{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T11:37:46Z","timestamp":1780573066233,"version":"3.54.1"},"reference-count":69,"publisher":"BMJ","issue":"6","license":[{"start":{"date-parts":[[2021,6,25]],"date-time":"2021-06-25T00:00:00Z","timestamp":1624579200000},"content-version":"unspecified","delay-in-days":24,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100002714","name":"Albert-Ludwigs-Universit\u00e4t Freiburg","doi-asserted-by":"publisher","award":["DE142116817"],"award-info":[{"award-number":["DE142116817"]}],"id":[{"id":"10.13039\/501100002714","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003542","name":"Ministerium f\u00fcr Wissenschaft, Forschung und Kunst Baden-W\u00fcrttemberg","doi-asserted-by":"publisher","award":["DE142116817"],"award-info":[{"award-number":["DE142116817"]}],"id":[{"id":"10.13039\/501100003542","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2021,6,11]]},"published-print":{"date-parts":[[2021,6]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Cognitive\u2013behavioural therapy (CBT) with exposure and response prevention is the recommended standard for the treatment of obsessive\u2013compulsive disorder (OCD). However, a high proportion of patients refuse this treatment, do not respond or relapse shortly after treatment. Growing evidence suggests that mindfulness-based and acceptance-based programmes (MABPs) are an effective option for the treatment of OCD. This systematic review and meta-analysis will examine the effectiveness of MABPs in treating OCD. We also aimed to explore potential moderators of the programmes\u2019 effectiveness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>We will systematically search MEDLINE, Embase, PsycINFO, PSYINDEX, Web of Science, CINAHL and Cochrane Register of Controlled Trials (no language restrictions) for studies that evaluate the effect of MABPs on patients with OCD. We will conduct backward and forward citation searches of included studies and relevant reviews and contact corresponding authors. The primary outcome will be pre-post intervention change in symptom severity. A secondary outcome will be change in depressive symptoms. Two reviewers will independently screen the records, extract the data and rate the methodological quality of the studies. We will include both controlled and uncontrolled trials. Randomised controlled trials will be meta-analysed, separately assessing between-group effects. A second meta-analysis will assess the within-group effect of all eligible studies. We will explore moderators and sources of heterogeneity such as the specific programme, study design, changes in depressive symptoms, hours of guided treatment, control condition and prior therapy (eg, CBT) using metaregression and subgroup analyses. We will perform sensitivity analyses using follow-up data. A narrative synthesis will also be pursued. We will use the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to assess the quality of the evidence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>Ethical approval is not required. Results will be published in peer-reviewed journals and presented at international conferences.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2021-050329","type":"journal-article","created":{"date-parts":[[2021,6,25]],"date-time":"2021-06-25T12:36:28Z","timestamp":1624624588000},"page":"e050329","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Mindfulness-based and acceptance-based programmes in the treatment of obsessive\u2013compulsive disorder: a study protocol for a systematic review and meta-analysis"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7905-1326","authenticated-orcid":false,"given":"Johannes Julian","family":"B\u00fcrkle","sequence":"first","affiliation":[{"name":"Department for Mental Health, University of Freiburg, Freiburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3852-5422","authenticated-orcid":false,"given":"Johannes Caspar","family":"Fendel","sequence":"additional","affiliation":[{"name":"Department of Psychosomatic Medicine and Psychotherapy, University of Freiburg, Freiburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Schmidt","sequence":"additional","affiliation":[{"name":"Department of Psychosomatic Medicine and Psychotherapy, University of Freiburg, Freiburg, Germany"},{"name":"Institute for Frontier Areas of Psychology and Mental Health, Freiburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,6,25]]},"reference":[{"key":"2025121300041819000_11.6.e050329.