Background
Obsessive compulsive disorder (OCD) is a chronic anxiety disorder associated with significant morbidity, social impairment and lower
quality of life. Psychological treatments are a frequently used approach for OCD.
Objectives
To perform a systematic review of randomised trials of psychological treatments for obsessive compulsive disorder in comparison with
treatment as usual.
Search strategy
We conducted an electronic search of CCDANCTR-Studies (31/10/2006), and other databases. We searched reference lists, and
contacted experts in the field.
Selection criteria
Published and unpublished randomised trials of psychological treatments versus treatment as usual for adults with a diagnosis of OCD
Data collection and analysis
Two review authors worked independently throughout the selection of trials and data extraction. Findings were compared and disagreements
were discussed with a third review author. Full data extraction, using a standardised data extraction sheet, was performed
on all studies included in the review. Results were synthesised using Review Manager software. For dichotomous data, odds ratios
were calculated. For continuous data, effect sizes were obtained and the standardised mean difference, with 95% confidence intervals,
was calculated. Fixed and random effects models were used to pool the data. Reasons for heterogeneity in studies were explored and
sensitivity analyses were performed by excluding trials of lower quality.
Main results
Eight studies (11 study comparisons) were identified, all of which compared cognitive and/or behavioural treatments versus treatment
as usual control groups. Seven studies (ten comparisons) had usable data for meta-analyses. These studies demonstrated that patients
receiving any variant of cognitive behavioural treatment exhibited significantly fewer symptoms post-treatment than those receiving
treatment as usual (SMD-1.24, 95%CI -1.61 to -0.87, I2 test for heterogeneity 33.4%). Different types of cognitive and/or behavioural
treatments showed similar differences in effect when compared with treatment as usual. The overall treatment effect appeared to be
influenced by differences in baseline severity.
Authors’ conclusions
The findings of this review suggest that psychological treatments derived from cognitive behavioural models are an effective treatment
for adult patients with obsessive compulsive disorder. Larger high quality randomised controlled trials involving longer follow up
periods are needed, to further test cognitive behavioural treatments, and other psychological approaches, in comparison to each other
and control conditions. Future trials should examine the predictors of response to each treatment, and also conduct cost-effectiveness
evaluations.
