If you have ever caught yourself double-checking (or even triple-checking) whether you locked the front door or unplugged your hair curler, you will understand how the mind can play tricks on us. But imagine if those urges amplified to the point where it takes over your life, causing hours of lost time every day: that is the reality for people living with obsessive-compulsive disorder (OCD).
OCD affects roughly 4% of the world’s population (Stein et al., 2025) and is characterised by irrepressible, recurring thoughts (obsessions) and/or repetitive, extreme behaviours (compulsions). Cognitive behavioural therapy (CBT) tends to be the gold-standard approach for treating OCD, but it does not always work for everyone (Öst et al., 2015), for several different reasons (read Lawson’s Mental Elf blog here). This begs the question: what other options are available?
A recent systematic review and meta-analysis by Burkle et al. (2025) explores whether mindfulness- and acceptance-based programmes (MABPs) might be an effective alternative approach to treating OCD. MABPs teach individuals to eliminate judgment and foster acceptance towards their internal experiences, skills that have previously been identified as beneficial to intervention success in OCD (Riquelme-Marín et al., 2022).
Cognitive behavioural therapy is the gold standard treatment for OCD, but it doesn’t work for everyone. Could mindfulness-based and acceptance-based programmes be an effective alternative?
Methods
The authors searched seven databases for trials including individuals with a primary diagnosis of OCD who were receiving a standardised MABP (i.e., mindfulness-based (MB)-CBT, MB-Stress Reduction (MB-SR), Acceptance and Commitment Therapy (ACT) and Dialectical Behaviour Therapy (DBT)). They looked for studies that measured changes in OCD symptom severity at pre- and post-intervention as the main outcomes. They mostly included randomised controlled trials (RCTs) but did include some non-randomised trials as well.
Two independent reviewers screened titles and abstracts, and full texts were independently rated for final inclusion. Data was then combined in a random-effects meta-analysis, pooling both between-group effect sizes from RCTs and within-group pre-post effects across all studies, enabling them to estimate the overall impact of MABPs on OCD symptom severity. They also evaluated study quality (EPHPP) and risk of bias (RoB V.2.0) to help understand the reliability of the results. Of the included studies, results were consistent between the RoB V.2.0 and the EPHPP (RoB V.2.0: low-bias, n = 7; moderate-bias, n = 21; high-bias, n = 5).
Results
A total of 46 studies were included in the review and meta-analysis, with an overall study population of 2,221 participants (controls: n = 1,036; OCD: n = 1,215). Participants were assigned to one of 49 MABPs (ACT, MB-CBT, MB-SR) or one of 49 controls (waitlist, CBT, medication).
Across 33 RCTs, the evidence suggests that MABPs significantly improve OCD symptoms:
- MABPs led to a large, statistically significant reduction in OCD symptom severity compared to control groups (g= -0.87; 95% CI [-1.13 to -0.60])
- Participants improved between pre- and post-treatment in within-group analyses (k= 49; g = -1.72; 95% CI [-2.00 to -1.44])
- Secondary outcomes (i.e., depressive symptoms, obsessive beliefs, anxiety, quality of life) also showed reductions, although the strength of these effects varied.
The authors noted high heterogeneity in effect sizes and conducted subsequent moderator analyses to explore reasons for the variability.
Subgroup analyses examined differences in treatment effects by programme type, study design, comparator, and world region. Effects were largest versus waitlist controls (g = −1.66; 95% CI [-2.1 to -1.24]), no different than CBT (g = 0.02; 95% CI [-0.23 to 0.26]), and superior to medication (g = −0.77; 95% CI [-1.44 to -0.11]). No programme type outperformed others, and symptom reductions were observed across all world regions.
Meta-regressions tested continuous moderators like treatment duration, sample characteristics, and therapist features, finding no significant moderation of OCD symptom reductions. However, combined increases in mindfulness and psychological flexibility significantly predicted OCD symptom reductions.
Sensitivity analyses were conducted and confirmed the robustness of the findings.
Mindfulness- and acceptance-based programmes appear to significantly reduce OCD symptoms, with consistent effects across programme types, study designs, and control conditions.
Conclusions
The authors concluded that MABPs can lead to significant reductions in OCD symptoms, as well as improvements in related areas such as depression, anxiety, and quality of life. They noted, however, that the current evidence is heterogeneous and differs among study designs, comparator types, and programme formats.
While MABPs appear broadly effective and comparable to active treatments such as CBT, the authors emphasised the need for higher-quality, long-term trials to confirm their durability.
Programmes based on the principles of mindfulness and acceptance could provide an additional treatment option for individuals with OCD, but more trials with active control conditions are needed.
Strengths and limitations
This was a well-conducted review that followed the strict guidelines (PRISMA 2020) to ensure transparent reporting. Reviewers worked independently with an established search strategy (with the help of a librarian), and the inclusion of both RCTs and non-RCTs, as well as non-English studies and grey literature ensured a breadth of evidence was included. This reduces the likelihood of bias, and strengths our confidence in the findings.
