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Published in: Trials 1/2019

Open Access 01-12-2019 | Obsessive-Compulsive Disorder | Study protocol

Metacognitive therapy versus exposure and response prevention for obsessive-compulsive disorder: study protocol for a randomized controlled trial

Authors: Kim Melchior, Ingmar Franken, Mathijs Deen, Colin van der Heiden

Published in: Trials | Issue 1/2019

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Abstract

Background

The 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 method

In 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.

Discussion

By 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 registration

Dutch Trial Register, NTR4855. Registered on 21 October 2014.
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Literature
1.
go back to reference American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (5th edition (DSM-5)). Washington, DC: American Psychiatric Association; 2013.CrossRef American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (5th edition (DSM-5)). Washington, DC: American Psychiatric Association; 2013.CrossRef
2.
go back to reference Beck AT, Steer RA, Brown GK. Manual for the Beck Depression Inventory-II. San Antonio: Psychological Corporation; 1996. Beck AT, Steer RA, Brown GK. Manual for the Beck Depression Inventory-II. San Antonio: Psychological Corporation; 1996.
3.
go back to reference Blanco C, Olfson M, Stein DJ, Simpson HB, Gameroff MJ, Narrow MH. Treatment of obsessive–compulsive disorder by U.S. psychiatrists. J Clin Psychiatry. 2006;67:946–51.CrossRef Blanco C, Olfson M, Stein DJ, Simpson HB, Gameroff MJ, Narrow MH. Treatment of obsessive–compulsive disorder by U.S. psychiatrists. J Clin Psychiatry. 2006;67:946–51.CrossRef
4.
go back to reference Burns GL, Keortge S, Formea G, Sternberger L. Revision of the Padua Inventory of obsessive-compulsive disorder symptoms: Distinctions between worry, obsessions, and compulsions. Behav Res Ther. 1996;34:163–73.CrossRef Burns GL, Keortge S, Formea G, Sternberger L. Revision of the Padua Inventory of obsessive-compulsive disorder symptoms: Distinctions between worry, obsessions, and compulsions. Behav Res Ther. 1996;34:163–73.CrossRef
5.
go back to reference Clark DA. Cognitive-behavioral therapy for OCD. New York: Guilford Press; 2004. Clark DA. Cognitive-behavioral therapy for OCD. New York: Guilford Press; 2004.
7.
go back to reference Craske MG, Treanor M, Conway C, Zbozinek T, Vervliet B. Maximizing Exposure Therapy: An inhibitory learning approach. Behav Res Ther. 2016;58:10–23.CrossRef Craske MG, Treanor M, Conway C, Zbozinek T, Vervliet B. Maximizing Exposure Therapy: An inhibitory learning approach. Behav Res Ther. 2016;58:10–23.CrossRef
8.
go back to reference Derogatis LR. SCL-90-R: administration, scoring & procedures: Manual II. Towson: Clinical Psychometric Research; 1983. Derogatis LR. SCL-90-R: administration, scoring & procedures: Manual II. Towson: Clinical Psychometric Research; 1983.
9.
go back to reference Eddy KT, Dutra L, Bradely R, Westen DA. Multidimensional meta-analysis of psychotherapy and pharmacotherapy for obsessive-compulsive disorder. Clin Psychol Rev. 2004;24:1011–30.CrossRef Eddy KT, Dutra L, Bradely R, Westen DA. Multidimensional meta-analysis of psychotherapy and pharmacotherapy for obsessive-compulsive disorder. Clin Psychol Rev. 2004;24:1011–30.CrossRef
10.