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpr.2009.09.005"},{"key":"2025121300041819000_11.6.e050329.2","doi-asserted-by":"publisher","DOI":"10.1038\/mp.2008.94"},{"key":"2025121300041819000_11.6.e050329.3","unstructured":"World Health Organization . The\u201cnewly defined\u201d burden of mental problems. Fact Sheets n\u00b0217. Geneva: WHO, 1999."},{"key":"2025121300041819000_11.6.e050329.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpr.2015.03.002"},{"key":"2025121300041819000_11.6.e050329.5","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1016\/j.ajp.2016.02.001","article-title":"Adult obsessive\u2013compulsive disorder and quality of life outcomes: a systematic review and meta-analysis","volume":"22","author":"Coluccia","year":"2016","journal-title":"Asian J Psychiatr"},{"key":"2025121300041819000_11.6.e050329.6","doi-asserted-by":"publisher","DOI":"10.1016\/S0165-0327(02)00351-8"},{"key":"2025121300041819000_11.6.e050329.7","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1016\/j.jad.2013.09.004","article-title":"Obsessive-Compulsive disorder; chronic versus non-chronic symptoms","volume":"152-154","author":"Visser","year":"2014","journal-title":"J Affect Disord"},{"key":"2025121300041819000_11.6.e050329.8","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpr.2015.06.003"},{"key":"2025121300041819000_11.6.e050329.9","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.janxdis.2016.03.006","article-title":"Dropout rates in exposure with response prevention for obsessive-compulsive disorder: what do the data really say?","volume":"40","author":"Ong","year":"2016","journal-title":"J Anxiety Disord"},{"key":"2025121300041819000_11.6.e050329.10","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.162.1.151"},{"key":"2025121300041819000_11.6.e050329.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.beth.2010.10.002"},{"key":"2025121300041819000_11.6.e050329.12","doi-asserted-by":"publisher","DOI":"10.1016\/j.brat.2014.04.006"},{"key":"2025121300041819000_11.6.e050329.13","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbtep.2004.04.002"},{"key":"2025121300041819000_11.6.e050329.14","doi-asserted-by":"crossref","first-page":"1057","DOI":"10.1002\/da.22672","article-title":"How willing are you? willingness as a predictor of change during treatment of adults with obsessive-compulsive disorder","volume":"34","author":"Reid","year":"2017","journal-title":"Depress Anxiety"},{"key":"2025121300041819000_11.6.e050329.15","doi-asserted-by":"publisher","DOI":"10.1016\/j.janxdis.2014.06.008."},{"key":"2025121300041819000_11.6.e050329.16","doi-asserted-by":"crossref","first-page":"594","DOI":"10.1016\/j.encep.2016.10.004","article-title":"Les interventions bas\u00e9es sur la pleine conscience dans le trouble obsessionnel compulsif: m\u00e9canismes d\u2019action et pr\u00e9sentation d\u2019une \u00e9tude pilote","volume":"43","author":"Gasnier","year":"2017","journal-title":"L\u2019Enc\u00e9phale"},{"key":"2025121300041819000_11.6.e050329.17","unstructured":"Baer RA , Huss DB . Mindfulness- and acceptance- based therapy. In: Lebow J , ed. Twenty-first century psychotherapies: contemporary approaches to theory and practice. Hoboken, N.J: John Wiley & Sons, 2008: 123\u201366."