INTRODUCTION Although cognitive behavioral therapy (CBT) effectively treats obsessive-compulsive disorder (OCD), many patients refuse CBT or drop out prematurely, partly because of anxiety regarding exposure and response prevention (ERP) exercises. Inference-based cognitive behavioral therapy (I-CBT) focuses on correcting distorted inferential thinking patterns, enhancing reality-based reasoning, and addressing obsessional doubt by targeting underlying dysfunctional reasoning, without incorporating an ERP component. We hypothesized that I-CBT would be non-inferior to CBT. Additionally, we hypothesized that I-CBT would be more tolerable than CBT. METHODS 197 participants were randomly assigned to 20 sessions CBT or I-CBT and assessed at baseline, posttreatment, and 6 and 12 months' follow-up. The primary outcome was OCD symptom severity measured using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS; non-inferiority margin: 2 points). The secondary outcome, treatment tolerability, was assessed using the Treatment Acceptability/Adherence Scale (TAAS). A linear mixed-effects model was used to assess the non-inferiority of the primary outcome and superiority of secondary outcomes. RESULTS Statistically significant within-group improvements in the primary and secondary outcomes were observed in both treatments. No statistically significant between-group differences in Y-BOCS were found at any assessment point, but the confidence intervals exceeded the non-inferiority threshold, making the results inconclusive. The estimated mean posttreatment TAAS score was significantly higher in the I-CBT group than in the CBT group. CONCLUSION While both CBT and I-CBT are effective for OCD, whether I-CBT is non-inferior to CBT in terms of OCD symptom severity remains inconclusive. Nevertheless, I-CBT offers better tolerability and warrants consideration as an alternative treatment for OCD.

中文翻译：

---

强迫症的基于推理的认知行为疗法与认知行为疗法：一项多中心随机对照非劣效性试验。


引言 尽管认知行为疗法 （CBT） 有效治疗强迫症 （OCD），但许多患者拒绝 CBT 或过早退出，部分原因是对暴露和反应预防 （ERP） 练习的焦虑。基于推理的认知行为疗法 （I-CBT） 侧重于纠正扭曲的推理思维模式，增强基于现实的推理，并通过针对潜在的功能失调推理来解决强迫性怀疑，而无需加入 ERP 组件。我们假设 I-CBT 不劣于 CBT。此外，我们假设 I-CBT 比 CBT 更容易耐受。方法 将 197 名参与者随机分配到 20 次 CBT 或 I-CBT 组，并在基线、治疗后以及 6 个月和 12 个月的随访中进行评估。主要结局是使用耶鲁-布朗强迫症量表 （Y-BOCS;非劣效性边际：2 分）测量的强迫症症状严重程度。次要结局，治疗耐受性，使用治疗可接受性/依从性量表 （TAAS） 进行评估。线性混合效应模型用于评估主要结局的非劣效性和次要结局的优效性。结果 在两种治疗中，主要和次要结局的组内改善均具有统计学意义。在任何评估点均未发现 Y-BOCS 的组间差异具有统计学意义，但置信区间超过非劣效性阈值，使结果不确定。I-CBT 组估计的平均治疗后 TAAS 评分显著高于 CBT 组。结论 虽然 CBT 和 I-CBT 对 OCD 均有效，但 I-CBT 在 OCD 症状严重程度方面是否不劣于 CBT 仍无定论。 尽管如此，I-CBT 提供了更好的耐受性，值得考虑作为 OCD 的替代疗法。