Abstract
BackgroundThe recommended psychological treatment of choice for obsessive-compulsive disorder (OCD) is exposure with response prevention (ERP). However, recovery rates are relatively modest, so better treatments are needed. This superiority study aims to explore the relative efficacy of metacognitive therapy (MCT), a new form of cognitive therapy based on the metacognitive model of OCD.Design and methodIn a randomized controlled trial, we will compare MCT with ERP. One hundred patients diagnosed with OCD will be recruited in an outpatient mental health center in Rotterdam (the Netherlands). The primary outcome measure is OCD severity, measured by the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). Data are assessed at baseline, after treatment, and at 6 and 30 months follow-up.DiscussionBy comparing MCT with ERP we hope to provide an indication whether MCT is efficacious in the treatment of OCD and, if so, whether it has the potential to be more efficacious than the current “gold standard” psychological treatment for OCD, ERP.Trial registrationDutch Trial Register, NTR4855. Registered on 21 October 2014.
Highlights
The recommended psychological treatment of choice for obsessive-compulsive disorder (OCD) is exposure with response prevention (ERP)
By comparing metacognitive therapy (MCT) with ERP we hope to provide an indication whether MCT is efficacious in the treatment of OCD and, if so, whether it has the potential to be more efficacious than the current “gold standard” psychological treatment for OCD, ERP
MCT is a relatively new treatment for OCD, based on a metacognitive model that states that, rather than the intrusive thoughts and compulsive behaviors, it is beliefs about the meaning and significance of obsessive thoughts on the one hand and beliefs about the need to conduct rituals and neutralizing behaviors on the other hand that are crucial for the development of OCD As a result, interventions should be targeted at these metacognitive beliefs
Summary
The recommended psychological treatment of choice for obsessive-compulsive disorder (OCD) is exposure with response prevention (ERP). OCD has been ranked among the 10 most debilitating disorders by the World Health Organization (WHO) and tends to be chronic without adequate treatment [48] Both studies into pharmacological treatment, primarily with selective serotonin reuptake inhibitors (SSRIs), and studies into specific forms of psychological treatment supported the effectiveness of these treatment. As approximately 30% of patients with OCD refuse ERP or drop out from treatment prematurely, it is assumed that overall recovery rates are lower [30]. These figures suggest that ERP might be hard to tolerate and is burdensome, which is supported by the finding that an important reason for not attempting ERP are the requirements of treatment (e.g. exposure to anxiety provoking stimuli [46]). It is assumed that this improvement could result from a better understanding in the mechanisms involved in the maintenance of the disorder
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