Metacognitive beliefs predict early response to pharmacological treatment in patients with obsessive-compulsive disorder

Rationale Metacognitions, beliefs that monitor or control thoughts and coping, are considered to be important components for development and maintenance of obsessive-compulsive disorder (OCD). Objectives This study prospectively investigated whether metacognitive beliefs can predict early treatment response after serotonin reuptake inhibitor (SRI) initiation in patients with OCD. Methods Drug-naive or medication-free patients with OCD (N = 156) were assessed for various characteristics, including metacognitions. In total, 132 patients were followed for 4 weeks, and their clinical responses to pharmacological treatment were assessed using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). Early treatment response was defined as a 20% or greater reduction from the baseline Y-BOCS score at 4 weeks. Logistic and linear regression analyses were performed to identify major determinants for the early treatment outcome. Results Among participants with OCD, 53 patients (40.15%) were early responders. The logistic regression model revealed two significant predictors, age (beta = - 0.113,p < 0.001) and positive beliefs about worry, which refers to metacognitive beliefs concerning the benefits of engaging in worry (beta = - 0.067,p = 0.001), for identifying early responders. Moreover, in the linear regression model, lower positive beliefs about worry was also shown as a significant predictor for the degree of better early improvement (beta = - 0.566,p = 0.001). Conclusions These results suggest that lower metacognition of positive beliefs about worry predicts improvement of obsessive-compulsive symptoms seen early on in the SRI treatment, and that pathological metacognitive belief would lead to delayed response to SRI treatment in OCD.