A systematic review of cognitive-behavioral therapy for pharmacotherapy treatment-resistant obsessive-compulsive disorder

Although pharmacotherapy is a widely used first-line treatment for obsessive-compulsive disorder (OCD), a substantial proportion of individuals have an unsatisfactory response following an adequate medication trial, suggesting that alternative next-step treatments should be used. Expert clinical guidelines recommend the use of cognitive-behavioral therapy (CBT) for pharmacotherapy treatment-resistant OCD, though a lack of evidence is cited within guidelines to support this approach. The current systematic review examined the literature on the effectiveness of CBT delivered to individuals with pharmacotherapy treatment-resistant OCD with regard to changes in OCD symptoms as well as secondary outcomes. Twenty-three studies were included in the review. CBT produced impressive rates of treatment response, with all studies demonstrating significant reductions in OCD symptoms following treatment. Many studies also noted significant improvements in depressive symptoms, functioning, and quality of life. Additional methodologically rigorous studies are needed to understand the long-term effects of treatment, the usefulness of CBT as a switching strategy, the sequential addition of medications to CBT, and therapy adaptations for individuals who are resistant to standard CBT.