An update on the efficacy of psychological treatments for obsessive-compulsive disorder in adults

May combine two claims.

OCD is best conceptualized as a dimensional disorder with at least five consistently identified symptom dimensions.

“Given the wide variation in the presentation of OCD, there is increasing evidence that it may be best conceptualized as a dimensional disorder and the following symptom dimensions have been most consistently identified: (a) contamination obsessions with cleaning/washing rituals, (b) doubts about harm with checking/reassurance seeking rituals, (c) obsessions relating to a need for symmetry, exactn”

• cites Abramowitz et al., 2010 sourceNot checked — no full text of the source
• cites Bloch et al., 2008 sourceDisputed

  The Discussion supports a dimensional approach, but identifies a fairly robust four-factor structure—not at least five consistently identified dimensions. It recommends specifying those four dimensions: symmetry, forbidden thoughts, cleaning, and hoarding. (LLM, conf=0.88)

  Checked by a reasoning model — may be wrong.

  Experimental — accuracy not yet measured
• cites Mataix-Cols et al., 2005 sourceNot checked — no full text of the source

May combine two claims.

The only trial finding an advantage for CBT over ERP used a version of self-guided exposure, which might have diluted its efficacy.

“It is also noteworthy that the only trial to find an advantage for CBT over ERP used a version of self-guided exposure (van Oppen et al., 1995), which might have diluted its efficacy.”

• cites van Oppen et al., 1995 sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing).

Several studies have shown associations between OCD and cognitive variables including inflated responsibility, threat perceptions, lowered memory confidence, difficulty tolerating uncertainty, perfectionism, thought-action fusion, and over-importance/need to control thoughts.

“Several studies have shown associations between OCD and cognitive variables including inflated responsibility and threat perceptions, lowered confidence in memory, difficulty tolerating uncertainty, perfectionism, thought-action fusion, and the over-importance of and need to control thoughts (e.g. Abramowitz et al., 2006; Moore & Abramowitz, 2007; Rassin et al., 2000; Salkovskis et al., 2000; Shaf”

• cites Abramowitz et al., 2006 sourceNot checked — no full text of the source
• cites Moore & Abramowitz, 2007 sourceNot checked — no full text of the source
• cites Rassin et al., 2000 sourcePartly supported

  The Discussion reports correlations between thought-action fusion, thought suppression, and obsessive–compulsive symptom scores. This supports citing the study for those cognitive associations, but its participants were undergraduate students, so it does not establish associations in people diagnosed with OCD; it also does not test every variable in the citing sentence. (LLM, conf=0.85)

  Experimental — accuracy not yet measured

May combine two claims.

Many ERP trials used the Yale-Brown Obsessive-Compulsive Scale as an outcome measure, which is viewed as the gold standard for OCD symptom severity.

“A strength of many ERP trials was the use of the Yale-Brown Obsessive-Compulsive Scale (YBOCS; Goodman, Price et al, 1989 a; b) as an outcome measure. This clinician-administered tool is viewed as the gold standard for ascertaining OCD symptom severity (Abramowitz, 2006; Summerfeldt, 2001).”

• cites Goodman, Price et al, 1989 a; bNot matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites Abramowitz, 2006 sourceSupported
• cites Summerfeldt, 2001Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

Standard ERP and a less expensive stepped care approach were similarly efficacious, and 28% of patients who started stepped care responded to the low intensity intervention.

“A comparison of standard ERP to a less expensive stepped care approach found that these approaches were similarly efficacious, and 28% of patients who started stepped care responded to the low intensity intervention (Tolin et al., 2011).”

• cites Tolin et al., 2011 sourcePartly supported

  The Results > Efficacy section reports no apparent efficacy difference between stepped care and standard ERP, and Abstract > Results reports significantly lower costs for stepped care. Method > Procedure describes the low-intensity first step and its responder criterion, but the passages available from our copy do not establish that 28% of patients who started stepped care responded to that step. (LLM, conf=0.84)

  Experimental — accuracy not yet measured

May combine two claims.

