Comparison of the Effectiveness of Metacognitive Therapy and Cognitive-Behavior Therapy on Intrusive Thoughts of Obsessive-Compulsive Disorder




Metacognitive therapy, Cognitive-behavior therapy, Intrusive thoughts obsessive-compulsive disorder


Background: According to WHO statistics, Obsessive-Compulsive Disorder (OCD) is the tenth most disabling condition. Thus, this study aimed to compare the efficacy of metacognitive therapy (MCT) against Cognitive-Behavior Therapy(CBT)  on intrusive thoughts in obsessive-compulsive disorder.

Methods: In this study, a quasi-experimental design was used with pre-tests, post-test, and a control group. The study population was all patients who attended psychological clinics in Tehran, Iran, between August to September 2019. Using a purposeful sampling method, 24 OCD patients were selected from the study population, eight in every two experimental groups and eight in the control group. The experimental groups received 8, 120-minute sessions of therapy once a week. The study instruments were a questionnaire on demographic features and the Thought-Action fusion scale (TAFS). To analyze the data, inferential statistics (Multivariate Analysis of covariance (MANCOVA) by SPSS24.

Results: The results revealed that MCT and CBT treatments had a significant effect on variables (Pvalue<0.05). As observed, there is a significant difference in all subscales between the two groups of experiment and control in pre-test and post-test, after removing the pre-test effect (Pvalue<0.05). Moreover, findings showed that both approaches significantly differ from the control group when comparing variables between the two treatments. However, MCT treatment had the greatest effect.

Conclusions: Both MCT and CBT were found to be effective in reducing intrusive thoughts, though MCT had a greater reduction than CBT.

Keywords: Metacognitive therapy, Cognitive-behavior therapy, Intrusive thoughts obsessive-compulsive disorder