go back to reference First MB, Spitzer RL, Gibbon M, Williams JBW. Structured Clinical Interview for DSM-IV-TR Axis-I Disorders (Research Version, Patient Edition (SCID-I/P). New York: Biometrics Research Department, NY State Psychiatric Institute; 2001. First MB, Spitzer RL, Gibbon M, Williams JBW. Structured Clinical Interview for DSM-IV-TR Axis-I Disorders (Research Version, Patient Edition (SCID-I/P). New York: Biometrics Research Department, NY State Psychiatric Institute; 2001.
11.
go back to reference Fisher PL, Wells A. How effective are cognitive and behavioral treatments for obsessive-compulsive disorder: A clinical significance analysis. Behav Res Ther. 2005;43:1543–58.CrossRef Fisher PL, Wells A. How effective are cognitive and behavioral treatments for obsessive-compulsive disorder: A clinical significance analysis. Behav Res Ther. 2005;43:1543–58.CrossRef
12.
go back to reference Fisher PL, Wells A. Metacognitive therapy for obsessive-compulsive disorder: A case series. J Behav Ther Exp Psychiatry. 2008;39:117–32.CrossRef Fisher PL, Wells A. Metacognitive therapy for obsessive-compulsive disorder: A case series. J Behav Ther Exp Psychiatry. 2008;39:117–32.CrossRef
13.
go back to reference Fisher PL. Obsessive Compulsive Disorder: A comparison between CBT and the metacognitive approach. Int J Cogn Ther. 2009;2:107–22.CrossRef Fisher PL. Obsessive Compulsive Disorder: A comparison between CBT and the metacognitive approach. Int J Cogn Ther. 2009;2:107–22.CrossRef
14.
go back to reference Fisher PL, Wells A. How effective are cognitive and behavioral treatments for obsessive-compulsive disorder: a clinical significance analysis. Behav Res Ther. 2005;43:1543–58.CrossRef Fisher PL, Wells A. How effective are cognitive and behavioral treatments for obsessive-compulsive disorder: a clinical significance analysis. Behav Res Ther. 2005;43:1543–58.CrossRef
15.
16.
go back to reference Fitt S, Rees C. Metacognitive Therapy for obsessive compulsive disorder by videoconference: A preliminary study. Behav Change. 2012;29:213–29.CrossRef Fitt S, Rees C. Metacognitive Therapy for obsessive compulsive disorder by videoconference: A preliminary study. Behav Change. 2012;29:213–29.CrossRef
17.
go back to reference Frost RO, Steketee G. Cognitive approaches to obsessions and compulsions: Theory, assessment, and treatment. New York: Pergamon Press; 2002. Frost RO, Steketee G. Cognitive approaches to obsessions and compulsions: Theory, assessment, and treatment. New York: Pergamon Press; 2002.
18.
go back to reference Frost RO, Steketee G, Krause MS, Trepanier KL. The relationship of the Yale-Brown Obsessive Compulsive Scale (YBOCS) to other measures of obsessive compulsive symptoms in a nonclinical population. J Pers Assess. 2010;65:158–68.CrossRef Frost RO, Steketee G, Krause MS, Trepanier KL. The relationship of the Yale-Brown Obsessive Compulsive Scale (YBOCS) to other measures of obsessive compulsive symptoms in a nonclinical population. J Pers Assess. 2010;65:158–68.CrossRef
19.
go back to reference Goodman WK, Price LM, Rasmussen SA, Mazure C, Fleischmann RL, Hill CL, et al. The Yale-Brown Obsessive Compulsive Scale (Y-BOCS): Part I. Development, use, and reliability. Arch Gen Psychiatry. 1995;46:1006–11.CrossRef Goodman WK, Price LM, Rasmussen SA, Mazure C, Fleischmann RL, Hill CL, et al. The Yale-Brown Obsessive Compulsive Scale (Y-BOCS): Part I. Development, use, and reliability. Arch Gen Psychiatry. 1995;46:1006–11.CrossRef
20.
go back to reference Gwilliam PDH, Wells A, Cartwright-Hatton S. Does metacognition or responsibility predict obsessive–compulsive symptoms: A test of the metacognitive model. Clin Psychol Psychother. 2004;11:137–44.CrossRef Gwilliam PDH, Wells A, Cartwright-Hatton S. Does metacognition or responsibility predict obsessive–compulsive symptoms: A test of the metacognitive model. Clin Psychol Psychother. 2004;11:137–44.CrossRef
