[Table], Characteristics of Included Studies - Obsessive-Compulsive Disorder

Characteristics of Included Studies

Methods	Participants	Outcomes	Interventions	Notes
BARRETT2004

Study Type: RCT Study Description: Allocation: random, blocked by child's age and timing of referral; assessors blind to treatment group Duration of study: 14 weeks, 3&6-mo follow-up Blindness: Single blind Duration (days): Setting: Not reported Notes: Country of study: Australia; Analysis: ITT Info on Screening Process: Not reported	N= 77 Age: Mean 12 Sex: 38 males 39 females Diagnosis: OCD by DSM-IV Exclusions: Primary major depression or another primary anxiety disorder, primary externalizing disorder, Tourette's syndrome, autistic spectrum disorder, schizophrenia, organic mental disorder, mental retardation, receiving concurrent psychotherapy Inclusions: those receiving psychopharmacological treatment, were receiving stable doses of the drug, had normal IQ and at least one parent was willing to attend weekly sessions Notes: Baseline Y-BOCS (child version) 22.66; common compulsions: cleaning/washing rituals, checking for reassurance, common obsessions: fears of contamination/illness or disease, fears of harm to self and others	Data Used Multidimensional Anxiety Scale in Children-sibling Sibling accomodation Child Depression Inventory - sibling Child Depression Inventory - patient Father Stress Father Depression Father Anxiety Multidimensional Anxiety Scale for Children Mother Stress Mother Depression Mother Anxiety McMaster Family Assessment Device - Mother McMaster Family Assessment Device - Father Children's Yale-Brown Obsessive-Compulsive Scale NIMH Global OCD Scale	Group 1 N= 24 Wait list control Group 2 N= 24 Cognitive Behavioural Therapy -Individual CBT: 14 sessions +2 booster sessions at 1&3 months post-treatment, duration 1.5 hours, parent skills training, family review of progress, 3 components: 1.psychoeducation, anxiety management, cognitive therapy, 2.ERP, 3.maintenance of gains Group 3 N= 29 Cognitive behavioural therapy - group - In 8 groups ranging from 3 to 6 participants per group (see Individual CBT for intervention details)
CORDIOLI2003

Study Type: RCT Study Description: Allocation: random (computer-generated random numbers list by an independent researcher); raters were blind to treatment Duration of study: 12 weeks Blindness: Single blind Duration (days): Setting: Not reported Notes: Country of study: Brazil; Analysis: ITT; Participants recruited through media advertisement Info on Screening Process: 65 screened, 18 excluded: depression with suicide risk (2), OCD secondary to brain injury (1), severe social phobia (2), mental retardation (1), severe anorexia nervosa (1), severe personality disorders (2), Y-BOCS<16 (3), refused treatment (6)	N= 47 Age: Mean 36 Sex: 23 males 24 females Diagnosis: OCD by DSM-IV Exclusions: Aged <18 and >65 years, Y-BOCS <16, taking anti-obesessional medication <3 months before study Notes: mean duration of OCD 21.1 years; mean baseline Y-BOCS 27 Sessions conducted by therapist with 10 years experience in CBT	Data Used WHO-QoL Abbreviated Social WHO-QoL Abbreviated Psychological WHO-QoL Abbreviated Physical Overvalued Ideas Scale Responders (35% Y-BOCS) Leaving study early Hamilton Rating Scale for Depression Hamilton Rating Scale for Anxiety NIMH Obsessive Compulsive Rating Yale-Brown Obsessive-Compulsive Scale: total	Group 1 N= 23 Cognitive behavioural therapy - group -7-8 participants per group, 12 weekly 2-hour sessions, treatment consisted of practical exercises of exposure-response prevention and cognitive restructuring, homework exercises and focus on strategies for relapse prevention Group 2 N= 24 Wait list control
COTTRAUX2001

