title: A systematic review and meta-analysis of self-help therapeutic interventions for obsessive-compulsive disorder: Is therapeutic contact key to overall improvement?
abstract: OBJECTIVE
  The presence of obsessive-compulsive disorder (OCD) can result in low quality of life, with significant impairments in social and occupational functioning. An increase in the dissemination of self-help programs has been observed in the treatment of OCD, and has provided improved accessibility to treatment. The present study examined the efficacy of self-help interventions for OCD in the context of therapeutic contact.
  
  
  METHODS
  Randomised controlled trials and quasi-experimental studies were identified through computerised database searches. Self-help format (bibliotherapy, internet-based, computerised), and therapeutic contact were examined for their effect on treatment outcomes.
  
  
  RESULTS
  Eighteen studies targeting self-help for OCD met inclusion criteria with 1570 participants. The average post-treatment effect size (Hedges' g) of self-help interventions on primary outcomes was .51 (95% CI: .41 to 0.61). Subgroup analysis revealed large effect sizes for minimal-contact self-help (g = 0.91, 95% CI: 0.66 to 1.17), moderate effect sizes for predominantly self-help (g = 0.68, 95% CI: 0.40 to 0.96), and small effect sizes for self-administered self-help (g = 0.33, 95% CI: .18 to 0.47).
  
  
  CONCLUSIONS
  A large variation of treatment approaches, amount of therapeutic contact, and risk of bias within each study may account for the large magnitude in effect sizes across studies. Additionally, the long-term follow-up effects of treatment approaches were not examined.
  
  
  CONCLUSIONS
  A growing body of literature supporting to the use of self-help treatments for OCD is evident, however, further investigation through use of randomised controlled trials is required, particularly the use of stepped care and long-term effectiveness.
authors.affiliation: School of Psychology and Speech Pathology, Curtin University, Perth, Australia. Electronic address: caitlin.pearcy@curtin.edu.au.
authors.forename: Caitlin P
authors.initials: CP
authors.lastname: Pearcy
authors.affiliation: School of Psychology and Speech Pathology, Curtin University, Perth, Australia. Electronic address: rebecca.anderson@curtin.edu.au.
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Anderson
authors.affiliation: School of Psychology and Speech Pathology, Curtin University, Perth, Australia. Electronic address: S.Egan@exchange.curtin.edu.au.
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Egan
authors.affiliation: School of Psychology and Speech Pathology, Curtin University, Perth, Australia. Electronic address: C.Rees@curtin.edu.au.
authors.forename: Clare S
authors.initials: CS
authors.lastname: Rees
mesh_terms: D015928:Cognitive Behavioral Therapy / Q000379:methods*; D006801:Humans; D009771:Obsessive-Compulsive Disorder / Q000523:psychology* / Q000628:therapy*; D012648:Self Care / Q000379:methods*
keywords: Meta-analysis; Obsessive-compulsive disorder (OCD); Self-help; Systematic review; Therapeutic contact