Psychological treatment of obsessive–compulsive disorder: A meta-analysis
Abstract
The benefits of cognitive-behavioral treatment for obsessive-compulsive disorder (OCD) have been evidenced by several meta-analyses. However, the differential effectiveness of behavioral and cognitive approaches has shown inconclusive results. In this paper a meta-analysis on the effectiveness of psychological treatment for OCD is presented by applying random- and mixed-effects models. The literature search enabled us to identify 19 studies published between 1980 and 2006 that fulfilled our selection criteria, giving a total of 24 independent comparisons between a treated and a control group. The effect size index was the standardized mean difference in the posttest. The effect estimates for exposure with response prevention (ERP) alone (d(+)=1.127), cognitive restructuring (CR) alone (d(+)=1.090), and ERP plus CR (d(+)=0.998) were very similar, although the effect estimate for CR alone was based on only three comparisons. Therapist-guided exposure was better than therapist-assisted self-exposure, and exposure in vivo combined with exposure in imagination was better than exposure in vivo alone. The relationships of subject, methodological and extrinsic variables with effect size were also examined, and an analysis of publication bias was carried out. Finally, the implications of the results for clinical practice and for future research in this field were discussed.
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Cognitive therapy was developed to target these cognitive biases and involves teaching patients about the implausibility and maladaptive nature of these cognitions.
“To target these cognitive biases, “cognitive therapy” was developed (Rosa‐Alcázar et al., 2008). Cognitive therapy typically involves teaching patients about the implausibility and maladaptive nature of these cognitions”
From Obsessive-compulsive disorder: Etiology, neuropathology, and cognitive dysfunction (2023) · cites this paper as Rosa‐Alcázar et al., 2008
CT and ERP both reduced OC symptoms to a similar extent.
“A recent study by Steketee, Siev, Yovel, Lit, and Wilhelm [32] as well as two meta-analyses showed that CT and ERP both reduced OC symptoms to a similar extent [33, 34].”
From Metacognitive Training for Obsessive-Compulsive Disorder: A study protocol for a randomized controlled trial (2020) · cites this paper as [33]
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 [48]
Obsessive-compulsive disorder can be treated successfully with cognitive behavioural treatment (CBT), particularly exposure with response prevention.
“Obsessive-compulsive disorder can be treated successfully with cognitive behavioural treatment (CBT), particularly exposure with response prevention [3], [4], [5], [6].”
From The acceptability of internet-based treatment and characteristics of an adult sample with obsessive compulsive disorder: An internet survey (2011) · cites this paper as [3]
Exposure in vivo combined with imaginal exposure is better than exposure in vivo alone for OCD.
“One meta-analysis found that exposure in vivo combined with imaginal exposure was better than exposure in vivo alone [60].”
From Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders (2014) · cites this paper as [60]
Psychological treatment, mainly CBT generally including exposure with response prevention (ERP), has beneficial effects for OCD.
“Meta-analyses support the beneficial effects of psychological treatment for OCD, mainly CBT, generally including exposure with response prevention (ERP) [60-63,70,71, 655-657].”
From Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders (2014) · cites this paper as [60]
There are no significant differences in efficacy between group and individual CBT for OCD.
“Several meta-analyses have demonstrated no significant differences in efficacy between group and individual CBT [60,62,663].”
From Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders (2014) · cites this paper as [60]
Results with CBT are generally similar in comparisons of interventions emphasizing ERP and those emphasizing cognitive elements for OCD.
“Results with CBT were generally similar in comparisons of interventions with an emphasis on ERP and those with an emphasis on cognitive elements [60,63,655].”
From Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders (2014) · cites this paper as [60]
Therapist-guided exposure is better than self-exposure for OCD.
“Data suggest that therapist-guided exposure is better than self-exposure [60].”
From Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders (2014) · cites this paper as [60]
Both cognitive restructuring and ERP alone, and in combination, are effective in the treatment of OCD.
“Rosa-Alcázar, Sánchez-Meca, Gómez-Conesa, and Marín-Martínez (2008) demonstrated that both cognitive restructuring (CR) and ERP alone, and in combination, are effective in the treatment of OCD [9].”
From Low intensity technology-delivered cognitive behavioral therapy for obsessive-compulsive disorder: a meta-analysis (2021) · cites this paper as [9]
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- Authors
- Rosa-Alcázar, A. I., Sánchez-Meca, J., Gómez-Conesa, A., & Marín-Martínez, F.
- Venue
- Clinical Psychology Review
- Publisher
- Elsevier BV
- Published
- 2008-12
- Volume
- 28
- Issue
- 8
- Pages
- 1310-1325
- ISSN
- 0272-7358 (ISSN-L)
- OpenAlex
- W1984403880
- Cited by
- 444
- References
- 73
- Citations by year
- 2026: 10 · 2025: 8 · 2024: 22 · 2023: 22 · 2022: 45 · 2021: 27 · 2020: 30 · 2019: 26 · 2018: 23 · 2017: 31 · 2016: 18 · 2015: 38 · 2014: 33 · 2013: 30 · 2012: 29
- FWCI
- 2.98
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Psychology Review (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, psychological intervention, exposure and response prevention, cognitive restructuring, cognitive behavioral therapy, behavior therapy, in vivo exposure, treatment effectiveness, publication bias
- MeSH terms
- Adult, Anxiety Disorders, Behavior Therapy, Depressive Disorder, Humans, Implosive Therapy, Obsessive-Compulsive Disorder, Outcome and Process Assessment, Health Care, Personality Assessment, Psychometrics, Reproducibility of Results, Cognitive Behavioral Therapy, Publication Bias, Controlled Clinical Trials as Topic
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