There were no significant differences in outcome between CBT and fluoxetine, but comorbidity reduced magnitude of response.

“There were no significant differences in outcome between treatments, but comorbidity reduced the magnitude of response.”

• cites Belotto-Silva et al., 2012 sourceNot checked — no full text of the source
• cites Hoexter et al., 2012 sourcePartly supported

  The Treatment Outcome section reports no statistical difference in OCD symptom reduction between fluoxetine and CBT. The Methodological Considerations and Conclusions section says comorbidities may have added variability to the findings, but does not say they reduced the magnitude of treatment response. Page numbers were not provided in our copy. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

May combine two claims.

Hoarding may respond less well to treatment than other types of OCD, leading to development of type of CBT that appears specifically efficacious for hoarding problems.

“For example, hoarding may respond less well to treatment than other types of OCD (Abramowitz et al., 2003; Rufer et al., 2006), leading to the development of a type of CBT that appears to be specifically efficacious for hoarding problems (Steketee et al., 2010).”

• cites Abramowitz et al., 2003 sourceNot checked — no full text of the source
• cites Rufer et al., 2006 sourceNot checked — no full text of the source
• cites Steketee et al., 2010 sourceSupported

May combine two claims.

Although comorbidity may lead to poorer ERP or CBT outcome, patients with more complex presentations may still benefit from established OCD treatments either in isolation or integrated with other interventions.

“Finally, although comorbidity may lead to a poorer ERP or CBT outcome (Belotto-Silva et al., 2012; Maher et al., 2010; Pinto et al., 2011), patients with more complex presentations may still benefit from established OCD treatments either in isolation or integrated with other interventions (Belotto-Silva et al., 2012; Fals-Stewart & Schafer, 1992; Rector et al., 2009).”

• cites Belotto-Silva et al., 2012 sourceNot checked — no full text of the source
• cites Maher et al., 2010 sourceSupported
• cites Pinto et al., 2011 sourceSupported

May combine two claims.

Adding ERP to standard substance use treatment in a therapeutic community was superior to adding Progressive Muscle Relaxation or no other intervention on OCD symptom reduction, length of time in treatment, and substance use relapse rate after discharge in comorbid patients.

“One study found that adding ERP to standard substance use treatment provided in a therapeutic community was superior to adding Progressive Muscle Relaxation or no other intervention on OCD symptom reduction, the length of time in treatment and the rate of substance use relapse following discharge in comorbid patients (Fals-Stewart & Schafer, 1992).”

• cites Fals-Stewart & Schafer, 1992 sourceNot checked — no full text of the source

May combine two claims.

ERP was superior to CBT in one study and did not differ in five others, although several of these studies had relatively small samples.

“It was superior to CBT in one study (McLean et al., 2001) and did not differ in five others (Cottraux et al., 2001; Emmelkamp & Beens, 1991; O’Connor et al., 2005; Vogel et al., 2004; Whittal et al., 2005), although in a number of these studies, the sample sizes were relatively small.”

• cites McLean et al., 2001 sourceNot checked — no full text of the source
• cites Cottraux et al., 2001 sourceNot checked — no full text of the source
• cites Emmelkamp & Beens, 1991 sourceNot checked — no full text of the source

May combine two claims.

Only about half of all treated patients show clinically significant change with ERP, and fewer still show full remission.

“Only about half of all treated patients show clinically significant change with ERP (Abramowitz, 1998), and fewer still show full remission (Belloch et al., 2008; McLean et al., 2001; Simpson et al., 2006; Simpson et al., 2010; van Oppen et al., 2010; Vogel et al., 2004; Whittal et al., 2005).”

• cites Abramowitz, 1998 sourceNot checked — no full text of the source
• cites Belloch et al., 2008 sourceNot checked — no full text of the source
• cites McLean et al., 2001 sourceNot checked — no full text of the source

May combine two claims.

ERP was superior to clomipramine and to a pill-placebo.

