Assessing the Impact of Metacognitive Therapy on OCD Severity and Beliefs: A Three-Wave Multisite RCT With Panel Mediation Analysis.
Saeed Anwar, Romana Younas, Wejdan Deebani et al.
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In 30 seconds
This multisite, assessor-blinded randomized controlled trial compared 12 weekly sessions of individual metacognitive therapy (MCT) with documented treatment as usual (TAU) in 76 adults with OCD receiving outpatient care in Pakistan. Across assessments at baseline, post-treatment, and 6-month follow-up, MCT led to greater reductions in clinician-rated OCD severity and more frequent treatment response. The mean between-group differences in severity were -4.00 at post-treatment and -6.92 at follow-up (both p < 0.001). Metacognitive belief scores also improved, but the exploratory analysis did not support the proposed lagged indirect effect through post-treatment beliefs.
Key findings
- MCT produced greater reductions in Yale-Brown Obsessive-Compulsive Scale severity than TAU; mean differences were -4.00 post-treatment and -6.92 at follow-up (both p < 0.001).
- Treatment response was more frequent with MCT than with TAU.
- MCT reduced Metacognitions Questionnaire-30 belief domains, with gains maintained at follow-up.
- The proposed lagged indirect effect through post-treatment metacognitive beliefs was not supported (β = -0.01).
Why it matters
The trial adds randomized evidence for individual MCT in a Pakistani outpatient setting, extending evaluation beyond the high-income Western contexts in which it has mostly been studied. Its symptom findings support further consideration of MCT as an OCD treatment option, while the mediation result cautions against assuming that broad metacognitive belief changes are the mechanism driving improvement.
What to keep in mind
The mediation analysis was exploratory, and assessments at three waves may not establish the fine-grained timing of changes needed to test treatment mechanisms.