Intensive cognitive behavioral therapy for obsessive-compulsive disorder: a meta-analysis of randomized controlled trials

Abstract

Background Intensive cognitive behavioral therapy (CBT) delivers more or longer sessions over a shorter time than standard CBT. This review aimed to examine the effects of intensive CBT in comparison to non-active conditions and other active treatments for obsessive-compulsive disorder (OCD). Method We analyzed standardized mean difference (SMD) at post-treatment and follow-up for OCD symptoms, depression, anxiety, and family accommodation (FA). Moderator analyses and meta-regression were conducted to investigate factors associated with OCD symptom reduction. Results Fourteen randomized controlled trials (n = 786) were included. At post-treatment, the effect of intensive CBT varied by comparator types. It was significant against non-active/minimal intervention controls (SMD = -1.74, 95% CI [-2.53, -0.95], p < 0.001) and not significant against active psychological treatments or pharmacotherapy. Significant improvements were also found for depression, anxiety, and FA. Exploratory meta-regression suggested that higher weekly treatment intensity (hours per week) was associated with greater symptom reduction, although this finding should be interpreted cautiously due to the limited number of studies. Follow-up analyses suggested sustained OCD improvement, while secondary outcome data were limited. The certainty of evidence was low to very low across outcomes at post-treatment. Discussion Intensive CBT appears superior to non-active controls, while its advantage over active treatments remains uncertain and the certainty of the evidence is low to very low. The substantial heterogeneity and potential publication bias require cautious interpretation. Future high-quality RCTs with longer follow-up are needed. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022365015.