A systematic review of predictors and moderators of response to psychological therapies in OCD: Do we have enough empirical evidence to target treatment?

Abstract

Obsessive-compulsive disorder (OCD) is a disabling mental health condition. Despite effective psychological treatments for OCD, a significant percentage of patients fail to experience lasting benefit. Factors underlying variable treatment response are poorly understood. Moderators of outcome can help understand "for whom" and "under what circumstances" an intervention works best and thus improve service effectiveness. This paper synthesizes the evidence on predictors and moderators and assesses the quality of reporting of related analyses in psychological therapies for adults with OCD. Trials were identified through electronic searches (CENTRAL, MEDLINE, PsycINFO, EMBASE), key author, and reference list searches of relevant systematic reviews. Fifty five percent (38/69) of relevant trials reported baseline factors associated with outcome; these encompassed clinical, demographic, interpersonal, OCD symptom-specific, psychological/psychosocial, and treatment-specific variables. Predictors were commonly assessed via a validated pre-randomization measure, though few trials adopted best practice by stating a priori hypotheses or conducting a test of interaction. Potential associations emerged between worse OCD treatment outcome and the following factors: hoarding pathology, increased anxiety and OCD symptom severity, certain OCD symptom subtypes, unemployment, and being single/not married. However, the applied utility of these analyses is currently limited by methodological weaknesses.

Predictors of outcomes of psychological treatments for disordered gambling: A systematic review

“…Understanding the influence of treatment and therapist characteristics on treatment outcomes would enable the enhancement of treatment outcomes through the modification of treatment processes and therapist training. Previous research has recognised the influence of treatment and therapist-related characteristics on treatment outcomes in various disorders, including borderline personality disorder and obsessive-compulsive disorder (Barnicot, et al, 2012;Knopp, Knowles, Bee, Lovell, & Bower, 2013). There have, however, been few studies exploring the influence of these characteristics in treatment outcome studies in the gambling field (Crisp, Thomas, Jackson, & Thomason, 2001;Dowling & Cosic, 2011;Ladouceur, et al, 2006).…”

“…While a box-score approach was utilised to synthesise the results, this method is limited by the lack of consideration given to the magnitude of the effect (Green & Hall, 1984;Knopp, et al, 2013). Additionally, a box-score approach does not facilitate more nuanced analyses, such as subgroup analyses, which can explore the degree to which methodological differences in the studies influence the results (e.g.…”

Predictors and moderators of Internet-based cognitive behavior therapy for obsessive–compulsive disorder: Results from a randomized trial

“…As patients presenting with hoarding-and sexual/religious obsessions have been shown to have worse treatment response in previous studies (Jaurrieta et al, 2008;Keeley, Storch, Merlo, & Geffken, 2008;Knopp, Knowles, Bee, Lovell, & Bower, 2013), our first hypothesis was that this would also be the case in ICBT. Another clinical variable that has been shown to be important in CBT for OCD is pre-treatment symptom levels (Keeley et al, 2008).…”

The state of personalized treatment for anxiety disorders: A systematic review of treatment moderators

“…Moderator findings from the adult and childhood depression and childhood anxiety disorder literatures have been synthesized in reviews (Nilsen, Eisemann, & Kvernmo, 2013;Simon & Perlis, 2010). For the adult anxiety disorder literature, numerous meta-analyses and reviews of treatment predictors have been published (Eskildsen, Hougaard, & Rosenberg, 2010;Keeley, Storch, Merlo, & Geffken, 2008;Luborsky, Auerbach, Chandler, Cohen, & Bachrach, 1971;Mennin & Heimberg, 2000;Mululo, de Menezes, Vigne, & Fontenelle, 2012;Olatunji, Davis, Powers, & Smits, 2013;Pampaloni, Bruscoli, & Pallanti, 2004;Solvason, Ernst, & Roth, 2003;Steketee & Shapiro, 1995;Taylor, Abramowitz, & McKay, 2012), however, apart from obsessive-compulsive disorder (Knopp, Knowles, Bee, Lovell, & Bower, 2013), we lack a corresponding synthesis of treatment moderators.…”