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Cognitive behavioral therapy combined with antidepressant effective in treating adolescent OCD


Breakthrough data suggests cognitive behavioral therapy alone is effective when provided by expert therapists

According to current epidemiological data, approximately 1 in 200 young people suffer from obsessive-compulsive disorder (OCD). OCD patients ’obsess’ about thoughts of bad things that can happen (obsessions) and perform repetitive, destructive actions (compulsions) as a means of dealing with those thoughts. OCD can cripple their lives, disrupt their learning, and drive a wedge through their families. Now, University of Pennsylvania School of Medicine researchers, in conjunction with a team of researchers from Duke University Medical Center, have developed a scientifically conclusive treatment combination – using Cognitive Behavior Therapy (CBT) and commonly a prescribed anti-depressant medication – to help pediatric patients overcome OCD. Their conclusions – based on a five-year study – may be found in the October 27th issue of the Journal of the American Medical Association (JAMA).

Edna B. Foa, PhD, Professor of Psychology in Psychiatry; Director, Center for the Treatment and Study of Anxiety; and Co-Principal Investigator for Penn’s component of ’The Pediatric OCD Treatment Study (POTS)’ says, "This investigation shows that children diagnosed with OCD respond better to a combination of CBT and Zoloft as compared to placebo and either treatment alone. However, at the Penn site, children responded equally well to CBT alone and to the combined treatment". Zoloft (sertraline) is a commonly prescribed selective serotonin reuptake inhibitor (SSRI), which elicits its effects by increasing the activity of serotnin in the brain. CBT includes helping the children confront anxiety-evoking situations and refraining from performing compulsions in order to learn their fears are exaggerated or unrealistic. This is the first study to test the efficacy of combining the two treatments in pediatric patients.

One hundred twelve children, ages seven to 17, were enrolled in POTS. The patients were randomly assigned to receive CBT plus sertraline, CBT alone, sertraline alone, or a placebo for 12 weeks.

The researchers found that 53.6 percent of the participants in the combination group (CBT plus sertraline) showed little or no symptoms by the end of their treatment. For those only given CBT, 39.3 percent of participants showed less severe OCD symptoms. Participants on sertraline alone saw 21.4 percent of their group with less severe OCD symptoms. Only 3.6 percent of those receiving the placebo responded with greatly reduced OCD symptoms. "According to the data, some children may respond to CBT alone, and others to sertraline alone, but most patients did better with a combination of the two, " says Dr. Foa. "However, the Penn specific data showed that CBT alone was more effective than the medication, and as effective as the combined, " added Dr. Foa. "This suggests that the manner in which the therapists provide CBT is an important factor in determining the effectiveness of the treatment." Of the Penn patients, 64 percent of participants in both the CBT alone and combination group showed little or no symptoms by the end of treatment. "These findings suggest we must determine which treatment works best for individual patients, and at the same time, we need to teach therapists how best to conduct CBT. This study proves that the effective use of CBT alone, and a combination of CBT with an SSRI, will greatly improve the chance for decreasing the symptoms of OCD."

Because most children who receive SSRIs continue to have clinical symptoms, The Center for the Treatment and Study of Anxiety is conducting a second study to investigate the efficacy of augmenting SSRIs with adjunctive CBT. Martin Franklin, PhD, Associate Professor of Psychology in Psychiatry is the Principal Investigator and Dr. Foa is the co-Principal Investigator of the study at the Penn site. This study was funded by the National Institute for Mental Health (NIMH). Sertraline and the placebos were provided by Pfizer, Inc. Neither the NIMH nor Pfizer participated in the design or implementation of this study.

Researchers also contributing to this effort include: Martin Franklin, PhD, Jonathan Huppert, PhD, Moira Rynn, MD, Ning Zhao, PhD, Lori Zoellner, PhD, and Xin Tu, PhD from Penn; John March, MD, Patricia Gammon, PhD, Allan Chrisman, MD, John Curry, MD, David Fitzgerald, PhD, and Kevin Sullivan from Duke University Medical Center; Jennifer Freeman, PhD, at Bradley/Hasbro Children’s Research Center (Brown University).

Ed Federico | EurekAlert!
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