Augmenting drug therapy with CBT helps young people with OCD: results from new randomised controlled trial

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Research shows that using antidepressants (serotonin reuptake inhibitors, SRIs) to treat obsessive compulsive disorder (OCD) in young people is sometimes problematic. Patients often do not respond to the drugs and so other therapies are necessary to augment the treatment. One such therapy is CBT (cognitive behavioural therapy).

This 12-week randomised controlled trial took 124 paediatric outpatients between the ages of 7 and 17 years with OCD as a primary diagnosis and a Children’s Yale-Brown Obsessive Compulsive Scale score of 16 or higher despite an adequate SRI trial.

Patients were randomly assigned to one of three groups:

  1. Medication management only
  2. Medication management plus instructions in CBT *
  3. Medication management plus augmentation with CBT **

* The “instructions in CBT” were administered according to protocol (7 visits over 12 weeks), with an average time of 45 minutes, and comprised psychoeducation, establishing and re-evaluating a simple stimulus hierarchy, identifying exposure plus response prevention targets, and assigning homework.

** Augmentation with CBT consisted of 14 one-hour-long visits conducted over 12 weeks involving psychoeducation, cognitive training, development of treatment hierarchies to arrange feared situations from least to most anxiety-provoking to guide exposure treatment, and exposure plus response prevention.

The main outcomes were:

  • 30% improvement in baseline OCD scores
  • Change in continuous scores over 12 weeks

Here’s what the research team from the University of Pennsylvania School of Medicine discovered:

  • Medication management plus CBT was superior to the other 2 treatments on all outcome measures
    • In the primary intention-to-treat analysis, 68.6% (95% CI, 53.9%-83.3%) in the plus CBT group were considered responders,
    • which was significantly better than the 34.0% (18.0%-50.0%) in the plus instructions in CBT group,
    • and 30.0% (14.9%-45.1%) in the medication management only group.
  • The number needed-to-treat analysis with the plus CBT vs medication management only in order to see 1 additional patient at week 12, on average, was estimated as 3; for the plus CBT vs the plus instructions in CBT strategy, the number needed to treat was also estimated as 3; for the plus instructions in CBT vs medication management only the number needed to treat was estimated as 25.

The authors 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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