},{"key":"2025121300041819000_11.6.e050329.18","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0221897","article-title":"Mindfulness- and acceptance-based interventions for patients with fibromyalgia - A systematic review and meta-analyses","volume":"14","author":"Haugmark","year":"2019","journal-title":"PLoS One"},{"key":"2025121300041819000_11.6.e050329.19","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpr.2014.01.001"},{"key":"2025121300041819000_11.6.e050329.20","doi-asserted-by":"crossref","first-page":"e363","DOI":"10.1093\/geront\/gny024","article-title":"The effectiveness of mindfulness- and acceptance-based interventions for informal caregivers of people with dementia: a meta-analysis","volume":"59","author":"Collins","year":"2019","journal-title":"Gerontologist"},{"key":"2025121300041819000_11.6.e050329.21","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.cbpra.2011.12.004","article-title":"Using mindfulness- and acceptance-based treatments with clients from nondominant cultural and\/or marginalized backgrounds: clinical considerations, meta-analysis findings, and introduction to the special series","volume":"20","author":"Fuchs","year":"2013","journal-title":"Cogn Behav Pract"},{"key":"2025121300041819000_11.6.e050329.22","doi-asserted-by":"publisher","DOI":"10.1080\/16506073.2015.1098724"},{"key":"2025121300041819000_11.6.e050329.23","doi-asserted-by":"crossref","DOI":"10.3389\/fpsyg.2014.00603","article-title":"Mindfulness-based interventions in schools-a systematic review and meta-analysis","volume":"5","author":"Zenner","year":"2014","journal-title":"Front Psychol"},{"key":"2025121300041819000_11.6.e050329.24","doi-asserted-by":"publisher","DOI":"10.1016\/j.ridd.2014.03.005"},{"key":"2025121300041819000_11.6.e050329.25","doi-asserted-by":"publisher","DOI":"10.1097\/PRA.0000000000000377"},{"key":"2025121300041819000_11.6.e050329.26","doi-asserted-by":"publisher","DOI":"10.1016\/j.brat.2009.02.015"},{"key":"2025121300041819000_11.6.e050329.27","unstructured":"Segal ZV , Williams JMG , Teasdale JD . Mindfulness-based cognitive therapy for depression: a new approach to preventing relapse. New York, NY: Guilford Press, 2002."},{"key":"2025121300041819000_11.6.e050329.28","doi-asserted-by":"crossref","unstructured":"Hayes SC , Strosahl KD , Wilson KG . Acceptance and commitment therapy: the process and practice of mindful change. 2nd ed. New York, NY: Guilford Press, 2012.","DOI":"10.1037\/17335-000"},{"key":"2025121300041819000_11.6.e050329.29","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1111\/papt.12180","article-title":"Relations of mindfulness facets with psychological symptoms among individuals with a diagnosis of obsessive-compulsive disorder, major depressive disorder, or borderline personality disorder","volume":"92","author":"Didonna","year":"2019","journal-title":"Psychol Psychother"},{"key":"2025121300041819000_11.6.e050329.30","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1007\/s10608-019-10049-4","article-title":"The association of trait mindfulness and self-compassion with obsessive-compulsive disorder symptoms: results from a large survey with treatment-seeking adults","volume":"44","author":"Leeuwerik","year":"2020","journal-title":"Cognit Ther Res"},{"key":"2025121300041819000_11.6.e050329.31","doi-asserted-by":"publisher","DOI":"10.1016\/j.brat.2007.06.012"},{"key":"2025121300041819000_11.6.e050329.32","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1016\/j.janxdis.2017.03.003","article-title":"The structure, correlates, and treatment related changes of mindfulness facets across the anxiety disorders and obsessive compulsive disorder","volume":"49","author":"Hawley","year":"2017","journal-title":"J Anxiety Disord"},{"key":"2025121300041819000_11.6.e050329.33","doi-asserted-by":"crossref","first-page":"1109","DOI":"10.1002\/cpp.2076","article-title":"Mindfulness-based cognitive therapy as an augmentation treatment for obsessive-compulsive disorder","volume":"24","author":"Key","year":"2017","journal-title":"Clin Psychol Psychother"},{"key":"2025121300041819000_11.6.e050329.34","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1007\/s00406-018-0957-4","article-title":"Mindfulness-based cognitive therapy (MBCT) in patients with obsessive-compulsive disorder (OCD) and residual symptoms after cognitive behavioral therapy (CBT): a randomized controlled trial","volume":"269","author":"K\u00fclz","year":"2019","journal-title":"Eur Arch