The impact of cognitive behavioral therapy and third-wave therapies on the quality of life of patients with obsessive-compulsive disorder: a systematic review and meta-analysis

Abstract

The aim of this study is to evaluate the impact of cognitive behavioural therapy (CBT) and third-wave therapies on the quality of life of patients with obsessive-compulsive disorder (OCD). A systematic search was conducted in PubMed, Embase, Web of Science and the Cochrane Library databases, up until June 20, 2026, to identify randomised controlled trials (RCTs) that used quality of life as an outcome measure. Quality assessment was performed using the Cochrane Risk of Bias Assessment Tool. Meta-analysis was conducted using Stata 18.0 software, and subgroup analyses, sensitivity analyses and tests for publication bias were performed. A total of 13 randomised controlled trials ( N = 1,324) were included. The meta-analysis revealed that CBT and third-wave therapies improve quality of life in patients with OCD (SMD = 0.18, 95% CI: 0.06 to 0.29, P = 0.004), with no overall heterogeneity ( I² = 0.0%). The results of sensitivity analyses were stable, and the risk of publication bias was low. Subgroup analyses indicated that CBT and third-wave therapies were effective in improving quality of life in non-European countries, early studies (≤ 2020), short-term interventions (≤ 12 weeks), adult populations, standard CBT, third-wave therapies, active control groups, and subjective experience/satisfaction scales; however, statistical significance was not achieved in some subgroups. Since the differences between subgroups aren’t significant, the subgroup analysis is just exploratory, so the results should be interpreted with caution. CBT and third-wave therapies can improve the quality of life of patients with OCD to a certain extent, but the overall effect is modest. Future research should be larger in scale, multi-center, and prospective. It’s also necessary to further clarify the mechanisms behind different intervention modules, optimize intervention plans, and improve long-term follow-up, so that we can provide stronger evidence to support clinical practice.