Study Type: RCT Study Description: Allocation: random (no details), assessor blind to treatment allocation Duration of study: 16 weeks treatment + 26 and 52-week follow-up Blindness: Single blind Duration (days): Setting: Outpatient Notes: Country of study: France; Analysis: ITT Therapists were psychologists or psychiatrists with a CBT diploma, received additional training of 20h Info on Screening Process: 85 screened, 20 met exclusion criteria	N= 65 Age: Mean 36 Sex: 16 males 46 females Diagnosis: OCD by DSM-IV Exclusions: Aged <18 and >65 years, taking psychotropic medication, apart from hypnotic drugs, NIMH-OC<7, Y-BOCS<16; psychosis, Tourette syndrome, addiction, pregnancy, major depression and/or Hamilton Depression score >20, or suicidal ideation Notes: Mean OCD duration 13.45 years; number with Axis 1 comorbidity 23	Data Used Responders (25% Y-BOCS) Quality of Life Beck Depression Inventory Salkovskis Responsibility Scale ITIQ - Responsibility ITIQ - Interpretation/intrusion ITIQ - Instrusive thoughts ITIQ - Inferiority ITIQ - Guilt Behavioural Avoidance Test - Discomfort Behavioural Avoidance Test - Avoidance Yale-Brown Obsessive-Compulsive Scale: total Leaving study early	Group 1 N= 32 Cognitive therapy - Based on Beckian model, 20 1-h sessions over 16 weeks; consisted of elicitation of intrusive and automatic throughts, dysfunctional danger, responsibility schemas, Socratic discussion, modification of unrealistic interpretations and magical thinking Group 2 N= 33 Individual BT - 20 hours over 16 weeks - first 4 weeks 2 2-hour session per week, maintenance phase of 12 weeks with 40min booster sessions every 2 weeks, therapist-aided Ex/RP in imagination and/or in vivo, Ex/RP through homework and family intervention
DEARAUJO1995

Study Type: RCT Study Description: Allocation: random (no details); ratings by independent blind assessor Study duration: 9 weeks treatment + 20- & 32-week follow-ups Blindness: Single blind Duration (days): Setting: Outpatient Notes: Country of study: UK; Analysis: completer Therapists (2 of the authors and nurse therapists) were experienced in procedures and followed a protocol Info on Screening Process: Not reported	N= 56 Age: Mean 33 Sex: 23 males 23 females Diagnosis: OCD by DSM-III-R Exclusions: OCD duration <1 year, current depression (BDI>=15), suicidal intent, psychosis, organic disease, failure to stop previous medication for at least 15 days before treatment Notes: Mean OCD duration 12 years	Data Used Target rituals (assessor rated): time Compulsive activity checlist Fixity Social Adjustment Scale (self-rated) Anxiety during exposure Target rituals (self rated): discomfort Target rituals (self rated): time Yale-Brown Obsessive-Compulsive Scale: obsessions Clinical Global Impressions Target rituals (assessor rated): discomfort Relapse	Group 1 N= 28 ERP - imaginal and live exposure - 90-sub min sessions, treatment consisted of con devising & performing self-exposure tasks and not engaging in rituals, listening to their own voice describing imagined situations that evoked fear, daily homework sessions (60min live + 30 min imagined exposure) Group 2 N= 28 ERP - live exposure only - Weekly 90-min sessions, treatment consisted of devising & performing self-exposure tasks and not engaging in rituals, remaining in the anxiety-evoking situations until anxiety had dropped, daily homework sessions (60min live) based on therapy sessions	Outcome details Fixity: 3 0-8-point subscales: belief in consequences of not ritualizing, insight, conviction Bizarreness: 0-8 point measure of how bizarre belief is Relapse: loss of 50% improvement on several scales
EMMELKAMP1983

Study Type: RCT Study Description: Allocation: random (no details) Duration of study: 5 weeks treatment + 1-month & 6-month follow-up Blindness: No mention Duration (days): Setting: Outpatient Notes: Country of study: the Netherlands, Analysis: completer Therapists were 8 advanced clinical psychology students who had received training in BT Info on Screening Process: 15 met criteria, 1 did not accept treatment rationale and refused treatment, 2 were unable to carry on homework assignments and dropped out	N= 12 Age: Mean 33 Range 21-52 Sex: 2 males 10 females Diagnosis: OCD by Not reported Exclusions: OCD not main problem and not severe enough to warrant intensive treatment, not married or not living together with partner, not willing to attend sessions as couple, previous behavioural treatment Notes: Mean OCD duration 7 years (range 1.5-26 years)	Data Used Maudsley Marital Questionnaire Anxious mood and depression Self-Rating Depression Scale Maudsley Obsessive-Compulsive Inventory Anxiety Discomfort Scale	Group 1 N= 6 Self-controlled exposure in vivo - 10 45-min sessions, hierarchy of fears constructed, at each session patient was given several tasks to perform at home starting with easiest, patient decided speed of working through tasks, included self-controlled response prevention Group 2 N= 6 Partner-assisted exposure - 10 twice weekly treatment sessions at which partner accompanied patient, at home partner encouraged patient and helped him confront distressing stimuli until the patient got used to them, partner had to withold reassurance, included response prevention
EMMELKAMP1988

