Does cognitive-behavioral therapy cure obsessive-compulsive disorder? A meta-analytic evaluation of clinical significance

doi:10.1016/S0005-7894(98)80012-9

Behavior Therapy

Volume 29, Issue 2, Spring 1998, Pages 339-355

https://doi.org/10.1016/S0005-7894(98)80012-9 Get rights and content

Meta-analytic methods were employed to investigate the clinical significance of exposure therapy in the treatment of obsessive-compulsive disorder (OCD). Samples of patients treated in 16 outcome trials were compared with 9 normative samples to clarify how similar the symptoms of treated patients were to those without history of OCD. The Maudsley Obsessional-Compulsive Inventory (MOCI) was used as the basis for comparison. As expected, substantial improvements during the course of treatment were observed. Additionally, at posttest, the average patient was functioning at a level more similar to the general population than to individuals with untreated OCD. Follow-up scores indicated that clinically significant changes were stable for up to 5 months. Treated patients, however, did remain more symptomatic than members of the general population. The results are discussed in terms of the advantages of routinely including tests of clinical significance in outcome research.

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Behavioral avoidance as a factor in concentrated exposure and response prevention for obsessive-compulsive disorder
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Although exposure and response prevention (ERP) is recommended for adults with obsessive-compulsive disorder (OCD), some recipients do not fully respond while others improve and subsequently relapse. Identifying factors associated with poor outcomes is therefore highly important. We investigated behavioral avoidance as one potential factor. Data came from a large randomized controlled trial that delivered a concentrated ERP protocol over the course of four consecutive days in accord with the Bergen 4-Day Treatment (B4DT). Avoidance was assessed with the auxiliary item from the Yale-Brown Obsessive-Compulsive Scale (YBOCS). Although behavioral avoidance did not predict acute outcome at immediate post-treatment, patients with substantial avoidance behaviors prior to treatment had worse long term (12-month) outcomes (increased OCD severity and greater functional impairment), after controlling for OCD severity at baseline. Avoidance significantly decreased from pre-to post-treatment but increased from post-treatment to 3-month and 12-month follow-up. Change in avoidance from post-treatment to 3-month follow-up predicted subsequent OCD worsening at 12-months, after controlling for change in global OCD severity. Results suggest that avoidant patients can benefit from concentrated ERP but may be at increased risk of poorer long-term outcomes. Future work should investigate strategies to identify and ameliorate worsening avoidance to reduce relapse.
A systematic review and meta-analysis on the effectiveness of exposure and response prevention therapy in the treatment of Obsessive-Compulsive Disorder
2021, Journal of Obsessive-Compulsive and Related Disorders
Exposure and Response Prevention (ERP) is considered the most effective psychotherapeutic treatment for Obsessive-Compulsive Disorder (OCD). The literature supports its adoption yet results vary and vagueness regarding therapy protocol exists. We present an updated review and meta-analysis to provide clarity in the comparison of strict ERP protocol to control or active therapy groups. Moderator analyses were conducted to investigate treatment effect of cognitive elements, hours of therapy and duration of OCD.
A systematic literature search, concluded in January 2021, identified twenty-four studies, published between 1997 and 2018, including a total of 1134 patients. The main analysis assessed the difference between pre-treatment and post-treatment scores compared amongst ERP and the other groups.
We found a statistically significant different reduction in pre-treatment to post-treatment Yale-Brown Obsessive Compulsive Scale scores between ERP therapy versus other groups. We also found a statistically significant moderation effect of cognitive elements. The other two moderators, hours of therapy and OCD duration, were non-significant.
Our review suggests that ERP was superior to the other groups, including both neutral and active treatments, in reducing OCD symptomatology and should therefore be recommended as an optimal therapy. Future research should focus on tailoring ERP to the individual and investigating further refinements.
Improving treatment outcome in obsessive-compulsive disorder: Does motivational interviewing boost efficacy?
2019, Journal of Obsessive-Compulsive and Related Disorders
Although exposure and response prevention (ERP) is the first line psychological treatment for individuals with obsessive compulsive disorder (OCD), many people experience partial recovery and others refuse treatment or drop out. This randomized controlled study (n= 40) examined the effect of a three-session motivational interviewing (MI) intervention compared to a three-session relaxation intervention prior to 15 sessions of ERP on treatment dropout, homework compliance, and treatment outcome post-ERP and at follow up. Contrary to hypotheses, there were no group differences in ERP dropout rates or homework compliance. Both groups experienced significant reductions in OCD symptoms post-ERP. Consistent with our hypothesis, the MI group experienced a greater reduction in OCD symptoms (clinician-rated YBOCS) compared to the comparison group immediately post-ERP. However, this difference did not hold over 12-month follow up. There were also no group differences in associated symptoms (depression, anxiety, stress) across treatment. All participants achieved significant symptom reductions that were maintained over time. A correlational analysis of the whole sample revealed that action scores pre-ERP were significantly negatively correlated with post-ERP OCD symptom severity. These findings suggest that MI prior to ERP may confer a small but meaningful benefit for enhancing treatment outcome post ERP.
