| Abstract: |
Metacognitive processes are increasingly being identified as key mediators of the pathophysiology underlying two clinically prevalent mental health constructs, depression and obsessive-compulsive disorder (OCD), which have different phenomenological presentations but share cognitive features. This meta-analytic review examines data spanning 87 studies between 2000 and 2024 to clarify distinct metacognitive differences between depression and OCD. The analysis shows that although both disorders are associated with maladaptive metacognitive strategies, they occur through different mechanisms. Depression mostly reflects self-focused negative attention, ruminations on failures and future catastrophes, and metacognitive beliefs of thought-in controllability. On the other hand, OCD extends metacognitive control efforts, unwanted thought monitoring and perception of moral ownership regarding intrusive thoughts. The present dense version of an integrative synthesis 147 effect sizes confirms that metacognitive measures are highly heterogeneous across disorders, with the narrow range for core constructs corresponding to a standardized mean difference from 0.68 and onwards (Cohen's d = 1.44). Procedures may yield stronger effects within cognitive-behavioral frameworks when treatment protocols reflect disorder-specific metacognitive profiles. Conclusion: These considerations make metacognitive differentiation unusually informative in terms of diagnosis, treatment choice and prognosis ability. Future research should include longitudinal designs measuring metacognitive development over the lifespan, mechanistic studies using neuroimaging techniques, and transdiagnostic treatments targeting shared metacognitive processes common to both disorders. |
