Children and teens with obsessive-compulsive disorder who were receiving some benefit from treatment with medication had a significantly greater reduction in OCD symptoms with the addition of cognitive behavior therapy.
"Obsessive-compulsive disorder affects up to one in 50 people, is evident across development and is associated with substantial dysfunction and psychiatric comorbidity," the authors wrote in the Sept. 21 issue of JAMA. "Randomized controlled trial findings support the efficacy of pharmacotherapy with serotonin reuptake inhibitors (SRIs), cognitive behavior therapy involving exposure plus prevention, and combined treatment.
"However, a paucity of expertise in pediatric OCD prevents most families from accessing exposure plus response prevention or combined treatment. 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."
Martin E. Franklin, PhD, of the University of Pennsylvania School of Medicine in Philadelphia, and colleagues conducted a study to examine the effects of augmenting SRIs with CBT or instructions in CBT delivered in the context of medication management. The 12-week randomized controlled trial was conducted at three academic medical centers between 2004 and 2009, involving 124 outpatients between ages 7 and 17 with OCD as a primary diagnosis. Participants were randomly assigned to one of three treatment strategies that included seven sessions over 12 weeks: medication management only, medication management plus instructions in CBT or medication management plus CBT; the last included 14 concurrent CBT sessions.
The researchers found that at 12 weeks the percentages of participants who had at least a 30% reduction in their Children's Yale-Brown Obsessive Compulsive Scale baseline score were 68.6% in the "plus CBT" group, 34% in the "plus instructions in CBT" group and 30% in "medication management only" group. Comparisons showed that the plus CBT strategy was superior to both the medication management only strategy and the plus instructions in CBT strategy. The plus instructions in CBT strategy was not statistically better than medication management only.
The researchers added 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.
They also wrote that the findings "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. Toward these ends, research must focus on developing, evaluating and comparing various models for disseminating CBT beyond the academic medical context."
To view a study summary, visit http://jama.ama-assn.org/content/306/11/1224.short.
"Obsessive-compulsive disorder affects up to one in 50 people, is evident across development and is associated with substantial dysfunction and psychiatric comorbidity," the authors wrote in the Sept. 21 issue of JAMA. "Randomized controlled trial findings support the efficacy of pharmacotherapy with serotonin reuptake inhibitors (SRIs), cognitive behavior therapy involving exposure plus prevention, and combined treatment.
"However, a paucity of expertise in pediatric OCD prevents most families from accessing exposure plus response prevention or combined treatment. 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."
Martin E. Franklin, PhD, of the University of Pennsylvania School of Medicine in Philadelphia, and colleagues conducted a study to examine the effects of augmenting SRIs with CBT or instructions in CBT delivered in the context of medication management. The 12-week randomized controlled trial was conducted at three academic medical centers between 2004 and 2009, involving 124 outpatients between ages 7 and 17 with OCD as a primary diagnosis. Participants were randomly assigned to one of three treatment strategies that included seven sessions over 12 weeks: medication management only, medication management plus instructions in CBT or medication management plus CBT; the last included 14 concurrent CBT sessions.
The researchers found that at 12 weeks the percentages of participants who had at least a 30% reduction in their Children's Yale-Brown Obsessive Compulsive Scale baseline score were 68.6% in the "plus CBT" group, 34% in the "plus instructions in CBT" group and 30% in "medication management only" group. Comparisons showed that the plus CBT strategy was superior to both the medication management only strategy and the plus instructions in CBT strategy. The plus instructions in CBT strategy was not statistically better than medication management only.
The researchers added 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.
They also wrote that the findings "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. Toward these ends, research must focus on developing, evaluating and comparing various models for disseminating CBT beyond the academic medical context."
To view a study summary, visit http://jama.ama-assn.org/content/306/11/1224.short.
Send comments to editor@nurse.com or post a comment below.
