scholarly journals Obsessive-compulsive disorder: does CBT with exposure and response (ERP) prevention work?

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S284-S285
Author(s):  
Jemma Reid ◽  
Naomi A Fineberg ◽  
Lynne Drummond ◽  
Keith Laws ◽  
Matteo Vismara ◽  
...  
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Effect Size ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Obsessive Compulsive ◽  
Related Factors ◽  
Psychological Treatments ◽  
Compulsive Disorder ◽  
Control Intervention ◽  
Randomised Controlled

AimsSince the 1970s treatment for obsessive Compulsive Disorder (OCD) has consisted of the the application of drugs acting on the serotonin system of the brain or psychological treatments using graded exposure. Although there is a large number of studies on psychological treatments, they often are underpowered. Other major methodological issues include ignoring the effects of medication during the trial, using a variety of techniques and using waiting list data as controls.We decided to systematically review and perform a meta-analysis on randomised controlled trials (RCTs) of CBT with ERP (abbreviated to ERP)1.MethodThe study was preregistered in PROSPERO (CRD42019122311). RCTs incorporating ERP were examined. The primary outcome was the end-of-trial symptoms scores for OCD. In addition, factors which may have influenced the outcome including patient-related factors, type of control intervention, researcher allegiance and other potential forms of bias were examined. The moderating effects of patient-related and study-related factors including type of control intervention and risk of bias were also examined.ResultOverall, 36 studies were included in the analyses, involving 537 children/adolescents and 1483 adults (total 2020 subjects). A total of 1005 received ERP and the remainder a variety of control treatments. Initial results showed that ERP had a large effect size compared with placebo treatments. This was more marked in younger than older persons. However, whereas ERP was markedly more effective than waiting list or psychological control, this positive effect size disappeared when it was compared with other psychological treatments.When ERP was compared against psychopharmacological treatment it initially appeared significantly superior but this reduced to marginal benefit when compared with adequate doses of appropriate medication.The majority of studies were performed where there may be expected to be researcher allegiance to ERP and in these studies the effect size was large. In contrast, in the 8 studies considered to have low risk of researcher bias, ERP was found to be ineffective.ConclusionAlthough on initial sight CBT incorporating ERP seems to be highly efficacious in the treatment of OCD, further analysis revealed that this varied depending on the choice of comparator control. In addition there are considerable concerns about methodological rigour and reporting of studies using CBT with ERP. Further studies examining the role of researcher bias and allegiance are needed.Ref : 1 Jemma E Reid, Keith R Laws, Lynne Drummond, Matteo Vismara, Benedetta Grancini , Davis Mpavaenda, Naomi A Fineberg (2021) Cognitive Behavioural Therapy with Exposure and Response Prevention in the treatment of Obsessive-Compulsive Disorder: A systematic review and meta-analysis of randomised controlled trials. Comprehensive Psychiatry , in press.

A Meta-Analysis Examining the Relations among Pathological Gambling, Obsessive-Compulsive Disorder, and Obsessive-Compulsive Traits

2008 ◽  
Vol 103 (2) ◽  
pp. 485-498 ◽  
Author(s):  
Heather Durdle ◽  
Kevin M. Gorey ◽  
Sherry H. Stewart
Keyword(s):  
Pathological Gambling ◽  
Obsessive Compulsive Disorder ◽  
Effect Size ◽  
Meta Analysis ◽  
Strong Relationship ◽  
Obsessive Compulsive ◽  
Pathological Gamblers ◽  
Compulsive Disorder ◽  
Disorder Effect ◽  
Obsessive Compulsive Personality Disorder

Pathological gambling has been proposed to belong to the obsessive-compulsive spectrum of disorders. Disorders on this spectrum are thought to share similar clinical features, neurobiology, and responses to treatment as Obsessive-Compulsive Disorder. A total of 18 studies were included in a meta-analysis to assess the strength of the association between these disorders. A strong relationship (effect size = 1. 01) was found between pathological gambling and obsessive-compulsive traits. A weak relationship was found between pathological gambling and Obsessive-Compulsive Disorder (.07) and Obsessive-Compulsive Personality Disorder (effect size = .23). These results suggest pathological gambling and Obsessive-Compulsive Disorder are distinct disorders. However, pathological gamblers do appear to show high rates of obsessive-compulsive traits relative to controls. These findings are only moderately supportive of the inclusion of pathological gambling within the obsessive-compulsive spectrum of conditions.

scholarly journals The efficacy of exposure and response prevention for Obsessive-Compulsive Disorder and Tourette Syndrome: A meta-analysis

2020 ◽  
Author(s):  
Junjuan Yan ◽  
Fang Wen ◽  
Liping Yu ◽  
Fang Wang ◽  
Jingran Liu ◽  
...  
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Tourette Syndrome ◽  
Effect Size ◽  
Meta Analysis ◽  
Response Prevention ◽  
Medium Effect ◽  
Exposure And Response Prevention ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Standard Mean Difference

