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Psychological treatments versus treatment as usual for obsessive compulsive disorder (OCD)

  • Review
  • Intervention

Authors


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 methods

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Published and unpublished randomised trials of psychological treatments versus treatment as usual for adults with a diagnosis of OCD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, I² 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.

摘要

背景

強迫症(obsessive compulsive disorder, OCD)的心理治療與一般療法

強迫性疾患是一種慢性的焦慮性疾患,與顯著的不健康、社交功能損害與生活品質降低有關。心理治療是處理強迫性疾患常用的方法。

目標

對於比較心理治療法與一般療法用在治療強迫症的隨機試驗做一個系統性回顧。

搜尋策略

我們使用電腦搜尋搜尋CCDANCTRStudies (31/10/2006)及其他資料庫。我們也尋找了參考文獻,並聯絡此領域專家。

選擇標準

針對成人強迫症患者心理治療法與一般療法的隨機試驗,出版及未出版的均納入。

資料收集與分析

兩位檢閱作者獨立完成試驗的選擇和資料的摘選。再由第三位檢閱作者完成資料的比較與不一致的討論。所有資料的摘選,是利用一個標準化的資料摘錄表,這個表亦使用在所有回顧資料裡的研究。結論是以回顧管理軟(Review Manager software)產生。二分項資料會計算其odds ratios,連續性資料則會取其effect sizes ,並計算95%信賴區間的標準平均差異值(standardised mean difference)。使用固定與隨機效果模型整合資料。藉由排除較低品質的試驗進行靈敏度分析,來探究研究中產生異質性的原因。

主要結論

被辨識出的八個研究(11個研究比較)都是比較認知及/或行為治療與一般療法。七個研究(十個研究比較)的資料可使用於後設分析。這些研究顯示病患接受任何形式的認知行為治療後,與接受一般療法的患者比較起來,明顯表現出較少的症狀(SMD −1.24, 95% CI −1.61 to −0.87, I² test for heterogeneity 33.4%)。不同形式的認知與/或行為治療與一般療法比較時,在效果上都顯示出相似的差異。不同的原始病情嚴重度會影響最後的治療結果.

作者結論

來自這篇回顧的發現,建議認知行為模式衍伸出來的心理治療是強迫症成人患者的一種有效治療方法。未來需要更大的高品質隨機樣本及更長的介入期間的控制試驗,進一步測試認知行為治療,和其它心理治療法,與彼此和控制組的比較。未來的試驗應檢視能預測各種治療效果的預測因素,並且做成本效益的評估。

翻譯人

本摘要由彰化基督教醫院張庭綱翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

強迫症是一種慢性、失功能的焦慮型疾患,特徵是不斷重複的強迫性意念,譬如,固著想法、衝動或引發焦慮的心理圖像,伴隨著強制的言行,包括重複性的行為或精神思考,這會不斷的出現以回應強迫性意念。目前強迫症最普遍的治療法是藥物治療法,其次才是心理治療法,尤其是認知行為取向。我們回顧比較接受心理介入以及未接受治療或正等待治療或接受一般治療的研究. 我們發現8個研究均一致推薦認知與/或行為治療比一般用來減低臨床症狀的療法有效. 原始的強迫症嚴重度和憂鬱症狀可以預期療效的程度. 然而,結論是根據較小的樣本數及較少的隨機控制研究. 也沒有其他形式的心理治療,例如精神動力治療和以案主為中心的治療(clientcentred therapy)且缺少 對於心理治療長期療效的可得證據.

Plain language summary

Psychological treatments compared with treatment as usual for obsessive compulsive disorder

Obsessive compulsive disorder (OCD) is a chronic and disabling anxiety disorder characterised by recurrent obsessions, such as persistent thoughts, impulses or mental images, that promote anxiety, together with compulsions, such as repetitive behaviours or mental acts, that are performed in response to the obsessions. Currently the most commonly used therapies for OCD are pharmacological therapies, followed by psychotherapies, particularly cognitive behavioural approaches. We reviewed studies that compared psychological interventions to treatment as usual groups who either received no treatment, or were on a waiting list for treatment or received usual care. We found eight studies, which together suggested that cognitive and/or behavioural treatments were better than treatment as usual conditions at reducing clinical symptoms. Baseline OCD severity and depressive symptom level predicted the degree of response. However, the conclusions were based on a small number of randomised controlled trials with small sample sizes. There were no trials of other forms of psychological treatment such as psychodynamic therapy and client-centred therapy, and a lack of available evidence for the long-term effectiveness of psychological treatments.

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