Group Metacognitive Therapy for Pediatric Obsessive-Compulsive Disorder: A Pilot Study

Abstract

Cognitive-behavioral therapy including exposure and response prevention is the first-line treatment of pediatric OCD showing response- and remission rates around 70% and 53%. Thus, there is room for improvements. Metacognitive therapy (MCT) for OCD might be cost-effective and focuses on modifying metacognitive beliefs about the significance and dangerousness of intrusive thoughts/feelings, and about the need to perform rituals. MCT is effective in adults but needs to be evaluated in youths. In the current study, eleven adolescents divided in three groups received eight MCT group sessions of 75 minutes duration (and two 60 minutes workshop for parents) delivered by an MCT-therapist and an assistant. The within-group effect size (hedges g) from pre- to post-treatment on the CY-BOCS was 1.90, and the response and remission rates were 82% and 55%, respectively. Effect sizes for secondary outcomes were also large. Therapist time (one certified MCT-therapist and a clinical psychology student working together) used per patient to achieve these results were 2.18 therapy sessions of 75-minutes duration in addition to 33 minutes therapist time per patient of workshops for the parents. Follow-up assessments were not available, and the results should be interpreted with caution. However, they are encouraging and suggest that MCT for pediatric OCD should be evaluated further.