Study Type: RCT Study Description: Allocation: random (no details) Duration of study: 8 weeks + 1-month + 6-month follow-ups Blindness: No mention Duration (days): Setting: Not reported Notes: Country of study: the Netherlands; Analysis: completer Therapists were 9 advanced clinical psychology students who had received training in CBT	N= 18 Age: Mean 30 Range 20-56 Sex: 9 males 9 females Diagnosis: OCD by DSM-III Exclusions: Previous behavioural treatment Notes: Mean OCD duration: 6.6 years;	Data Used Responder:Anixety Discomfort Scale 70% improvement Hostility & Direction of Hostility:Intrapunitivity Hostility & Direction of Hostility:Extrapunitivity Social Anxiety Scale Anxiety Discomfort Scale Self-Rating Depression Scale Irrational Belief Inventory Maudsley Obsessive-Compulsive Inventory	Group 1 N= 9 Cognitive therapy - 14 twice-weekly 1-hour group sessions; treatment based on ABC framework (person's Activating event, Belief about event, Consequences of belief), patients used ABC homework sheets, irrational beliefs were challenged using a Socratic design Group 2 N= 9 Group BT - 14 twice-weekly 1-hour group sessions; a hierarchy of fears constructed from which homework tasks performed for 90 minutes twice weekly, all items practiced in vivo; treatment components: self-controlled exposure in vivo, self-imposed response prevention
EMMELKAMP1991

Study Type: RCT Study Description: Allocation: random (no details) Duration of study: 44 weeks (see notes for study design) Blindness: No mention Duration (days): Setting: Not reported Notes: Country of study: the Netherlands; Analysis: completer Therapists were advanced clinical psychology students who had done CBT Info on Screening Process: 31 met criteria, 1 refused treatment because she did not expect that treatment would help her	N= 21 Age: Sex: 10 males 11 females Diagnosis: OCD by DSM-III Exclusions: Aged <18 and >65 years, OCD duration <half a year, received previous cognitive or behavioural treatment, psychosis, being suicidal Notes: OCD duration: <5 yrs (n=10), >5 yrs (n=11) Study design: 2 assessment/preparatory sessions + 4-wk waiting period + 6 CT or BT treatment sessions over 4 wks + 4-wk waiting period + 6 CBT or BTsessions over 4 wks + 4-wk follow-up + 6 month follow-up	Data Used Dutch Obsessive-Compulsive Questionnaire Self-Rating Depression Scale Irrational Belief Inventory Anxiety Discomfort Scale Maudsley Obsessive-Compulsive Inventory	Group 1 N= 10 Cognitive therapy - Treatment based on ABC framework (person's Activating event, Belief about event, Consequences of belief), patients used ABC homework sheets and analysed irrational beliefs 6 days a week for 30 min, irrational beliefs challenged using a Socratic design Group 2 N= 11 Individual BT - A hierarchy of fears constructed from which homework tasks performed for 90 minutes twice weekly, all items practiced in vivo starting with the easiest; self-controlled exposure in vivo, self-imposed response prevention
FOA2005

Study Type: RCT Study Description: Allocation: random (no details); indepentent assessor blind to randomization Duration of study: acute phase 12 weeks + discontinuation phase 12 weeks Blindness: Single blind Duration (days): Setting: Outpatient Notes: Country of study: US Info on Screening Process: 833 screened, 312 did not meet criteria: no OCD (93), received EX/RP or CMI (117), excluded for medical reason (22), comorbidity (75), other reasons (5), unwilling to participate (65), refused to receive CMI (56), or EX/RP (54) or placebo (6), other (191)	N= 122 Age: Mean 35 Sex: 64 males 58 females Diagnosis: Obsessive-compulsive neurosis by DSM-III-R Exclusions: Aged <18 and >70 years, OCD duration <1 year, Y-BOCS<17, current major depression, HAM-D>18, substance abuse or dependence within past 6 months, current schizotypal or borderline personality disorder, previous intensive treatment with CMI or ERP Notes: Duration of illness 16.4 years, baseline Y-BOCS scores 25	Data Used Responders (CGI) Yale-Brown Obsessive-Compulsive Scale: total Leaving study early Clinical Global Impressions Adverse events NIMH-OC	Group 1 N= 36 Clomipramine - Fixed dose first 5 weeks, starting at 25mg/d, increasing to 200mg/d, increased to 250mg/d as tolerated, mean final dose 196mg/d Group 2 N= 26 Placebo - Mean final dose for 209mg/d Group 3 N= 29 Exposure + response prevention - 15 2-hr sessions over first 3 weeks and 2 home visits, weekly 45 min meetings for remaining 8 weeks, imaginal and in vivo exposure performed Group 4 N= 31 BT + clomipramine - ERP + CMI, patients met individually with both a therapist and a psychopharmacologist, mean final dose 163+-65mg/d	Responders: CGI=<2
FREESTON1997