“ERP was superior to clomipramine and to a pill-placebo (Foa et al., 2005)”

• cites Foa et al., 2005 sourceNot checked — no full text of the source

May combine two claims.

ERP was superior to Anxiety Management, Progressive Muscle Relaxation, Stress Management combined with medication, and Autogenic Training combined with pill-placebo.

“It also was superior to Anxiety Management (Lindsay et al., 1997) and Progressive Muscle Relaxation (see Fals-Stewart et al., 1993; Greist et al., 2002; Marks et al., 2000), as well as Stress Management when each was combined with medication (Simpson et al., 2008b) and to Autogenic Training when each was combined with pill-placebo (Nakatani et al., 2005).”

• cites Lindsay et al., 1997 sourceNot checked — no full text of the source
• cites Fals-Stewart et al., 1993 sourceNot checked — no full text of the source
• cites Simpson et al., 2008bNot matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

ERP combined with medication was more efficacious than medication alone or medication plus anti-exposure instructions, but not more efficacious than ERP alone.

“ERP combined with medication was also more efficacious than either medication alone (Foa et al., 2005) or medication plus anti-exposure instructions (Marks et al., 1988), but not more efficacious than ERP alone (de Haan et al., 1997; Foa et al., 2005; van Balkom et al., 1998).”

• cites Foa et al., 2005 sourceNot checked — no full text of the source
• cites Marks et al., 1988 sourceNot checked — no full text of the source
• cites de Haan et al., 1997 sourceNot checked — no full text of the source

May combine two claims.

The majority of studies recruited mixed or unspecified patient samples and did not test for moderation.

“Although the majority of the studies recruited mixed or unspecified samples of patients and did not test for moderation”

May combine two claims.

ERP was evaluated in 31 trials, CBT in 18, purely cognitive interventions in 4, ACT and Satiation Therapy once each, Stress Management in 9, Motivational Interviewing twice, and Psychodynamic Therapy and EMDR once each.

“ERP was evaluated in the largest number of trials (N=31), with CBT second (N=18). More purely cognitive interventions were evaluated in a handful of trials (N=4) and the newer behavioral interventions—ACT and Satiation Therapy—once each (N’s=1). Stress Management was tested in several trials, but almost always as the control treatment in comparison to other preferred alternatives (N=9). MI was”

May combine two claims.

Exposure and response prevention and cognitive-behavioral therapy are efficacious and specific for obsessive-compulsive disorder.

“Exposure and response prevention (ERP) and cognitive-behavioral therapy (CBT) were found to be efficacious and specific for OCD.”

• Also stated in: § Behavioral Interventions · hedged

  “This indicates that ERP is efficacious and specific in the treatment of OCD.”

May combine two claims.

Only a few studies investigated treatment effects on specific OCD subtypes: contamination obsessions and washing compulsions in 2 studies and obsessions without overt compulsions in 3 studies.

“Only a few studies investigated the effects of treatment on specific OCD subtypes, including contamination obsessions and washing compulsions (N=2) and obsessions without overt compulsions (N=3).”

May combine two claims.

On the whole, there is little clear evidence that either CBT or ERP modality is superior to the other, although ERP may be easier to learn and better suited to group format.

“On the whole, there is little clear evidence that either modality is superior to the other, although ERP may be easier to learn and better suited to a group format.”

May combine two claims.

In the only study of satiation therapy, it was comparable to conventional ERP, both were superior to a wait list condition, and these advantages were maintained at six-month follow-up.

“In the only study to examine satiation therapy, Khodarahimi (2009) found that it was comparable to conventional ERP; and both treatments were superior to a wait list condition. These advantages were also maintained at six-month follow-up.”

• cites Khodarahimi (2009) sourceNot checked — no full text of the source

Classified as probably not a substantial claim. May combine two claims.

That one study is enough to earn more generic cognitive interventions designation of possibly efficacious, but this was not a particularly impressive set of studies.

“Although that one study is enough to earn the more generic cognitive interventions the designation of possibly efficacious, this was not a particularly impressive set of studies.”

