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When CBT does not work for OCD: may mindfulness assist?

Qamar by Qamar
February 5, 2026
in Mental Health
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When CBT does not work for OCD: may mindfulness assist?
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Chaos and order business concept flat style design vector illustration isolated on white background. Tangled disorder turns into spiral order line, find solution. Coaching, mentoring or psychotherapy.

If in case you have ever caught your self double-checking (and even triple-checking) whether or not you locked the entrance door or unplugged your hair roller, you’ll perceive how the thoughts can play tips on us. However think about if these urges amplified to the purpose the place it takes over your life, inflicting hours of misplaced time daily: that’s the actuality for individuals dwelling with obsessive-compulsive dysfunction (OCD).

OCD impacts roughly 4% of the world’s inhabitants (Stein et al., 2025) and is characterised by irrepressible, recurring ideas (obsessions) and/or repetitive, excessive behaviours (compulsions). Cognitive behavioural remedy (CBT) tends to be the gold-standard strategy for treating OCD, nevertheless it doesn’t all the time work for everybody (Öst et al., 2015), for a number of completely different causes (learn Lawson’s Psychological Elf weblog right here). This begs the query: what different choices can be found?

A current systematic evaluation and meta-analysis by Burkle et al. (2025) explores whether or not mindfulness- and acceptance-based programmes (MABPs) may be an efficient various strategy to treating OCD. MABPs educate people to eradicate judgment and foster acceptance in direction of their inner experiences, expertise which have beforehand been recognized as helpful to intervention success in OCD (Riquelme-Marín et al., 2022).

Cognitive behavioural therapy is the gold standard treatment for OCD, but it doesn’t work for everyone. Could mindfulness-based and acceptance-based programmes be an effective alternative?

Cognitive behavioural remedy is the gold customary therapy for OCD, nevertheless it doesn’t work for everybody. May mindfulness-based and acceptance-based programmes be an efficient various?

Strategies

The authors searched seven databases for trials together with people with a main analysis of OCD who have been receiving a standardised MABP (i.e., mindfulness-based (MB)-CBT, MB-Stress Discount (MB-SR), Acceptance and Dedication Remedy (ACT) and Dialectical Behaviour Remedy (DBT)). They appeared for research that measured modifications in OCD symptom severity at pre- and post-intervention as the principle outcomes. They principally included randomised managed trials (RCTs) however did embody some non-randomised trials as properly.

Two impartial reviewers screened titles and abstracts, and full texts have been independently rated for remaining inclusion. Information was then mixed in a random-effects meta-analysis, pooling each between-group impact sizes from RCTs and within-group pre-post results throughout all research, enabling them to estimate the general impression of MABPs on OCD symptom severity. In addition they evaluated research high quality (EPHPP) and danger of bias (RoB V.2.0) to assist perceive the reliability of the outcomes. Of the included research, outcomes have been constant between the RoB V.2.0 and the EPHPP (RoB V.2.0: low-bias, n = 7; moderate-bias, n = 21; high-bias, n = 5).

Outcomes

A complete of 46 research have been included within the evaluation and meta-analysis, with an general research inhabitants of two,221 individuals (controls: n = 1,036; OCD: n = 1,215). Contributors have been assigned to one among 49 MABPs (ACT, MB-CBT, MB-SR) or one among 49 controls (waitlist, CBT, treatment).

Throughout 33 RCTs, the proof means that MABPs considerably enhance OCD signs:

  • MABPs led to a big, statistically important discount in OCD symptom severity in comparison with management teams (g= -0.87; 95% CI [-1.13 to -0.60])
  • Contributors improved between pre- and post-treatment in within-group analyses (ok= 49; g = -1.72; 95% CI [-2.00 to -1.44])
  • Secondary outcomes (i.e., depressive signs, obsessive beliefs, nervousness, high quality of life) additionally confirmed reductions, though the power of those results diverse.

The authors famous excessive heterogeneity in impact sizes and performed subsequent moderator analyses to discover causes for the variability.

