Mindfulness-Based Interventions for Pediatric Obsessive-Compulsive Disorder: A Systematic Review

Abstract

Introduction: Obsessive-compulsive disorder (OCD) affects 1–3% of children and adolescents. Exposure and response prevention (ERP) is first-line but has non-response rates of 30–40%. Mindfulness-based interventions (MBIs) have been proposed as adjunctive or alternative treatments, but pediatric evidence is preliminary.

Methods: We searched PubMed, PsycINFO, and Scopus for interventional studies (RCTs, open-label) of MBIs (mindfulness-based cognitive therapy, mindfulness-based stress reduction, acceptance and commitment therapy) for youth (7–18 years) with diagnosed OCD. Primary outcome: Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS) change. Secondary: mindfulness skills (Child and Adolescent Mindfulness Measure). No meta-analysis due to heterogeneity.

Results: Seven studies (n=254 youth; 3 RCTs, 4 open-label) were included. In the largest RCT (n=72), MBI + ERP was superior to ERP alone at post-treatment (CY-BOCS reduction –9.4 vs. –5.2 points, p=0.01) and 6-month follow-up (–10.1 vs. –4.8). Open-label studies of MBI monotherapy showed CY-BOCS reductions of 28–35% (pre-post). Response rates (≥35% reduction) ranged 45–65%. Improvements in mindfulness skills correlated with OCD reduction (r=–0.52). Adverse events: transient anxiety increase (12% of MBI sessions) but no dropouts. Control groups in RCTs were waitlist or treatment as usual, not active psychological placebo.

Discussion: Mindfulness-based interventions show promise for pediatric OCD, particularly as an adjunct to ERP. The mechanism may involve enhancing cognitive flexibility and reducing thought-action fusion. However, evidence quality is low due to small samples and lack of active comparators.

Conclusions: Mindfulness-based interventions may augment ERP for pediatric OCD, but rigorous RCTs comparing MBI to ERP or pill placebo are needed before clinical recommendation. MBI monotherapy is not yet supported.