Mindfulness and Metacognitive Processes in Obsessive-Compulsive Disorder: Neurocognitive Mechanisms and Clinical Implications
Emel Uysal
IntechOpen eBooks September 24, 2026 DOI: 10.5772/intechopen.1017564 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Narrative review Peer reviewed |
|---|---|
| Topics | Meditation |
| Key findings | Proposes that mindfulness in OCD is best understood as distinct processes (decentering, cognitive defusion, attentional regulation, tolerance of uncertainty) that may each map onto particular neurocognitive dysfunctions and symptom dimensions. Notes that metacognitive therapy and acceptance and commitment therapy show non-inferiority to exposure-based treatment, and that these approaches have not reliably improved outcomes when added to exposure and response prevention but are non-inferior as stand-alone treatments. |
Abstract
Obsessive-compulsive disorder (OCD) is increasingly understood not simply as a disorder of intrusive thoughts, but as one of how those thoughts are interpreted, regulated, and invested with meaning. This narrative, conceptually oriented review, brings together three literatures that are usually treated separately – mindfulness, Wells’ metacognitive model, and the neurocognitive and neuroimaging findings in OCD – and advances a single proposal that mindfulness is best understood not as a uniform intervention but as a set of distinct processes decentering, cognitive defusion, attentional regulation, and tolerance of uncertainty, each of which may map onto a particular neurocognitive dysfunction and symptom dimension. These ideas are situated against a neurobiology now framed less in terms of isolated regions than of interacting networks, spanning cortico-striato-thalamo-cortical circuitry, error-monitoring systems, and the default mode network. Recent controlled trials have strengthened the clinical case: metacognitive therapy and acceptance and commitment therapy have shown non-inferiority to exposure-based treatment at post-treatment, and mindfulness-based cognitive therapy has shown benefit as an augmentation strategy. However, when added to exposure and response prevention, these approaches have not reliably improved on it, whereas when delivered as stand-alone treatments they have proved non-inferior, suggesting they may serve better as alternatives for particular patients than as universal augmentations. The first OCD-specific neuroimaging studies have appeared but remain largely prognostic rather than mechanistic. The proposed framework is therefore best regarded as a coherent and testable hypothesis, and these approaches as carefully delivered, well-monitored options for defined clinical situations rather than replacements for first-line care.
Comparable studies
Other narrative reviews on meditation, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Mindfulness training as a clinical intervention: A conceptual and empirical review. Clinical populations | 2003 | Review | |
| Mindfulness: Theoretical Foundations and Evidence for its Salutary Effects | 2007 | Review | |
| Mindfulness Interventions | 2016 | Review | |
| Mind the Hype: A Critical Evaluation and Prescriptive Agenda for Research on Mindfulness and Meditation | 2017 | Review | |
| Mindfulness and acceptance: expanding the cognitive-behavioral tradition | 2005 | Review |
Citations in the library
Cites 16
- Mindfulness: A proposed operational definition. Clinical Psychology Science and Practice 2004
- How Does Mindfulness Meditation Work? Proposing Mechanisms of Action From a Conceptual and Neural Perspective Perspectives on Psychological Science October 14, 2011
- Mind the Hype: A Critical Evaluation and Prescriptive Agenda for Research on Mindfulness and Meditation Perspectives on Psychological Science October 10, 2017
- Meditation experience is associated with differences in default mode network activity and connectivity Proceedings of the National Academy of Sciences November 23, 2011
- Attending to the present: mindfulness meditation reveals distinct neural modes of self-reference Social Cognitive and Affective Neuroscience August 13, 2007
and 11 more in the library