21.
go back to reference Jacobson NS, Truax P. Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. J Consul Clin Psychol. 1991;59:12–9.CrossRef Jacobson NS, Truax P. Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. J Consul Clin Psychol. 1991;59:12–9.CrossRef
22.
go back to reference Liu G, Liang KY. Sample size calculations for studies with correlated observations. Biometrics. 1997;53:937–47.CrossRef Liu G, Liang KY. Sample size calculations for studies with correlated observations. Biometrics. 1997;53:937–47.CrossRef
23.
go back to reference Lobbestael J, Leurgans M, Arntz A. Inter-rater reliability of the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID I) and Axis II Disorders (SCID II). Clin Psychol Psychother. 2010;21:75–9. Lobbestael J, Leurgans M, Arntz A. Inter-rater reliability of the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID I) and Axis II Disorders (SCID II). Clin Psychol Psychother. 2010;21:75–9.
24.
go back to reference McLeod AI. Remark AS R58. A remark on algorithm AS 183. An efficient and portable pseudo-random number generator. Appl Stat. 1985;34:198–200.CrossRef McLeod AI. Remark AS R58. A remark on algorithm AS 183. An efficient and portable pseudo-random number generator. Appl Stat. 1985;34:198–200.CrossRef
25.
go back to reference McNicol K, Wells A. Metacognitions and obsessive-compulsive symptoms: the contribution of thought-fusion beliefs and beliefs about rituals. Int J Cogn Ther. 2012;3:330–40.CrossRef McNicol K, Wells A. Metacognitions and obsessive-compulsive symptoms: the contribution of thought-fusion beliefs and beliefs about rituals. Int J Cogn Ther. 2012;3:330–40.CrossRef
26.
go back to reference Meyer V. Modifications of expectations in case of obsessional rituals. Behav Res Ther. 1966;4:273–80.CrossRef Meyer V. Modifications of expectations in case of obsessional rituals. Behav Res Ther. 1966;4:273–80.CrossRef
27.
go back to reference Mowrer OH. Two-factor learning theory: summary and content. Psychological Review. 1951;58:350–4.CrossRef Mowrer OH. Two-factor learning theory: summary and content. Psychological Review. 1951;58:350–4.CrossRef
28.
go back to reference Myers SG, Fisher PL, Wells A. Belief domains of the Obsessive Beliefs Questionnaire-44 (OBQ-44) and their specific relationship with obsessive– compulsive symptoms. J Anxiety Disord. 2008;22:475–84.CrossRef Myers SG, Fisher PL, Wells A. Belief domains of the Obsessive Beliefs Questionnaire-44 (OBQ-44) and their specific relationship with obsessive– compulsive symptoms. J Anxiety Disord. 2008;22:475–84.CrossRef
29.
go back to reference Obsessive Compulsive Cognitions Working Group. Psychometric validation of the Obsessive Beliefs Questionnaire and the Interpretation of Intrusions Inventory: Part 2: Factor analyses and testing of a brief version. Behav Res Ther. 2005;43:1527–42.CrossRef Obsessive Compulsive Cognitions Working Group. Psychometric validation of the Obsessive Beliefs Questionnaire and the Interpretation of Intrusions Inventory: Part 2: Factor analyses and testing of a brief version. Behav Res Ther. 2005;43:1527–42.CrossRef
30.
go back to reference Olatunji BO, Cisler JM, Deacon BJ. Efficacy of cognitive behavioral therapy for anxiety disorders: a review of meta-analytic findings. Psychiatr Clin North Am. 2010;33:557–77.CrossRef Olatunji BO, Cisler JM, Deacon BJ. Efficacy of cognitive behavioral therapy for anxiety disorders: a review of meta-analytic findings. Psychiatr Clin North Am. 2010;33:557–77.CrossRef
