Multimodal Interventions for Obsessive-Compulsive Disorder: Efficacy of Exposure Therapy, Cognitive Approaches, and Pharmacological Treatment
DOI:
https://doi.org/10.31580/pjmls.v7i3.3143Keywords:
Cognitive therapy, Exposure therapy, Mental health, Multimodal interventions, Obsessive-compulsive disorder, Pharmacological treatment, Selective serotonin reuptake inhibitors (SSRIs), Symptom reductionAbstract
Objective: The purpose of this systematic review is to review the effectiveness of multimodal therapies including exposure therapy, cognitive behavioral therapy, and pharmacotherapy for obsessive-compulsive disorder (OCD).
Methodology: Following PRISMA guidelines, this systematic review evaluated the effectiveness of multimodal interventions for OCD, with a focus on exposure therapy, cognitive approaches, and pharmacological treatments. A search across databases, including PubMed, PsycINFO, and the Cochrane Library, identified 90 articles from 2010 to 2023. The inclusion criteria focused on studies that reported on the effectiveness of multimodal treatments for OCD in both adult and pediatric populations, while the exclusion criteria ruled out studies with fewer than 20 participants and single-modality studies. The quality of 40 studies was then examined using meta-analytic techniques, with the I² statistic used to assess heterogeneity. After evaluation with the Cochrane Risk of Bias Tool and the Newcastle-Ottawa Scale, 16 studies met the inclusion criteria. The table included only low to moderate risk of bias studies to produce high-quality evidence.
Results: Multimodal interventions lead to dramatic reductions in OCD symptom severity, and exposure therapy (ERP) improved compulsive behaviour (mean Y-BOCS reduction of 6.5, p < 0.01). ERP (3 sessions) combined with cognitive therapy was effective in decreasing obsessive thoughts (mean reduction of 4.3 points on Y-BOCS, p < 0.05). The combination of pharmacotherapy with ERP and cognitive therapy was most effective in producing substantial symptom control, increasing remission rates by 15% above that of ERP alone.
Conclusion: Integration of exposure therapy with cogitative and pharmacological therapy forms a very effective method of dealing with OCD, making multimodal antigrowth therapies possible. The multimodal intervention type is particularly beneficial for people who belong to older age group with severe OCD than younger ones. Applying these therapies in hospitals can be associated with increasing the effectiveness, prognosis and quality of life of patients with OCD.
References
Carmi L, Brakoulias V, Arush OB, Cohen H, Zohar J. A prospective clinical cohort-based study of the prevalence of OCD, obsessive compulsive and related disorders, and tics in families of patients with OCD. BMC psychiatry. 2022;22(1):190.
Albert U, Brunatto C. Obsessive-compulsive disorder in adults: Efficacy of combined and sequential treatments. Clin Neuropsychiatry. 2009;6(2):83-93.
Hezel DM, Simpson HB. Exposure and response prevention for obsessive-compulsive disorder: A review and new directions. Indian journal of psychiatry. 2019;61(Suppl 1):S85-92.
Wilhelm S, Tolin DF, Steketee G. Challenges in treating obsessive‐compulsive disorder: Introduction. Journal of clinical psychology. 2004;60(11):1127-32.
Van Oppen P, De Haan E, Van Balkom AJ, Spinhoven P, Hoogduin K, Van Dyck R. Cognitive therapy and exposure in vivo in the treatment of obsessive compulsive disorder. Behaviour research and therapy. 1995;33(4):379-90.
Del Casale A, Sorice S, Padovano A, Simmaco M, Ferracuti S, Lamis DA, Rapinesi C, Sani G, Girardi P, Kotzalidis GD, Pompili M. Psychopharmacological treatment of obsessive-compulsive disorder (OCD). Current neuropharmacology. 2019;17(8):710-36.
Vogel PA, Stiles TC, Götestam KG. Adding cognitive therapy elements to exposure therapy for obsessive compulsive disorder: A controlled study. Behavioural and cognitive Psychotherapy. 2004;32(3):275-90.
Heidari T, Mousavi SM, Mousavinasab SN, AzimiLolaty H. Effect of Family and Patient Centered Empowerment Program on Depression, Anxiety and Stress in Patients with Obsessive-Compulsive Disorder and Their Caregivers' Burden. Iranian Journal of Nursing and Midwifery Research. 2020;25(6):482-9.
Javaherirenani R, Mortazavi SS, Shalbafan M, Ashouri A, Farani AR. Virtual reality exposure and response prevention in the treatment of obsessive-compulsive disorder in patients with contamination subtype in comparison with in vivo exposure therapy: a randomized clinical controlled trial. BMC psychiatry. 2022;22(1):740.