Psychiatry Clin Neurosci"},{"key":"2025121300041819000_11.6.e050329.35","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/j.janxdis.2018.04.007","article-title":"Mindfulness-based exposure and response prevention for obsessive compulsive disorder: findings from a pilot randomised controlled trial","volume":"57","author":"Strauss","year":"2018","journal-title":"J Anxiety Disord"},{"key":"2025121300041819000_11.6.e050329.36","first-page":"705","article-title":"A randomized clinical trial of acceptance and commitment therapy vs. progressive relaxation training for obsessive compulsive disorder","volume":"78","author":"Twohig","year":"2010","journal-title":"J Clin Psychol"},{"key":"2025121300041819000_11.6.e050329.37","doi-asserted-by":"publisher","DOI":"10.1016\/j.brat.2018.06.005"},{"key":"2025121300041819000_11.6.e050329.38","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1016\/j.jocrd.2015.05.003","article-title":"Mindfulness for OCD? no evidence for a direct effect of a self-help treatment approach","volume":"6","author":"Cludius","year":"2015","journal-title":"J Obsessive Compuls Relat Disord"},{"key":"2025121300041819000_11.6.e050329.39","article-title":"Acceptance and commitment therapy, selective serotonin reuptake inhibitors and their combination in the improvement of obsessive-compulsive symptoms and experiential avoidance in patients with obsessive-compulsive disorder","volume":"9","author":"Vakili","year":"2015","journal-title":"Iran J Psychiatry Behav Sci"},{"key":"2025121300041819000_11.6.e050329.40","unstructured":"Madani NAM , Kananifar N , Atashpour SH . The effects of mindfulness group training on the rate of obsessive-compulsive disorder symptoms on the women in Isfahan City (Iran 2013;20:13\u201317."},{"key":"2025121300041819000_11.6.e050329.41","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1007\/s41811-018-0003-3","article-title":"Mindfulness-based cognitive therapy for OCD: stand-alone and post-CBT augmentation approaches","volume":"11","author":"Selchen","year":"2018","journal-title":"Int J Cogn Ther"},{"key":"2025121300041819000_11.6.e050329.42","first-page":"65","article-title":"Preliminary findings of efficacy of mindfulness integrated cognitive therapy (MICT) for obsessive-compulsive disorder (OCD","volume":"17","author":"Mathur","year":"2016","journal-title":"AP J Psychol Med"},{"key":"2025121300041819000_11.6.e050329.43","doi-asserted-by":"crossref","first-page":"196","DOI":"10.15171\/jarcm.2016.033","article-title":"Is mindfulness a mediator factor in obsessive compulsive disorder?","volume":"4","author":"Alam Dianati","year":"2016","journal-title":"J Anal Res Clin Med"},{"key":"2025121300041819000_11.6.e050329.44","doi-asserted-by":"crossref","first-page":"366","DOI":"10.4103\/0019-5545.196723","article-title":"Efficacy of mindfulness-integrated cognitive behavior therapy in patients with predominant obsessions","volume":"58","author":"Kumar","year":"2016","journal-title":"Indian J Psychiatry"},{"key":"2025121300041819000_11.6.e050329.45","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1037\/h0100898","article-title":"An initial investigation into the processes of change in act, CT, and Erp for OCD","volume":"6","author":"Twohig","year":"2010","journal-title":"Int J Behav Consult Ther"},{"key":"2025121300041819000_11.6.e050329.46","first-page":"1","article-title":"Mindfulness-based cognitive therapy for obsessive-compulsive disorder: study protocol for a randomized controlled trial with functional magnetic resonance imaging and a 6-month follow-up","volume":"00","author":"Lu","year":"2018","journal-title":"J Health Psychol"},{"key":"2025121300041819000_11.6.e050329.47","doi-asserted-by":"crossref","first-page":"104","DOI":"10.4103\/psychiatry.IndianJPsychiatry_531_18","article-title":"New-wave behavioral therapies in obsessive-compulsive disorder: moving toward integrated behavioral therapies","volume":"61","author":"Manjula","year":"2019","journal-title":"Indian J