Objective To evaluate the efficacy of metacognitive therapy (MCT) for obsessive-compulsive disorder (OCD) via meta-analysis. Methods PubMed, Web of Science, ScienceDirect and PsycInfo were searched from Jan.1, 2010, to Mar. 1, 2025. Randomized controlled trials of MCT for OCD were included for meta-analysis. Two researchers independently conducted literature screening and data extraction. The quality assessment of the included articles was performed in accordance with the Cochrane Handbook for Systematic Reviews of Interventions (version 5.0.1), and the data analysis was performed using RevMan 5.3 software. The Yale-Brown obsessive compulsive scale was used to assess obsessive-compulsive symptoms. Results A total of 2 171 articles were retrieved; 13 studies met the inclusion criteria, involving 1 111 patients. The results showed that the improvement of obsessive-compulsive symptoms in OCD patients by MCT was similar to that of traditional method (exposure and response prevention [ERP]), with no significant difference (mean difference＝0.04, 95% confidence interval －1.28-1.36, P＝0.95). Conclusion MCT has a significant effect on improving the core symptoms of OCD, and its efficacy is comparable to that of ERP. Moreover, due to its structured and short-term (8-12 weeks) characteristics, MCT may reduce the treatment dropout rate. MCT provides a valuable alternative to ERP for OCD treatment, especially suitable for resource-limited medical scenarios, but more high-quality and diverse clinical studies are needed to further verify its advantages.