Study Type: RCT Study Description: Allocation: random (no details) Duration of study: mean 19 weeks Participants referred by professionals or directly contacted the treatment centre Blindness: Open Duration (days): Mean 133 Setting: Not reported Notes: Country of study: Canada, Analysis: ITT Info on Screening Process: 199 responded, 97 interviewed, no anxiety disorder (12), anxiety disorders other than OCD (11), dominant compulsions (21), below entry-level severity criteria (8), other comorbid conditions (8)	N= 29 Age: Mean 36 Sex: 16 males 13 females Diagnosis: OCD by DSM-III-R Exclusions: Overt compulsions, primary mood disorders, psychoactive substance abuse disorder, psychotic disorder, organic mental disorder, paraphilia or impulse control disorder, medication not stabilized by 12 weeks Notes: Mean OCD duration 9.4 years, baseline Y-BOCS 23.5, therapists were graduate students trained in cognitive behavioural techniques		Group 1 N= 15 Cognitive Behavioural Therapy - 1.5h sessions twice weekly, mean of 25.7 sessions, terminated if sufficient clinical improvement or reached 40 sessions, training on exposure and response prevention using hierarchies of thought, cognitive restructuring, relapse prevention Group 2 N= 14 Wait list control - Average length of waiting was 18.7 weeks
GREIST2002

Study Type: RCT Study Description: Allocation: random (no details) Duration of study: 2 weeks assessment + 10 weeks therapy Blindness: Open Duration (days): Setting: Not reported Notes: Country of study: US (8 sites), Analysis: ITT Info on Screening Process: 16 placebo responders, 5 did not complete assessment tasks, 12 violated protocol, 2 withdrew	N= 218 Age: Mean 39 Range 15-80 Sex: Diagnosis: OCD by DSM-IV Exclusions: Y-BOCS<16, Y-BOCS compulsions subscale <7; history of Tourette's disorder, schizophrenia, bipolar disorder, psychosis, primary major depression Notes: Mean OCD duration 22 +-12 years; 24% had secondary diagnosis of mental disorder; 51% had not taken an SRI for at least 2 weeks before study; baseline Y-BOCS 25 +-5; baseline HRSD 10+-8	Data Used Relapse Hamilton Rating Scale for Depression Yale-Brown Obsessive-Compulsive Scale: total	Group 1 N= 74 Computer-guided BT - Used “BT STEPS”, steps 1-3 concern education and assessment, steps 4-9 guide daily self-exposure to triggers of rituals, obsessions and discomfort, self-imposed ritual prevention, planning and performing of self-exposure homework, relapse prevention Group 2 N= 69 Clinician-guided BT - 11 weekly 1-hour sessions to discuss self-exposure homework to be done daily for an hour and recorded in diaries Group 3 N= 75 Control - Patients received relaxation therapy - performed relaxation exercises for minimum 1 hour daily, record in daily relaxation diaries	Y-BOCS self-rated WSAS self-rated
HISS1994

Study Type: RCT Study Description: Allocation: random (no details) Duration of study: 3 weeks ERP + 1 week relapse prevention/associate therapy + 6-month follow-up Blindness: No mention Duration (days): Setting: Not reported Notes: Country of study: US; Analysis: ITT Therapists were 4 doctoral-level clinical psychologists with expertise in ERP with OCD Info on Screening Process: Not reported	N= 20 Age: Mean 31 Sex: 12 males 8 females Diagnosis: OCD by DSM-III-R Exclusions: Not reported Notes: Mean OCD duration 11 years; primary compulsion washing (n=6), primary compulsion checking (n=8), washing and checking (n=3), cognitive rituals (n=1)	Data Used Obsessive-compulsive symptom severity Responders (50% Y-BOCS) State-Trait Anxiety Inventory Beck Depression Inventory Hamilton Rating Scale for Depression Yale-Brown Obsessive-Compulsive Scale: total	Group 1 N= 8 BT + relapse prevention - BT: 15 90-min daily sessions over 3 weeks, imaginal and in vivo exposure + response prevention, homework assignments Relapse prevention: 4 90-min sessions over 1 week, training in self-exposure and cognitive restructuring, how to deal with set-back Group 2 N= 10 BT + associative therapy - BT: see BT + relpase prevention intervention Associative therapy: 4 90-min sessions over 1 week, deep muscle relaxation, free association about OC symptoms by patient and by patient's significant other	Obsessive-Compulsive Symptom Severity: measured obsessive fear, avoidance, and ritualistic behaviour on 9-point scale, range 0-24, rated by independent assessor
KENWRIGHT2004

