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-naïve 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. [ABSTRACT FROM AUTHOR]