May combine two claims.

Computer-guided ERP (BT Steps) was less efficacious than therapist-guided ERP but more efficacious than relaxation training in reducing OCD symptoms.

“Computer-guided ERP (BT Steps) was less efficacious than a more expensive therapist-guided ERP, but more efficacious in reducing OCD symptoms than was relaxation training (Greist et al., 2002).”

• cites Greist et al., 2002 sourceNot checked — no full text of the source

May combine two claims.

CBT is efficacious and specific in treatment of OCD.

“we conclude that CBT is efficacious and specific in the treatment of OCD.”

• cites Whittal et al., 2010 sourceNot checked — no full text of the source

May combine two claims.

Satiation Therapy meets criteria for possibly efficacious treatment based on a single study, but the designation is tenuous due to methodological shortcomings.

“On the basis of this single study, Satiation Therapy meets the criteria for a possibly efficacious treatment, but this designation is tenuous given the methodological shortcomings noted above.”

May combine two claims.

Few early studies found differences and are of interest only because ERP was not so powerful that it separated from these approaches.

“As might be expected, few found differences and are of interest only because ERP was not so powerful that it separated from these approaches.”

May combine two claims.

One study found CBT superior to sertraline in reducing OCD symptoms, but medication dosage was low and most differences were non-significant trends.

“One study found CBT superior to sertraline in reducing OCD symptoms, but the medication dosage was low (100 mg/day) and most of the differences between treatment effects were non-significant trends (Sousa et al., 2006).”

• cites Sousa et al., 2006 sourceNot checked — no full text of the source

May combine two claims.

CBT has fared well relative to medication treatment, although evidence is not as compelling as for ERP.

“CBT also has fared well relative to medication treatment, although the evidence is not as compelling as it is for ERP.”

May combine two claims.

Involving the family in ERP treatment led to greater OCD symptom reduction and greater amelioration of impairment in work and family domains in one study.

“Involving the family in ERP treatment led to greater OCD symptom reduction and greater amelioration of impairment in work and family domains in one study (Mehta, 1990), although van Oppen et al. (2010) found no differences in outcome between self-conducted versus therapist-assisted ERP, regardless of whether experienced or student therapists were used.”

• cites Mehta, 1990 sourceNot checked — no full text of the source
• cites van Oppen et al. (2010) sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

None of the patients in the satiation therapy study reported comorbid psychiatric diagnoses.

“Similarly, none of the patients in this study reported comorbid psychiatric diagnoses.”

May combine two claims.

DIRT showed promise and appeared possibly efficacious in treatment of patients with fears of contamination, but effects require replication by other groups.

“DIRT showed promise and appeared to be possibly efficacious in the treatment of patients with fears of contamination, but the effects of DIRT require replication by groups other than that which developed the treatment.”

May combine two claims.

Mean YBOCS scores at pre-treatment in the satiation therapy study were considerably higher than reported in most trials, and post-treatment scores were well below typical OCD treatment studies.

“Mean YBOCS scores at pre-treatment were considerably higher (M = 37.10 for satiation therapy and 37.20 for ERP out of a possible 40) than is reported in most trials (mid to late 20’s); and the post-treatment YBOCS scores (M = 6.40 for satiation therapy and 5.58 for ERP) were well below what typically is observed in most OCD treatment studies (low double digits).”

May combine two claims.

Two studies evaluated efficacy of adding MI to cognitive and behavioral treatments, with mixed results.

“Two studies have evaluated the efficacy of adding MI to cognitive and behavioral treatments, with mixed results.”

May combine two claims.

Most studies comparing ERP and CBT found comparable efficacy, and those few differences found can be attributed plausibly to variability in how treatments were implemented.

“Most studies comparing the two found comparable efficacy, and those few differences that were found can be attributed plausibly to variability in how the treatments were implemented.”

May combine two claims.

This one study is sufficient to state that Stress Management is possibly efficacious in treatment of obsessional patients, but outcomes across studies generally have been unimpressive.

