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Cited by 276Obsessive-Compulsive Spectrum DisordersAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychoanalysis and Psychopathology Research

Behavioral versus pharmacological treatments of obsessive compulsive disorder: a meta-analysis

Kobak, K. A., Greist, John H., Jefferson, James W., Katzelnick, David J., Henk, Henry J.·1998·Psychopharmacology
DOI 10.1007/s002130050558
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Abstract

The goal of the study was to provide a quantitative analysis of the relative efficacy of all five currently available serotonin reuptake inhibitors (SRIs) and behavior therapy [exposure and response prevention (ERP)] for obsessive compulsive disorder. The relationship between effect size and methodological characteristics was also empirically examined. A search was conducted of several computerized databases covering the dates from 1973 to 1997. Seventy-seven studies were identified, yielding 106 treatment comparisons involving 4641 patients. Effect sizes were analyzed between individual interventions and between intervention class [SRI, ERP or the combined treatment of an SRI with ERP(ERP/SRI)]. Data were analyzed both before and after controlling for methodological variables. The effect size for clomipramine (CMI) was significantly greater than the other SRIs, with the exception of fluoxetine (FLX). CMI was not significantly greater than ERP or ERP/SRI. As a class, ERP was significantly greater than SRIs as a whole. Effect sizes were larger for studies without a control group or random assignment, for self-reported outcome measures, and varied significantly by method of effect size calculation. Year of publication was significantly related to effect size. When controlling for these methodological variables, CMI was not significantly greater than FLX or fluvoxamine (FLV), and ERP was no longer significantly greater than the SRIs as a whole. No significant difference was found between CMI and the other SRIs as a group in head to head trials. No differences in drop-out rates were found. CMI stands out from the other SRIs. This difference is probably not clinically significant enough to warrant first choice treatment, given CMI's greater lethality in overdose. The choice between an SRI or ERP is dominated primarily by the infrequent availability of ERP and to a lesser degree by personal preference. Methodological differences significantly impact effect size.

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  • These studies demonstrate that large effect sizes comparable to those obtained in face-to-face therapy can be obtained with minimal therapist contact, although follow-up periods have been relatively shorter than in other OCD outcome studies.

    “These studies demonstrate that large effect sizes, which were comparable to those obtained in face-to-face therapy [47, 48], can be obtained with minimal therapist contact, although follow-up periods have been relatively shorter than in other outcome studies for OCD that usually report 6-to-12 month follow-up data.”

    From Study protocol for a randomised controlled trial of internet-based cognitive-behavioural therapy for obsessive-compulsive disorder (2014) · cites this paper as [47]

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Authors
Kobak, K. A., Greist, J. H., Jefferson, J. W., Katzelnick, D. J., & Henk, H. J.
ORCID
Venue
Psychopharmacology
Publisher
Springer Science and Business Media LLC
Published
1998-03-23
Volume
136
Issue
3
Pages
205-216
ISSN
  • 0033-3158 (ISSN-L)
  • 1432-2072
DOI
10.1007/s002130050558
OpenAlex
W2019929334
Cited by
276
References
41
Citations by year
2025: 1 · 2024: 2 · 2023: 2 · 2022: 39 · 2021: 7 · 2020: 1 · 2019: 1 · 2018: 2 · 2017: 5 · 2016: 8 · 2015: 11 · 2014: 8 · 2013: 7 · 2012: 14
FWCI
8.00
Type
journal article
Language
en
Open access
closed
Licence
www.springer.com/tdm (tdm)
Locations
  • Psychopharmacology (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
Keywords
obsessive-compulsive disorder, serotonin reuptake inhibitors, exposure and response prevention, clomipramine, fluoxetine, fluvoxamine, treatment efficacy, methodological quality, effect size, dropout rates
MeSH terms
Behavior Therapy, Humans, Obsessive-Compulsive Disorder, Patient Dropouts, Selective Serotonin Reuptake Inhibitors

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