Unguided computer-assisted self-help interventions without human contact in patients with obsessive-compulsive disorder: a systematic review and meta-analysis (Preprint)

BACKGROUND Computer-assisted treatment may reduce therapist contact and costs and promote client participation. However, there are no updated review about the efficacy and acceptability of an unguided computer-assisted therapy without human contact in patients with obsessive-compulsive disorder (OCD). OBJECTIVE This meta-analysis examined the efficacy and acceptability of an unguided computer-assisted therapy without human contact in patients with obsessive-compulsive disorder (OCD) compared to a waiting list or attention placebo. METHODS We conducted a search on PubMed, Cochrane Central Register of Controlled Trials, EMBASE, WHO International Clinical Trials Registry Platform, and ClinicalTrials.gov (7/28/2021), as well as the reference lists of the included studies. The primary outcomes were short-term improvement of OCD symptoms measured by validated scales and dropout for any reason. RESULTS We included 11 randomized controlled trials with a total of 983 participants. The results indicated that unguided computer-assisted self-help therapy was significantly more effective than a waiting list or psychological placebo (standard mean difference, −0.47; 95% CI, −0.73 to −0.22, 659 participants). The intervention was significantly less acceptable than control in terms of dropout for any reason (Risk Ratio, 1.98; 95% CI, 1.21 to 3.23; 11 studies, 983 participants). However, the quality of evidence was very low because of the risk of bias and inconsistent results among the included studies. The subgroup analysis showed that exposure response prevention and an intervention duration of over 4 weeks strengthen the efficacy. Only a few studies have examined the interaction between participants and systems, and no study has used gamification. Most researchers only used text-based interventions, and no study has used a mobile device. CONCLUSIONS Unguided computer-assisted therapy without human contact in patients with OCD were more effective but less acceptable compared to a waiting list or attention placebo. However, efficacy and acceptability may be influenced by factors such as the type of intervention and duration. Future studies should examine these as well as other factors including gamification and interaction. CLINICALTRIAL PROSPERO CRD42021264644