Standard individual cognitive behaviour therapy for paediatric obsessive -compulsive disorder: A
systematic review of effect estimates across comparisons
Sammanfattning
Background: Previous meta-analyses of paediatric obsessive-compulsive disorder (OCD) have
shown much higher effect size for standard individual cognitive behaviour therapy (SI-CBT) compared
with control conditions than for serotonin reuptake inhibitors (SRIs) compared with placebo. Other
factors, such as systematic differences in the provided care or exposure to factors other than the
interventions of interest (performance bias) may be stronger confounders in psychotherapy research
than in pharmacological research. Aims: These facts led us to review SI-CBT studies of paediatric
OCD with the aim to compare the effect estimates across different comparisons, including active
treatments. Method: We included only randomized controlled trials (RCTs) or cluster RCTs with
treatment periods of 12-16 weeks. Outcome was post-test score on the Children's Yale-Brown
Obsessive Compulsive Scale (CYBOCS). Results: Thirteen papers reporting from 13 RCTs with 17
comparison conditions were included. SI-CBT was superior to wait-list and placebo therapy but not
active treatments. Effect estimates for SI-CBT in wait-list comparison studies were significantly larger
than in placebo-therapy comparison studies. In addition, the SI-CBT effect estimate was not
significantly different when compared with SRIs alone or combined SRIs and CBT. Conclusions:
Performance bias may have inflated previous effect estimates for SI-CBT when comparison
contingencies included wait-list. However, the calculated SI-CBT effect estimate was lower but
significant when compared with placebo therapy. The effects of SI-CBT and active treatments were not
significantly different. In conclusion, our data support the current clinical guidelines, although better
comparisons between SI-CBT and SRIs are needed.