Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Center for Children Healthy, 100101 Beijing, China.
Department of Medical Psychology, the First Medical Center, Chinese PLA General Hospital, 100853 Beijing, China.
J Integr Neurosci. 2022 May 17;21(3):97. doi: 10.31083/j.jin2103097.
Exposure and response prevention (ERP) is a form of cognitive behavioral therapy that can effectively relieve obsessive-compulsive symptoms and tic symptoms in patients with obsessive-compulsive disorder (OCD) and Tourette syndrome (TS). However, the effect size of ERP-based therapy is still unclear.
In this study, we performed a meta-analysis to identify the efficacy of ERP-based therapy for individuals with OCD and TS. The standard mean difference (SMD) with a 95% confidence interval (CI) was calculated to assess the effect size of the efficacy for ERP-based therapy. We used subgroup and meta-regression analyses to explore the heterogeneity of the pooled SMD of ERP-based therapy for OCD. We also summarized the neuroimaging studies for ERP-based therapy for OCD. This meta-analysis was registered within the International Platform of Registered Systematic Review and Meta-analysis Protocols (number: INPLASY2021120112).
A total of 18 studies including a total of 1057 patients with OCD and 3 studies including 267 with TS/chronic tic disorder were identified. We did not observe any indication of publication bias using Egger's funnel plot ( = 0.41). We observed a small-to-medium effect size of ERP for both OCD (SMD = -0.27, 95% CI: -0.53 to -0.01) and TS/chronic tic disorder (SMD = -0.35, 95% CI: -0.59 to -0.1). We found no heterogeneity of ERP-based therapy for OCD between the ERP-based therapy subgroup and medicine subgroup in the subgroup analysis ( = 0.72). We found no heterogeneity of ERP-based therapy for OCD between the child subgroup and adult subgroup in the subgroup analysis ( = 0.37). We used meta-regression analysis to identify the heterogeneity of ERP-based therapy for OCD and found that the sessions of therapy and publication year did not account for any significant heterogeneity ( > 0.05). The neurological mechanism of EPR-based therapy is unclear, but it may lie in changes in the prefrontal cortex and anterior cingulate cortex.
In conclusion, we found that ERP-based therapy is effective for patients with OCD and TS/chronic tic disorder. We suggest a combination with other therapies and the development of online ERP services that might prove a promising new direction for healthcare providers.
暴露和反应预防（ERP）是一种认知行为疗法，可有效缓解强迫症（OCD）和妥瑞氏症（TS）患者的强迫症状和抽动症状。然而，基于 ERP 的治疗效果的效应大小仍不清楚。
本研究通过荟萃分析确定基于 ERP 的治疗对 OCD 和 TS 患者的疗效。使用标准均数差（SMD）和 95％置信区间（CI）评估基于 ERP 的治疗的疗效的效应大小。我们使用亚组和荟萃回归分析来探讨基于 ERP 的 OCD 治疗的汇总 SMD 的异质性。我们还总结了基于 ERP 的 OCD 治疗的神经影像学研究。本荟萃分析在国际系统评价和荟萃分析方案注册平台（注册号：INPLASY2021120112）中进行了注册。
共纳入 18 项研究，共纳入 1057 例 OCD 患者和 3 项研究，共纳入 267 例 TS/慢性抽动障碍患者。Egger 漏斗图未提示存在发表偏倚（ = 0.41）。我们观察到 ERP 对 OCD（SMD = -0.27，95％CI：-0.53 至 -0.01）和 TS/慢性抽动障碍（SMD = -0.35，95％CI：-0.59 至 -0.1）的治疗均具有小到中等的效果大小。我们发现亚组分析中 ERP 基础治疗亚组和药物亚组之间 OCD 的 ERP 基础治疗没有异质性（ = 0.72）。我们发现亚组分析中 OCD 的 ERP 基础治疗儿童亚组和成人亚组之间没有异质性（ = 0.37）。我们使用荟萃回归分析来确定 OCD 的 ERP 基础治疗的异质性，发现治疗次数和发表年份均未引起显著的异质性（>0.05）。EPR 基础治疗的神经机制尚不清楚，但可能在于前额叶皮层和前扣带回皮层的变化。
总之，我们发现 ERP 基础治疗对 OCD 和 TS/慢性抽动障碍患者有效。我们建议将其与其他疗法相结合，并开发在线 ERP 服务，这可能为医疗保健提供者提供一个有前途的新方向。