Subgroup analyses examined variations in therapy results by programme sort, research design, comparator, and world area. Results have been largest versus waitlist controls (g = −1.66; 95% CI [-2.1 to -1.24]), no completely different than CBT (g = 0.02; 95% CI [-0.23 to 0.26]), and superior to treatment (g = −0.77; 95% CI [-1.44 to -0.11]). No programme sort outperformed others, and symptom reductions have been noticed throughout all world areas.

Meta-regressions examined steady moderators like therapy length, pattern traits, and therapist options, discovering no important moderation of OCD symptom reductions. Nonetheless, mixed will increase in mindfulness and psychological flexibility considerably predicted OCD symptom reductions.

Sensitivity analyses have been performed and confirmed the robustness of the findings.

Mindfulness- and acceptance-based programmes appear to significantly reduce OCD symptoms, with consistent effects across programme types, study designs, and control conditions.

Mindfulness- and acceptance-based programmes seem to considerably cut back OCD signs, with constant results throughout programme sorts, research designs, and management situations.

Conclusions

The authors concluded that MABPs can result in important reductions in OCD signs, in addition to enhancements in associated areas resembling despair, nervousness, and high quality of life. They famous, nevertheless, that the present proof is heterogeneous and differs amongst research designs, comparator sorts, and programme codecs.

Whereas MABPs seem broadly efficient and similar to lively therapies resembling CBT, the authors emphasised the necessity for higher-quality, long-term trials to substantiate their sturdiness.

Programmes based on the principles of mindfulness and acceptance could provide an additional treatment option for individuals with OCD, but more trials with active control conditions are needed.

Programmes primarily based on the ideas of mindfulness and acceptance may present a further therapy choice for people with OCD, however extra trials with lively management situations are wanted.

Strengths and limitations

This was a well-conducted evaluation that adopted the strict pointers (PRISMA 2020) to make sure clear reporting. Reviewers labored independently with an established search technique (with the assistance of a librarian), and the inclusion of each RCTs and non-RCTs, in addition to non-English research and gray literature ensured a breadth of proof was included. This reduces the probability of bias, and strengths our confidence within the findings.

Nonetheless, there are a number of essential limitations to bear in mind. Research diverse extensively in design, length, and supply, making it tougher to immediately evaluate outcomes. Some outcomes have been primarily based on research with comparatively small energy, which suggests sure components which may affect effectiveness (e.g., age, comorbidities) may have been missed. Comply with-up was additionally brief in most trials, that means that it’s unclear how lengthy any enhancements final; as OCD is a life-long situation, it’s necessary that therapies are useful within the long-term. General, whereas the findings are promising, bigger, longer, and extra constant research are wanted to be assured in regards to the lasting impression of MABPs for OCD.

This was a well-conducted meta-analysis using rigorous methods to capture a broad and reliable evidence base. However, more high-quality, long-term research is needed to confirm the lasting benefits of mindfulness- and acceptance-based programmes for OCD.

This was a well-conducted meta-analysis utilizing rigorous strategies to seize a broad and dependable proof base. Nonetheless, extra high-quality, long-term analysis is required to substantiate the lasting advantages of mindfulness- and acceptance-based programmes for OCD.

Implications for observe

For clinicians, MABPs could also be an efficient various or further software for supporting individuals with OCD. This can be notably related for the 30% of individuals with OCD who decline, drop out of, or don’t reply adequately to CBT. Nonetheless, at current, MABPs are higher considered as a further choice underneath analysis slightly than a longtime various inside nationwide pointers (Bürkle et al., 2021; Nationwide Institute for Well being and Care Excellence, 2005; Ong et al., 2016). Maybe sooner or later, we might even see a change.

For sufferers and members of the general public, together with these dwelling with OCD and their mates and households, this therapeutic strategy could also be skilled as empowering, and assist to cut back the stigma and disgrace that if usually current with OCD (Glazier et al., 2015). MABPs usually give attention to constructing present-moment, non-judgmental consciousness of undesirable ideas and emotions and encourage openness to experiencing them with out reacting (Gkintoni et al., 2025; Twohig et al., 2010), which can assist to deal with a few of the obstacles to therapy confronted.

