Third-Generation Cognitive and Behavioral Therapies for Obsessive-Compulsive Disorder: A Narrative Review

Obsessive-compulsive disorder (OCD) is a chronic and disabling condition associated with significant distress and functional impairment. First-line treatments rely primarily on pharmacotherapy and cognitive-behavioral therapy (CBT), particularly exposure and response prevention (ERP). Although effective, a substantial proportion of patients continue to show clinically significant symptoms after treatment. In recent decades, alternative psychological therapies have been investigated to complement CBT and address its limitations in OCD management. This narrative review, based on the relevant literature indexed in PubMed/MEDLINE from 2003 to 2023, examines the evidence on third-generation therapies in OCD, with a focus on acceptance and commitment therapy (ACT), mindfulness-based therapy (MBT), and metacognitive therapy (MCT). Across study designs ranging from case reports to randomized controlled trials, these interventions have shown potential to reduce OCD symptoms, alleviate comorbid depression and anxiety, improve maladaptive beliefs, and enhance psychological flexibility. Despite promising findings, the evidence remains preliminary and constrained by small samples, heterogeneous designs, variable control conditions, and limited long-term data. Comparative studies with established first-line treatments are relatively few and show mixed findings, limiting conclusions about relative efficacy. Larger, well-controlled randomized trials with standardized outcome measures and long-term follow-up are needed to establish efficacy and clarify the role of third-generation therapies within OCD treatment algorithms.