Cognitive behavioral treatments of obsessive-compulsive disorder. A systematic review and meta-analysis of studies published 1993-2014

Lars-Göran Öst; Audun Havnen; Bjarne Hansen; Gerd Kvale

doi:10.1016/j.cpr.2015.06.003

Cognitive behavioral treatments of obsessive-compulsive disorder. A systematic review and meta-analysis of studies published 1993-2014

Clin Psychol Rev. 2015 Aug:40:156-69. doi: 10.1016/j.cpr.2015.06.003. Epub 2015 Jun 14.

Authors

Lars-Göran Öst¹, Audun Havnen², Bjarne Hansen², Gerd Kvale²

Affiliations

¹ Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Psychology, Stockholm University, Sweden; Department of Clinical Psychology, University of Bergen, Norway; Haukeland University Hospital, OCD-team, 5021 Bergen, Norway. Electronic address: ost@psychology.su.se.
² Department of Clinical Psychology, University of Bergen, Norway; Haukeland University Hospital, OCD-team, 5021 Bergen, Norway.

PMID: 26117062
DOI: 10.1016/j.cpr.2015.06.003

Abstract

Obsessive-compulsive disorder is ranked by the WHO as among the 10 most debilitating disorders and tends to be chronic without adequate treatment. The only psychological treatment that has been found effective is cognitive behavior therapy (CBT). This meta-analysis includes all RCTs (N=37) of CBT for OCD using the interview-based Yale-Brown Obsessive Compulsive Scale, published 1993 to 2014. The effect sizes for comparisons of CBT with waiting-list (1.31), and placebo conditions (1.33) were very large, whereas those for comparisons between individual and group treatment (0.17), and exposure and response prevention vs. cognitive therapy (0.07) were small and non-significant. CBT was significantly better than antidepressant medication (0.55), but the combination of CBT and medication was not significantly better than CBT plus placebo (0.25). The RCTs have a number of methodological problems and recommendations for improving the methodological rigor are discussed as well as clinical implications of the findings.

Keywords: Cognitive therapy; Exposure and response prevention; Meta-analysis; Obsessive–compulsive disorder; Systematic review.

Publication types

Meta-Analysis
Review
Systematic Review

MeSH terms

Adult
Cognitive Behavioral Therapy / methods*
Cognitive Behavioral Therapy / statistics & numerical data
Humans
Obsessive-Compulsive Disorder / therapy*
Outcome Assessment, Health Care / statistics & numerical data*
Randomized Controlled Trials as Topic / statistics & numerical data*