31.
go back to reference Ost LG, Havnen A, Hansen B, Kvale G. Cognitive behavioral treatments of obsessive-compulsive disorder. A systematic review and meta- analysis of studies published 1993–2014. Clin Psychol Rev. 2015;40:156–69.CrossRef Ost LG, Havnen A, Hansen B, Kvale G. Cognitive behavioral treatments of obsessive-compulsive disorder. A systematic review and meta- analysis of studies published 1993–2014. Clin Psychol Rev. 2015;40:156–69.CrossRef
32.
go back to reference Rachman S. Obsessions, responsibility and guilt. Behav Res Ther. 1993;31:149–54.CrossRef Rachman S. Obsessions, responsibility and guilt. Behav Res Ther. 1993;31:149–54.CrossRef
33.
go back to reference Rees CS, van Koesveld KE. An open trial of group metacognitive therapy for obsessive-compulsive disorder. J Behav Ther Exp Psychiatry. 2008;39:451–8.CrossRef Rees CS, van Koesveld KE. An open trial of group metacognitive therapy for obsessive-compulsive disorder. J Behav Ther Exp Psychiatry. 2008;39:451–8.CrossRef
34.
go back to reference Rosa-Alcazar AI, Sanchez-Meca J, Gomez-Conesa A, Martin-Martinez F. Psychological treatment of obsessive-compulsive disorder: A meta-analysis. Clin Psychol Rev. 2008;28:1310–25.CrossRef Rosa-Alcazar AI, Sanchez-Meca J, Gomez-Conesa A, Martin-Martinez F. Psychological treatment of obsessive-compulsive disorder: A meta-analysis. Clin Psychol Rev. 2008;28:1310–25.CrossRef
35.
go back to reference Simons M, Schneider S, Herpertz-Dahlmann B. Metacognitive therapy versus exposure and response prevention for pediatric obsessive-compulsive disorder. Psychother Psychosom. 2006;75:257–64.CrossRef Simons M, Schneider S, Herpertz-Dahlmann B. Metacognitive therapy versus exposure and response prevention for pediatric obsessive-compulsive disorder. Psychother Psychosom. 2006;75:257–64.CrossRef
36.
go back to reference Singer JD, Willett JB. Applied longitudinal data analysis: modelling change and event occurrence. New York: Oxford University Press, Inc; 2003.CrossRef Singer JD, Willett JB. Applied longitudinal data analysis: modelling change and event occurrence. New York: Oxford University Press, Inc; 2003.CrossRef
37.
go back to reference Skapinakis P, Caldwell D, Hollingworth W, Bryden P, Fineberg N, Salkovskis P. A systematic review of the clinical effectiveness and cost-effectiveness of pharmacological and psychological interventions for the management of obsessive-compulsive disorder in children/adolescents and adults. Health Technol Assess. 2016;20:1–392.CrossRef Skapinakis P, Caldwell D, Hollingworth W, Bryden P, Fineberg N, Salkovskis P. A systematic review of the clinical effectiveness and cost-effectiveness of pharmacological and psychological interventions for the management of obsessive-compulsive disorder in children/adolescents and adults. Health Technol Assess. 2016;20:1–392.CrossRef
38.
go back to reference Tolin DF, Maltby N, Diefenbach GJ, Hannan SE, Worhunsky P. Cognitive-behavioral therapy for medication non-responders with obsessive compulsive disorder: a wait-list-controlled open trial. J Clin Psychiatry. 2004;65:922–31.CrossRef Tolin DF, Maltby N, Diefenbach GJ, Hannan SE, Worhunsky P. Cognitive-behavioral therapy for medication non-responders with obsessive compulsive disorder: a wait-list-controlled open trial. J Clin Psychiatry. 2004;65:922–31.CrossRef
39.
