If your child has been diagnosed with OCD, you've probably wondered: should they see a psychologist, take medication, or both? A major new analysis published in 2024 looked at 30 clinical trials involving over 2,000 young people with OCD, and the results are genuinely reassuring.
The research found that face-to-face Cognitive Behavioural Therapy (CBT) — a type of talking therapy that teaches people to resist OCD's urges step by step — works significantly better than doing nothing or relaxation training alone. Medication (a class of antidepressants called SRIs) also helps, but CBT has a stronger overall evidence base.
One finding that surprises a lot of people: CBT delivered over webcam or phone worked just as well as in-person sessions. So if you live outside a major city or can't easily get to a clinic, online therapy is a genuinely effective option, not a compromise.
The combination of CBT plus medication may produce the best outcomes of all, though more research is still needed to be certain.
The bottom line? Effective, evidence-backed treatment for childhood OCD exists — and there are more ways to access it than ever before. If OCD is affecting your child's life, reaching out to a psychologist who specialises in this area is a great first step.
What the study actually did
This paper is a network meta-analysis (NMA) by Cervin et al. An NMA is a step up from an ordinary meta-analysis: instead of only combining trials that directly compared two treatments, it builds a 'network' of all the trials in an area, allowing indirect comparisons too (e.g. if Treatment A was tested against placebo, and Treatment B was also tested against placebo, the NMA can estimate how A and B likely compare to each other, even though they were never tested head-to-head). The researchers pooled 30 randomised controlled trials (RCTs) — studies where participants are randomly assigned to different treatments, which reduces bias — covering 2,057 young people with OCD. They compared in-person cognitive-behavioural therapy (CBT), CBT by webcam/telephone, internet-delivered CBT (ICBT), serotonin reuptake inhibitors (SRIs, a class of antidepressant), combined CBT+SRIs, waitlist, relaxation training, and pill placebo. Outcomes were measured using the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS), a clinician-rated measure of OCD symptom severity, plus how often people dropped out of treatment (a proxy for acceptability).
What the numbers actually show
Results are reported as mean differences (MD) in post-treatment CY-BOCS scores, with 95% confidence intervals (the range within which the true effect likely falls). In-person CBT outperformed ICBT, waitlist, relaxation training, and pill placebo, with MDs ranging from 3.95 to 11.10 points — and this was rated 'moderate confidence' using CINeMA, a formal framework for judging how much trust to place in NMA estimates. However, in-person CBT did not significantly differ from webcam/telephone-delivered CBT (MD 0.85, CI -2.51 to 4.21), from SRIs alone (MD 3.07, CI -0.07 to 6.20), or from combined CBT+SRIs (MD -1.20, CI -5.29 to 2.91). SRIs clearly beat pill placebo (MD 4.59, CI 2.70 to 6.48) and waitlist (MD 8.03, CI 4.24 to 11.82). For acceptability, no treatment differed significantly in dropout rates, though confidence in that particular finding was rated low.
Why the confidence ratings matter
Notice that not every result carries the same weight. Some comparisons (like in-person CBT vs. controls, and SRIs vs. waitlist) were rated 'moderate' confidence, meaning the evidence is fairly solid. Others — including CBT vs. SRIs, and the combination therapy comparison — were rated 'low' confidence. This isn't a flaw in the analysis; it reflects that fewer, smaller, or less consistent trials fed into those specific comparisons. It means we shouldn't treat these numbers as final answers, especially the promising-looking combination therapy result.
The limits worth knowing
The authors are upfront that few studies have directly tested combined CBT+SRI treatment, so that finding needs replication before it's treated as settled. ICBT also has a thinner evidence base than webcam/telephone delivery, so its true effectiveness is less certain. And because acceptability findings were low-confidence, we can't yet say definitively whether one treatment is easier for young people to stick with than another.
If OCD is affecting a young person's life, this evidence supports reaching out to a qualified psychologist to discuss what treatment — or combination — might fit best.