However, there are a few critical limitations to keep in mind. Studies varied widely in design, duration, and delivery, making it harder to directly compare results. Some outcomes were based on studies with relatively small power, which means certain factors that might influence effectiveness (e.g., age, comorbidities) could have been missed. Follow-up was also short in most trials, meaning that it’s unclear how long any improvements last; as OCD is a life-long condition, it’s important that treatments are helpful in the long-term. Overall, while the findings are promising, larger, longer, and more consistent studies are needed to be confident about the lasting impact of MABPs for OCD.
This was a well-conducted meta-analysis using rigorous methods to capture a broad and reliable evidence base. However, more high-quality, long-term research is needed to confirm the lasting benefits of mindfulness- and acceptance-based programmes for OCD.
Implications for practice
For clinicians, MABPs may be an effective alternative or additional tool for supporting people with OCD. This may be particularly relevant for the 30% of people with OCD who decline, drop out of, or do not respond adequately to CBT. However, at present, MABPs are better viewed as an additional option under evaluation rather than an established alternative within national guidelines (Bürkle et al., 2021; National Institute for Health and Care Excellence, 2005; Ong et al., 2016). Perhaps in the future, we may see a change.
For patients and members of the public, including those living with OCD and their friends and families, this therapeutic approach may be experienced as empowering, and help to reduce the stigma and shame that if often present with OCD (Glazier et al., 2015). MABPs typically focus on building present-moment, non-judgmental awareness of unwanted thoughts and feelings and encourage openness to experiencing them without reacting (Gkintoni et al., 2025; Twohig et al., 2010), which may help to address some of the barriers to treatment faced.
Finally, as a person with lived experience of OCD who did not experience success with CBT, I find the results of this review incredibly hopeful for others with the same concerns. It demonstrates the importance of eliminating the “one size fits all” approach to mental healthcare and why continuing research is so imperative in bettering the lives of people coexisting with mental illness. The conclusions drawn from this study are important to my PhD and wider interests in considering the range of ways we might support people living with mental illness.
Through emphasising acceptance, mindfulness, and self-compassion, mindfulness- and acceptance-based programmes may help individuals with OCD who experience high levels of self-stigma and shame.
Statement of interests
Ella Bradley – None.
Edited by
Dr Nina Higson-Sweeney.
Links
Primary paper
Johannes J. Bürkle, Stefan Schmidt, & Johannes C. Fendel (2025). Mindfulness- and acceptance-based programmes for obsessive-compulsive disorder: A systematic review and meta-analysis. Journal of Anxiety Disorders, 110, 102977. https://doi.org/https://doi.org/10.1016/j.janxdis.2025.102977
Other references
Bürkle, J. J., Fendel, J. C., & Schmidt, S. (2021). Mindfulness-based and acceptance-based programmes in the treatment of obsessive-compulsive disorder: a study protocol for a systematic review and meta-analysis. BMJ Open, 11(6), e050329. https://doi.org/10.1136/bmjopen-2021-050329
Gkintoni, E., Vassilopoulos, S. P., & Nikolaou, G. (2025). Mindfulness-Based Cognitive Therapy in Clinical Practice: A Systematic Review of Neurocognitive Outcomes and Applications for Mental Health and Well-Being. Journal of Clinical Medicine, 14(5), 1703.
Glazier, K., Wetterneck, C., Singh, S., & Williams, M. (2015). Stigma and shame as barriers to treatment for obsessive-compulsive and related disorders. Journal of Depression and Anxiety, 4(3), 191.
National Institute for Health and Care Excellence. (2005). Obsessive-compulsive disorder and body dysmorphic disorder: treatment. NICE guideline CG31. https://www.nice.org.uk/guidance/cg31
Ong, C. W., Clyde, J. W., Bluett, E. J., Levin, M. E., & Twohig, M. P. (2016). Dropout rates in exposure with response prevention for obsessive-compulsive disorder: What do the data really say? Journal of Anxiety Disorders, 40, 8-17. https://doi.org/https://doi.org/10.1016/j.janxdis.2016.03.006
Öst, L.-G., Havnen, A., Hansen, B., & Kvale, G. (2015). Cognitive behavioral treatments of obsessive–compulsive disorder. A systematic review and meta-analysis of studies published 1993–2014. Clinical Psychology Review, 40, 156-169. https://doi.org/https://doi.org/10.1016/j.cpr.2015.06.003
Riquelme-Marín, A., Rosa-Alcázar, A. I., & Ortigosa-Quiles, J. M. (2022). Mindfulness-based psychotherapy in patients with obsessive-compulsive disorder: A meta-analytical Study. Int J Clin Health Psychol, 22(3), 100321. https://doi.org/10.1016/j.ijchp.2022.100321
Twohig, M. P., Hayes, S. C., Plumb, J. C., Pruitt, L. D., Collins, A. B., Hazlett-Stevens, H., & Woidneck, M. R. (2010). A randomized clinical trial of acceptance and commitment therapy versus progressive relaxation training for obsessive-compulsive disorder. J Consult Clin Psychol, 78(5), 705-716. https://doi.org/10.1037/a0020508
Taylor, L. (2021). Why CBT can fail those with OCD: service users’ perspectives. The Mental Elf.
