The effectiveness of exposure and response prevention combined with pharmacotherapy for obsessive-compulsive disorder: A systematic review and meta-analysis

Abstract

ObjectiveTo systematically evaluate the effectiveness of exposure and response prevention (ERP) combined with medication on obsessive-compulsive disorder (OCD).MethodsPubMed, Web of Science, EBSCO, Cochrane, Embase, and Science Direct databases were searched to include randomized controlled trials of ERP combined with medication for OCD that met the criteria. The Yale Brown Obsessive Compulsive Scale was used as the primary outcome indicator, and Depression scales were used as secondary outcome indicators. An evaluation of bias risk was conducted to identify possible sources of bias based on methodological and clinical factors. Review Manager 5.3 and Stata 16.0 software was used to perform meta-analysis of the extracted data.ResultsA total of 21 studies with 1113 patients were included. Meta-analysis showed that ERP combined with medication therapy was significantly better than medication therapy alone including selective serotonin reuptake inhibitors, clomipramine and risperidone (MD = –6.60, 95% CI: –8.35 to –4.84, P < 0.00001), but D-cycloserine (DCS) drugs do not enhance the effect of ERP intervention in patients with OCD (MD = 0.15, 95% CI: –0.87 to 1.17, P = 0.77). There is more significant maintenance by combined treatment method of medication plus ERP than medication treatment alone during the follow-up period (MD = –7.14, 95% CI: –9.17 to –5.10, P < 0.00001). DCS drugs did not enhance the effect of ERP intervention on depression in patients with OCD (SMD = –0.08, 95% CI: –0.31 to 0.15, P = 0.50). ERP combined with drug improved patients’ depression levels significantly better than providing drug alone (SMD = –0.40, 95% CI: –0.68 to –0.11, P = 0.006).ConclusionPatients with OCD have significant improvement in symptoms of obsessive-compulsive disorder and depression when ERP is combined with medication, however, not enough to prove that DCS can enhance ERP effectiveness.

Long-term effectiveness and cost-effectiveness of guided internet-based cognitive behavioral therapy for obsessive-compulsive disorder: 24-month follow-up

“…All participants received guided ICBT; during the intervention, they had psychiatric outpatient visits, with the majority undergoing pharmacotherapy (64.0 %). Since 60 % ( n = 3) of the adolescents and 65 % ( n = 13) of the adults were on pharmacotherapy, the outcomes of the present study likely could have reflected the combined effects of CBT and medication ( Mao et al, 2022 ). A network meta-analysis of 54 RCTs suggested that the combination of psychotherapeutic and psychopharmacological interventions was more effective in treating severe OCD ( Skapinakis et al, 2016 ).…”

Variations in obsessive compulsive disorder symptomatology across cultural dimensions

“…Common treatments that have shown promising efficacy in OCD include Exposure and Response Prevention (ERP), cognitive-behavioral therapy (CBT), and medications such as selective serotonin reuptake inhibitors (SSRIs) ( 4 ). The goals of therapy are to decrease the frequency and intensity of obsessions and compulsions, mitigate anxiety, and improve overall quality of life.…”