Gamma Ventral Capsulotomy in Intractable Obsessive-Compulsive Disorder
2018, Biological Psychiatry
Despite the development of effective pharmacologic and cognitive behavioral treatments for obsessive-compulsive disorder (OCD), some patients continue to be treatment-refractory and severely impaired. Fiber tracts connecting orbitofrontal and dorsal anterior cingulate cortex with subcortical nuclei have been the target of neurosurgical lesions as well as deep brain stimulation in these patients. We report on the safety and efficacy of ventral gamma capsulotomy for patients with intractable OCD.
Fifty-five patients with severely disabling, treatment-refractory OCD received bilateral lesions in the ventral portion of the anterior limb of the internal capsule over a 20-year period using the Leksell Gamma Knife. The patients were prospectively followed over 3 years with psychiatric, neurologic, and neuropsychological assessments of safety and efficacy, as well as structural neuroimaging.
Thirty-one of 55 patients (56%) had an improvement in the primary efficacy measure, the Yale-Brown Obsessive Compulsive Scale, of ≥35% over the 3-year follow-up period. Patients had significant improvements in depression, anxiety, quality of life, and global functioning. Patients tolerated the procedure well without significant acute adverse events. Five patients (9%) developed transient edema that required short courses of dexamethasone. Three patients (5%) developed cysts at long-term follow-up, 1 of whom developed radionecrosis resulting in an ongoing minimally conscious state.
Gamma Knife ventral capsulotomy is an effective radiosurgical procedure for many treatment-refractory OCD patients. A minority of patients developed cysts at long-term follow-up, 1 of whom had permanent neurological sequelae.
Basic Strategies of Cognitive Behavioral Therapy
2017, Psychiatric Clinics of North America
Citation Excerpt :
In one meta-analysis of exposure-based CBT for anxiety disorders, a very large pre-post-treatment effect size of 1.56 was observed.39 Moreover, meta-analytic work has demonstrated that exposure-based CBT outperforms placebo-controlled conditions40 and other credible treatments for anxiety disorders (eg, relaxation)41 and that patients who complete a trial of exposure-based CBT score within one SD of the population norm on self-report inventories of anxiety.42 However, these data are based on exposure delivered from a habituation framework, and full-scale randomized controlled trials examining the efficacy of inhibitory learning-based exposure and comparing exposure delivered from a habituation framework with exposure delivered from an inhibitory learning framework have yet to be conducted.
Initial data on a 5-item measure of OCD symptom severity and change: The obsessive compulsive session change index (OCSCI)
2016, Journal of Anxiety Disorders
Citation Excerpt :
Further, Clomipromine and several selective serotonin reuptake inhibitors (SSRIs) have been found to lead to clinically significant reductions in OCD symptoms, and a combination of pharmacological and behavioral interventions has been shown highly effective (Eddy, Dutra, Bradley, & Westen, 2004; Van Balkom, Oppen, Vermeulen, & van Dyck, 1994). Although existing treatments provide relief for many, approximately one third of clients do not see significant symptom reduction (Abramowitz, 1998; Belloch, Cabedo, & Carrio, 2008; Neziroglu & Mancusi, 2014). Given the variability in treatment response, it may be clinically useful to measure OCD symptoms repeatedly in order to assess patterns of OCD symptom reduction.
Repeated measurement of symptoms throughout treatment allows providers to assess individual patterns of symptom change. However, outside of a clinical trial, administration of lengthy measures at each session is unlikely. Therefore, in order to bridge the gap between clinical research and actual clinical practice we developed a brief self-report measure of obsessive compulsive symptoms that can be used at each session, the Obsessive Compulsive Session Change Index (OCSCI). The OCSCI assesses time spent on obsessions, time spent on compulsions, interference and distress related to obsessions and compulsions, and relative change in symptoms from the beginning of treatment. This paper reports initial psychometric properties of the OCSCI. Twenty-seven adults receiving exposure and ritual prevention for obsessive compulsive disorder (OCD) completed the OCSCI at each session. Results showed that the OCSCI had good internal consistency, and convergent and divergent validity. Specifically, the OCSCI had moderate to strong correlations with both self-reported and clinician rated OCD. Finally, the OCSCI was not as strongly correlated with depressive symptoms as it was with OCD symptoms. The findings presented herein suggest that the OCSCI can be useful as a measure of client progress throughout treatment.

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Does cognitive-behavioral therapy cure obsessive-compulsive disorder? A meta-analytic evaluation of clinical significance