“This one study is sufficient to state that Stress Management is possibly efficacious in the treatment of obsessional patients, but outcomes across studies generally have been unimpressive.”

• cites Whittal et al., 2010 sourceNot checked — no full text of the source

May combine two claims.

ERP has consistently been found efficacious and specific, whereas CBT has gained this status only in last decade.

“ERP has consistently been found to be efficacious and specific, whereas CBT has gained this status only in the last decade (DeRubeis & Crits-Christoph, 1998; Roth & Fonagy, 2005).”

• cites DeRubeis & Crits-Christoph, 1998 sourceNot checked — no full text of the source
• cites Roth & Fonagy, 2005Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

Adding MI to behavioral and cognitive treatments to enhance readiness to change in OCD patients can be said to be possibly efficacious, but not yet established.

“Accordingly, adding MI to behavioral and cognitive treatments to enhance readiness to change in OCD patients can be said to be possibly efficacious, but not yet established.”

May combine two claims.

We rated each study on eight criteria developed by Cuijpers and colleagues (2010) and found mean quality rating for all RCTs included in this review was only 4.6 (SD 2.2) out of maximum 8.0.

“We rated each study on eight criteria developed by Cuijpers and colleagues (2010) and found that the mean quality rating for all RCTs included in this review was only 4.6 (SD 2.2) out of a maximum of 8.0.”

• cites Cuijpers et al., 2010 sourceNot checked — no full text of the source

May combine two claims.

Based on findings of single studies in each instance (with one supporting ACT being most methodologically sound), ACT, EMDR, and satiation therapy can be said to be possibly efficacious.

“Based on the findings of single studies in each instance (with the one supporting ACT being the most methodologically sound), these treatments can be said to be possibly efficacious.”

May combine two claims.

EMDR outperformed citalopram in symptom reduction, but doses were less than adequate.

“Although EMDR outperformed citalopram in symptom reduction, doses were less than adequate.”

• cites Nazari et al., 2011 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S2 (checkable).

Replication by other research groups is required before firm conclusions can be drawn regarding efficacy of each.

“Replication by other research groups, however, is required before firm conclusions can be drawn regarding the efficacy of each.”

Classified as probably not a substantial claim.

Our review extends earlier reviews by applying criteria developed by Chambless and Hollon (1998) to more recently tested therapies and treatment of specific OCD presentations.

“Our review extends these earlier reviews by applying the criteria developed by Chambless and Hollon (1998) to more recently tested therapies and the treatment of specific OCD presentations.”

• cites Chambless and Hollon, 1998Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

While both ERP and CBT are efficacious and specific in treatment of OCD, it remains unclear whether adding cognitive restructuring enhances efficacy of more purely behavioral interventions.

“While both ERP and CBT are efficacious and specific in the treatment of OCD, it remains unclear whether adding cognitive restructuring enhances the efficacy of more purely behavioral interventions.”

Probably not a substantial claim: may not pass S3 (load-bearing).

One difference between ERP and satiation therapy is that latter can include instructions to repeatedly engage in compulsive behaviors.

“One difference between ERP and satiation therapy, however, is that the latter can include instructions to repeatedly engage in compulsive behaviors.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

There is too much overlap among treatment elements to define ERP as purely behavioral and cognitive therapy as purely cognitive; their differences are best conceptualized as a matter of emphasis and focus.

“Abramowitz et al. (2005) have argued that there is too much overlap among treatment elements to define ERP as “purely” behavioral and cognitive therapy as “purely” cognitive, and have suggested that it may be best to conceptualize their differences as a matter of emphasis and focus, with cognitive interventions focusing more on cognitive elements and behavioral (ERP) devoting more attention to”

• cites Abramowitz et al., 2005 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

ERP protocols often include cognitive procedures.

“Although originally derived from learning theory, ERP protocols often include cognitive procedures.”

• cites Foa et al., 2005 sourceNot checked — no full text of the source

May combine two claims.

