close
Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2015 Aug;32(8):580-93.
doi: 10.1002/da.22389. Epub 2015 Jun 30.

A META-ANALYSIS OF COGNITIVE BEHAVIOR THERAPY AND MEDICATION FOR CHILD OBSESSIVE-COMPULSIVE DISORDER: MODERATORS OF TREATMENT EFFICACY, RESPONSE, AND REMISSION

Joseph F McGuire  1   2   3 , John Piacentini  3 , Adam B Lewin  1   2   4 , Erin A Brennan  2 , Tanya K Murphy  2   4 , Eric A Storch  1   2   4   5   6   7
Affiliations
Meta-Analysis

A META-ANALYSIS OF COGNITIVE BEHAVIOR THERAPY AND MEDICATION FOR CHILD OBSESSIVE-COMPULSIVE DISORDER: MODERATORS OF TREATMENT EFFICACY, RESPONSE, AND REMISSION

Joseph F McGuire et al. Depress Anxiety. 2015 Aug.

Abstract

Background: Individual randomized controlled trials (RCTs) have demonstrated the efficacy of cognitive behavioral therapy (CBT) and serotonin reuptake inhibitors (SRIs) for the treatment of youth with obsessive-compulsive disorder (OCD). Although meta-analyses have confirmed these results, there has been minimal examination of treatment moderators or an examination of treatment response and symptom/diagnostic remission for these two treatment types. The present report examined the treatment efficacy, treatment response, and symptom/diagnostic remission for youth with OCD receiving either CBT or SRIs relative to comparison conditions, and examined treatment moderators.

Method: A comprehensive literature search identified 20 RCTs that met inclusion criteria, and produced a sample size of 507 CBT participants and 789 SRI participants.

Results: Random effects meta-analyses of CBT trials found large treatment effects for treatment efficacy (g = 1.21), treatment response (relative risk [RR] = 3.93), and symptom/diagnostic remission (RR = 5.40). Greater co-occurring anxiety disorders, therapeutic contact, and lower treatment attrition were associated with greater CBT effects. The number needed to treat (NNT) was three for treatment response and symptom/diagnostic remission. Random effects meta-analyses of SRI trials found a moderate treatment effect for treatment efficacy (g = 0.50), treatment response (RR = 1.80), and symptom/diagnostic remission (RR = 2.06). Greater methodological quality was associated with a lower treatment response for SRI trials. The NNT was five for treatment response and symptom/diagnostic remission.

Conclusions: Findings demonstrate the treatment effects for CBT and SRIs across three important outcome metrics, and provide evidence for moderators of CBT across trials.

Keywords: clomipramine; cognitive behavior therapy; diagnostic remission; obsessive-compulsive disorder; selective serotonin reuptake inhibitors; treatment outcome; treatment response.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Study Selection and Rationale For Exclusion.
Figure 2
Figure 2
Forest plots of treatment efficacy in CBT trials (A) and SRI trials (B)
Figure 3
Figure 3
Forest plots of treatment response in CBT trials (A) and SRI trials (B)
Figure 4
Figure 4
Forest plots of symptom/diagnostic remission in CBT trials (A) and SRI trials (B)
See this image and copyright information in PMC

References

    1. Zohar AH. The epidemiology of obsessive-compulsive disorder in children and adolescents. Child and Adolescent Psychiatric Clinics of North America. 1999;8(3):445–460. - PubMed
    1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Arlington, VA: American Psychiatric Association; 2013.
    1. Ruscio AM, Stein DJ, Chiu WT, Kessler RC. The epidemiology of obsessive-compulsive disorder in the National Comorbidity Survey Replication. Molecular Psychiatry. 2010;15(1):53–63. - PMC - PubMed
    1. Nestadt G, Samuels J, Riddle M, et al. A family study of obsessive-compulsive disorder. Archives of General Psychiatry. 2000;57(4):358–363. - PubMed
    1. Geller DA, Biederman J, Faraone S, et al. Developmental aspects of obsessive compulsive disorder: Findings in children, adolescents, and adults. Journal of Nervous and Mental Disease. 2001;189(7):471–477. - PubMed

Publication types

MeSH terms

Substances