Mindfulness- and acceptance-based programmes for obsessive-compulsive disorder: A systematic review and meta-analysis.

Mindfulness- and acceptance-based programmes (MABPs) produce large reductions in obsessive-compulsive disorder (OCD) severity, according to a meta-analysis of 46 trials involving 2221 patients. In randomized controlled trials, MABPs outperformed medication and waitlist controls but did not differ from cognitive behavioral therapy or exposure and response prevention. Depressive symptoms decreased with small to moderate effects, and improvements in anxiety, obsessive beliefs, and quality of life were moderate to large. Increases in mindfulness and psychological flexibility predicted OCD symptom reductions. Outcomes were not moderated by treatment duration or therapist characteristics. The authors call for more high-quality trials with long-term follow-ups to confirm the findings.

Study at a glance

Abstract

Mindfulness- and acceptance-based programmes (MABPs) in the treatment of obsessive-compulsive disorder (OCD) are increasingly gaining research interest, yet a comprehensive systematic review and meta-analysis is missing. To fill this gap, we analysed 46 trials involving 2221 patients. Two independent reviewers screened records, extracted data, assessed risk of bias, and rated overall quality of evidence. MABPs were associated with large reductions in OCD-severity in between-group analysis in randomised controlled trials (k = 33; g = -.87; CI = -1.13,-.60) and within-group pre-post analysis in all MABPs (k = 49; g = -1.72; CI = -2.00,-1.44). Depressive symptoms decreased between- and within-group with a small to moderate effect, with maintained reductions at follow-up for both OCD and depression. Moderate to large pre-post improvements were also observed in anxiety, obsessive beliefs, and quality of life. MABPs did not differ from cognitive behavioural therapy and exposure and response prevention (k = 9; g=.02; CI = -.23,.26) but were superior to medication (k = 5; g = -.77; CI = -1.44,-.11) and waitlist (k = 16; g = -1.66; CI = -2.1,-1.24). Symptom reductions were observed across world regions, but to varying degrees. When combined, increases in mindfulness and psychological flexibility predicted reductions in OCD symptoms. Outcomes were not moderated by treatment duration, samples', and therapists' characteristics. MABPs can reduce OCD-severity, but further high-quality trials with long-term follow-ups are needed to confirm results.