Systematic Review and Meta-Analysis: Cognitive-Behavioral Therapy for Obsessive-Compulsive Disorder in Children and
Camilla Funch Uhre1, Valdemar Funch Uhre2, Nicole Nadine Lønfeldt3
1Child and Adolescent Mental Health Centre, Mental Health Services, Capital Region, Denmark; Faculty of Health Sciences, University of Copenhagen, Denmark.
Insights
Cognitive-behavioral therapy (CBT) shows promise for treating pediatric obsessive-compulsive disorder (OCD) compared to no intervention. While comparable to SSRIs, evidence certainty is low, requiring further research.
Area of Science:
- Pediatric Psychiatry
- Child Psychology
- Clinical Neuroscience
Background:
- Pediatric obsessive-compulsive disorder (OCD) significantly impacts children's lives.
- Cognitive-behavioral therapy (CBT) is a common treatment approach.
- Understanding CBT's efficacy and safety compared to other interventions is crucial.
Purpose of the Study:
- To evaluate the benefits and harms of CBT versus no intervention for pediatric OCD.
- To compare CBT with other interventions, such as selective serotonin reuptake inhibitors (SSRIs), for pediatric OCD.
- To assess primary outcomes including OCD severity, functioning, and adverse events.
Main Methods:
- Systematic review of randomized clinical trials (RCTs) on CBT for pediatric OCD.
- Inclusion of 9 trials (N=645) comparing CBT to no intervention.
- Inclusion of 3 trials (N=146) comparing CBT to SSRIs.
- Assessment of OCD severity, functioning, quality of life, and adverse events.
- Risk of bias assessment and certainty of evidence evaluation using GRADE.
Main Results:
- CBT significantly decreased OCD severity and improved functioning compared to no intervention (low to very low certainty evidence).
- CBT showed similar effectiveness to SSRIs in reducing OCD severity and remission rates (very low certainty evidence).
- Adverse event proportions were similar between CBT and no intervention; data on serious adverse events and quality of life were insufficient.
Conclusions:
- CBT may be more effective than no intervention and comparable to SSRIs for pediatric OCD.
- The certainty of these effect estimates is very low, highlighting the need for high-quality research.
- Further investigation is warranted to confirm CBT's efficacy and safety profile in pediatric OCD populations.
Objective:
To assess benefits and harms of cognitive-behavioral therapy (CBT) versus no intervention or versus other interventions for pediatric obsessive-compulsive disorder (OCD).
Method:
We searched for randomized clinical trials of CBT for pediatric OCD. Primary outcomes were OCD severity, serious adverse events, and level of functioning. Secondary outcomes were quality of life and adverse events. Remission from OCD was included as an exploratory outcome. We assessed risk of bias and evaluated the certainty of the evidence with the Grading of Recommendations Assessment, Development and Evaluation (GRADE).
Results:
Nine trials (N = 645) were included comparing CBT with no intervention and 3 trials (N = 146) comparing CBT with selective serotonin reuptake inhibitors (SSRIs). Compared with no intervention, CBT decreased OCD severity (mean difference [MD] = -8.51, 95% CI = -10.84 to -6.18, p < .00001, low certainty), improved level of functioning (patient-rated: standardized MD [SMD] = -0.90, 95% CI = -1.19 to -0.62, p < .00001, very low certainty; parent-rated: SMD = -0.68, 95% CI = -1.12 to -0.23, p = .003, very low certainty), had similar proportions of participants with adverse events (risk ratio = 1.06, 95% CI = 0.93-1.22, p = .39, GRADE: low certainty), and was associated with reduced risk of still having OCD (risk ratio = 0.50, 95% CI = 0.37-0.67, p < .00001, very low certainty). We had insufficient data to assess the effect of CBT versus no intervention on serious adverse events and quality of life. Compared with SSRIs, CBT led to similar decreases in OCD severity (MD = -0.75, 95% CI = -3.79 to 2.29, p = .63, GRADE: very low certainty), and was associated with similar risk of still having OCD (risk ratio = 0.85, 95% CI = 0.66-1.09, p = .20, very low certainty). We had insufficient data to assess the effect of CBT versus SSRIs on serious adverse events, level of functioning, quality of life, and adverse events.
Conclusion:
CBT may be more effective than no intervention and comparable to SSRIs for pediatric OCD, but we are very uncertain about the effect estimates.
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