Mindfulness-based exposure and response prevention for obsessive compulsive disorder: Findings from a pilot randomised controlled trial
Clara Strauss, Laura Lea, Mark Hayward, Elizabeth Forrester, Tamara Leeuwerik, Anna-Marie Bibby-Jones, Claire Rosten
Journal of Anxiety Disorders April 30, 2018 DOI: 10.1016/j.janxdis.2018.04.007 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Randomized controlled trial Peer reviewed |
|---|---|
| Sample size | 37 |
| Population | Adults meeting DSM-IV criteria for obsessive compulsive disorder |
| Intervention | Exposure and response prevention (ERP) |
| Topics | Meditation |
| Citations | 47 |
| Key findings | Both group MB-ERP and group ERP improved OCD symptom severity, but MB-ERP did not lead to clinically important improvements over ERP; the minimum clinically important difference was not contained in the 95% confidence intervals. Between-group differences in engagement, depression, wellbeing, and OCD-related beliefs were negligible, while MB-ERP produced medium to medium-large improvements in mindfulness. The authors conclude MB-ERP is unlikely to yield clinically meaningful OCD symptom improvement beyond ERP alone. |
Abstract
Background: Only about half of people with obsessive compulsive disorder (OCD) show clinically significant improvement following the recommended therapy, exposure and response prevention (ERP), partly due to poor therapy acceptability. A mindfulness-based approach to ERP (MB-ERP) has the potential to improve acceptability and outcomes.
Methods: This was an internal pilot randomised controlled trial (RCT) of group MB-ERP compared to group ERP. 37 participants meeting DSM-IV OCD criteria were randomly allocated to MB-ERP or ERP.
Results: Both groups improved in OCD symptom severity. However, MB-ERP did not lead to clinically important improvements in OCD symptom severity at post-intervention compared to ERP - the minimum clinically important difference was not contained in the 95% confidence intervals. There were negligible between-group differences in engagement and MB-ERP did not appear to have broader benefits compared to ERP on depression, wellbeing or OCD-related beliefs. Conversely, MB-ERP led to medium/medium-large improvements in mindfulness compared to ERP.
Conclusions: MB-ERP is unlikely to lead to clinically meaningful improvements in OCD symptom severity compared to ERP alone. We underline the importance of adhering to treatment guidelines recommending ERP for OCD. Insufficient attention may have been given to mindfulness practice/discussion in MB-ERP and further research is recommended to explore this possibility.
Comparable studies
Other randomized controlled trials on meditation, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Alterations in Brain and Immune Function Produced by Mindfulness Meditation Healthy employees in a work environment | 2003 | Randomized controlled trial | n = 41 |
| Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. Recovered recurrently depressed patients | 2000 | Randomized controlled trial | n = 145 |
| Open hearts build lives: Positive emotions, induced through loving-kindness meditation, build consequential personal resources. Working adults | 2008 | Randomized controlled trial | n = 139 |
| Short-term meditation training improves attention and self-regulation Undergraduate Chinese students | 2007 | Randomized controlled trial | n = 40 |
| Mindfulness-Based Cognitive Therapy for Depression: Replication and Exploration of Differential Relapse Prevention Effects. Recovered recurrently depressed patients | 2004 | Randomized controlled trial | n = 73 |
Citations in the library
Cited by 11
- Mindfulness- and acceptance-based programmes for obsessive-compulsive disorder: A systematic review and meta-analysis. Journal of Anxiety Disorders March 1, 2025
- Mindfulness in treatment-seeking adults with comorbid obsessive-compulsive and major depressive disorders: Mediating effects of obsessive beliefs and mental well-being. Indian Journal of Psychiatry May 1, 2025
- Mindfulness and Metacognitive Processes in Obsessive-Compulsive Disorder: Neurocognitive Mechanisms and Clinical Implications IntechOpen eBooks September 24, 2026
- The effectiveness of mindfulness based cognitive therapy on rumination, perfectionism and thought-action fusion of women suffering from obsessive-compulsive disorder Journal of Adolescent and Youth Psychological Studies July 1, 2023
- Clinical and Neuroimaging Effects of Mindfulness-Based Cognitive Therapy for Symptomatic Obsessive-Compulsive Disorder Patients after First-Line Treatments: A Randomised Controlled Trial. Psychotherapy and Psychosomatics 2026
and 6 more in the library
Cites 9
- Using Self-Report Assessment Methods to Explore Facets of Mindfulness Assessment January 27, 2006
- Mindfulness: A proposed operational definition. Clinical Psychology Science and Practice 2004
- Mindfulness-based cognitive therapy for depression August 21, 2006
- Efficacy of Mindfulness-Based Cognitive Therapy in Prevention of Depressive Relapse JAMA Psychiatry April 28, 2016
- Mindfulness-based cognitive therapy for depression. Industrial Psychiatry Journal October 29, 2024
and 4 more in the library