Efficacy of remotely-delivered cognitive behavioural therapy for obsessive-compulsive disorder: An updated meta-analysis of randomised controlled trials

Introduction: Despite remotely-delivered cognitive behavioural therapy (CBT) being an emerging field, the evi-dence of its efficacy in obsessive-compulsive disorder (OCD) is limited. We aimed to estimate the efficacy of remotely-delivered CBT for OCD, compared to face-to-face CBT and non-CBT control conditions.Methods: Randomised clinical trials (RCTs) identified through a systematic literature search of PubMed, Ovid/ PsychINFO and Web of Science until 21/06/2021. Eligible studies included individuals with OCD evaluating at least one form of remotely-delivered CBT versus a control condition. Random-effects meta-analyses, sub -analyses, meta-regressions, heterogeneity analyses, publication bias assessment and quality assessment.Results: Twenty-two RCTs were included (n = 1796, mean age = 27.7 years, females = 59.1 %). Remotely -delivered CBT was more efficacious than non-CBT control conditions for OCD symptoms (g = 0.936 95 % CI = 0.597-1.275, p < .001), depressive symptoms (g = 0.358, 95 % CI = 0.125-0.590, p = .003) and anxiety symptoms (g = 0.468, 95 % CI = 0.135-0.800, p = .006). There were no significant differences in efficacy be-tween remotely-delivered CBT and face-to-face CBT for OCD symptoms (g =-0.104 95 % CI =-0.391-0.184, p = .479), depressive symptoms (g = 0.138, 95 % CI =-0.044-0.320, p = .138), anxiety symptoms (g = 0.166, 95 % CI = -0.456-0.780, p = .601) or quality of life (g = 0.057, 95 % CI =-0.178-0.292, p = .489). Higher baseline severity of OCD symptoms was associated with a lower efficacy of remotely-delivered CBT compared to face-to-face CBT (beta =-0.092, p = .036). The quality of the included studies was mostly identified as low risk of bias (45.5 %) or some concerns (45.5 %).Limitations: Heterogeneity and limited evidence for some outcomes.Conclusions: Remotely-delivered CBT appears efficacious in reducing OCD symptoms and other relevant out-comes and is therefore a viable option for increasing treatment access. Preliminary evidence suggests some in-dividuals with severe OCD may benefit more from face-to-face than remotely-delivered CBT.

Automated summary

Remotely-delivered CBT has been found to be effective in reducing symptoms of OCD and other related outcomes. There is no significant difference in efficacy between remotely-delivered CBT and face-to-face CBT, but individuals with severe OCD may benefit more from face-to-face treatment.