OCD remains one of the most refractory non-psychotic disorders, and few patients end treatment completely symptom free.

“Still, ERP is no panacea. OCD remains one of the most refractory of the non-psychotic disorders and few patients end treatment completely symptom free (Abramowitz, 1998).”

• cites Abramowitz, 1998 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Therapist training, experience, and supervision varied across ERP studies.

“The training, experience, and supervision of study therapists varied as well.”

May combine two claims.

There was considerable variability in how ERP was implemented across studies, which affects interpretation of the results.

“That being said, there was considerable variability in the way ERP was implemented across the studies, which affects interpretation of the results.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Some studies did not provide information on therapist training and supervision.

“Moreover, some studies did not provide information on therapist training and supervision (e.g. Marks et al., 1988).”

• cites Marks et al., 1988 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

Greater weight can be given to studies that employed independent assessors for YBOCS administration.

“Moreover, even greater weight can be given to those studies that employed independent assessors for YBOCS administration (e.g. Foa et al., 2005).”

• cites Foa et al., 2005 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

The quality of included studies was considered using criteria derived by Cuijpers et al. from work by others.

“The quality of the included studies was considered using in part the criteria derived by Cuijpers et al. (2010) from work by others (Chambless & Hollon, 1998; Higgins & Green, 2006).”

• cites Cuijpers et al. (2010) sourceNot checked — no full text of the source
• cites Chambless & Hollon, 1998Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites Higgins & Green, 2006Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

Further analysis found evidence of moderation: patients with more severe symptoms responded better to CBT, whereas patients with milder symptoms showed greater change following Stress Management.

“further analysis of the data from that trial found evidence of moderation in that patients who suffered from more severe symptoms responded better to CBT, whereas patients with milder symptoms showed greater change following Stress Management (Woody et al., 2011).”

• cites Woody et al., 2011 sourceNot checked — no full text of the source

May combine two claims.

This suggests CBT may have an enduring effect similar to that found for ERP, but conclusion is less compelling due to absence of comparison to medication withdrawal.

“While this suggests that CBT may have an enduring effect similar to that found for ERP, this conclusion is made less compelling by the absence of any comparison to medication withdrawal (see Simpson et al., 2004, with respect to ERP).”

• cites Simpson et al., 2004 sourceNot checked — no full text of the source

May combine two claims.

Stress Management in Whittal et al. (2010) study produced very good results and was almost as effective as CBT.

“Stress Management in the Whittal et al. (2010) study produced very good results and was almost as effective as CBT.”

• cites Whittal et al., 2010 sourceNot checked — no full text of the source

May combine two claims.

The conclusion that CBT is efficacious and specific is based on fewer studies than was case for ERP.

“This conclusion, however, is based on fewer studies than was the case for ERP.”

Classified as probably not a substantial claim. May combine two claims.

It is unclear whether patients in the satiation therapy study were asked to increase frequency of compulsive behaviors and whether they succeeded.

“Thus, it is not clear whether the patients were asked to increase the frequency of their compulsive behaviors and, if so, whether they succeeded.”

Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing).

Training clinicians in ERP is easier than training them in CBT for OCD.

“It has been argued that training clinicians in ERP is easier than training them in CBT for OCD (McLean et al., 2001), and the same has been said with respect to behavioral activation relative to cognitive therapy (a cognitive-behavioral intervention) for depression (Coffman et al., 2007).”

• cites McLean et al., 2001 sourceNot checked — no full text of the source
• cites Coffman et al., 2007 sourceNot checked — no full text of the source

May combine two claims.

Early studies used generic cognitive approaches that did not specifically target obsessional thinking, with small samples and less experienced graduate students often delivering treatments.

“Early studies used generic cognitive approaches that did not specifically target obsessional thinking. Sample sizes were small and less experienced graduate students often delivered the treatments (e.g., Emmelkamp et al., 1988).”

• cites Emmelkamp et al., 1988 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

If YBOCS scores mean the same thing in this trial as in other studies, then this was the most severe OCD sample and the most efficacious interventions.