Öst LG, Enebrink P, Finnes A, Ghaderi A, Havnen A, Kvale G, Salomonsson S, Wergeland GJ. Cognitive behavior therapy for obsessive-compulsive disorder in routine clinical care: A systematic review and meta-analysis. Behaviour Research and Therapy. 2022;159:104170.
Mao L, Hu M, Luo L, Wu Y, Lu Z, Zou J. The effectiveness of exposure and response prevention combined with pharmacotherapy for obsessive-compulsive disorder: A systematic review and meta-analysis. Frontiers in psychiatry. 2022;13:973838.
Kayser RR. Pharmacotherapy for treatment-resistant obsessive-compulsive disorder. The Journal of clinical psychiatry. 2020;81(5):14428.
Külz AK, Landmann S, Schmidt-Ott M, Zurowski B, Wahl-Kordon A, Voderholzer U. Long-term follow-up of cognitive-behavioral therapy for obsessive-compulsive disorder (OCD): Symptom severity and the role of exposure 8–10 Years after inpatient treatment. Journal of Cognitive Psychotherapy. 2020.
Uhre CF, Uhre VF, Lønfeldt NN, Pretzmann L, Vangkilde S, Plessen KJ, Gluud C, Jakobsen JC, Pagsberg AK. Systematic review and meta-analysis: cognitive-behavioral therapy for obsessive-compulsive disorder in children and adolescents. Journal of the American Academy of Child & Adolescent Psychiatry. 2020;59(1):64-77.
Reid JE, Laws KR, Drummond L, Vismara M, Grancini B, Mpavaenda D, Fineberg NA. Cognitive behavioural therapy with exposure and response prevention in the treatment of obsessive-compulsive disorder: A systematic review and meta-analysis of randomised controlled trials. Comprehensive psychiatry. 2021;106:152223.
Spencer SD, Stiede JT, Wiese AD, Goodman WK, Guzick AG, Storch EA. Cognitive-behavioral therapy for obsessive-compulsive disorder. Psychiatric Clinics. 2023 ;46(1):167-80.
Song Y, Li D, Zhang S, Jin Z, Zhen Y, Su Y, Zhang M, Lu L, Xue X, Luo J, Liang M. The effect of exposure and response prevention therapy on obsessive-compulsive disorder: A systematic review and meta-analysis. Psychiatry Research. 2022 ;317:114861.
Xu J, Hao Q, Qian R, Mu X, Dai M, Wu Y, Tang Y, Xie M, Wang Q. Optimal dose of serotonin reuptake inhibitors for obsessive-compulsive disorder in adults: A systematic review and dose–response meta-analysis. Frontiers in Psychiatry. 2021;12:717999.
Bragdon LB, Harvey JR, Moldow R. Cognitive-behavioral therapy for obsessive-compulsive disorder: a brief review. Psychiatric Annals. 2024;54(3):e75-9.
Mendez EM, Dahlsgaard KK, Hjelmgren JM, Mills JA, Suresh V, Strawn JR. What is the added benefit of combining cognitive behavioral therapy and selective serotonin reuptake inhibitors in youth with obsessive compulsive disorder? A Bayesian hierarchical modeling meta-analysis. Journal of Child and Adolescent Psychopharmacology. 2023;33(6):203-11.
Hühne V, Chacur C, de Oliveira MV, Fortes PP, Bezerra de Menezes GM, Fontenelle LF. Considerations for the treatment of obsessive-compulsive disorder in patients who have comorbid major depression. Expert Review of Neurotherapeutics. 2023;23(11):955-67.
Zhang T, Lu L, Didonna F, Wang Z, Zhang H, Fan Q. Mindfulness-based cognitive therapy for unmedicated obsessive-compulsive disorder: A randomized controlled trial with 6-month follow-up. Frontiers in Psychiatry. 2021;12:661807.
Maloney G, Kelmendi B, Pittenger C. Imagery Rescripting (ImRs) as an adjunctive treatment to exposure and response prevention (ERP)-resistant obsessive-compulsive disorder: A case study. Clinical Case Studies. 2023;22(2):174-91.
Uhre CF, Uhre VF, Lønfeldt NN, Pretzmann L, Vangkilde S, Plessen KJ, Gluud C, Jakobsen JC, Pagsberg AK. Systematic review and meta-analysis: cognitive-behavioral therapy for obsessive-compulsive disorder in children and adolescents. Journal of the American Academy of Child & Adolescent Psychiatry. 2020;59(1):64-77.
