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A meta‐analysis of dropout rates from exposure with response prevention and pharmacological treatment for youth with obsessive compulsive disorder
Author(s) -
Johnco Carly,
McGuire Joseph F.,
Roper Tegan,
Storch Eric A.
Publication year - 2020
Publication title -
depression and anxiety
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.634
H-Index - 129
eISSN - 1520-6394
pISSN - 1091-4269
DOI - 10.1002/da.22978
Subject(s) - pharmacotherapy , attrition , placebo , randomized controlled trial , psychology , psychiatry , adverse effect , medicine , clinical psychology , alternative medicine , dentistry , pathology
Objective Beliefs that exposure with response prevention (ERP) is excessively distressing and will result in client dropout from treatment are commonly‐cited reasons for clinicians not providing evidence‐based treatment. This meta‐analysis examined treatment attrition for ERP for youth with obsessive compulsive disorder (OCD) compared with other treatment modalities. Method A systematic literature search identified 11 randomized controlled trials (RCTs) comparing ERP to active or waitlist control conditions, 9 comparing pharmacotherapy to control, and 3 comparing ERP to pharmacotherapy for youth with OCD. Results Attrition rates were low for ERP (10.24%) compared to pharmacotherapy (17.29%), active control (e.g., relaxation, metacognitive therapy; 20.63%), and pill placebo (23.49%). ERP had lower risk of attrition compared to active control conditions (RR = 0.60; p = .02), and was not significantly different to waitlist (RR = 0.80; p = .59). In head‐to‐head trials, there was no difference between the risk of attrition from ERP and pharmacotherapy (RR = 1.26; p = .74). Of the pharmacotherapy trials, risk of attrition from serotonin reuptake inhibitors treatment was not significantly different compared to placebo (RR = 0.94; p = .76), with no difference between antidepressants and clomipramine ( p = .19). Attrition from ERP was primarily for logistical reasons, compared to lack of efficacy for relaxation and/or adverse reactions from pharmacotherapy. Conclusions Attrition from ERP is low, and is generally lower than non‐ERP interventions. Given favorable attrition and efficacy data, there is little justification for appropriately‐trained clinicians not to offer ERP as a first‐line treatment for youth with OCD.