1. Miegel F, Demiralay C, Moritz S, Wirtz J, Hottenrott B, Jelinek L. Metacognitive training for obsessive-compulsive disorder: a study protocol for a randomized controlled trial. BMC psychiatry. 2020 Dec;20(1):1-3.
2. Micha M, Drakos I, Bacopoulou F, Kritseli E, Kokka I, Tigani X, Chrousos G, Kanaka-Gantenbein C. Effectiveness of Mindfulness Based Interventions on Symptom Reduction According to Y-BOCS and OCI-R in Adult Patients with Obsessive-Compulsive Disorder. A Systematic Review of Randomized Controlled Trials. Psychology. 2021 Nov 23;12(11):1863-77.doi: 10.4236/psych.2021.1211112.
3. Nayebaghayee A, Aleyasin SA, Heidari H, Davodi H. Effectiveness of Metacognitive Therapy on Dysfunctional Beliefs, Inflated Sense of Responsibility, and Intolerance of Uncertainty in Patients with Obsessive-Compulsive Disorder. Quarterly of Clinical Psychology Studies . 2019;9(33):1-24. doi: 10.22054/jcps.2019.35742.1969
4. Türkarslan, K. K. (2020). A Review of Thought Action Fusion and Related Concepts.
5. Gjelsvik B, Kappelmann N, von Soest T, Hinze V, Baer R, Hawton K, Crane C. Thought–Action Fusion in Individuals with a History of Recurrent Depression and Suicidal Depression: Findings from a Community Sample. Cognitive therapy and research. 2018 Dec;42(6):782-93.
6. Hezel DM, Stewart SE, Riemann BC, McNally RJ. Clarifying the thought-action fusion bias in obsessive-compulsive disorder. Journal of Obsessive-Compulsive and Related Disorders. 2019 Jan 1;20:75-84.
7. Odriozola-González P, Pérez-Álvarez M, García-Montes JM, Perona-Garcelán S, Vallina-Fernández O. The mediating role of metacognitive variables in the relationship between Thought-Action Fusion and obsessive-compulsive symptomatology. suma psicológica. 2016 Jul 1;23(2):80-9.
8. Black MJ, Grisham JR. A pilot study of interpretive cognitive bias modification for OCD: Targeting memory, uncertainty, and perfectionism biases. Journal of Experimental Psychopathology. January 2018. doi:10.1177/2043808718778969
9. Kim ST, Park CI, Kim HW, Jeon S, Kang JI, Kim SJ. Dysfunctional Metacognitive Beliefs in Patients With Obsessive–Compulsive Disorder and Pattern of Their Changes Following a 3-Month Treatment. Frontiers in Psychiatry. 2021;12.
10. Melchior K, Franken I, Deen M, van der Heiden C. Metacognitive therapy versus exposure and response prevention for obsessive-compulsive disorder: study protocol for a randomized controlled trial. Trials. 2019 May 20;20(1):277. doi: 10.1186/s13063-019-3381-9. PMID: 31109349; PMCID: PMC6528220.
11. van der Heiden C, van Rossen K, Dekker A, Damstra M, Deen M. Metacognitive therapy for obsessive–compulsive disorder: A pilot study. Journal of Obsessive-Compulsive and Related Disorders. 2016 Apr 1;9:24-9.
12. Papageorgiou C, Carlile K, Thorgaard S, Waring H, Haslam J, Horne L, et al. Group cognitive-behavior therapy or group metacognitive therapy for obsessive-compulsive disorder? Benchmarking and comparative effectiveness in a routine clinical service. Front Psychol. (2018) 9:2551. doi: 10.3389/fpsyg.2018.02551
13. Glombiewski J, Hansmeier J, Haberkamp A, Rief W, Exner C. Metacognitive therapy versus exposure and response prevention for obsessive-compulsive disorder - a pilot randomized trial. J Obsess Compuls Relat Disord. (2021) 30:100650. doi: 10.1016/j.jocrd.2021.100650
14. McKay D, Sookman D, Neziroglu F, Wilhelm S, Stein DJ, Kyrios M, Matthews K, Veale D. Efficacy of cognitive-behavioral therapy for obsessive–compulsive disorder. Psychiatry research. 2015 Feb 28;225(3):236-46. doi:10.1016/j.psychres.2014.11.058
15. Kathmann N, Jacobi T, Elsner B, Reuter B. Effectiveness of Individual Cognitive-Behavioral Therapy and Predictors of Outcome in Adult Patients with Obsessive-Compulsive Disorder. Psychotherapy and Psychosomatics. 2022 Jan 14:1-3. doi:10.1159/000520454
16. Olatunji BO, Cole D, McGuire JF, et al. Decoupling of Obsessions and Compulsions During Cognitive Behavioral Therapy for Youths With Obsessive Compulsive Disorder. Clinical Psychological Science. 2022;10(1):175-185. doi:10.1177/21677026211013771
17. Sunde T, Walseth LT, Himle JA, Vogel PA, Launes G, Haaland VØ, et al. A long-term follow-up of group behavioral therapy for obsessive-compulsive disorder in a general outpatient clinic in Norway. J Obsessive Compuls Relat Disord. 2017;14:59–64.
18. Schwartze, D., Barkowski, S., Burlingame, G. M., Strauss, B., & Rosendahl, J. (2016). Efficacy of group psychotherapy for obsessive-compulsive disorder: A meta-analysis of randomized controlled trials. Journal of Obsessive-Compulsive and Related Disorders, 10, 49-61. doi:10.1016/j.jocrd.2016.05.001
19. Rachman S. Psychological treatment of anxiety: the evolution of behavior therapy and cognitive behavior therapy. Annual Review of Clinical Psychology. 2009 Apr 27;5:97-119. doi: 10.1146/annurev.clinpsy.032408.153635.
20. Wells A, King P. Metacognitive therapy for generalized anxiety disorder: An open trial. J Behav Ther Exper Psychiatr 2006; 37(3): 206-12. doi: 10.1016/j.jbtep.2005.07.002.
21. Shafran R, Thordarson DS, Rachman S. Thought-action fusion in obsessive compulsive disorder. J Anxiety Disord. 1996;10:379–391 doi:10.1016/0887-6185(96)00018-7
22. Pourfaraj M, Mohammadi N, Taghavi M. Psychometric properties of revised thought–action fusion questionnaire (TAF-R) in an Iranian population. Journal of behavior therapy and experimental psychiatry. 2008 Dec 1;39(4):600-9. doi:10.1016/j.jbtep.2008.02.001
23. Andouz Z, Dolatshahi B, Moshtagh N, Dadkhah A. The efficacy of metacognitive therapy on patients suffering from pure obsession. Iran J Psychiatry. 2012 Winter;7(1):11-21. PMID: 23056112; PMCID: PMC3395965
24. Ashouri A, Atef Vahid MK, Gharaee B, Rasoulian M. Effectiveness of meta-cognitive and cognitive-behavioral therapy in patients with major depressive disorder. Iran J Psychiatry Behav Sci. 2013 Fall;7(2):24-34. PMID: 24644507; PMCID: PMC3939994
25. Mohammadkhani S. The role of fusion beliefs and metacognitions in obsessive–compulsive symptoms in general population. Practice in Clinical Psychology. 2013 Apr 10;1(2):97-104.







How to Cite

Comparison of the Effectiveness of Metacognitive Therapy and Cognitive-Behavior Therapy on Intrusive Thoughts of Obsessive-Compulsive Disorder. (2022). International Journal of Health Studies, 9(1).