How Does Metacognitive Training Help People with OCD?

What you need to know

• Metacognitive training for OCD (MCT-OCD) is a new group therapy approach that targets unhelpful thought patterns.
• The study found MCT-OCD improved patients’ thought control, obsessions, compulsions, and beliefs about OCD.
• The module on controlling thoughts was especially effective at reducing patients’ need to control their thoughts.

Background on OCD and existing treatments

Obsessive-compulsive disorder (OCD) is a mental health condition characterized by unwanted, intrusive thoughts (obsessions) and repetitive behaviors or mental acts (compulsions) that a person feels driven to perform. OCD can significantly impact a person’s daily life, relationships, and overall wellbeing.

The current gold standard treatment for OCD is cognitive-behavioral therapy (CBT) with exposure and response prevention (ERP). While CBT with ERP is effective for many patients, it requires administration by highly trained professionals, leading to long wait times for treatment. There is a need for more accessible treatment options that can be easily delivered and disseminated.

What is metacognitive training for OCD?

Metacognitive training for OCD (MCT-OCD) is a new group therapy approach developed to address this need. MCT-OCD targets unhelpful thought patterns and beliefs that contribute to OCD symptoms. It is delivered in a structured, manualized format that can potentially be administered by less experienced professionals.

The MCT-OCD program consists of 8 modules, each targeting a different cognitive or metacognitive belief related to OCD:

1. False assumptions about OCD
2. Perfectionism
3. Intolerance of uncertainty
4. Action fusion (believing thoughts can influence events)
5. Control of thoughts
6. Overestimation of threat
7. Inflated sense of responsibility
8. Biased attention and cognitive networks

Each module uses interactive exercises and discussions to help patients recognize and challenge these unhelpful thought patterns.

How was the study conducted?

The researchers wanted to evaluate the effectiveness of MCT-OCD and determine if specific modules produced changes in their targeted beliefs. They recruited 34 patients with OCD to participate in the 8-week MCT-OCD program.

Before and after each weekly session, patients completed questionnaires assessing their OCD symptoms, mood, and the cognitive/metacognitive beliefs targeted by MCT-OCD. This allowed the researchers to look at both overall changes across the 8 weeks and immediate changes after individual sessions.

What were the main findings?

Overall improvements

Over the course of the 8-week program, patients showed significant improvements in several areas:

• Obsessions
• Compulsions
• Need to control thoughts
• Belief of being well-informed about OCD
• Action fusion beliefs

This suggests that MCT-OCD was effective at reducing core OCD symptoms as well as some of the underlying unhelpful beliefs.

Effectiveness of specific modules

The researchers were especially interested in whether individual modules produced immediate changes in their targeted beliefs. The most notable finding was for the module on controlling thoughts (module #5). After this session, patients showed a significant reduction in their belief that they need to control their thoughts.

This is an important result, as the need to control thoughts is a key factor that maintains OCD symptoms for many patients. Learning to let go of thought control can help break the cycle of obsessions and compulsions.

Interestingly, the other modules did not show significant immediate effects on their targeted beliefs. The researchers suggest a few possible reasons for this:

1. The questionnaire items may not have adequately assessed the targeted beliefs.
2. The modules may need to be revised to more specifically address their targeted beliefs.
3. Some beliefs may take longer to change and not show immediate effects.
4. The modules may be working through other mechanisms not measured by the questionnaires.

Improvements from previous version

This study was building on a previous pilot version of MCT-OCD. The researchers made some revisions based on the pilot results, including:

• Separating modules that previously covered two topics into individual modules
• Revising the content and presentation to be more engaging and less likely to worsen mood

These changes appear to have been successful. Unlike in the pilot study, no modules worsened patients’ mood or symptoms in this version.

What are the implications of these findings?

The results of this study provide several valuable insights that can inform both clinical practice and future research:

1. MCT-OCD shows promise as an effective treatment for OCD, producing improvements in symptoms and unhelpful beliefs.

2. The module on controlling thoughts appears especially effective and could potentially be used as a standalone intervention for patients struggling with thought control.

3. The lack of immediate effects for other modules suggests the need for further refinement of both the intervention and assessment methods. Future studies should look at a broader range of potential mechanisms of change.

4. The successful revision of problematic elements from the pilot version demonstrates the value of this type of session-by-session analysis for improving psychological interventions.

5. The structured, manualized nature of MCT-OCD and its delivery in a group format could help increase access to evidence-based treatment for OCD.

Limitations and future directions

While this study provides valuable insights, there are some limitations to consider:

• The sample size was relatively small (34 patients), which may have limited the ability to detect smaller effects.
• There was no control group, so improvements cannot be definitively attributed to MCT-OCD rather than other factors.
• The study relied heavily on self-report measures, which can be subject to biases.
• The researchers who developed MCT-OCD conducted the study, potentially introducing bias.

Future research should address these limitations with larger, controlled trials. It would also be valuable to compare MCT-OCD to established treatments like CBT with ERP to determine relative effectiveness. Additionally, longer-term follow-up could reveal whether improvements are maintained over time.

Conclusions

• Metacognitive training for OCD (MCT-OCD) shows promise as an accessible, group-based treatment option.
• MCT-OCD produced improvements in OCD symptoms and unhelpful beliefs, particularly the need to control thoughts.
• Further refinement and research is needed, but MCT-OCD could potentially help increase access to evidence-based OCD treatment.
• Analyzing session-by-session effects, as done in this study, provides valuable insights for improving psychological interventions.