Differential efficacy of cognitive-behavioral therapy and pharmacological treatments for pediatric obsessive-compulsive disorder: a meta-analysis

J Anxiety Disord. 2014 Jan;28(1):31-44. doi: 10.1016/j.janxdis.2013.10.007. Epub 2013 Nov 22.

Abstract

The aim of this paper is to present a meta-analysis about the differential efficacy of cognitive-behavioral therapy (CBT), pharmacological and combined treatment for pediatric obsessive-compulsive disorder (OCD). The literature research and the application of the inclusion criteria enabled us to locate 18 studies, yielding a total of 24 independent comparisons between a treated (10 pharmacological, 11 CBT, and 3 combined interventions) and a control group. All types of interventions were efficacious in reducing obsessive-compulsive symptoms, with effect sizes adjusted by the type of control group of d=1.203 for CBT, d=0.745 for pharmacological treatments, and d=1.704 for mixed treatments. Depression, anxiety and other secondary responses were also improved, especially with CBT interventions. The analysis of moderator variables showed that the CBT protocol and the total of intervention hours exhibited a significant influence on the effect size. Within pharmacological treatment, clomipramine (d=1.305) was more efficacious than selective serotonin reuptake inhibitors (d=0.644), but its adverse effects were more severe. Finally, the clinical implications of the results are discussed.

Keywords: Children and adolescents; Cognitive-behavioral therapy; Meta-analysis; Obsessive–compulsive disorder; Pharmacological treatment.

Publication types

  • Meta-Analysis
  • Review

MeSH terms

  • Child
  • Cognitive Behavioral Therapy*
  • Combined Modality Therapy
  • Humans
  • Obsessive-Compulsive Disorder / drug therapy
  • Obsessive-Compulsive Disorder / therapy*
  • Randomized Controlled Trials as Topic
  • Serotonin Uptake Inhibitors / adverse effects
  • Serotonin Uptake Inhibitors / therapeutic use
  • Treatment Outcome

Substances

  • Serotonin Uptake Inhibitors