Metacognitive Beliefs and Symptom Dimensions in OCD: A Network Analysis Identifying Central Nodes and a Severity Predictor.

Obsessive-compulsive disorder (OCD) is a heterogeneous condition characterized by a wide range of symptoms and maladaptive beliefs. However, previous research has often studied these symptoms and metacognitive beliefs in isolation, creating a critical gap in our understanding. To address this, our study used network analysis to uncover the interconnected relationships between these factors in 167 adults with primary OCD. By identifying the most central cognitive nodes, our findings suggest new targets for targeted interventions that could significantly enhance treatment effectiveness. Data were collected from two outpatient clinics in Pakistan. Participants completed measures of OCD symptoms (Yale-Brown Obsessive-Compulsive Scale; Padua Inventory-Revised) and metacognitive beliefs (Obsessive Beliefs Questionnaire-44; Metacognitions Questionnaire-30). Network analysis revealed two clusters, one for symptoms and one for metacognitive beliefs, indicating distinct yet interconnected domains of OCD pathology. Centrality analyses identified cognitive confidence (CC) and negative beliefs about worry (NBW) as the most central nodes, with strong connections to other nodes. Regression analyses indicated that, contrary to expectations, only positive beliefs about worry (PBW) uniquely predicted OCD severity, whereas CC and NBW did not show unique predictive effects. These findings support targeting central cognitive processes, such as memory confidence and beliefs about the uncontrollability of worry, in the treatment of OCD. Mapping the interplay between symptoms and beliefs within the OCD network may inform the development of targeted interventions and enhance treatment efficacy.