Abstract Background Exposure and response prevention (ERP) is a form of cognitive behavioral therapy (CBT) that can effectively relieve obsessive-compulsive symptoms and tic symptoms in patients with obsessive-compulsive disorder (OCD) and Tourette syndrome (TS). However, the effect size of ERP is still unclear. Methods In this study, we performed a meta-analysis to identify the efficacy of ERP for individuals with OCD and TS. The standard mean difference (SMD) with a 95% confidence interval (CI) was calculated to assess the effect size of the efficacy for ERP. We used subgroup and meta-regression analysis to explore the heterogeneity of the pooled SMD of ERP for OCD. Results A total of 17 studies including a total of 926 patients with OCD and 66 patients with TS were identified. We observed a small-to-medium effect size of ERP for both OCD (SMD = -0.21, 95% CI: -0.47 to 0.06) and TS (SMD = -0.26, 95% CI: -0.75 to 0.22). Conclusions In conclusion, we found that ERP is effective for patients with OCD and TS. We suggest a combination with other therapies and the development of online ERP services that might prove a promising new direction for healthcare providers.

scholarly journals Is Intensive Cognitive Behavioural Therapy an Efficacious and Acceptable Treatment Format for Adults with Obsessive Compulsive Disorder? A Systematic Review of Randomised Controlled Trials

2020 ◽  
Author(s):  
Josie Frances Adeline Millar ◽  
Andreas Bauer ◽  
Sarah Halligan ◽  
Sophie-Anne Purnell ◽  
Gemma Taylor ◽  
...  
Keyword(s):  
Systematic Review ◽  
Obsessive Compulsive Disorder ◽  
Cognitive Behavioural Therapy ◽  
Randomised Controlled Trials ◽  
Behavioural Therapy ◽  
Controlled Trials ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Cognitive Behavioural ◽  
Randomised Controlled

Background: Clinical guidelines recommend the use of an intensive version of cognitive behavioural therapy (iCBT) in obsessive compulsive disorder (OCD) when evidence-based treatment has previously failed. This systematic review aimed to 1) assess the efficacy of iCBT for adults with OCD; 2) assess the acceptability of iCBT for adults with OCD.Methods: PROSPERO ID: CRD42018106840. We searched the Cochrane Controlled Register of Trials (CENTRAL), Cochrane Library, PubMed, Embase and PsycINFO for articles published between 1966 and November 2018, and reference lists and other sources for registered or ongoing studies. We included Randomised Controlled Trials (RCTs) of adults with OCD comparing iCBT to active or non-active controls. iCBT was defined as: at least five hours of CBT delivered per week in no more than four weeks for at least 10 CBT hours. The primary outcome was change in OCD symptoms from baseline to follow-up; secondary outcome was attrition; risk of bias was assessed using the Cochrane Tool. Results: Searches retrieved 5125 records, with only four RCTs with a total of 313 participants meeting inclusion criteria. Large effect sizes in favour of iCBT relative to controls were found, range (1.35 to 3.18). Drop-out rate across studies was low. However, none of the included studies focused on participants with a specific history of treatment failure. Studies were highly heterogeneous, which precluded meta-analysis. Conclusions: There was evidence that iCBT may be efficacious and acceptable. Further high quality RCTs are required to assess the efficacy and acceptability of iCBT specifically for OCD non-responders.

scholarly journals Mindfulness-based and acceptance-based programmes in the treatment of obsessive–compulsive disorder: a study protocol for a systematic review and meta-analysis

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e050329
Author(s):  
Johannes Julian Bürkle ◽  
Johannes Caspar Fendel ◽  
Stefan Schmidt
Keyword(s):  
Systematic Review ◽  
Depressive Symptoms ◽  
Obsessive Compulsive Disorder ◽  
Meta Analysis ◽  
Sensitivity Analyses ◽  
Secondary Outcome ◽  
Controlled Trials ◽  
Obsessive Compulsive ◽  
Compulsive Disorder

IntroductionCognitive–behavioural therapy (CBT) with exposure and response prevention is the recommended standard for the treatment of obsessive–compulsive disorder (OCD). However, a high proportion of patients refuse this treatment, do not respond or relapse shortly after treatment. Growing evidence suggests that mindfulness-based and acceptance-based programmes (MABPs) are an effective option for the treatment of OCD. This systematic review and meta-analysis will examine the effectiveness of MABPs in treating OCD. We also aimed to explore potential moderators of the programmes’ effectiveness.Methods and analysisWe will systematically search MEDLINE, Embase, PsycINFO, PSYINDEX, Web of Science, CINAHL and Cochrane Register of Controlled Trials (no language restrictions) for studies that evaluate the effect of MABPs on patients with OCD. We will conduct backward and forward citation searches of included studies and relevant reviews and contact corresponding authors. The primary outcome will be pre-post intervention change in symptom severity. A secondary outcome will be change in depressive symptoms. Two reviewers will independently screen the records, extract the data and rate the methodological quality of the studies. We will include both controlled and uncontrolled trials. Randomised controlled trials will be meta-analysed, separately assessing between-group effects. A second meta-analysis will assess the within-group effect of all eligible studies. We will explore moderators and sources of heterogeneity such as the specific programme, study design, changes in depressive symptoms, hours of guided treatment, control condition and prior therapy (eg, CBT) using metaregression and subgroup analyses. We will perform sensitivity analyses using follow-up data. A narrative synthesis will also be pursued. We will use the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to assess the quality of the evidence.Ethics and disseminationEthical approval is not required. Results will be published in peer-reviewed journals and presented at international conferences.

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