Metacognitive therapy versus exposure and response prevention for obsessive-compulsive disorder-A pilot randomized trial

Cognitive behaviour therapy, especially exposure and response prevention (ERP) is the treatment of choice for obsessive-compulsive disorder (OCD). However, a substantial number of patients refuse this method or fail to benefit enough. Metacognitive therapy (MCT) claims to successfully treat OCD without prolonged exposures. However, only case series and small, mostly uncontrolled trials have been published so far. The efficacy and feasibility of MCT for OCD compared to ERP were investigated in a pilot randomized trial. Thirty-seven outpatients with OCD according to DSM-IV criteria were randomly allocated to individual, weekly 14-sessions of therapy with either MCT or ERP. Analyses focused on treatment efficacy at post-treatment and 3months follow-up, treatment fidelity and credibility. Participants showed a significant reduction in OCD symptoms in both treatment conditions and with no differences between MCT and ERP. Participants in the MCT condition required less face-to-face time with a therapist than those in the ERP condition. MCT and ERP were both effective with large effect sizes. There was no evidence that the two treatments lead to statistically different outcomes. Larger controlled trials are justified.