go back to reference van der Heiden C, Rossen van K, Dekker A, Damstra M, Deen M. Metacognitive therapy for obsessive-compulsive disorder: A pilot study. J Obsessive Compulsive Relat Disord. 2016;9:24–9.CrossRef van der Heiden C, Rossen van K, Dekker A, Damstra M, Deen M. Metacognitive therapy for obsessive-compulsive disorder: A pilot study. J Obsessive Compulsive Relat Disord. 2016;9:24–9.CrossRef
40.
go back to reference van Oppen P, Emmelkamp PMG, Balkom van AJLM, van Dyck R. The sensitivity to change of measures for obsessive-compulsive disorder. J Anxiety Disord. 1995;9:241–28.CrossRef van Oppen P, Emmelkamp PMG, Balkom van AJLM, van Dyck R. The sensitivity to change of measures for obsessive-compulsive disorder. J Anxiety Disord. 1995;9:241–28.CrossRef
41.
go back to reference Wegner DM, Schneider DJ, Carter SR, White TL. Paradoxical effects of thoughts suppression. J Pers Soc Psychol. 1987;53:5–13.CrossRef Wegner DM, Schneider DJ, Carter SR, White TL. Paradoxical effects of thoughts suppression. J Pers Soc Psychol. 1987;53:5–13.CrossRef
42.
go back to reference Wells A. Cognitive therapy of anxiety disorders: a practice manual and conceptual guide. Chichester: Wiley; 1997. Wells A. Cognitive therapy of anxiety disorders: a practice manual and conceptual guide. Chichester: Wiley; 1997.
43.
go back to reference Wells A. Emotional disorders and metacognition: innovative cognitive therapy. Chichester: Wiley; 2000. Wells A. Emotional disorders and metacognition: innovative cognitive therapy. Chichester: Wiley; 2000.
44.
go back to reference Wells A. Metacognitive therapy for anxiety and depression. New York: Guilford Press; 2009. Wells A. Metacognitive therapy for anxiety and depression. New York: Guilford Press; 2009.
45.
go back to reference Wells A, Gwilliam P, Cartwright-Hatton S. The Thought Fusion Instrument. Manchester: University of Manchester; 2001. Wells A, Gwilliam P, Cartwright-Hatton S. The Thought Fusion Instrument. Manchester: University of Manchester; 2001.
46.
go back to reference Whittal ML, Thordarson PD, McLean PD. Treatment of obsessive-compulsive disorder: Cognitive behavior therapy vs. exposure and response prevention. Behav Res Ther. 2005;43:1559–76.CrossRef Whittal ML, Thordarson PD, McLean PD. Treatment of obsessive-compulsive disorder: Cognitive behavior therapy vs. exposure and response prevention. Behav Res Ther. 2005;43:1559–76.CrossRef
47.
go back to reference Whittal ML, Robichaud M, Thordarson DS, McLean PD. Group and individual treatment of obsessive-compulsive disorder using cognitive therapy and exposure plus response prevention: a 2-year follow-up of two randomized trials. J Consult Clinical Psychol. 2008;76:1003–14.CrossRef Whittal ML, Robichaud M, Thordarson DS, McLean PD. Group and individual treatment of obsessive-compulsive disorder using cognitive therapy and exposure plus response prevention: a 2-year follow-up of two randomized trials. J Consult Clinical Psychol. 2008;76:1003–14.CrossRef
48.
go back to reference World Health Organization. The World Health Organization Quality Of Life (WHOQOL) –Bref. Geneva: World Health Organization; 2004. World Health Organization. The World Health Organization Quality Of Life (WHOQOL) –Bref. Geneva: World Health Organization; 2004.
Metadata
Title
Metacognitive therapy versus exposure and response prevention for obsessive-compulsive disorder: study protocol for a randomized controlled trial
Authors
Kim Melchior
Ingmar Franken
Mathijs Deen
Colin van der Heiden
Publication date
01-12-2019
Publisher
BioMed Central
Published in
Trials / Issue 1/2019
Electronic ISSN: 1745-6215
DOI
https://doi.org/10.1186/s13063-019-3381-9

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