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Mindfulness-based cognitive therapy (MBCT) in patients with obsessive–compulsive disorder (OCD) and residual symptoms after cognitive behavioral therapy (CBT): a randomized controlled trial

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Abstract

Up to one-third of individuals with obsessive–compulsive disorder (OCD) do not benefit from evidence-based psychotherapy. We examined the efficacy of mindfulness-based cognitive therapy (MBCT) as a complementary treatment option. In a prospective, bicentric, assessor-blinded, randomized, and actively controlled clinical trial, 125 patients with OCD and residual symptoms after cognitive behavioral therapy (CBT) were randomized to either an MBCT group (n = 61) or to a psychoeducational group (OCD-EP; n = 64) as an active control condition. At post-treatment, there was no significant benefit of MBCT over OCD-EP with the Yale-Brown-Obsessive–Compulsive Scale (Y-BOCS) as the primary outcome measure, but with the Obsessive–Compulsive Inventory [OCI-R; F(1, 101) = 5.679, p = .036, effect size η2partial = 0.053]. Moreover, the response rate and the improvement on secondary outcomes such as obsessive beliefs and quality of life was significantly larger in the MBCT group. Non-completion rates were below 10%. At the 6-month follow-up, OC symptoms were further improved in both groups; group differences were no longer significant. Our findings suggest that MBCT, compared to a psychoeducational program, leads to accelerated improvement of self-reported OC symptoms and secondary outcomes, but not of clinician-rated OC symptoms. In the midterm, both interventions yield similar and stable, but small improvements, suggesting that additional treatment options may be necessary.

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Acknowledgements

This work was supported by the German Research Foundation (DFG) (Grant numbers KU 2754/4 − 1, MO 969/15 − 1).

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Authors and Affiliations

  1. Department of Psychiatry and Psychotherapy, Medical Center, Faculty of Medicine, University of Freiburg, Hauptstraße 5, 79104, Freiburg, Germany

    Anne Katrin Külz, Sarah Landmann, Nina Rose, Ulrich Voderholzer & Jonathan G. Maier

  2. Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Barbara Cludius, Lena Jelinek, Heike Alsleben & Steffen Moritz

  3. Esslingen University of Applied Sciences, Esslingen am Neckar, Germany

    Thomas Heidenreich

  4. Department of Psychology, Clinical Psychology and Epidemiology, University of Basel, Basel, Switzerland

    Karina Wahl

  5. Department of Psychiatry and Psychotherapy, University Hospital Karl-Jaspers-Klinik, Bad Zwischenahn, Germany

    Alexandra Philipsen

  6. Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany

    Alexandra Philipsen

  7. Schoen Clinic Roseneck, Prien am Chiemsee, Germany

    Ulrich Voderholzer

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  1. Anne Katrin Külz
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Correspondence to Anne Katrin Külz.

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Külz, A.K., Landmann, S., Cludius, B. et al. Mindfulness-based cognitive therapy (MBCT) in patients with obsessive–compulsive disorder (OCD) and residual symptoms after cognitive behavioral therapy (CBT): a randomized controlled trial. Eur Arch Psychiatry Clin Neurosci 269, 223–233 (2019). https://doi.org/10.1007/s00406-018-0957-4

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