People with Obsessive-Compulsive Disorder Often Remain Symptomatic following Psychological Treatment: A Clinical Significance Analysis of Manualised Psychological Interventions



Fisher, PL ORCID: 0000-0002-7388-720X, Cherry, MG, Stuart, T, Rigby, JW and Temple, J ORCID: 0000-0001-5351-5196
(2020) People with Obsessive-Compulsive Disorder Often Remain Symptomatic following Psychological Treatment: A Clinical Significance Analysis of Manualised Psychological Interventions. Journal of Affective Disorders, 275. pp. 94-108.

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Abstract

<h4>Background</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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.<h4>Limitations</h4>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.<h4>Conclusion</h4>Almost 80% of treated patients remain symptomatic. The efficacy of psychological interventions for patients with OCD must be enhanced.

Item Type: Article
Uncontrolled Keywords: Obsessive-compulsive disorder, Psychological intervention, Individual patient data, Meta-analysis, Systematic review
Depositing User: Symplectic Admin
Date Deposited: 09 Jul 2020 08:25
Last Modified: 18 Jan 2023 23:46
DOI: 10.1016/j.jad.2020.06.019
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URI: https://livrepository.liverpool.ac.uk/id/eprint/3093378

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