Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands.
Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands.
Compr Psychiatry. 2024 Apr;130:152453. doi: 10.1016/j.comppsych.2024.152453. Epub 2024 Jan 20.
Evidence-based psychological interventions exist for individuals with obsessive-compulsive disorder (OCD), but many individuals with OCD are unable to access them because of barriers, such as geographical isolation, treatment cost, and stigma etc. Unguided self-help psychological intervention has emerged as a potential solution to this problem. However, there is limited research on its overall effectiveness. This study aimed to address this gap.
Comprehensive searches from inception to 1st Jan 2023 were conducted in both international (PubMed, Embase, PsycINFO, International clinical trials registry platform of WHO) and Chinese (China National Knowledge Infrastructure, WeiPu, WanFang, Chinese Clinical Trial Registry) databases. The registered protocol is accessible at https://doi.org/10.17605/OSF.IO/FKB5W. We included randomized controlled trials (RCTs) comparing unguided self-help psychological interventions to control groups for individuals with OCD. The primary outcome was OCD symptom severity, with Hedges' g calculated post-intervention. Heterogeneity was deemed to be low, moderate, and high if the I value was quantified 25%, 50%, and 75% respectively. Relative Risks (RRs) was calculated for dropout rates post-intervention. Random-effects models were used for all analyses.
12 RCTs comparing unguided self-help psychological interventions to control groups were identified, with a total of 20 comparisons and 769 OCD patients. Overall, unguided self-help psychological interventions demonstrated a significant moderate effect on reducing OCD symptom severity (g = -0.42; 95% CI [-0.69; -0.14]) compared to control groups, with a moderate heterogeneity (I = 59%; 95% CI [22.73; 78.38]). This finding remained significant in sensitivity analyses for the self-rated Yale-Brown Obsessive-Compulsive Scale (Y-BOCS; k = 7, g = -0.46; 95% CI [-0.71; -0.2]) and after removing an outlier (g = -0.37; 95% CI [-0.55; -0.19]), but not for the clinician-rated Y-BOCS (k = 4, g = -0.78; 95% CI [-2.75; 1.19]) and Obsessive Compulsive Inventory-Revised (k = 6, g = -0.26; 95% CI [-0.53; 0]). Subgroup analyses revealed a significant difference in effect size between studies conducting intention-to-treat and completers-only analyses (p = .01). The completers-only analyses demonstrated a moderate significant effect (g = -0.65; 95% CI [-1.08; -0.21]), whereas the effect of the intention-to-treat analyses was not significant (g = -0.18; 95% CI [-0.36; 0]). Participants in the unguided self-help groups exhibited a significantly higher dropout rate (RR = 2.08; 95% CI [1.53; 2.81]) compared to control groups. Furthermore, participants recruited from the community had a higher likelihood of dropping out compared to those recruited from clinical settings (p < .001). Additionally, participants who received cognitive-behavioural therapy intervention were more likely to drop out than those who received other types of intervention (p < .001). Most trials (92%) were rated at a high risk of bias.
Unguided self-help psychological interventions demonstrate potential effectiveness in alleviating OCD symptom severity post-intervention. However, caution should be exercised when interpreting the results due to high risk of bias across trials and the relatively small sample size. And the considerable dropout rate might hinder treatment effects. Future studies with strict methodology should investigate the long-term effectiveness of unguided self-help psychological interventions for OCD, explore the reasons for high dropout rates, and improve intervention adherence.
对于强迫症（OCD）患者，存在基于证据的心理干预措施，但由于地理隔离、治疗费用和污名等障碍，许多 OCD 患者无法获得这些措施。非指导性自助心理干预已成为解决这一问题的潜在方法。然而，其整体效果的研究有限。本研究旨在解决这一差距。
从成立到 2023 年 1 月 1 日，在国际（PubMed、Embase、PsycINFO、WHO 国际临床试验注册平台）和中国（中国国家知识基础设施、维普、万方、中国临床试验注册中心）数据库中进行了全面搜索。可在 https://doi.org/10.17605/OSF.IO/FKB5W 访问注册协议。我们纳入了将非指导性自助心理干预与对照组进行比较的随机对照试验（RCTs），用于 OCD 患者。主要结局是 OCD 症状严重程度，干预后采用 Hedges'g 计算。如果 I 值量化为 25%、50%和 75%，则认为异质性低、中、高。干预后计算辍学率的相对风险（RR）。对于所有分析，均使用随机效应模型。
确定了 12 项将非指导性自助心理干预与对照组进行比较的 RCTs，共涉及 20 项比较和 769 名 OCD 患者。总体而言，与对照组相比，非指导性自助心理干预对降低 OCD 症状严重程度具有显著的中度效果（g=-0.42；95%CI[-0.69；-0.14]），具有中度异质性（I=59%；95%CI[22.73；78.38]）。在对自我报告的耶鲁-布朗强迫症量表（Y-BOCS；k=7，g=-0.46；95%CI[-0.71；-0.2]）和去除异常值（g=-0.37；95%CI[-0.55；-0.19]）后的敏感性分析中，以及在排除认知行为疗法干预的参与者（g=-0.31；95%CI[-0.51；-0.11]）后，这一发现仍然显著，但在临床报告的 Y-BOCS（k=4，g=-0.78；95%CI[-2.75；1.19]）和强迫症量表修订版（k=6，g=-0.26；95%CI[-0.53；0]）中不显著。亚组分析表明，意向治疗和完成者仅分析之间的效应大小存在显著差异（p=0.01）。完成者仅分析显示出中度显著效果（g=-0.65；95%CI[-1.08；-0.21]），而意向治疗分析的效果不显著（g=-0.18；95%CI[-0.36；0]）。与对照组相比，非指导性自助组的参与者辍学率显著更高（RR=2.08；95%CI[1.53；2.81]）。此外，与社区招募的参与者相比，从临床环境招募的参与者更有可能辍学（p<0.001）。此外，接受认知行为疗法干预的参与者比接受其他类型干预的参与者更有可能辍学（p<0.001）。大多数试验（92%）被评为高偏倚风险。
非指导性自助心理干预在干预后减轻 OCD 症状严重程度方面具有潜在效果。然而，由于试验之间存在高度偏倚风险和相对较小的样本量，在解释结果时应谨慎。并且相当高的辍学率可能会阻碍治疗效果。未来应进行严格方法学的研究，以调查非指导性自助心理干预对 OCD 的长期效果，探索高辍学率的原因，并提高干预的依从性。
