Obsessive-compulsive disorder (OCD) can be better treated in teenagers and children when a full course of cognitive-behavioral therapy is added to treatment, according to new research.
Cognitive-behavioral therapy (CBT) is a time-limited form of psychotherapy that has been shown to be effective in treating a wide range of mental disorders, including clinical depression and anxiety.
OCD is typically and commonly treated with a course of serotonin reuptake inhibitors (SRIs), cognitive behavioral therapy (CBT) involving exposure plus response prevention, or some combination of the two. But, the researchers complain, “a paucity of expertise in pediatric OCD prevents most families from accessing CBT or combined treatment.”
Researchers led by Martin E. Franklin, Ph.D., of the University of Pennsylvania School of Medicine conducted the new 12-week randomized controlled trial to examine the effects of augmenting a common psychiatric medication used to treat obsessive-compulsive disorder with a regular, full course of CBT or a brief form of CBT — instructions in cognitive-behavior therapy that were delivered in medication management sessions.
The research was conducted at 3 academic medical centers between 2004 and 2009, involving 124 outpatients between the ages of 7 and 17 years with OCD as a primary diagnosis. Participants were randomly assigned to one of the three treatment groups — medication management by itself, medication + CBT, and medication + brief CBT.
The researchers found that at end of 12 weeks, the percentages of participants who had at least a 30 percent reduction in their Children’s Yale-Brown Obsessive Compulsive Scale baseline score — which the researchers defined as clinically significant change — were nearly 69 percent in the full CBT group, 34 percent in the brief CBT group, and 30 percent in medication management only-group.
Comparisons showed that the full cognitive-behavioral therapy group was superior to both the medication management only group and brief CBT group.
The researchers add that the findings from this and other studies highlight the importance of disseminating CBT for pediatric OCD into community settings so that affected children have options beyond medication management alone.
The findings from the new study, according to the researchers, “indicate that these dissemination efforts should focus on making the full CBT protocol more widely available in such settings rather than on attempting to create and disseminate truncated versions of this efficacious form of treatment.”
Obsessive-compulsive disorder affects up to 1 in 50 people, according to background information in the article, and is evident across development, and is associated with substantial dysfunction in many areas of a person’s life.
“Outcome data for pharmacotherapy alone, the most widely available treatment indicate that partial response is the norm and clinically significant residual symptoms often persist even after an adequate trial.”
The new study suggests that the standard of care for OCD in teens and children should be altered to ensure cognitive-behavior therapy is offered as an effective adjunct treatment option.
The study appears in the September 21 issue of JAMA.