Meta analysis on mindfulness and acceptance-based programs for OCD

This systematic review and meta-analysis evaluates the effectiveness of mindfulness- and acceptance-based programmes (MABPs), such as acceptance and commitment therapy (ACT) and mindfulness-based cognitive therapy (MBCT), in treating obsessive-compulsive disorder (OCD). It synthesises data from 46 trials involving 2,221 OCD patients, comparing MABPs to other treatments like cognitive behavioural therapy (CBT), exposure and response prevention (ERP), medication, and waitlist controls. The study also explores moderators of treatment outcomes, including mindfulness and psychological flexibility, and evaluates the stability of these effects over time.

Key findings

1. Effectiveness of MABPs:
   • MABPs significantly reduced OCD symptom severity with large effects in both between-group (g = -0.87) and within-group pre-post (g = -1.72) analyses.
   • MABPs were comparable to CBT and ERP in effectiveness but were superior to medication (SSRIs) and waitlist controls.
2. Secondary outcomes:
   • Moderate improvements were noted in depressive symptoms, obsessive beliefs, anxiety, and quality of life.
   • Increases in mindfulness and psychological flexibility predicted reductions in OCD symptoms. These mechanisms were central to the effectiveness of MABPs.
3. Treatment stability:
   • Symptom reductions were maintained at follow-up (average of 4.3 months), suggesting that MABPs produce lasting effects.
4. Global differences:
   • Symptom reductions varied by world region, with European studies showing smaller effects compared to regions like the Middle East, North America, and South Asia. This may be influenced by cultural factors or differences in delivery methods.
5. No association with treatment duration or therapist expertise:
   • The effectiveness of MABPs was not significantly influenced by the number of treatment hours, therapists’ clinical expertise, or therapists’ familiarity with specific MABPs.
6. Comparison of programmes:
   • ACT showed slightly larger reductions in OCD symptoms compared to MBCT, though both were effective.

Recommendations for practice

• Consider MABPs as an alternative or adjunct to traditional OCD treatments:
  • MABPs offer an empirically supported, effective treatment option for OCD, particularly for patients who may not respond to or prefer not to engage in CBT with ERP.
  • Treatments like ACT and MBCT can be integrated into clinical practice to provide additional frameworks for addressing OCD symptoms.
• Focus on mindfulness and psychological flexibility:
  • Incorporating mindfulness techniques can help patients non-reactively observe intrusive thoughts and emotions, which aligns with the principles of exposure therapy.
  • Therapists should emphasise fostering psychological flexibility, as this predicts better outcomes in OCD treatment.
• Account for cultural and regional factors:
  • When implementing MABPs, consider cultural adaptations to maximise treatment effectiveness, particularly in regions with less research on mindfulness-based interventions.
• Monitor long-term outcomes:
  • Given the average follow-up period of only 4.3 months in the included studies, clinicians should aim to track long-term outcomes and consider booster sessions to sustain benefits.

Recommendations for children and young people

• Tailor MABPs for younger populations:
  • Programmes like ACT and mindfulness-integrated cognitive behavioural therapy (MiCBT) have shown effectiveness in children and adolescents. These should be adapted to suit developmental needs, such as shorter sessions or engaging delivery methods.
• Include parents or caregivers:
  • Family involvement can enhance the effectiveness of MABPs for children. For example, ACT interventions have been successfully delivered to children with OCD alongside parent participation.
• Use age-appropriate tools:
  • Mindfulness practices like guided breathing exercises, visualisation, or child-friendly metaphors can help younger patients engage with these therapies.
• Early intervention:
  • Introducing MABPs in children and adolescents with OCD may help prevent chronicity and reduce the severity of symptoms earlier in life.

Bürkle, J. J., Schmidt, S., & Fendel, J. C. (2025). Mindfulness- and acceptance-based programmes for obsessive-compulsive disorder: A systematic review and meta-analysis. Journal of Anxiety Disorders. Advance online publication. https://doi.org/10.1016/j.janxdis.2025.102977