BACKGROUND: Cognitive-behavioral therapy (CBT) is generally recommended for obsessive-compulsive disorder (OCD) patients who have failed to respond to approved medications. However, few studies of the efficacy of CBT have selected patients who did not respond to medications. METHOD: We selected 20 adult OCD (DSM-IV criteria) patients with a history of inadequate response to adequate doses of multiple medications, as well as a high rate of comorbid disorders. After a 1-month wait-list period, patients received 15 sessions of outpatient CBT incorporating exposure and ritual prevention. RESULTS: OCD severity (as measured with the Yale-Brown Obsessive Compulsive Scale) decreased significantly (p <.05) after treatment, and gains appeared to have been maintained over a 6-month follow-up period. Analysis of clinical significance indicated that 53% (8/15) of treatment completers met this criterion at posttreatment and 40% (6/15) met the criterion at 6-month follow-up. The sample was characterized as having generally poor insight and putting low effort into CBT; these factors significantly (p <.05) predicted degree of improvement. CONCLUSION: CBT is a useful treatment for OCD patients who have failed to respond adequately to multiple serotonin reuptake inhibitor medications. However, these results were attenuated compared with previous trials. Patients with a long history of poor response to medication may have poor insight and/or not put sufficient effort into treatment; these factors are likely to diminish treatment outcome.
BACKGROUND: Cognitive-behavioral therapy (CBT) is generally recommended for obsessive-compulsive disorder (OCD) patients who have failed to respond to approved medications. However, few studies of the efficacy of CBT have selected patients who did not respond to medications. METHOD: We selected 20 adult OCD (DSM-IV criteria) patients with a history of inadequate response to adequate doses of multiple medications, as well as a high rate of comorbid disorders. After a 1-month wait-list period, patients received 15 sessions of outpatient CBT incorporating exposure and ritual prevention. RESULTS:OCD severity (as measured with the Yale-Brown Obsessive Compulsive Scale) decreased significantly (p <.05) after treatment, and gains appeared to have been maintained over a 6-month follow-up period. Analysis of clinical significance indicated that 53% (8/15) of treatment completers met this criterion at posttreatment and 40% (6/15) met the criterion at 6-month follow-up. The sample was characterized as having generally poor insight and putting low effort into CBT; these factors significantly (p <.05) predicted degree of improvement. CONCLUSION: CBT is a useful treatment for OCDpatients who have failed to respond adequately to multiple serotonin reuptake inhibitor medications. However, these results were attenuated compared with previous trials. Patients with a long history of poor response to medication may have poor insight and/or not put sufficient effort into treatment; these factors are likely to diminish treatment outcome.
Authors: Helen Blair Simpson; Edna B Foa; Michael R Liebowitz; Jonathan D Huppert; Shawn Cahill; Michael J Maher; Carmen P McLean; James Bender; Sue M Marcus; Monnica T Williams; Jamie Weaver; Donna Vermes; Page E Van Meter; Carolyn I Rodriguez; Mark Powers; Anthony Pinto; Patricia Imms; Chang-Gyu Hahn; Raphael Campeas Journal: JAMA Psychiatry Date: 2013-11 Impact factor: 21.596
Authors: Robert R Selles; Davið R M A Højgaard; Tord Ivarsson; Per Hove Thomsen; Nicole Michelle McBride; Eric A Storch; Daniel Geller; Sabine Wilhelm; Lara J Farrell; Allison M Waters; Sharna Mathieu; S Evelyn Stewart Journal: J Am Acad Child Adolesc Psychiatry Date: 2019-06-20 Impact factor: 8.829
Authors: Carmen P McLean; Laurie J Zandberg; Page E Van Meter; Joseph K Carpenter; Helen Blair Simpson; Edna B Foa Journal: J Clin Psychiatry Date: 2015-12 Impact factor: 4.384