Psychiatry"},{"key":"2025121300041819000_11.6.e050329.48","doi-asserted-by":"publisher","DOI":"10.1007\/s12671-012-0137-y"},{"key":"2025121300041819000_11.6.e050329.49","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.g7647","article-title":"Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation","volume":"350","author":"Shamseer","year":"2015","journal-title":"BMJ"},{"key":"2025121300041819000_11.6.e050329.50","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-151-4-200908180-00135"},{"key":"2025121300041819000_11.6.e050329.51","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2019-032295","article-title":"Mindfulness-based interventions to reduce burnout and stress in physicians: a study protocol for a systematic review and meta-analysis","volume":"9","author":"Fendel","year":"2019","journal-title":"BMJ Open"},{"key":"2025121300041819000_11.6.e050329.52","doi-asserted-by":"publisher","DOI":"10.1097\/ACM.0000000000003936"},{"key":"2025121300041819000_11.6.e050329.53","unstructured":"Kabat-Zinn J , Hanh TN . Full catastrophe living: using the wisdom of your body and mind to face stress, pain, and illness. New York, NY: Delta Trade Paperbacks, 2009."},{"key":"2025121300041819000_11.6.e050329.54","doi-asserted-by":"publisher","DOI":"10.1016\/j.pain.2010.11.002"},{"key":"2025121300041819000_11.6.e050329.55","unstructured":"Higgins J , Green S , eds. Cochrane handbook for systematic reviews of interventions version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011."},{"key":"2025121300041819000_11.6.e050329.56","doi-asserted-by":"crossref","first-page":"35","DOI":"10.2147\/CLEP.S178723","article-title":"Observational studies of treatment effectiveness: worthwhile or worthless?","volume":"11","author":"Sharma","year":"2019","journal-title":"Clin Epidemiol"},{"key":"2025121300041819000_11.6.e050329.57","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.1989.01810110048007"},{"key":"2025121300041819000_11.6.e050329.58","doi-asserted-by":"publisher","DOI":"10.1037\/a0031865"},{"key":"2025121300041819000_11.6.e050329.59","doi-asserted-by":"publisher","DOI":"10.1016\/j.janxdis.2011.05.004"},{"key":"2025121300041819000_11.6.e050329.60","doi-asserted-by":"crossref","DOI":"10.1186\/s13643-016-0384-4","article-title":"Rayyan-a web and mobile APP for systematic reviews","volume":"5","author":"Ouzzani","year":"2016","journal-title":"Syst Rev"},{"key":"2025121300041819000_11.6.e050329.61","unstructured":"Roy Rosenzweig center for history and new media, 2019. Available: http:\/\/www.zotero.org"},{"key":"2025121300041819000_11.6.e050329.62","doi-asserted-by":"publisher","DOI":"10.1177\/001316446002000104"},{"key":"2025121300041819000_11.6.e050329.63","doi-asserted-by":"publisher","DOI":"10.1177\/1073191113490790"},{"key":"2025121300041819000_11.6.e050329.64","first-page":"29","article-title":"A revised tool for assessing risk of bias in randomized trials","volume":"10","author":"Higgins","year":"2016","journal-title":"Cochrane Database of Systematic Reviews"},{"key":"2025121300041819000_11.6.e050329.65","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2753.2010.01516.x"},{"key":"2025121300041819000_11.6.e050329.66","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.315.7109.629"},{"key":"2025121300041819000_11.6.e050329.67","doi-asserted-by":"publisher","DOI":"10.1037\/\/0033-2909.86.3.638"},{"key":"2025121300041819000_11.6.e050329.68","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39489.470347.AD"},{"key":"2025121300041819000_11.6.e050329.69","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.327.7414.557"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2021-050329","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T08:04:39Z","timestamp":1765613079000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2021-050329"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,6]]},"references-count":69,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2021,6,25]]},"published-print":{"date-parts":[[2021,6]]}},"alternative-id":["10.1136\/bmjopen-2021-050329"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2021-050329","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,6]]}}}