Effectiveness and acceptability of cognitive–behavioural therapy delivery formats for obsessive–compulsive disorder: network meta-analysis

BACKGROUND: While various delivery formats of cognitive-behavioural therapy (CBT) for obsessive-compulsive disorder (OCD) are available, comprehensive evidence on their comparative effectiveness and acceptability is lacking. AIM: To examine the comparative effectiveness and acceptability of different CBT delivery formats for OCD. METHOD: An existing database of psychological interventions for OCD was utilised, with randomised controlled trials (RCTs) comparing CBT delivery formats with each other/control groups were included. Pairwise and network meta-analyses were conducted using a random-effects model. Comparative standard mean differences (SMDs) were calculated for effectiveness in reducing OCD symptom severity post-treatment. Relative risks were calculated for acceptability (conceptualised as any cause discontinuation in the acute treatment phase). RESULTS: A total of 61 RCTs involving 3710 patients with OCD were included. All CBT treatment formats were significantly more effective than control groups (SMDs: -0.39 to -1.66). No significant differences were found among individual, remote-delivery, guided self-help, time-intensive and family-involved formats. However, individual, remote-delivery and family-involved formats were more effective than group (SMDs, -0.38 to -0.60), and most treatment formats were more effective than unguided self-help (SMDs, -0.58 to -0.80). Regarding acceptability, most CBT formats showed no significant differences among themselves, although they were generally more acceptable (relative risks: 1.11-1.18) than unguided self-help. CONCLUSIONS: Most CBT delivery formats serve as potential alternatives to conventional individual CBT. Unguided self-help has lower but still moderate effects in reducing OCD symptom severity, and it holds important potential for assisting a larger number of individuals with OCD who face barriers to accessing treatments.