Sammendrag
Background: Previous meta-analyses of paediatric obsessive – compulsive disorder (OCD) have
shown much higher effect size for standard individual cognitive behaviour therapy (SI-CBT)
compared with control conditions than for serotonin reuptake inhibitors (SRIs) compared with
placebo. Other factors, such as systematic differences in the provided care or exposure to
factors other than the interventions of interest (performance bias) may be stronger confounders
in psychotherapy research than in pharmacological research. Aims: These facts led us to review
SI-CBT studies of paediatric OCD with the aim to compare the effect estimates across different
comparisons, including active treatments. Method: We included only randomized controlled
trials (RCTs) or cluster RCTs with treatment periods of 12 – 16 weeks. Outcome was post-test
score on the Children ’ s Yale – Brown Obsessive Compulsive Scale (CYBOCS). Results: Thirteen
papers reporting from 13 RCTs with 17 comparison conditions were included. SI-CBT was
superior to wait-list and placebo therapy but not active treatments. Effect estimates for SI-CBT
in wait-list comparison studies were signifi cantly larger than in placebo-therapy comparison
studies. In addition, the SI-CBT effect estimate was not signifi cantly different when compared
with SRIs alone or combined SRIs and CBT. Conclusions: Performance bias may have infl ated
previous effect estimates for SI-CBT when comparison contingencies included wait-list.
However, the calculated SI-CBT effect estimate was lower but signifi cant when compared with
placebo therapy. The effects of SI-CBT and active treatments were not signifi cantly different. In
conclusion, our data support the current clinical guidelines, although better comparisons between
SI-CBT and SRIs are needed.
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