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Table 1 Overview of metacognitive therapy (MCT; [39]; based on [44]) and exposure and response prevention (ERP) for obsessive-compulsive disorder (OCD)

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

Phase MCT ERP
Interventions Sessions Interventions Sessions
1 - Provide treatment overview 1–2 - Provide treatment overview 1–3
- Psycho-education about the metacognitive model of OCD - Psycho-education about the behavioral model of OCD
- Elicit metacognitions by guided questioning - Generation of a hierarchy of anxiety-provoking situations and avoidance behaviors
- Practicing of detached mindfulness
2 - Modifying metacognitions about intrusions by verbal methods (e.g. questioning the evidence) and behavioral experiments (e.g. exposure with response commission, ritual postponement, and exposure and response prevention experiments) 3–8 - Exposure and response prevention exercises, both within-session and between sessions 4–13
3 - Modifying metacognitions about the necessity of rituals by verbal methods (e.g. questioning the evidence, advantages–disadvantages analysis of performing rituals) and behavioral experiments (e.g. ritual modulation experiments) 9–12 - Generation of a treatment summary consisting of an overview of OCD complaints pretreatment, rest symptoms at post-treatment, and a relapse prevention plan containing helpful interventions to maintain 14–15
4 Generation of a new plan for processing in response to unwanted thoughts, feelings, or events and a therapy blueprint consisting of the case conceptualization, a list of metacognitive beliefs and an overview of evidence challenging them 13–15