Adding cognitive behaviour therapy to drug treatment helps children with obsessive compulsive disorder


Children with obsessive-compulsive disorder (OCD) are often prescribed antidepressant drugs (serotonin reuptake inhibitors – SRI), but many only partially respond to this treatment. This randomised controlled trial conducted by researchers from the University of Pennsylvania School of Medicine, examined the effects of augmenting the antidepressant medication with cognitive behaviour therapy (CBT).

The trial was quite short (12 weeks) and fairly small (124 patients aged 7-17 with a primary diagnosis of OCD and a Children’s Yale-Brown Obsessive Compulsive Scale score of 16 or higher despite an adequate SRI trial).

Patients were randomised to one of three groups:

  1. Medication management only (42 patients)
  2. Medication management plus instructions in CBT (42 patients)
  3. Medication management plus CBT (42 patients)

The main outcome that the researchers were looking for was an improvement on baseline OCD score of 30% or more and a change in continuous scores over the 12 weeks.

Here’s what they found:

  • Medication management plus CBT was better than the other two treatments on all outcomes
  • The authors conducted an intention to treat analysis which showed:
    • 68.6% response rate (95% CI, 53.9%-83.3%) in the plus CBT group
    • 34.0% (95% CI, 18.0%-50.0%) in the plus instructions in CBT group
    • 30.0% (95% CI, 14.9%-45.1%) in the medication management only group

The researchers concluded:

Among patients aged 7 to 17 years with OCD and partial response to SRI use, the addition of CBT to medication management compared with medication management alone resulted in a significantly greater response rate, whereas augmentation of medication management with the addition of instructions in CBT did not.

Franklin ME, Sapyta J, Freeman JB, Khanna M, Compton S, Almirall D, Moore P, Choate-Summers M, Garcia A, Edson AL, Foa EB, March JS. Cognitive behavior therapy augmentation of pharmacotherapy in pediatric obsessive-compulsive disorder: the Pediatric OCD Treatment Study II (POTS II) randomized controlled trial. JAMA. 2011 Sep 21;306(11):1224-32. [PubMed abstract]

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