Study Type: RCT Study Description: Allocation: random (sealed-envelope) Duration of study: 17 weeks Blindness: No mention Duration (days): Setting: Outpatient Notes: Country of study: US BTSTEPS is an interactive-voice-response system which guides E/RP in 9 steps Info on Screening Process: 48 referred by a GP or psychiatrist, 4 were unsuitable - 3 wanted at least some face-to-face sessions, 1 had no OCD	N= 44 Age: Mean 40 Sex: 21 males 23 females Diagnosis: OCD by DSM-IV Exclusions: OCD duration<2 years, schizophrenia, bipolar disorder or other psychosis, primary major depression, suicidal plans, alcohol or substance abuse, not on stable dose of SRI Notes: Mean OCD duration 16+-13 years, mean baseline Y-BOCS 26+-6.2; included patients with cleaning (45%), checking (34%), reapeating/ordering (39%), hoarding (5%), mental rituals (31%) and sexual, violent or blasphemous obsessions (33%)	Data Used Leaving study early Work and Social Adjustment Scale Target rituals (assessor rated): discomfort Yale-Brown Obsessive-Compulsive Scale: obsessions Yale-Brown Obsessive-Compulsive Scale: compulsions Yale-Brown Obsessive-Compulsive Scale: total	Group 1 N= 22 BT Steps + requested support - Patient advised to phone the clinic for help with working through BTSteps. Mean total support time per patient 16 minutes over 1.5 calls Group 2 N= 22 BT Steps + scheduled support - 9 telephone calls were scheduled to review progress and to help work through exposure issues. Mean total support time per patient 76 minutes over a mean of 7.5 calls
KHEMLANIPATEL2001

Study Type: RCT Study Description: Allocation: random assigment for first participant, then alternate allocation to each treatment for following participants Duration of study: 16 week Blindness: Single blind Duration (days): Setting: 17 recruited, 7 dropped out Notes: Country of study: US; Analysis: completer Therapists were a doctoral intern with Master's degree, 2 licensed clinical psychologists	N= 10 Age: Mean 32 Range 21-54 Sex: 7 males 3 females Diagnosis: BDD by DSM-IV Exclusions: Not pre-occupied with imagined defect in appearance, preoccupation did not resut in significant distress, preoccupation better accounted for by Anorexia Nervosa or Transsexualism, patient wanted to continue other psychological treatment during study, medication was not stablized 3 months before study Notes: 6 had comorbid OCD, 5 had comorbid affective disorder		Group 1 N= 5 Cognitive Behavioural Therapy - Four wks CT+4 wks ERP (12 90-min sessions each); CT based on Beck (1995) & Geremia (1997), therapists modeled how to transform negative irrational thinking into rational adaptive thoughts; for ERP hierarchy of 3 most distressing symptoms constructed Group 2 N= 5 Individual BT - 8 wks of 24 90-min sessions; ERP involved constructing hierarchy of 3 most distressing symptoms, subjective units of distress were recorded each week, most distressing symptoms were treated first, used paradoxical intention during exposure sessions
LINDSAY1997

Study Type: RCT Study Description: Allocation: random (no details) Duration of study: 3 weeks Blindness: Open Duration (days): Setting: Outpatient Notes: Country of study: Australia; Analysis: ITT Info on Screening Process: Not reported	N= 18 Age: Mean 33 Sex: 6 males 12 females Diagnosis: Exclusions: Not reported Notes: Mean OCD duration 11 years (range 1-26 years)	Data Used PADUA State-Anxiety Inventory Maudsley Obsessive-Compulsive Inventory Beck Depression Inventory Y-BOCS (self-report version)	Group 1 N= 9 Individual BT - Exposure and response prevention: 15 hours face-to-face therapy over 3 weeks, graded exposure to situations previously associated with obsessional thoughts or impulses, self-imposed prevention of compulsive rituals, homework exposure tasks Group 2 N= 9 Control - Anxiety management: comprised teaching techniques, such as breathing for management of hyperventilation, progressive muscle relaxation, structured problem-solving about non-OCD life stressors and practicising this at home
LOVELL1994

