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Standard individual cognitive behaviour therapy for paediatric obsessive-compulsive disorder: a systematic review of
Gudmundur Skarphedinsson1, Ketil Hanssen-Bauer, Hege Kornør
1Gudmundur Skarphedinsson, Centre for Child and Adolescent Mental Health , Eastern and Southern Norway, Oslo , Norway.
Insights
Standard individual cognitive behaviour therapy (SI-CBT) is effective for paediatric obsessive-compulsive disorder (OCD), but effect sizes may be inflated by wait-list comparisons. SI-CBT shows similar efficacy to active treatments.
Area of Science:
- Child and Adolescent Psychiatry
- Behavioral Therapy
- Pharmacotherapy
Background:
- Previous meta-analyses indicated higher effect sizes for SI-CBT versus controls than for SRIs versus placebo in pediatric OCD.
- Potential confounders like performance bias may inflate psychotherapy effect estimates.
Purpose of the Study:
- To review SI-CBT studies in pediatric OCD.
- To compare effect estimates across different control conditions, including active treatments.
Main Methods:
- Included randomized controlled trials (RCTs) with 12-16 week treatment periods.
- Outcome measure was the Children's Yale-Brown Obsessive Compulsive Scale (CYBOCS) post-test score.
Main Results:
- SI-CBT outperformed wait-list and placebo but not active treatments.
- Effect estimates were larger in wait-list comparisons than placebo comparisons.
- SI-CBT effect estimates were comparable to those of SRIs alone or combined treatments.
Conclusions:
- Performance bias may inflate SI-CBT effect estimates, particularly with wait-list controls.
- SI-CBT demonstrated significant effects against placebo and comparable efficacy to active treatments.
- Further research comparing SI-CBT and SRIs is warranted to refine clinical guidelines.
Background:
Previous meta-analyses of paediatric obsessive-compulsive disorder (OCD) have shown much higher effect size for standard individual cognitive behaviour therapy (SI-CBT) compared with control conditions than for serotonin reuptake inhibitors (SRIs) compared with placebo. Other factors, such as systematic differences in the provided care or exposure to factors other than the interventions of interest (performance bias) may be stronger confounders in psychotherapy research than in pharmacological research.
Aims:
These facts led us to review SI-CBT studies of paediatric OCD with the aim to compare the effect estimates across different comparisons, including active treatments.
Method:
We included only randomized controlled trials (RCTs) or cluster RCTs with treatment periods of 12-16 weeks. Outcome was post-test score on the Children's Yale-Brown Obsessive Compulsive Scale (CYBOCS).
Results:
Thirteen papers reporting from 13 RCTs with 17 comparison conditions were included. SI-CBT was superior to wait-list and placebo therapy but not active treatments. Effect estimates for SI-CBT in wait-list comparison studies were significantly larger than in placebo-therapy comparison studies. In addition, the SI-CBT effect estimate was not significantly different when compared with SRIs alone or combined SRIs and CBT.
Conclusions:
Performance bias may have inflated previous effect estimates for SI-CBT when comparison contingencies included wait-list. However, the calculated SI-CBT effect estimate was lower but significant when compared with placebo therapy. The effects of SI-CBT and active treatments were not significantly different. In conclusion, our data support the current clinical guidelines, although better comparisons between SI-CBT and SRIs are needed.
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