Metacognitive Therapy versus Exposure and Response Prevention for Pediatric Obsessive-Compulsive Disorder

Abstract

Background: Exposure with ritual prevention (ERP) is the psychotherapeutic treatment of choice for pediatric obsessive-compulsive disorder (OCD). In the present study, a new treatment rationale – metacognitive therapy (MCT) for children – was developed and evaluated. Methods: Ten children and adolescents with OCD were randomly assigned to either MCT or ERP therapy condition. Patients were assessed before and after treatment and at the 3-month and 2-year follow-up by means of symptom severity interviews. Depressive symptoms were also assessed. Manualized treatment involved up to 20 sessions on a weekly basis. Results: We found clinically and statistically significant improvements in symptom severity after treatment. At the 3-month and 2-year follow-up, the attained improvements during treatment were retained. Conclusions:Despite some methodological limitations, results showed that MCT proved to be a promising psychotherapeutic alternative to the well-established ERP in the treatment of pediatric OCD. Further investigations into the efficacy of MCT are necessary to answer questions as to the working mechanisms underlying therapy for OCD.

A Review of Metacognition in the diagnosis and treatment of Obsessive Compulsive Disorder

“…Similar results were found in an open trial for group MCT for 8 adults with OCD [51] and in another case series study on patients reporting from pure obsessions (obsessions without overt compulsions) in Iran [52]. In another study MCT was applied in the treatment of pediatric OCD cases [53]. Ten children and adolescents were randomly assigned either to an Exposure Response Prevention (ERP) group or a MCT group.…”

Psychological Treatment of Obsessive-Compulsive Disorder in Children and Adolescents: a Meta-Analysis

“…However, the differential efficacy between the components of CBT has not received much attention. Only the study by Simons, Schneider, and Herpertz-Dahlmann, (2006) 2 A. I. Rosa-Alcázar et al has compared the benefits of ERP and meta-cognitive therapy, finding non-significant differences.…”

Eficacia de los tratamientos cognitivo-conductuales en el trastorno obsesivo-compulsivo en niños y adolescentes: Una revisión cualitativa

“…Los tamaños muestrales en los ensayos variaron entre 10 y 40 sujetos, con edades comprendidas entre los 7 y los 18 años. Las comparaciones realizadas son por un lado, entre dos tratamientos psicológicos ya sea diferenciándose en el tipo de técnica cognitivoconductual utilizada, terapia metacognitiva vs. EPR (Simons et al, 2006), en el formato de aplicación de la TCC, intensivo vs. semanal (Franklin et al, 1998;Storch et al, 2007) intensivo con entrevista motivacional (EM) vs. TCC intensivo junto a psicoeducación (Merlo et al, 2010). Por otro lado, encontramos la comparación entre el tratamiento psicológi-co y el tratamiento farmacológico, en los que se ha estudiado la eficacia diferencial de la EPR frente a la clomipramina y de la TCC grupal frente a la sertralina (de Haan et al, 1998;anales de psicología, 2012, vol.…”

“…A diferencia de otras terapias cognitivas en las que se pretende modificar el contenido de las creencias y pensamientos, la terapia Metacognitiva tiene como objetivo cambiar las estrategias y evaluaciones que realiza el sujeto acerca de sus pensamientos. Simons et al (2006) compararon los resultados obtenidos mediante la aplicación de la esta terapia con los observados mediante el uso de EPR en solitario en una muestra de 10 niños y adolescentes con TOC entre 8 y 17 años. Se programaron 20 sesiones para ambos tipos de intervención, con una frecuencia semanal.…”