Is the whole less than the sum of its parts? Full versus individually adapted metacognitive self-help for obsessive-compulsive disorder: A randomized controlled trial

Abstract

Self-help resources are frequently sought out by individuals with obsessive-compulsive disorder (OCD); however their efficacy has rarely been evaluated in randomized controlled trials, despite frequently bold claims for their efficacy. In the present study, we examined if a metacognitive self-help manual called myMCT (for “my Metacognitive Training”), which encompasses exercises from cognitive-behavioral therapy (CBT) and its "third wave", is superior to a wait-list control group in reducing OCD symptoms. Further, we examined whether an individually adapted version of the manual suited to personal problems would yield larger effects than the full manual. MethodsA total of 89 individuals with OCD symptoms participated in the online study. Participants were randomly assigned to three conditions; patients either received the full myMCT manual (sent via email attachment), an individually adapted myMCT version, or were allocated to a wait-list control group. Before randomization (pre-assessment) and six weeks later (post-assessment), individuals were asked to fill out several questionnaires tapping obsessive-compulsive and depressive symptoms. ResultsIndividuals in the two myMCT conditions improved significantly more on the Yale-Brown Obsessive Compulsive Scale and Obsessive-Compulsive Inventory-Revised total scores than the wait-list control group (between-group comparison), with a medium to large effect size. Subsidiary analyses showed that improvements were particularly pronounced for obsessions, while effects on compulsions were mainly small and insignificant. Contrary to our expectation, the adapted version did not lead to better outcomes than the full version. DiscussionThe present study supports the feasibility of a bibliotherapeutic metacognitive approach for the treatment of obsessive thoughts. While results confirm prior reports that metacognitive training is effective in OCD, results are limited by a rather high non-completion rate. Further studies should investigate the long-term effectiveness of the approach and its utility in the framework of guided self-help or face-to-face treatment.