(PS7-D77) Third-wave Approaches for the Treatment of Obsessive Compulsive Disorder: A Systematic Review

Obsessive-Compulsive Disorder (OCD) has a high comorbidity rate, with substantial risks for anxiety, mood, and substance use disorders. This, in addition to the early age of onset and significant functional impairment associated with OCD cause it to carry an increased health burden and risk of mortality. Improvement rates for OCD symptoms using Exposure and Response Prevention (ERP) vary from 50-76%. However, patients often refuse treatment, have poor compliance, or drop out of ERP. Also, many clinicians experience their own discomfort utilizing ERP, contributing to suboptimal exposures and treatment outcomes. Research suggests that patient willingness to experience unpleasant and unwanted internal states may improve treatment outcomes. Thus, a growing area of research is the utility of mindfulness in the treatment of OCD. In this systematic review, we examined the available evidence for the efficacy of two third-wave treatments with mindfulness components, Acceptance and Commitment Therapy (ACT) and Mindfulness-Based Cognitive Therapy (MBCT), as standalone, hybrid, and adjunctive treatments for OCD. Specifically, we address 1) how ACT and MBCT are adapted and applied to the treatment of OCD, and 2) the efficacy of these treatment approaches. This systematic review summarizes and synthesizes quantitative and qualitative research evidence from 21 studies from research groups located in the United States, Great Britain, Canada, China, India, and Iran. The results suggest that standalone ACT for OCD + SSRI treatment outperforms SSRI treatment alone, and hybrid ACT/ERP is comparable to ERP. Results also suggest that while MBCT is as efficacious in treating OCD as SSRI treatment and active control groups, the advantages dissipated by 6 months. However, the findings should be interpreted cautiously due to the small number of studies and sample sizes, as well as the heterogeneity of study and sample characteristics. Qualitative results asserted that participants post-MBCT for OCD reported decreased experiential avoidance. Thus, it is suggested that future studies examine the sequencing effects of treatments to see if MBCT for OCD could have the potential to increase the acceptability, adherence, and outcomes of ERP. It is also recommended that future research include the Yale-Brown Obsessive Compulsive Scale–Second Edition (Y-BOCS-II) as the primary outcome measure rather than the original Y-BOCS to examine the treatment effectiveness of third-wave treatments for OCD. Moreover, it is recommended that studies include sufficient follow-up to track the stability of treatment results over time.