A report in the September 21 issue of JAMA suggests that, children and teens who have obsessive-compulsive disorder (OCD) who received some benefit from therapy with medication had a considerably larger reduction in OCD symptoms when treatment was combined with cognitive behavior therapy.

According to background data in the report “Obsessive-compulsive disorder affects up to 1 in 50 people, is evident across development, and is associated with substantial dysfunction and psychiatric comorbidity.”

Randomized controlled trial findings support the efficacy of pharmacotherapy with serotonin reuptake inhibitors (SRIs), cognitive behavior therapy [CBT] involving exposure plus response 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, Ph.D., of the University of Pennsylvania School of Medicine, Philadelphia, and colleagues carried out an investigation to analyze the effects of augmenting SRIs with cognitive behavior therapy or a brief form of CBT, instructions in CBT delivered in the context of medication management.

Between 2004 and 2009, the 12-week randomized controlled investigation was carried out at three academic medical centers, and involved 124 outpatients aged between 7 and 17 years old with OCD as a main diagnosis. The 124 participants were randomly assigned to one of three therapy plans that involved 7 sessions over the period of 12 weeks. One group were assigned to medication management only, the second group to the medication management plus instructions in CBT, and the third group medication management plus CBT; the last included 14 concurrent CBT sessions.

At 12 weeks, they discovered that, the percentages of participants who had a minimum of a 30% reduction in their Children’s Yale-Brown Obsessive Compulsive Scale baseline score were 68.6% in the plus CBT group, 34.0% in the plus instructions in CBT group, and 30.0% in medication management only-group. Comparisons revealed that the plus CBT plan was better than both the medication management only plan and the plus instructions in CBT plan. The plus instructions in CBT plan was not statistically greater than medication management only.

The researchers state that the discoveries from this investigation and others reveal the importance of disseminating CBT for pediatric OCD into community settings so that those affected have choices beyond just medication management:

“Furthermore, [the findings from this study] 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.”

Written by Grace Rattue