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Studies were included if they involved individuals over the age of 18 who were diagnosed with OCD, according to either fourth or fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV or DSM-5), and had a total Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) score greater than 16, which is indicative of moderate to severe OCD ( Databases and search procedure We conducted the search across electronic databases of PubMed, Web of Science, Scopus (as databases of journal article) and ProQuest (as a database of grey literature) to identify relevant trials, using the search strategies outlined in Appendix 1 to collect the available evidence from original articles published until December 2023 in English