A systematic review and meta-analysis on the effectiveness of exposure and response prevention therapy in the treatment of Obsessive-Compulsive Disorder

Exposure and Response Prevention (ERP) is considered the most effective psychotherapeutic treatment for Obsessive-Compulsive Disorder (OCD). The literature supports its adoption yet results vary and vagueness regarding therapy protocol exists. We present an updated review and meta-analysis to provide clarity in the comparison of strict ERP protocol to control or active therapy groups. Moderator analyses were conducted to investigate treatment effect of cognitive elements, hours of therapy and duration of OCD. A systematic literature search, concluded in January 2021, identified twenty-four studies, published between 1997 and 2018, including a total of 1134 patients. The main analysis assessed the difference between pretreatment and post-treatment scores compared amongst ERP and the other groups. We found a statistically significant different reduction in pre-treatment to post-treatment Yale-Brown Obsessive Compulsive Scale scores between ERP therapy versus other groups. We also found a statistically significant moderation effect of cognitive elements. The other two moderators, hours of therapy and OCD duration, were non-significant. Our review suggests that ERP was superior to the other groups, including both neutral and active treatments, in reducing OCD symptomatology and should therefore be recommended as an optimal therapy. Future research should focus on tailoring ERP to the individual and investigating further refinements.