Adding Psychotherapy to Meds Helps Kids With OCD

TUESDAY Sept. 20, 2011 -- Adding cognitive behavioral therapy to medication seems to help children and teens with obsessive-compulsive disorder, new research shows.

The findings, published in the Sept. 21 issue of the Journal of the American Medical Association, confirm previous research on cognitive behavioral therapy (CBT) and obsessive-compulsive disorder (OCD).

"[If] a child has been taking one of the [medications for OCD] and has a partial response, we can get a much better response when we add on CBT," said Lawrence Newman, a psychologist with Children's Hospital of Pittsburgh, who was not involved with the study.

Treatment with the class of antidepressants known as serotonin reuptake inhibitors is the mainstay of treatment for OCD, but relief isn't always complete.

"There's plenty of evidence suggesting that medication works," said study author Martin E. Franklin, an associate professor of clinical psychology in psychiatry at the University of Pennsylvania School of Medicine in Philadelphia. "We find that kids in general are getting better, but there are clinically relevant residual symptoms. They're better, but they're still in need of more care."

Franklin and his colleagues tested the efficacy of both conventional CBT and an abbreviated form of CBT, called "instructions in CBT."

This truncated form of therapy, they had hoped, would help ease patients' symptoms.

"We know CBT works. The reality, unfortunately, is that there aren't a lot of practitioners in community settings," Franklin explained.

The study involved 124 kids aged 7 through 17, all of whom had OCD and who were randomized to one of three groups: medication alone; medication plus conventional CBT; or medication plus instructions in CBT.

The abbreviated CBT consisted of seven, 45-minute visits over a 12-week period while the full CBT program was 14 one-hour visits over the same period.

But there was no appreciable difference between the shortened version of CBT plus medication or medication alone, the researchers said.

The only group that saw appreciable benefits were those getting full-length CBT as well as antidepressants.

The findings pose a conundrum for the researchers -- and patients: The full therapy works, but there's not enough of it to go around.

Hopefully, the data will be further impetus to increase the availability of treatment, the authors stated.

"We know this treatment . . . is helpful for most who receive it, whether they get it as an initial treatment or as augmentation to meds, but it's frustrating to be providing families and other treatment providers with encouraging recommendations only to find that these recommendations are not feasible to follow in many communities," Franklin said.

"It's a huge public policy problem, access to good cognitive behavioral therapy for OCD," added Newman.

More information

The American Academy of Child & Adolescent Psychiatry has more on OCD in kids.

Posted: September 2011


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