Study Type: RCT Study Description: Allocation: random (no details) Duration of study: 8 weeks Patients were referrals from the Psychological treatment unit, Maudsley Hospital Blindness: No mention Duration (days): Setting: Not reported Notes: Country of study: UK; Analysis: completer Info on Screening Process: 17 referrals, 5 dropouts: 1 withdrawal at week 2 due to depression, 4 (1 exp; 3 neutral) dropped out	N= 12 Age: Mean 35 Sex: 5 males 7 females Diagnosis: OCD by DSM-III Exclusions: Aged <18 and >65 years, obsessive thoughts were not dominant feature, OCD duration<1 year, severe motor rituals, on stable doe of medication<3 months, taking >10mg diazepam equivalents, >3 units of alcohol daily, psychotic, severe affective, or physical illness Notes: Mean OCD duration 14 +-11 years, most common obsessive theme was harm/aggression towards others	Data Used Responders (“much improved” on ruminations Adjustment rating scales Beck Depression Inventory Compulsive activity checlist Target rituals (assessor rated): time Target rituals (assessor rated): discomfort	Group 1 N= 6 Individual BT - Audiotaped exposure to patient's anxiogenic thoughts as identified by therapist & patient: 8 weekly sessions, patient recorded anxiogenic thoughts onto 30sec loop audiotape, anxioloytic thoughts excluded, listening to audiotaped material 1 h twice daily Group 2 N= 6 Control - Neutral prose or poetry: patients recorded neutral non-anxiogenic material onto a 30-sec loop-tape which could be played as long as desired, 8 weekly sessions, listening to audiotaped material 1 h twice daily	Adjustment rating scales (9-point scales): work, home, social, private Responders: mean reduction in ruminations discomfort and time and in main problem and target of 16 or more Other measures: Main problem and target, assessor-rated (9-point scale)
MCLEAN2001

Study Type: RCT Study Description: Allocation: random (no details) Duration of study: 3 months treatment + 3 months follow-up Blindness: No mention Duration (days): Setting: Not reported Notes: Country of study: US; Analysis: completer Therapists were licenced clinical psychologists Info on Screening Process: Not reported	N= 93 Age: Mean 35 Range 18-56 Sex: 33 males 30 females Diagnosis: OCD by DSM-IV Exclusions: Aged <18 and >65 years, not fluent in written and spoken English, active thought disorder, mental retardation or organic mental disorder, commencement or change in psychotropic medication in the 3 months prior to assessment, any physical condition that would prevent completion of treatment, concurrent psychological treatment for current Axis I or II disorder Notes: Mean baseline Y-BOCS22; 33 participants were waitlisted for 3 months before receiving treatment; of 63 completers, 30 were using medication for OCD: multiple medications (6), SSRI alone (13), TCA alone (5), benzodiazepines alone (4), other (2)	Data Used Responder: Y-BOCS<12 + Y-BOCS 6-point reduction Responsibility Attitude Scale Yale-Brown Obsessive-Compulsive Scale: total Yale-Brown Obsessive-Compulsive Scale: obsessions Yale-Brown Obsessive-Compulsive Scale: compulsions Beck Depression Inventory	Group 1 N= 49 Cognitive Behavioural Therapy -Treatment conducted in groups of 6-8, 12 weekly sessions, 2.5 hr per session, al based on Salkovskis (1996) model -trigger leads to an intrusive thought followed by an appraisal, followed by distress and urge to neutralise or engage in compulsive behaviour Group 2 N= 44 Group BT - Treatment conducted in groups of 6-8, 12 weekly sessions, 2.5 hr per session, consisted of exposure and response prevention, hierarchy of fears developed, homework assignments performed
MEHTA1990

Study Type: RCT Study Description: Allocation: random (no details) Duration of treatment: 14 weeks (24 sessions, 2 per week) Blindness: Open Duration (days): Setting: Outpatient Notes: Country of study: India	N= 30 Age: Mean 34 Range 17-56 Sex: 19 males 11 females Diagnosis: OCD by DSM-III Notes: Duration of illness 3 years	Data Used Global Assessment of Severity: Occupation Global Assessment of Severity: leisure Global Assessment of Severity: household responsib Global Assessment of Severity: Family Zung Depression Rating Scale Montgomery-Asberg Depression Rating Scale	Group 1 N= 15 Family-based BT - Self-observation, monitoring of distressing symptoms, training in relaxation therapy, systematic desensitization and ERP, a family member acted as co-therapist who assisted in completing homework assignments, in relaxation therapy and response prevention Group 2 N= 15 Individual BT - Self-observation, monitoring of distressing symptoms, training in relaxation therapy, systematic desensitization and ERP, no instructions were given to the family
MORITZ1998

Study Type: Cross-over Study Description: Allocation: random, rater blind to treatment Duration of study: 18 wks -3 weekly contact sessions + 6 wks treatment (2 sessions per wk) in each arm Blindness: Single blind Duration (days): Setting: Outpatient Notes: Country of study: US; Analysis: completer; participants were community referrals and responders to media announcements Info on Screening Process: 8 included; dropped out due to lack of improvement (1); excluded: baseline CY-BOCS<15 (1); needed behavioural management for which the parents did not want to wait till end of study (2)	N= 4 Age: Mean 8 Range 6-11 Sex: all males Diagnosis: OCD by DSM-IV Exclusions: Age<11 years; Y-BOCS<15, OCD duration<6 months, not on stable doses of psychotropic medication; diagnosis of trichotillomania or nail-biting, schizophrenia, depression or bipolar disorder, severe mentally retarded patients, anorexia nervosa, bulimia nervosa, severe neurological disorder Notes: Mean baseline Y-BOCS 29.25	Data Used Parent Checklist for Compulsive Activities NIMH Global OCD Scale Children's Yale-Brown Obsessive-Compulsive Scale Data Not Used Subjective Units of Distress Scale - no data Behaviour Assessment System for Children -Parent - no pre-cross-over data	Group 1 N= 2 Individual BT - Game-like behavioural program: 2 sessions per week, duration 60-min, parents took part in 50% of games; 24 games in total; games addressed psychoeducation, reassurance-seeking behaviour, doubting, fear of not saying “right thing”, asymmetry problems, etc. Group 2 N= 2 Control - Comprised non-therapeutic mainstream games purchased at toy-store; games such as monopoly, hangman, tic tac toe	Subjective Units of Distress Scale: anxiety scores during each game no overall distress score reported
ROSEN1995