Lastly, as an individual with lived expertise of OCD who didn’t expertise success with CBT, I discover the outcomes of this evaluation extremely longing for others with the identical issues. It demonstrates the significance of eliminating the “one dimension suits all” strategy to psychological healthcare and why persevering with analysis is so crucial in bettering the lives of individuals coexisting with psychological sickness. The conclusions drawn from this research are necessary to my PhD and wider pursuits in contemplating the vary of the way we’d assist individuals dwelling with psychological sickness.

Through emphasising acceptance, mindfulness, and self-compassion, mindfulness- and acceptance-based programmes may help individuals with OCD who experience high levels of self-stigma and shame. 

By emphasising acceptance, mindfulness, and self-compassion, mindfulness- and acceptance-based programmes might assist people with OCD who expertise excessive ranges of self-stigma and disgrace.

Assertion of pursuits

Ella Bradley – None.

Edited by

Dr Nina Higson-Sweeney.

Hyperlinks

Major paper

Johannes J. Bürkle, Stefan Schmidt, & Johannes C. Fendel (2025). Mindfulness- and acceptance-based programmes for obsessive-compulsive dysfunction: A scientific evaluation and meta-analysis. Journal of Nervousness Issues, 110, 102977. https://doi.org/https://doi.org/10.1016/j.janxdis.2025.102977

Different references

Bürkle, J. J., Fendel, J. C., & Schmidt, S. (2021). Mindfulness-based and acceptance-based programmes within the therapy of obsessive-compulsive dysfunction: a research protocol for a scientific evaluation and meta-analysis. BMJ Open, 11(6), e050329. https://doi.org/10.1136/bmjopen-2021-050329

Gkintoni, E., Vassilopoulos, S. P., & Nikolaou, G. (2025). Mindfulness-Primarily based Cognitive Remedy in Scientific Apply: A Systematic Evaluation of Neurocognitive Outcomes and Functions for Psychological Well being and Properly-Being. Journal of Scientific Drugs, 14(5), 1703.

Glazier, Okay., Wetterneck, C., Singh, S., & Williams, M. (2015). Stigma and disgrace as obstacles to therapy for obsessive-compulsive and associated issues. Journal of Despair and Nervousness, 4(3), 191.

Nationwide Institute for Well being and Care Excellence. (2005). Obsessive-compulsive dysfunction and physique dysmorphic dysfunction: therapy. NICE guideline CG31. https://www.good.org.uk/steering/cg31

Ong, C. W., Clyde, J. W., Bluett, E. J., Levin, M. E., & Twohig, M. P. (2016). Dropout charges in publicity with response prevention for obsessive-compulsive dysfunction: What do the information actually say? Journal of Nervousness Issues, 40, 8-17. https://doi.org/https://doi.org/10.1016/j.janxdis.2016.03.006

Öst, L.-G., Havnen, A., Hansen, B., & Kvale, G. (2015). Cognitive behavioral therapies of obsessive–compulsive dysfunction. A scientific evaluation and meta-analysis of research revealed 1993–2014. Scientific Psychology Evaluation, 40, 156-169. https://doi.org/https://doi.org/10.1016/j.cpr.2015.06.003

Riquelme-Marín, A., Rosa-Alcázar, A. I., & Ortigosa-Quiles, J. M. (2022). Mindfulness-based psychotherapy in sufferers with obsessive-compulsive dysfunction: A meta-analytical Examine. Int J Clin Well being Psychol, 22(3), 100321. https://doi.org/10.1016/j.ijchp.2022.100321

Twohig, M. P., Hayes, S. C., Plumb, J. C., Pruitt, L. D., Collins, A. B., Hazlett-Stevens, H., & Woidneck, M. R. (2010). A randomized scientific trial of acceptance and dedication remedy versus progressive rest coaching for obsessive-compulsive dysfunction. J Seek the advice of Clin Psychol, 78(5), 705-716. https://doi.org/10.1037/a0020508

Taylor, L. (2021). Why CBT can fail these with OCD: service customers’ views. The Psychological Elf.

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