Cited by 90Obsessive-Compulsive Spectrum DisordersAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychotherapy Techniques and Applications

Patient adherence to cognitive behavioural therapy for obsessive-compulsive disorder: a systematic review and meta-analysis

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Leeuwerik, Tamara, Cavanagh, Kate, Strauss, Clara·2019·Journal of Anxiety Disorders

Abstract

Whilst cognitive behavioural therapy (CBT) is the treatment of choice for obsessive-compulsive disorder (OCD), around half of the participants do not experience remission following treatment. As yet, there is no comprehensive systematic review of the extent to which patient non-adherence presents a challenge to the overall benefit of CBT for OCD. The aim of this systematic review and meta-analysis was to identify the magnitude, moderators and reasons for poor patient adherence to CBT for OCD in terms of: (1) treatment refusal, (2) treatment dropout, (3) session attendance/module completion, and (4) between-session CBT task adherence. Sociodemographic and clinical variables, treatment and study design characteristics were examined as moderators of adherence. The systematic search identified 123 studies including 5627 participants taking part in CBT or control conditions. A pooled rate of 15.6% of eligible patients refused CBT and a further 15.9% of treatment starters dropped out from treatment. Group CBT had significantly lower dropout rates than individually-delivered CBT. No other significant moderators were found. Most studies reported moderate to good adherence to between-session CBT tasks, which had a significant medium to large association with post-treatment OCD symptom reduction. Recommendations for enhanced measurement and reporting of patient adherence to CBT for OCD are made along with clinical implications of findings.

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Crossref · 10.1016/j.janxdis.2019.102135

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Authors
Leeuwerik, T., Cavanagh, K., & Strauss, C.
Affiliations
University of Sussex (GB)
Corresponding author
Strauss, Clara
Venue
Journal of Anxiety Disorders
Publisher
Elsevier BV
Published
2019-12
Volume
68
Pages
102135
ISSN
0887-6185 (ISSN-L)
OpenAlex
W2970163619
Cited by
90
References
96
Citations by year
2026: 19 · 2025: 21 · 2024: 14 · 2023: 14 · 2022: 10 · 2021: 6 · 2020: 6
FWCI
0.87
Type
journal article
Language
en
Open access
Locations
  • Journal of Anxiety Disorders (publishedVersion)
  • PubMed (publishedVersion)
  • Figshare (submittedVersion, cc-by)
  • Sussex Research Online (University of Sussex) (submittedVersion)
Funders
Economic and Social Research Council
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 › Psychotherapy Techniques and Applications
Keywords
obsessive-compulsive disorder, cognitive behavioral therapy, medication adherence, treatment refusal, treatment discontinuation, session attendance, group versus individual therapy, symptom remission
MeSH terms
Humans, Obsessive-Compulsive Disorder, Patient Compliance, Patient Dropouts, Psychotherapy, Group, Research Design, Cognitive Behavioral Therapy, Treatment Outcome

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