Study Type: RCT Study Description: Allocation: random (no details) Duration of study: 10 weeks Blindness: No mention Duration (days): Setting: Outpatient Notes: Country of study: US; Analysis: ITT Info on Screening Process: 156; excluded: BDD symptoms not severe enough (58), significant physical abnormality (38), anorexia or bulimia nervosa (11), severe depression with suicidal behaviour (1), male (15)	N= 54 Age: Mean 36 Range 20-61 Sex: all females Diagnosis: BDD by DSM-III-R Exclusions: Male, significant physical abnormality, anorexia or bulimia nervosa Notes: Inclusion: Moderate to severe on items of the Body Dysmorphic Disorder examination and total score 1.25 S.D. above norm for adult women (>61)	Data Used Brief Symptom Inventory Multidimensional Body Self-Relations Questionnaire Rosenberg Self-Esteem Scale Responders (DSM-BDD, BDDE) Body Shape Questionnaire BDD Examination	Group 1 N= 27 Cognitive Behavioural Therapy -Treatment provided in groups of 4 or 5, consisted of 8 weekly 2-hour sessions, consisted of exposure therapy, thought stopping and relaxation, response prevention to decrease body-checking behaviour, participants kept body-image diary Group 2 N= 27 Wait list control - Participants were promised CBT after a minimum 10-week waiting period	Responder: (a) no longer meeting DSM-BDD criteria, (b) post-treatment BDDE score 2 S.E.s below baseline score
SHANNAHOFFKHALS1999

Study Type: RCT Study Description: Allocation: random (no details); participants not informed about meditation protocol Duration of study: 3 months (phase 1-RCT) + 12 months (phase 2) Blindness: Single blind Duration (days): Setting: Outpatient; patients recruited through television news commentary, newspaper advertisement, physician referral Notes: Country of study: US; Analysis: LOCF for Y-BOCS, completer for other outcomes Therapists were previously training in respective treatments Info on Screening Process: 130 adults +5 adolescents screened, 93 adults + 1 adolescent failed to meet initial criteria	N= 22 Age: Mean 39 Sex: 7 males 14 females Diagnosis: OCD by DSM-III-R Exclusions: Y-BOCS<15; aged<14 years; medication was not stablized for at least 3 months before study, patients smoked, had substance abuse disorder, or had spinal or other physically limiting problems that could interfere with meditation practice, such as being excessively overweight, seizure disorder, pulmonary disorder, hypertension, other cardiovascular disorders, primary diagnosis of schizophrenia, depression, bipolar disorder, mental retardation, anorexia nervosa, bulimia, tourette's syndrome, trichotillomania Notes: Baseline Y-BOCS 22.8; four patients had trichotillomania; if treatments differed significantly at the end of 3 months (phase 1), the two treatments were merged (phase 2) which lasted for 12 months	Data Used Leaving study early Purpose in Life test Profile of Moods scale Perceived Stress Scale Symptom Checklist-90 Yale-Brown Obsessive-Compulsive Scale: total	Group 1 N= 12 Yoga - Employed the Kundalini yoga protocol, includes 8 primary techniques, including a yogic breathing technique (blocking right nostril, slow deep inspiration through left nostril, breath retention, and slow complete expiration) and 3 nonmandatory techniques Group 2 N= 10 Relaxation response and mindfulness meditation - Relaxation response (RR) and Mindfulness meditation (MM) are passive techniques, RR requires a constant mental focus and repetition of a self-selected special word or phrase, MM requires conscious observation of thoughts
VANOPPEN1995

