Various regimens based on cognitive behavioral therapy models are effective for adult patients with obsessive-compulsive disorder, according to a meta-analysis in Issue 2 (2007) of the Cochrane Database of Systematic Reviews.

In the current study, Australian researchers, led by Ileana Gava of the Mandala Clinic in New South Wales, analyzed data from seven small studies of about 150 patients and concluded that “psychological treatments derived from cognitive behavioral models are an effective treatment for adult patients with obsessive-compulsive disorder.”

Carol Mathews, MD, associate professor of psychiatry at the University of California -San Francisco, who was not involved with the analysis, said another key review finding is that many variants of such therapy work for OCD, “whether [they are] primarily cognitive, primarily behavioral, a combination of both, individual or group therapy, and with or without medications.”

In general, cognitive therapies had the goal of teaching patients to distance themselves from their obsessive thoughts and to help them recognize that compulsive behaviors do not actually reduce anxiety. The behavioral aspect of treatment involves exposing patients to situations that provoke obsessive thoughts and then having them stop themselves from enacting the corresponding compulsive behavior in the hope of demonstrating that anxiety is unwarranted.

Many of the patients analyzed were also taking medication. Studies that included higher numbers of people using medication in both the waiting list and psychological therapy groups did slightly better with psychological therapy, although the results were not statistically significant.

“This is likely because the concomitant use of medication helps to minimize the anxiety, and make the individual more able to participate in the exposures. Medications are also known to help obsessive-compulsive symptoms even in the absence of therapy, so there could be a combined effect,” said Mathews.

Group therapies had significantly lower dropout rates, but the same effectiveness as individual treatment. “Group therapy, with its characteristics such as … encouragement, reciprocal support, imitation and interpersonal learning [could] result in an increased motivation,” the authors wrote.

“This is a relatively weak finding, but still interesting,” Mathews said. “It suggests that group therapy, which is more cost-effective by far than individual therapy, may actually be the preferred form of therapy. If this is true, it would potentially help to make treatment more available to people with obsessive-compulsive disorder, as it is less expensive, and requires fewer hours from trained personnel, so is easier to implement.”