P L Fisher1, M G Cherry2, T Stuart3, J W Rigby4, J Temple5. 1. Department of Psychological Sciences, Institute of Psychology, Health and Society, University of Liverpool, Whelan Building, Quadrangle, Brownlow Hill, Liverpool L69 3GB, UK; The Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK. Electronic address: peter.fisher@liverpool.ac.uk. 2. Department of Psychological Sciences, Institute of Psychology, Health and Society, University of Liverpool, Whelan Building, Quadrangle, Brownlow Hill, Liverpool L69 3GB, UK; The Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK. Electronic address: gcherry@liv.ac.uk. 3. Department of Psychological Sciences, Institute of Psychology, Health and Society, University of Liverpool, Whelan Building, Quadrangle, Brownlow Hill, Liverpool L69 3GB, UK. 4. St Helens and Knowsley Teaching Hospitals NHS Trust, UK. 5. Department of Psychological Sciences, Institute of Psychology, Health and Society, University of Liverpool, Whelan Building, Quadrangle, Brownlow Hill, Liverpool L69 3GB, UK; The Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK.
Abstract
BACKGROUND: Previous meta-analyses conclude that efficacious psychological treatments for obsessive-compulsive disorder (OCD) exist. However, determining the efficacy of psychological treatments requires multiple forms of assessment. We conducted an individual patient data meta-analysis of randomised controlled trials (RCTs) of manualised psychological therapy for adults with OCD. METHODS: Four electronic databases were searched from their inception until July 2019. IPD were available for 24 (n = 1626) of 43 (n = 2455) eligible RCTs. Treatment efficacy was evaluated using clinical significance analyses (using standardised Jacobson methodology) and standardised mean difference within-group effect-size analyses. Outcomes were Yale-Brown Obsessive Compulsive Scale (Y-BOCS) scores at post-treatment and follow-up. RESULTS: At follow-up, large within-group effect sizes were found for treated patients (g = 1.45) and controls (g = 0.90). Treated patients were significantly more likely than controls to recover, but recovery rates were low; post-intervention, only 32% of treated patients and 3% of controls recovered; rising to 38% and 21% respectively at follow-up. Regardless of allocation, only 20% of patients were asymptomatic at follow-up. Individual cognitive therapy (CT) was most efficacious, followed by group CT plus exposure and response prevention. Self-help interventions were generally less efficacious than face-to-face approaches. LIMITATIONS: Data were analysed from 24 of the 43 eligible RCTs. We were unable to consider the long-term efficacy of treatments because only two RCTs provided long-term (> 12 month) follow-up data. CONCLUSION: Almost 80% of treated patients remain symptomatic. The efficacy of psychological interventions for patients with OCD must be enhanced.
BACKGROUND: Previous meta-analyses conclude that efficacious psychological treatments for obsessive-compulsive disorder (OCD) exist. However, determining the efficacy of psychological treatments requires multiple forms of assessment. We conducted an individual patient data meta-analysis of randomised controlled trials (RCTs) of manualised psychological therapy for adults with OCD. METHODS: Four electronic databases were searched from their inception until July 2019. IPD were available for 24 (n = 1626) of 43 (n = 2455) eligible RCTs. Treatment efficacy was evaluated using clinical significance analyses (using standardised Jacobson methodology) and standardised mean difference within-group effect-size analyses. Outcomes were Yale-Brown Obsessive Compulsive Scale (Y-BOCS) scores at post-treatment and follow-up. RESULTS: At follow-up, large within-group effect sizes were found for treated patients (g = 1.45) and controls (g = 0.90). Treated patients were significantly more likely than controls to recover, but recovery rates were low; post-intervention, only 32% of treated patients and 3% of controls recovered; rising to 38% and 21% respectively at follow-up. Regardless of allocation, only 20% of patients were asymptomatic at follow-up. Individual cognitive therapy (CT) was most efficacious, followed by group CT plus exposure and response prevention. Self-help interventions were generally less efficacious than face-to-face approaches. LIMITATIONS: Data were analysed from 24 of the 43 eligible RCTs. We were unable to consider the long-term efficacy of treatments because only two RCTs provided long-term (> 12 month) follow-up data. CONCLUSION: Almost 80% of treated patients remain symptomatic. The efficacy of psychological interventions for patients with OCD must be enhanced.