Evidence remains unclear on whether CBT benefits children with OCD

Results of a systematic review and meta-analysis suggest that cognitive behavioral therapy for pediatric obsessive-compulsive disorder symptoms shows promise, but its efficacy remains uncertain overall.

“CBT may be more effective than no intervention and comparable to [selective serotonin reuptake inhibitors] for pediatric OCD, but high risk of bias in included trials and low certainty of the evidence prevent firm conclusions regarding the efficacy of CBT,” Camilla Funch Uhre, MSc, of the Child and Adolescent Mental Health Center in Copenhagen, Denmark, and colleagues wrote in the Journal of the American Academy of Child & Adolescent Psychiatry. “In addition, we had insufficient data to adequately explore potential reasons behind statistical heterogeneity in the meta-analyses.”

According to Uhre and colleagues, previous research supported recommendations of CBT for pediatric OCD, but these conclusions may be inaccurate. In addition to failing to assess risk of bias, previous reviews also pooled results from randomized trials and uncontrolled studies or included only symptom severity as an outcome measure, they wrote.

The researchers conducted the present review to assess potential harms and benefits of CBT vs. no intervention, as well as vs. other interventions for pediatric OCD. They analyzed nine trials with 645 patients who received CBT compared with no intervention three trials with 146 patients who received CBT compared with SSRIs.

They found that compared with no intervention, CBT decreased OCD severity for a mean difference of –8.51 (95% CI, –10.84 to –6.18), improved level of functioning, had similar proportions of patients with adverse events and was associated with reduced risk of still having OCD, they wrote. However, they had insufficient data to determine the effect of CBT vs. no intervention on quality of life and serious adverse events.

Compared with SSRIs, Uhre and colleagues noted that CBT produced similar decreases in OCD severity for a mean difference of –0.75 (95% CI, –3.79 to 2.29). However, the researchers’ data were insufficient to determine the effect of CBT vs. SSRIs on adverse events, serious adverse events, quality of life and level of functioning.

Overall, the review revealed a “lack of data on beneficial and harmful effects of CBT beyond OCD symptom severity,” they wrote.

“Our exploratory analysis showed that CBT may have a substantial beneficial effect on remission when compared with ‘no intervention’, although approximately half of patients in CBT were classified as non-remitters at end of treatment,” the researchers wrote. – by Joe Gramigna

Disclosures: The authors report no relevant financial disclosures.