Structured Psychological Interventions for Adults with Obsessive–Compulsive Disorder and Inadequate Treatment Response: A Scoping Review

Abstract

Purpose: This scoping review mapped structured psychological interventions for adults with obsessive–compulsive disorder (OCD) and an inadequate treatment response, described the available evidence, and identified research gaps.

Methods and Materials: PubMed/MEDLINE, Scopus, PsycINFO, the Cochrane Library, SID, Magiran, and Civilica were searched for English- and Persian-language studies published from January 2010 to May 2026. Inadequate treatment response was defined as nonresponse, partial response, or persistence of clinically significant symptoms after an adequate standard treatment. Original intervention studies of structured psychological treatments in adults were eligible. Two reviewers independently screened titles, abstracts, and full texts, resolving disagreements by consensus. Data were synthesized descriptively in accordance with PRISMA-ScR.

Findings: Of 150 records identified, 48 duplicates were removed and 102 records were screened. After 70 records were excluded, 32 full-text reports were assessed; 17 were excluded, leaving 15 reports representing 14 unique studies. CBT/ERP-based interventions formed the largest evidence cluster and included extended outpatient, intensive, concentrated, residential, inpatient, and pharmacotherapy-augmented formats. ACT and MBCT were examined less often, while inference-based therapy and schema therapy were supported by limited preliminary evidence. Although most reports described symptom reductions or improvement in selected outcomes, heterogeneity in definitions, study designs, concurrent treatments, and follow-up limited causal and comparative interpretation

Conclusion: Evidence remains limited and heterogeneous. CBT/ERP is the dominant framework, whereas evidence for other approaches is smaller and largely preliminary. Standardized definitions, clearer reporting of prior treatments, adequately powered comparative trials, and longer follow-up are needed.