Treating pediatric OCD with group metacognitive therapy in a naturalistic setting: a preliminary investigation of treatment effects and metacognitive change in light of comorbid disorders

Introduction: Studies suggest that metacognitive therapy (MCT) is a promising treatment for pediatric OCD, but less is known about its mechanisms and effects in light of comorbid disorders. The aim of this study was therefore to explore the magnitude of effects, response and remission rates, and trajectories of change associated with MCT for pediatric OCD in a sample presenting both with and without comorbid neurodevelopmental and anxiety disorders. Methods: In total, 37 participants aged 9-17 years received eight sessions of group MCT, accompanied by two parental workshops. Participants were diagnostically assessed at pre- and post-treatment, and completed self-report measures before, during, and after treatment. Results: 2.3) and response and remission rates of 81.1% and 51.4%, respectively. Moderate to large improvements were also found in comorbid symptoms, trait worry, and metacognitive beliefs and strategies. When provisionally exploring three types of diagnostic presentations (i.e., OCD only, OCD with comorbid neurodevelopmental disorder[s], and OCD with comorbid anxiety disorder[s]), slightly lower response rates were observed for the two subgroups with comorbid disorders, accompanied by indications of delayed, but steeper trajectories of change in thought-fusion beliefs. Discussion: Overall, the results indicate that group MCT for pediatric OCD is a feasible treatment in naturalistic settings with high rates of comorbidity, but that the presence of comorbid disorders may be associated with lower response rates and different trajectories of metacognitive change. However, these observations should be considered preliminary and evaluated further in larger samples with more stringent study designs.