A systematic review of predictors and moderators of response to psychological therapies in OCD: Do we have enough empirical evidence to target treatment?
Open accessAbstract
Obsessive-compulsive disorder (OCD) is a disabling mental health condition. Despite effective psychological treatments for OCD, a significant percentage of patients fail to experience lasting benefit. Factors underlying variable treatment response are poorly understood. Moderators of outcome can help understand "for whom" and "under what circumstances" an intervention works best and thus improve service effectiveness. This paper synthesizes the evidence on predictors and moderators and assesses the quality of reporting of related analyses in psychological therapies for adults with OCD. Trials were identified through electronic searches (CENTRAL, MEDLINE, PsycINFO, EMBASE), key author, and reference list searches of relevant systematic reviews. Fifty five percent (38/69) of relevant trials reported baseline factors associated with outcome; these encompassed clinical, demographic, interpersonal, OCD symptom-specific, psychological/psychosocial, and treatment-specific variables. Predictors were commonly assessed via a validated pre-randomization measure, though few trials adopted best practice by stating a priori hypotheses or conducting a test of interaction. Potential associations emerged between worse OCD treatment outcome and the following factors: hoarding pathology, increased anxiety and OCD symptom severity, certain OCD symptom subtypes, unemployment, and being single/not married. However, the applied utility of these analyses is currently limited by methodological weaknesses.
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Substantial ground has been covered in the adult literature on treatment predictors and moderators, but this is not the case for treatment of mental disorders in adolescents and young adults.
“And whilst substantial ground has been covered in the adult literature [38–40], this is not the case in treatment for mental disorders in adolescents and young adults [30].”
Previous research has recognised the influence of treatment and therapist-related characteristics on treatment outcomes in various disorders, including borderline personality disorder and obsessive-compulsive disorder.
“Previous research has recognised the influence of treatment and therapist-related characteristics on treatment outcomes in various disorders, including borderline personality disorder and obsessive-compulsive disorder (Barnicot et al., 2012;Knopp, Knowles, Bee, Lovell, & Bower, 2013).”
From Predictors of outcomes of psychological treatments for disordered gambling: A systematic review (2016) · cites this paper as Knopp et al., 2013
A box-score approach is limited by the lack of consideration given to the magnitude of the effect.
“While a box-score approach was utilised to synthesise the results, this method is limited by the lack of consideration given to the magnitude of the effect (Green & Hall, 1984;Knopp et al., 2013).”
From Predictors of outcomes of psychological treatments for disordered gambling: A systematic review (2016) · cites this paper as Knopp et al., 2013
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- Authors
- Knopp, J., Knowles, S., Bee, P., Lovell, K., & Bower, P.
- Affiliations
- Manchester Academic Health Science Centre (GB)
- University of Manchester (GB)
- Corresponding author
- Knopp, Jasmin
- Venue
- Clinical Psychology Review
- Publisher
- Elsevier BV
- Published
- 2013-12
- Volume
- 33
- Issue
- 8
- Pages
- 1067-1081
- ISSN
- 0272-7358 (ISSN-L)
- OpenAlex
- W2161829398
- Cited by
- 164
- References
- 95
- Citations by year
- 2026: 5 · 2025: 11 · 2024: 14 · 2023: 16 · 2022: 15 · 2021: 15 · 2020: 13 · 2019: 15 · 2018: 11 · 2017: 14 · 2016: 13 · 2015: 18 · 2014: 4
- FWCI
- 1.71
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Clinical Psychology Review (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Research Explorer (The University of Manchester) (publishedVersion, other-oa)
- Funders
- National Institute for Health and Care Research (SPCR-040)
- NIHR School for Primary Care Research
- 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, psychotherapy, treatment response, predictors of treatment outcome, moderators of treatment outcome, treatment moderators, hoarding, anxiety, symptom severity, unemployment, marital status, reporting quality
- MeSH terms
- Humans, Obsessive-Compulsive Disorder, Risk Factors, Severity of Illness Index, Treatment Outcome, Marital Status
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