Background Cognitive therapy (CT) for obsessive-compulsive disorder (OCD) has shown to be effective in diminishing OCD symptoms, but there is little known about the individual contributions of the specific treatment targets to CTtreatment outcome. Two of the treatment targets of CTare overestimations of danger and inflated beliefs of personal responsibility. No studies to date have investigated the relative efficacy of targeting inflated beliefs of personal responsibility compared to the overestimation of danger in the treatment of OCD. The aim of the present study was to experimentally investigate the relative efficacy of targeting inflated beliefs of responsibility (CT-R) versus targeting overestimations of danger (CT-D) in the cognitive treatment of DSM-III/DSM-IV OCDwith overt compulsions. Methods We conducted a randomized trial of CT-D (N = 38) versus CT-R (N = 40). Outcomes were change in OCDsymptoms and behavior, cognitions, and general psychopathology. Results The results showed that patients in both conditions improved significantly on all measures. Overall improvement effect sizes were large, percentages of clinically improved patients moderate. No differences between conditions were found. Conclusions These initial results suggest that both treatment targets are of value to the cognitive treatment of OCD. © 2012 Wiley Periodicals, Inc.