Foa EB, McLean CP. The efficacy of exposure therapy for anxiety-related disorders and its underlying mechanisms: The case of OCD and PTSD. Annual review of clinical psychology. 2016;12(1):1-28.
Cartwright C, Hollander E. SSRIs in the Treatment of obsessive‐compulsive disorder. Depression and Anxiety. 1998;8(S1):105-13.
Melchior K, van der Heiden C, Deen M, Mayer B, Franken IH. The effectiveness of metacognitive therapy in comparison to exposure and response prevention for obsessive-compulsive disorder: A randomized controlled trial. Journal of Obsessive-Compulsive and Related Disorders. 2023;36:100780.
Hansmeier J, Haberkamp A, Glombiewski JA, Exner C. Metacognitive change during exposure and metacognitive therapy in obsessive-compulsive disorder. Frontiers in Psychiatry. 2021;12:722782.
Pittenger C. Pharmacotherapeutic strategies and new targets in OCD. The Neurobiology and Treatment of OCD: Accelerating Progress. 2021:331-84.
Kim SK, McKay D, Murphy TK, Bussing R, McNamara JP, Goodman WK, Storch EA. Age moderated–anxiety mediation for multimodal treatment outcome among children with obsessive-compulsive disorder: an evaluation with correspondence analysis. Journal of affective disorders. 2021;282:766-75.
Kwak S, Kim M, Kim T, Kwak Y, Oh S, Lho SK, Moon SY, Lee TY, Kwon JS. Defining data-driven subgroups of obsessive–compulsive disorder with different treatment responses based on resting-state functional connectivity. Translational psychiatry. 2020;10(1):359.
Rautio D, Gumpert M, Jassi A, Krebs G, Flygare O, Andren P, Monzani B, Peile L, Jansson-Froejmark M, Lundgren T, Hillborg M. Effectiveness of multimodal treatment for young people with body dysmorphic disorder in two specialist clinics. Behavior therapy. 2022.
Voderholzer U, Hilbert S, Fischer A, Neumüller J, Schwartz C, Hessler-Kaufmann JB. Frequency and level of self-efficacy predict the effectiveness of therapist-and self-guided exposure in obsessive compulsive disorder. Behavioural and Cognitive Psychotherapy. 2020;48(6):751-5.
Yan J, Cui L, Wang M, Cui Y, Li Y. The efficacy and neural correlates of ERP-based therapy for OCD & TS: a systematic review and Meta-analysis. Journal of Integrative Neuroscience. 2022;21(3):97.
Claus N, Miegel F, Jelinek L, Landmann S, Moritz S, Külz AK, Rubel J, Cludius B. Perfectionism as possible predictor for treatment success in Mindfulness-Based Cognitive Therapy and Metacognitive Training as third-wave treatments for obsessive-compulsive disorder. Cognitive Therapy and Research. 2023 ;47(3):439-53.
de Oliveira MV, de Barros PM, de Mathis MA, Boavista R, Chacon P, Echevarria MA, Ferrao YA, Vattimo EF, Lopes AC, Torres AR, Diniz JB. Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders guidelines for the treatment of adult obsessive-compulsive disorder. Part I: pharmacological treatment. Brazilian Journal of Psychiatry. 2023;45:146-61.
Shephard E, Batistuzzo MC, Hoexter MQ, Stern ER, Zuccolo PF, Ogawa CY, Silva RM, Brunoni AR, Costa DL, Doretto V, Saraiva L. Neurocircuit models of obsessive-compulsive disorder: limitations and future directions for research. Brazilian Journal of Psychiatry. 2021 ;44(2):187-200.
.Reddy YJ, Sundar AS, Narayanaswamy JC, Math SB. Clinical practice guidelines for obsessive-compulsive disorder. Indian journal of psychiatry. 2017 ;59(Suppl 1):S74-90.
McKay D, Sookman D, Neziroglu F, Wilhelm S, Stein DJ, Kyrios M, Matthews K, Veale D. Efficacy of cognitive-behavioral therapy for obsessive–compulsive disorder. Psychiatry research. 2015;225(3):236-46.
Cohen SE, Zantvoord JB, Storosum BW, Mattila TK, Daams J, Wezenberg B, de Boer A, Denys DA. Influence of study characteristics, methodological rigour and publication bias on efficacy of pharmacotherapy in obsessive-compulsive disorder: a systematic review and meta-analysis of randomised, placebo-controlled trials. BMJ Ment Health. 2024 ;27(1).
Downloads
Published
Issue
Section
License
Copyright (c) 2024 Pak-Euro Journal of Medical and Life Sciences
This work is licensed under a Creative Commons Attribution 4.0 International License.
