Predictors and Moderators of Cognitive and Behavioral Therapy Outcomes for OCD: A Patient-Level Mega-Analysis of Eight Sites☆,☆☆
Section snippets
Design and Sample
Pre- and posttreatment data were collected from eight participating research clinic centers that studied cognitive and behavioral treatments alone and/or in combination for outpatients diagnosed with OCD. Sites were chosen because they used similar manualized treatment procedures and identical outcome measures. Investigators could include data from participants treated in research trials and/or in outpatient clinic settings that employed comparable assessment and treatment protocols.
Sample Characteristics
Analyses included 359 participants of whom 125 received BT, 108 received CT, and 126 received CBT. Table 1 provides demographic information and descriptive statistics for the three treatment types and the eight different sites. Of 242 (67%) participants for whom race/ethnicity data were available, a large majority were Caucasian (91%, n = 221). Of the 324 (90%) participants whose marital status was known, 147 (45%) were married or cohabitating, 144 (44%) were single and never married, and 33
Discussion
The primary purpose of this study was to identify predictors of treatment response across interventions for OCD as well as moderators for BT, CT, and CBT using data from eight treatment clinics. Combining sites increased the sample size and appeared justified by the generally similar demographic features, with few exceptions. Baseline severity of OCD, depression and beliefs was also comparable across sites, with only one site (Cottraux) reporting higher Y-BOCS scores. Treatment outcomes were
Conflict of Interest Statement
The authors of the paper submit the following information about potential conflicts of interest:
Gail Steketee: Dr. Steketee was Co-PI on a grant funded by the International OCD Foundation (IOCDF) to Dr. Sabine Wilhelm to support this project. The funding enabled us to employ research assistants to gather and analyze the data. I am not aware of any specific bias with regard to outcomes due to the source of funding. She has received royalties from Elsevier Publications, Guilford Publications, New
References (40)
- et al.
Obsessive–compulsive disorder with comorbid major depression: What is the role of cognitive factors?
Behaviour Research and Therapy
(2007) - et al.
Obsessive-compulsive disorder
The Lancet
(2009) - et al.
Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation
Clinical Psychology Review
(1988) - et al.
Clinical predictors of response to cognitive-behavioral therapy for obsessive–compulsive disorder
Clinical Psychology Review
(2008) - et al.
Efficacy of cognitive-behavioral therapy for obsessive–compulsive disorder
Psychiatry Research
(2015) Psychometric validation of the Obsessive Belief Questionnaire and Interpretation of Intrusions Inventory—Part 2: Factor analyses and testing of a brief version
Behaviour Research and Therapy
(2005)- et al.
Cognitive-behavioral therapy for obsessive-compulsive disorder: a meta-analysis of treatment outcome and moderators
Journal of Psychiatric Research
(2013) - et al.
Dropout rates in exposure with response prevention for obsessive-compulsive disorder: What do the data really say?
Journal of Anxiety Disorders
(2016) - et al.
Cognitive behavioral treatments of obsessive–compulsive disorder. A systematic review and meta-analysis of studies published 1993–2014
Clinical Psychology Review
(2015) - et al.
Psychological treatment of obsessive–compulsive disorder: A meta-analysis
Clinical Psychology Review
(2008)
Methodological issues in predicting treatment outcome
Clinical Psychology Review
Effects of axis I and II comorbidity on behavior therapy outcome for obsessive-compulsive disorder and agoraphobia
Comprehensive Psychiatry
The Yale-Brown Obsessive Compulsive Scale: Interview versus self-report
Behaviour Research and Therapy
Reliability and validity of the Yale-Brown Obsessive–Compulsive Scale
Behaviour Research and Therapy
Effectiveness of psychological and pharmacological treatments for obsessive-compulsive disorder: A quantitative review
Journal of Consulting and Clinical Psychology
Diagnostic and statistical manual of mental disorders
Cognitive therapy of depression
Anxiety disorders interview Schedule for DSM-IV: Adult version
Obsessive-compulsive disorder: Prediction of outcome from behavioural psychotherapy
Acta Psychiatrica Scandinavica
A randomized controlled trial of cognitive therapy versus intensive behavior therapy in obsessive compulsive disorder
Psychotherapy and Psychosomatics
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2023, Comprehensive PsychiatryCitation Excerpt :As stated above, ERP, CBT and CT are all highly effective. Steketee et al.'s [19] mega-analysis of RCTs and clinical studies showed large effect sizes for CBT, CT and ERP for OCD and depression symptom reduction. However, OCD symptom severity decreases were slightly smaller for ERP in comparison to treatments that incorporated CT.
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This study was supported by a grant from the International OCD Foundation awarded to Dr. Wilhelm. The authors are grateful to the following colleagues who provided data for this study: Dr. Jonathan Abramowitz, Dr. Jean Cottraux, Dr. Michael Kyrios, Dr. Kieron O’Connor, Dr. Neil Rector, Dr. David Tolin, Dr. Maureen Whittal, and Dr. Sabine Wilhelm.
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Data statement. All data files were shared with permission of the investigators of the 8 research sites, following IRB regulations regarding protection of human subjects. We do not have permission to share these data files with other investigators.