4 Research recommendations

The Guideline Development Group has made the following recommendations for research, on the basis of its review of the evidence. The Group regards these recommendations as the most important research areas to improve NICE guidance and patient care in the future. The Guideline Development Group's full set of research recommendations is detailed in the full guideline (see Section 5).

4.1 Treatment of OCD and BDD among young people and young adults

Appropriately blinded randomised controlled trials (RCTs) should be conducted to assess the acute and long‑term efficacy (including measures of social function and quality of life), acceptability and the cost effectiveness of CBT and SSRIs, alone and in combination, compared with each other and with appropriate control treatments for both the psychological and pharmacological arms. These should be carried out in a broadly based sample of young people and young adults (for example, aged 12–25 years) diagnosed with OCD and BDD across a range of functional impairment (using minimal exclusion criteria). The trials should be powered to examine the effect of treatment for combined versus single‑strand treatments and involve a follow‑up of 1, 2 and 5 years. Any treatment received in the follow‑up period should also be recorded.

4.2 CBT treatment intensity formats among adults with OCD

Appropriately blinded RCTs should be conducted to assess the efficacy (including measures of social function and quality of life), acceptability and the cost effectiveness of different delivery formats of CBT that include ERP for adults with OCD, including brief individual CBT using structured self‑help materials, brief individual CBT by telephone, group CBT and standard individual CBT compared with each other and with credible psychological treatment that is not specific to OCD and BDD (such as anxiety management training) in a broadly based sample of people diagnosed with OCD across a range of functional impairment (using minimal exclusion criteria). The trials should be powered to examine the effect of treatment in different bands of severity or functional impairment and involve a follow‑up of 1 and 2 years. Any treatment received in the follow‑up period should also be recorded.

4.3 CBT for adults with OCD who have not responded to treatment

An appropriately blinded RCT should be conducted to assess the efficacy (including measures of social functioning and quality of life as well as OCD) of intensive versus spaced individual treatments (that include both ERP and cognitive therapy elements) compared with a treatment‑as‑usual control in a broadly based sample of adults diagnosed with OCD who have not responded to one or more adequate trials of an SSRI or clomipramine and one or more trials of CBT (that included ERP). The trial should be powered to examine the relative efficacy of intensive versus spaced treatment and involve a follow‑up of 1 and 2 years. Any treatment received in the follow‑up period should also be recorded.

4.4 Screening for OCD and BDD

Appropriately designed studies should be conducted to compare validated screening instruments for the detection of OCD and BDD in children, young people and adults. An emphasis should be placed on examining those that use computer technology and more age‑appropriate methods of assessing both symptoms and functioning, taking into account cultural and ethnic variations in communication, and family values. For BDD, specific populations would include young people or adults who consult in dermatology or plastic surgery and those with other psychiatric disorders.

4.5 CBT for children and young people with OCD and BDD

An appropriately blinded RCT should be conducted to assess the efficacy (including measures of social functioning and quality of life) and the cost effectiveness of individual CBT and CBT involving the family or carers compared with each other and with a credible psychological treatment that is not specific to OCD and BDD (such as anxiety management training) in a broadly based sample of children and young people diagnosed with OCD and BDD (using minimal exclusion criteria). The trial should be powered to examine the effect of treatment in children and young people separately and involve a follow‑up of at least 1 year.