A systematic review and meta-analysis of self-help therapeutic interventions for obsessive-compulsive disorder: Is therapeutic contact key to overall improvement?

Background and objectives: The presence of obsessive-compulsive disorder (OCD) can result in low quality of life, with significant impairments in social and occupational functioning. An increase in the dissemination of self-help programs has been observed in the treatment of OCD, and has provided improved accessibility to treatment. The present study examined the efficacy of self-help interventions for OCD in the context of therapeutic contact. Methods: Randomised controlled trials and quasi-experimental studies were identified through computerised database searches. Self-help format (bibliotherapy, internet-based, computerised), and therapeutic contact were examined for their effect on treatment outcomes. Results: Eighteen studies targeting self-help for OCD met inclusion criteria with 1570 participants. The average post-treatment effect size (Hedges' g) of self-help interventions on primary outcomes was .51 (95% CI: .41 to 0.61). Subgroup analysis revealed large effect sizes for minimal-contact self-help (g = 0.91, 95% CI: 0.66 to 1.17), moderate effect sizes for predominantly self-help (g = 0.68, 95% CI: 0.40 to 0.96), and small effect sizes for self-administered self-help (g = 0.33, 95% CI: .18 to 0.47). Limitations: A large variation of treatment approaches, amount of therapeutic contact, and risk of bias within each study may account for the large magnitude in effect sizes across studies. Additionally, the long-term follow-up effects of treatment approaches were not examined. Conclusions: A growing body of literature supporting to the use of self-help treatments for OCD is evident, however, further investigation through use of randomised controlled trials is required, particularly the use of stepped care and long-term effectiveness. (C) 2015 Elsevier Ltd. All rights reserved.