This Highlight is based on findings from the following two NIHR-funded studies:
This large systematic review combined the findings of 86 randomised controlled trials on psychological and drug treatments for OCD in adults and children / adolescents. Through a technique known as network meta-analysis, the reviewers compared the effectiveness of psychological and drug treatments between different trials.
This NIHR trial (OCTET) is the largest trial to study the effectiveness of self-help in OCD. It investigated whether low-intensity (cheaper) treatments can help while people are waiting for high-intensity (more costly) treatment. We selected these studies because they are relatively recent, high quality and fall within the specific area of OCD.
There are other NIHR studies that have some relevance to the topic – you can find out more at the NIHR Journals Library website. Other NHS research includes the OTO trial: Optimal treatment for OCD which is comparing cognitive behavioural therapy (CBT) and selective serotonin reuptake inhibitors (SSRI) and their combination to treat OCD.
Systematic reviews of trials are a reliable way to compare how a range of different types of treatment work. However, the findings depend on the quality of the underlying trials. In this review, the trials did not provide enough evidence on the most effective treatments for different types of people with different levels of impairment from OCD. A major limitation of the evidence for psychological treatments was that many patients were already taking long term medication for their OCD. Drug trials were more likely to be large and sponsored by pharmaceutical companies, whereas psychological treatment studies tended to be smaller and have participants who were also taking medication. This makes it more difficult to compare treatments in an unbiased way, however it is the best research available at present.
OCTET was a large, well-designed, randomised controlled trial. This is the most reliable type of research to compare directly how well two or three different treatments work. It was the largest trial comparing self-help treatments for OCD, and is thought to be the largest trial ever of psychological treatments for OCD. OCTET was carried out in England, so is very applicable to the NHS.
NICE carried out an extensive review of the available evidence on OCD treatment when the most up to date guidance was written in 2005.
This guidance recommends different levels of treatment, starting with the least intensive treatment of guided self-help. If this does not work or a person prefers a different treatment, or is more severely impaired when first seen, they may be referred to more specialist treatment, such as psychotherapy from a qualified psychologist. Medical treatment with antidepressants may also be offered to those with moderate to severe symptoms of OCD. Both pieces of research broadly match the NICE guidance recommendations.
More recently (2014), the British Association for Psychopharmacology has updated the evidence, and the Royal College of Psychiatry has published help on treatment options.
Baldwin DS, Anderson IM, Nutt DJ, et al. Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder: a revision of the 2005 guidelines from the British Association for Psychopharmacology. Journal of Psychopharmacology. 2014 May 1;28(5):403-39.
NICE. Obsessive-compulsive disorder and body dysmorphic disorder: treatment. CG31. London: National Institute for Health and Care Excellence; 2005.
RCPsyc. Obsessive-compulsive disorder. London: Royal College of Psychiatrists; 2014.
Disclaimer: This report by the NIHR Dissemination Centre presents a synthesis of independent research. The views and opinions expressed by the authors of this publication are those of the authors and do not necessarily reflect those of the NHS or the Department of Health. Where blogs, sound recordings and verbatim quotations are included in this publication the views and opinions expressed are those of the named individuals and do not necessarily reflect those of the authors, the NHS, the NIHR or the Department of Health.