“If scores on the YBOCS mean the same thing in this trial that they do in other studies, then this was not only the most severe OCD sample studied in the literature, but also the most efficacious interventions.”

May combine two claims.

Differences between therapist-guided and computer-guided ERP were no longer significant when only patients who had completed at least one self-exposure homework session were considered, suggesting that the major benefit of a therapist is to increase the likelihood that the patient engages in exposure.

“Differences between therapist-guided and computer-guided ERP were no longer significant when only the patients who had completed one or more sessions of self-exposure for homework were considered, suggesting that the major benefit of having a therapist is to increase the likelihood that the patient will engage in the exposure process.”

May combine two claims.

Over half of these patients achieved full remission at end of treatment compared to about a third in control condition; difference both large and significant.

“Over half of these patients had achieved full remission at the end of treatment compared to about a third in the control condition; a difference which was both large and significant.”

• cites Meyer et al., 2010aNot matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing).

From theoretical perspective, it is possible that reason both ERP and CBT are efficacious and specific in treatment of OCD is because both address same maintaining factors, such as maladaptive beliefs, neutralizing strategies, and avoidance.

“From a theoretical perspective, it is possible that the reason both ERP and CBT are efficacious and specific in the treatment of OCD is because both address the same maintaining factors, such as maladaptive beliefs (e.g., inflated responsibility), neutralizing strategies (e.g., reassurance seeking and rituals), and avoidance (Salkovskis, 1999; Rachman, 1971; 1997; 1998).”

• cites Salkovskis, 1999 sourceNot checked — no full text of the source
• cites Rachman, 1971 sourceNot checked — no full text of the source
• cites Rachman, 1997 sourceNot checked — no full text of the source

May combine two claims.

A Canadian study found Stress Management superior to wait list control for patients without overt compulsions, but less efficacious than CBT.

“A Canadian study found Stress Management superior to a wait list control for patients without overt compulsions (the only study in which they were compared), but less efficacious than CBT (Whittal et al., 2010).”

• cites Whittal et al., 2010 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Both EMDR and satiation therapy involve some exposure, which might be a critical ingredient.

“Both EMDR (Nazari et al., 2011) and satiation therapy (Khodarahimi, 2009) involve some exposure, which might be a critical ingredient.”

• cites Nazari et al., 2011 sourceNot checked — no full text of the source
• cites Khodarahimi, 2009 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Access to appropriate training and supervision is important for adoption and competent practice of empirically supported treatments.

“Access to appropriate training and supervision is important for the adoption and competent practice of empirically supported treatments (Shafran et al., 2009).”

• cites Shafran et al., 2009 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S1 (asserted).

It has been argued that behavioral procedures are most powerful means of producing cognitive change.

“It has been argued that behavioral procedures are the most powerful means of producing cognitive change (Bandura, 1977).”

• cites Bandura, 1977 sourceNot checked — no full text of the source

May combine two claims.

Stress Management was less efficacious than ERP when combined with pill placebo, when added to ongoing medication treatment in partial responders, and when added to substance abuse treatment in comorbid patients.

“Stress Management was less efficacious than ERP when combined with pill placebo in a study in Japan (Nakatani et al., 2005), and less efficacious than ERP when added to ongoing medication treatment in patients who had shown partial response (Simpson et al., 2008b), and when added to substance abuse treatment in a therapeutic community for patients with comorbid substance use disorders (Fals-Stewar”

• cites Nakatani et al., 2005 sourceNot checked — no full text of the source
• cites Simpson et al., 2008bNot matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites Fals-Stewart & Schafer, 1992 sourceNot checked — no full text of the source

May combine two claims.

Symptom reduction was significantly greater among patients who received MI, with further reductions over subsequent 3-month follow-up.

“Symptom reduction was significantly greater among patients who received MI, with further reductions in OCD symptoms over a subsequent 3-month follow-up.”

• cites Meyer et al., 2010aNot matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.