Study Type: RCT Study Description: Allocation: random (no details) Duration of study: 16 weeks Blindness: No mention Duration (days): Setting: Outpatient Notes: Country of study: the Netherlands; Analysis: completer	N= 57 Age: Mean 35 Sex: 17 males 30 females Diagnosis: OCD by DSM-III-R Exclusions: Only obsessions; aged <18 and >65 years; OCD duration <1 year; organic mental disorder, mental retardation or a psychotic disorder; cognitive or behavioural treatment in preceeding 6 months, using anti-depressants Notes: Mean OCD duration 13 years	Data Used Irrational Belief Inventory Beck Depression Inventory Symptom Checklist-90 Padua Inventory - Revised Anxiety Discomfort Scale Yale-Brown Obsessive-Compulsive Scale: total	Group 1 N= 35 Cognitive therapy - 16 45-minute sessions, patients learned to consider instrusions as stimuli and to identify anxiety evoking automatic thoughts, which were challenged & replaced by alternative, rational, nondistressing thoughts, used Socratic Dialogue Group 2 N= 36 Individual BT - 16 sessions lasting 45 minutes, exposure in vivo with response prevention. After all compulsions and avoidance behaviour were inventoried, a fear hierarchy was made, and exposure homework was assigned, patients were asked to keep homework diaries	CT and BT part of data from VanBalkom2002. In addition, those who refused pharmacological treatment or were put on waiting list were randomised to CT or BT.
VEALE1996

Study Type: RCT Study Description: Allocation: random (stratified by degree of avoidance, severity of depressive symptoms) Duration of study: 12 wks Blindness: No mention Duration (days): Setting: Not reported Notes: Country of study: UK; Analysis: ITT Patients were self-referrals/referrals from other agencies Info on Screening Process: Not reported	N= 19 Age: Mean 35 Sex: 1 male 18 females Diagnosis: BDD by DSM-IV Exclusions: Patients with BDD whose primary concern was body weight or shape, concurrent dementia or organic brain disorder, schizophrenia, delusional disorder, alcohol or substance abuse, suicidal intent Notes: Mean duration of illness: 15 years; included patients with comorbid diagnoses (OCD, social phobia, depressive disorder) so long as patient's primary concern was with the defect in their appearance	Data Used BDD Examination Montgomery-Asberg Depression Rating Scale Derriford Scales Social phobia Hospital Anxiety Yale-Brown Obsessive-Compulsive Scale: compulsions Hospital Depression	Group 1 N= 9 Cognitive Behavioural Therapy - 12 sessions; response prevention by external focusing; cognitive restructuring; collecting positive and neutral information about paitient's assumptions to build realistic assumptions about body image. Therapy conducted by accredicted CBT therapists Group 2 N= 10 Wait list control
VOGEL2004

Study Type: RCT Study Description: Allocation: random (sealed envelope technique, wait list patients again randomised to either active treatment) Study duration: 6 weeks Blindness: Open Duration (days): Mean 42 Followup: 3, 6 & 12 months Setting: Outpatient Notes: Country of study: Norway; Analysis: ITT Three therapists experienced in cognitive and behavioural (ERP) interventions Info on Screening Process: 54 screened, exclusions: obessions without compulsions (n=4), another primary axis I disorder (n=5), unstable acting-out or suicidal behaviour (n=2), psychosis (n=1), chronic ego-syntonic OCD (n=1), subclinical OCD (n=2), refused treatment (n=4)	N= 35 Age: Mean 36 Sex: 10 males 25 females Diagnosis: OCD by DSM-III-R Exclusions: History of psychotic disorder, obsessions without compulsions, other primary axis I disorder, suicidal behaviour, chronic ego-syntonic OCD, subclinical OCD Notes: Twelve were taking stable doses of anti-obsessional medication at time of study Mean baseline Y-BOCS 24.3	Data Used Reliable change Remission (OCD) Clinical Significance State-Anxiety Inventory Beck Depression Inventory Yale-Brown Obsessive-Compulsive Scale: total	Group 1 N= 16 ERP + CT - Two-hour twice weekly sessions, 10 sessions in vivo/imaginal exposure + RP, 30 mins minimum per session for addressing case-specific comorbidity or OCD-specific beliefs using CT techniques, homework exposure exercises assigned after each session Group 2 N= 19 ERP + relaxation training - Two-hour twice weekly sessions, 10 sessions in vivo/imaginal exposure + RP, 30 mins per session of relaxation training -progressive muscle relaxation and release-only relaxation exercises, homework exposure exercises assigned after each session	Remission: Y-BOCS<16 Clinical Significance: Y-BOCS<16 + reliable change on Y-BCOS

From: Appendix 16, Characteristics of reviewed studies

Obsessive-Compulsive Disorder: Core Interventions in the Treatment of Obsessive-Compulsive Disorder and Body Dysmorphic Disorder.

NICE Clinical Guidelines, No. 31.

National Collaborating Centre for Mental Health (UK).

Leicester (UK): British Psychological Society (UK); 2006.

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