Augmentation of cognitive-behavioural therapy for obsessive-compulsive and anxiety disorders: a protocol for a systematic review and meta-analysis.

Introduction: While cognitive-behavioural therapy (CBT) for obsessive-compulsive disorder (OCD) and anxiety disorders (ADs) has been proven to be effective and is commonly recommended, a considerable proportion of patients remain symptomatic, do not respond to treatment or discontinue it. Thus, augmentation strategies aimed at enhancing CBT outcomes are essential to reduce the burden of OCD and ADs on patients and society. Various augmentation strategies for CBT in OCD and ADs have been investigated, yet it remains unclear if they show robust beneficial effects beyond first-line CBT. With this systematic review and meta-analysis, we will provide an overview and critically assess the efficacy of non-pharmacological augmentation strategies in addition to first-line CBT treatment for symptom reduction, response rates and dropout rates in individuals with OCD or ADs.
Methods and Analysis: We will screen PubMed, Embase, PsycArticles, PsycInfo, CINAHL, PSYNDEX and Cochrane Register of Controlled Trials without restrictions on publication dates or languages. Additionally, forward, and backward searches of included studies and systematic reviews will be conducted. Two reviewers will independently screen the studies, extract data and assess the methodological quality of the studies. We will exclusively include randomised controlled trials. The primary outcomes will be symptom severity and response rates. Dropout rates will serve as a secondary outcome. Moreover, we will provide a narrative review of the results. We will use subgroup and meta-regression analyses to identify potential moderators and sources of between-study heterogeneity. We will use the Grading of Recommendations Assessment, Development and Evaluation system to assess the overall quality of evidence.
Ethics and Dissemination: Ethical approval is not required. Results will be published in a peer-reviewed journal.
Prospero Registration Number: CRD42024561027.
Competing Interests: Competing interests: None declared.
(© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)