The extant literature on the treatment of pediatric OCD indicates that partial response to serotonin reuptake inhibitors (SRIs) is the norm, and that augmentation with short-term OCD-specific cognitive behavior therapy (CBT) may provide additional benefit.
To examine the effects of augmenting SRIs with CBT or a brief form of CBT, instructions in CBT (I-CBT) delivered in the context of medication management (MM).
A 12-week, 3 (site: Penn, Duke, Brown) × 3 (treatment conditions: MM, MM+I-CBT, & MM+CBT) × 4 (repeated measures: weeks 0, 4, 8, & 12) randomized controlled trial.
The outpatient clinics of three academic medical centers between 2004 and 2009.
Outpatients (N = 124) between the ages of 7–17 with primary OCD and a Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS) score ≥ 16 despite an adequate SRI trial.
Participants were randomized to receive 12 weeks of: 1) MM (7 sessions), 2) MM+I-CBT (7 sessions) or 3) MM+CBT (7 sessions of MM plus 14 concurrent CBT sessions).
Main Outcome Measures
Responder status as defined as a post-treatment CY-BOCS reduction of 30% or greater compared to baseline; change in continuous CY-BOCS total score over 12 weeks.
MM+CBT was superior to MM and to MM+I-CBT on all outcome measures. In the primary ITT analysis, 68.6% in MM+CBT (95% confidence interval [CI], 53.9%–83.3%) were considered responders, which was significantly better than the 34.0% in MM+I-CBT (95% CI, 18.0% to 50.0%), and 30.0% in MM (95% CI, 14.9% to 45.1%). Planned pairwise comparisons show that MM+CBT was superior to both MM and MM+I-CBT (p < 0.01 for both). MM+I-CBT was not statistically significant from MM (p = 0.72). The number needed to treat (NNT) with MM+CBT versus MM to see one additional RESPONSE at Week 12, on average, was estimated as 3; for MM+CBT versus MM+I-CBT the NNT was also estimated as 3 ;for MM+I-CBT versus MM the NNT was estimated as 25.
Among patients age 7–17 with OCD and partial response to SRI use, the addition of CBT by a psychologist 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 by the psychiatrist did not. Dissemination of full CBT augmentation for pediatric OCD partial responders of SRI should be an important public health objective.