Cognitive Behavioral Therapy
Combined with a Common Antidepressant Proven Effective
in Treating Adolescent Obsessive-Compulsive Disorder
Breakthrough Data Suggests Cognitive Behavioral
Therapy Alone is Effective when Provided by Expert Therapists
(Philadelphia, PA) – 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 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).
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Editor’s Notes: Dr. Foa
has received speaker and consultant fees, as well as
research support from Pfizer, Inc., for previous work.
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