Obsessive-compulsive disorder (OCD) has a high comorbidity rate, with substantial risks for anxiety, mood, and substance use disorders. Exposure and response prevention (ERP) is considered the first-line psychotherapy treatment for OCD. While highly efficacious, not all patients achieve full remission with ERP, and given the chronicity of OCD and its sensitivity to stress-related events, many patients struggle with ongoing symptoms. A growing area of research has been the use of third-wave behavioral and cognitive therapies that potentially enhance patients’ willingness to engage with exposure-based treatment and provide strategies to cope with residual symptoms. This integrative systematic review summarizes and synthesizes results from 21 research studies that examine efficacy of standalone uses of Acceptance and Commitment Therapy (ACT), Mindfulness-Based Cognitive Therapy (MBCT) and Mindfulness-Based Stress Reduction (MBSR), as well as the efficacy of ERP augmented with these interventions in the treatment of OCD. Results suggest that adaptations of ACT and MBCT are efficacious treatments for OCD with and without ERP. However, treatment comparisons yielded commensurate, but not superior results, especially for the few studies that included long-term follow-up assessment. Recommendations for future research include investigating the shared processes of change across treatments to hone in on treatment-specific processes that drive symptom change, tracking the stability of treatment results over time, and utilizing multiple OCD symptom severity outcomes measures that specifically account for avoidance behavior. Given the complex and heterogeneous nature of OCD, this study elucidates patient and therapist factors that should be considered when navigating treatment decisions.

Library of Congress Subject Headings

Cognitive therapy; Obsessive-compulsive disorder; Mindfulness-based cognitive therapy

Date of Award


School Affiliation

Graduate School of Education and Psychology



Degree Type


Degree Name


Faculty Advisor

Kathleen Eldridge