Gava I, Barbui C, Aguglia E, Carlino D, Churchill R, De Vanna M, McGuire H F
Mandala Clinic, PO Box 361, Gosford, New South Wales, Australia, 2250.
Cochrane Database Syst Rev. 2007 Apr 18(2):CD005333. doi: 10.1002/14651858.CD005333.pub2.
Obsessive compulsive disorder (OCD) is a chronic anxiety disorder associated with significant morbidity, social impairment and lower quality of life. Psychological treatments are a frequently used approach for OCD.
To perform a systematic review of randomised trials of psychological treatments for obsessive compulsive disorder in comparison with treatment as usual.
We conducted an electronic search of CCDANCTR-Studies (31/10/2006), and other databases. We searched reference lists, and contacted experts in the field.
Published and unpublished randomised trials of psychological treatments versus treatment as usual for adults with a diagnosis of OCD DATA COLLECTION AND ANALYSIS: Two review authors worked independently throughout the selection of trials and data extraction. Findings were compared and disagreements were discussed with a third review author. Full data extraction, using a standardised data extraction sheet, was performed on all studies included in the review. Results were synthesised using Review Manager software. For dichotomous data, odds ratios were calculated. For continuous data, effect sizes were obtained and the standardised mean difference, with 95% confidence intervals, was calculated. Fixed and random effects models were used to pool the data. Reasons for heterogeneity in studies were explored and sensitivity analyses were performed by excluding trials of lower quality.
Eight studies (11 study comparisons) were identified, all of which compared cognitive and/or behavioural treatments versus treatment as usual control groups. Seven studies (ten comparisons) had usable data for meta-analyses. These studies demonstrated that patients receiving any variant of cognitive behavioural treatment exhibited significantly fewer symptoms post-treatment than those receiving treatment as usual (SMD -1.24, 95% CI -1.61 to -0.87, I(2) test for heterogeneity 33.4%). Different types of cognitive and/or behavioural treatments showed similar differences in effect when compared with treatment as usual. The overall treatment effect appeared to be influenced by differences in baseline severity.
AUTHORS' CONCLUSIONS: The findings of this review suggest that psychological treatments derived from cognitive behavioural models are an effective treatment for adult patients with obsessive compulsive disorder. Larger high quality randomised controlled trials involving longer follow up periods are needed, to further test cognitive behavioural treatments, and other psychological approaches, in comparison to each other and control conditions. Future trials should examine the predictors of response to each treatment, and also conduct cost-effectiveness evaluations.
强迫症（OCD）是一种慢性焦虑症，与显著的发病率、社会功能损害和较低的生活质量相关。心理治疗是治疗强迫症常用的方法。
对强迫症心理治疗的随机试验与常规治疗进行系统评价。
我们对CCDANCTR-Studies（2006年10月31日）及其他数据库进行了电子检索。我们检索了参考文献列表，并联系了该领域的专家。
已发表和未发表的针对诊断为强迫症的成年人的心理治疗与常规治疗的随机试验。数据收集与分析：两位综述作者在整个试验选择和数据提取过程中独立工作。比较研究结果，并与第三位综述作者讨论分歧。对纳入综述的所有研究使用标准化数据提取表进行全面的数据提取。使用Review Manager软件综合结果。对于二分数据，计算比值比。对于连续数据，获得效应量并计算标准化平均差及95%置信区间。使用固定效应模型和随机效应模型汇总数据。探讨研究中异质性的原因，并通过排除质量较低的试验进行敏感性分析。
共识别出8项研究（11项研究比较），所有研究均比较了认知和/或行为治疗与常规治疗对照组。7项研究（10项比较）有可用于荟萃分析的数据。这些研究表明，接受任何认知行为治疗变体的患者在治疗后症状明显少于接受常规治疗的患者（标准化平均差 -1.24，95%置信区间 -1.61至 -0.87，异质性I(2)检验 33.4%）。与常规治疗相比，不同类型的认知和/或行为治疗在效果上显示出相似的差异。总体治疗效果似乎受基线严重程度差异的影响。
本综述结果表明，源自认知行为模型的心理治疗对成年强迫症患者是一种有效的治疗方法。需要开展规模更大、随访期更长的高质量随机对照试验，以进一步相互比较认知行为治疗及其他心理治疗方法，并与对照条件进行比较。未来的试验应研究每种治疗反应的预测因素，并进行成本效益评估。
