OCD. 16 In the first step, obsessions occur through metacognitive beliefs that cause intrusions to be interpreted as dangerous and harmful 29 because obsessional intrusions are mixed with events, actions, and objects, and this situation is named as “fusion.” In Wells’s theory, the system works as follows: when the thought-event, thought-action, thought-object fusion is activated, patient with OCD begins to give importance to their intrusions and shows a trend to interpret these intrusions as threatful. 30 At this point, second step is stimulated.…”

“…In the second step, a patient with OCD is forced to realize some relaxing behaviors to omit this threat and worry that arises, like “if I don’t turn around the tree three times my mother will die.” As a consequence, the patient finds herself/himself in an open and secret spiral of ritual, not knowing how to end this spiral, and thinks that stopping it will cause her/his anxiety to not control. 16 What does MCT basically try to do in OCD? MCT aims to enable patients with OCD to recognize, be aware of, and acquire some skills to change their metacognitive processing.…”

The efficacy of exposure and response prevention for Obsessive-Compulsive Disorder and Tourette Syndrome: A meta-analysis

“…Notably, Y-BOCS/CY-BOCS score range of severity for patients who have both obsession and compulsions was categorized as follows: mild OCD (< 13); moderate OCD (13)(14)(15)(16)(17)(18)(19)(20)(21)(22), severe OCD (> 22) [30] (Fig. 1: Flowchart of the identi cation of the included studies).…”