Psychological treatments versus treatment as usual for obsessive compulsive disorder (OCD) (Review)
- ISSN: 1469493X
- DOI: 10.1002/14651858.CD005333.pub2
- PubMed: 17443583
Abstract
BACKGROUND: Obsessive compulsive disorder (OCD) is a chronic anxiety disorder associated with significant morbidity, social impairment and lower quality of life. Psychological treatments are a frequently used approach for OCD. OBJECTIVES: To perform a systematic review of randomised trials of psychological treatments for obsessive compulsive disorder in comparison with treatment as usual. SEARCH STRATEGY: We conducted an electronic search of CCDANCTR-Studies (31/10/2006), and other databases. We searched reference lists, and contacted experts in the field. SELECTION CRITERIA: Published and unpublished randomised trials of psychological treatments versus treatment as usual for adults with a diagnosis of OCD DATA COLLECTION AND ANALYSIS: Two review authors worked independently throughout the selection of trials and data extraction. Findings were compared and disagreements were discussed with a third review author. Full data extraction, using a standardised data extraction sheet, was performed on all studies included in the review. Results were synthesised using Review Manager software. For dichotomous data, odds ratios were calculated. For continuous data, effect sizes were obtained and the standardised mean difference, with 95% confidence intervals, was calculated. Fixed and random effects models were used to pool the data. Reasons for heterogeneity in studies were explored and sensitivity analyses were performed by excluding trials of lower quality. MAIN RESULTS: Eight studies (11 study comparisons) were identified, all of which compared cognitive and/or behavioural treatments versus treatment as usual control groups. Seven studies (ten comparisons) had usable data for meta-analyses. These studies demonstrated that patients receiving any variant of cognitive behavioural treatment exhibited significantly fewer symptoms post-treatment than those receiving treatment as usual (SMD -1.24, 95% CI -1.61 to -0.87, I(2) test for heterogeneity 33.4%). Different types of cognitive and/or behavioural treatments showed similar differences in effect when compared with treatment as usual. The overall treatment effect appeared to be influenced by differences in baseline severity. AUTHORS' CONCLUSIONS: The findings of this review suggest that psychological treatments derived from cognitive behavioural models are an effective treatment for adult patients with obsessive compulsive disorder. Larger high quality randomised controlled trials involving longer follow up periods are needed, to further test cognitive behavioural treatments, and other psychological approaches, in comparison to each other and control conditions. Future trials should examine the predictors of response to each treatment, and also conduct cost-effectiveness evaluations.
Psychological treatments versus treatment as usual for obsessive compulsive disorder (OCD) (Review)
obsessive compulsive disorder (OCD) (Review)
Gava I, Barbui C, Aguglia E, Carlino D, Churchill R, De Vanna M, McGuire HF
This is a reprint of a Cochrane review, prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library
2008, Issue 2
http://www.thecochranelibrary.com
1Psychological treatments versus treatment as usual for obsessive compulsive disorder (OCD) (Review)
Copyright © 2008 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd
1ABSTRACT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2PLAIN LANGUAGE SUMMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2BACKGROUND . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3OBJECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3CRITERIA FOR CONSIDERING STUDIES FOR THIS REVIEW . . . . . . . . . . . . . . . . . .
4SEARCH METHODS FOR IDENTIFICATION OF STUDIES . . . . . . . . . . . . . . . . . . .
4METHODS OF THE REVIEW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5DESCRIPTION OF STUDIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6METHODOLOGICAL QUALITY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7RESULTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9DISCUSSION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11AUTHORS’ CONCLUSIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11POTENTIAL CONFLICT OF INTEREST . . . . . . . . . . . . . . . . . . . . . . . . . . .
11ACKNOWLEDGEMENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11SOURCES OF SUPPORT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
15TABLES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
15Characteristics of included studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
20Characteristics of excluded studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
21Characteristics of ongoing studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
21ANALYSES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
21Comparison 01. All psychological treatments versus Treatment as usual . . . . . . . . . . . . . . . .
21Comparison 02. Cognitive behaviour therapy versus Treatment as usual . . . . . . . . . . . . . . . .
22Comparison 03. Cognitive therapy versus Treatment as usual . . . . . . . . . . . . . . . . . . . .
22Comparison 04. Behaviour therapy versus Treatment as usual . . . . . . . . . . . . . . . . . . .
22Comparison 05. All psychological treatments versus Treatment as usual: sub-group analyses . . . . . . . . .
22Comparison 06. All psychological treatments versus Treatment as usual: sensitivity analyses . . . . . . . . .
23INDEX TERMS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
23COVER SHEET . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
24GRAPHS AND OTHER TABLES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
24Figure 01. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
25Analysis 01.01. Comparison 01 All psychological treatments versus Treatment as usual, Outcome 01 OCD symptoms
26Analysis 01.02. Comparison 01 All psychological treatments versus Treatment as usual, Outcome 02 Dropout . . .
27Analysis 01.03. Comparison 01 All psychological treatments versus Treatment as usual, Outcome 03 Depressive
symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
28Analysis 01.04. Comparison 01 All psychological treatments versus Treatment as usual, Outcome 04 Anxiety symptoms
28Analysis 01.05. Comparison 01 All psychological treatments versus Treatment as usual, Outcome 05 Quality of life .
29Analysis 02.01. Comparison 02 Cognitive behaviour therapy versus Treatment as usual, Outcome 01 Obsessive
compulsive symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
29Analysis 02.02. Comparison 02 Cognitive behaviour therapy versus Treatment as usual, Outcome 02 Dropout . .
30Analysis 02.03. Comparison 02 Cognitive behaviour therapy versus Treatment as usual, Outcome 03 Depressive
symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
30Analysis 02.04. Comparison 02 Cognitive behaviour therapy versus Treatment as usual, Outcome 04 Anxiety symptoms
31Analysis 02.05. Comparison 02 Cognitive behaviour therapy versus Treatment as usual, Outcome 05 Quality of life .
31Analysis 03.01. Comparison 03 Cognitive therapy versus Treatment as usual, Outcome 01 Obsessive compulsive
symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
32Analysis 03.02. Comparison 03 Cognitive therapy versus Treatment as usual, Outcome 02 Dropout . . . . . .
32Analysis 03.03. Comparison 03 Cognitive therapy versus Treatment as usual, Outcome 03 Depressive symptoms . .
33Analysis 03.04. Comparison 03 Cognitive therapy versus Treatment as usual, Outcome 04 Anxiety symptoms . . .
33Analysis 04.01. Comparison 04 Behaviour therapy versus Treatment as usual, Outcome 01 Obsessive compulsive
symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
iPsychological treatments versus treatment as usual for obsessive compulsive disorder (OCD) (Review)
Copyright © 2008 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd
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