Assessing the Impact of Metacognitive Therapy on OCD Severity and Beliefs: A Three-Wave Multisite RCT With Panel Mediation Analysis
In brief
Metacognitive therapy lowered OCD severity 6.9 points more at six months
In a randomized trial of 76 adults in Pakistan, 12 weekly sessions of metacognitive therapy reduced clinician-rated OCD severity 6.9 points more than usual care at six-month follow-up; more patients also responded to treatment. Metacognitive beliefs improved, but their change did not explain symptom improvement, leaving the therapy's active mechanisms unclear.
- Journal
- Depression and anxiety (Q1)
- Published
- 15 October 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Saeed Anwar, Romana Younas, Wejdan Deebani, Jiang Yingjie
- PMID
- 42890135
- DOI
- 10.1155/da/5060244
Why clinicians should know about it
- Picked for Psychiatry and Mental Health (paper of the day, 18 October 2026): Metacognitive therapy RCT for OCD, belief mediation
Abstract
Obsessive-compulsive disorder (OCD) is a chronic and disabling condition, and although exposure and response prevention (ERP) is the first-line psychological treatment, many patients decline it, drop out, or retain residual symptoms. According to Wells' metacognitive model, OCD is maintained less by intrusive thoughts themselves than by metacognitive beliefs about the significance, danger, and control of thoughts, which metacognitive therapy (MCT) targets directly. However, individual MCT has been evaluated almost exclusively in high-income Western settings, and whether metacognitive belief change temporally precedes symptom improvement remains untested. This multisite, assessor-blinded randomized controlled trial (RCT) addressed both gaps in Pakistani outpatient services. Seventy-six adults with OCD were randomized to 12 weekly sessions of individual MCT (n = 38) or documented treatment as usual (TAU; n = 38) and assessed at baseline, post-treatment, and 6-month follow-up; outcomes were analyzed with intention-to-treat (ITT) mixed-effects models and an exploratory three-wave panel mediation model. MCT produced greater reductions in clinician-rated Yale-Brown Obsessive-Compulsive Scale severity than TAU, F(1.81, 134) = 11.30, p < 0.001, with mean differences of -4.00 at post-treatment and -6.92 at follow-up (both p < 0.001) and more frequent treatment response. MCT also reduced Metacognitions Questionnaire-30 belief domains, with gains maintained at follow-up. However, the prespecified lagged indirect effect through post-treatment beliefs was not supported (β = -0.01). Findings extend the evidence for MCT to a non-Western clinical context and suggest that broad metacognitive belief domains behave as markers of clinical state rather than proximal mechanisms, underscoring the need for temporally fine-grained mechanism research.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.