Cognitive-Behavioral Therapy for Medication Nonresponders With Obsessive-Compulsive Disorder

Tolin, David F.; Maltby, Nicholas; Diefenbach, Gretchen J.; Hannan, Scott; Worhunsky, Patrick D.

doi:10.4088/jcp.v65n0708

Cited by 134 publications

(95 citation statements)

References 46 publications

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“…The encouraging outcome of exposure and ritual prevention observed in our study is consistent with studies conducted elsewhere that used similar exposure and ritual prevention procedures, including specialty fee-for-service practices (49,50) and anxiety research clinics in the United States (16) and Europe (17,51). Moreover, a recent study from Norway (46) found that even therapists in non-academic community clinics can achieve good outcomes with training and group supervision by experts in exposure and ritual prevention.…”

Section: Generalizabilitysupporting

confidence: 78%

See 1 more Smart Citation

A Randomized, Controlled Trial of Cognitive-Behavioral Therapy for Augmenting Pharmacotherapy in Obsessive-Compulsive Disorder

Simpson

Foa²,

Liebowitz³

et al. 2008

AJP

247

101

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Objective-Although serotonin reuptake inhibitors (SRIs) are approved for the treatment of obsessive-compulsive disorder (OCD), most OCD patients who have received an adequate SRI trial continue to have clinically significant OCD symptoms. The purpose of this study was to examine the effects of augmenting SRIs with exposure and ritual prevention, an established cognitive-behavioral therapy (CBT) for OCD.Method-A randomized, controlled trial was conducted at two academic outpatient clinics to compare the effects of augmenting SRIs with exposure and ritual prevention versus stress management training, another form of CBT. Participants were adult outpatients (N=108) with primary OCD and a Yale-Brown Obsessive Compulsive Scale total score ≥16 despite a therapeutic SRI dose for at least 12 weeks prior to entry. Participants received 17 sessions of CBT (either exposure and ritual prevention or stress management training) twice a week while continuing SRI pharmacotherapy.Results-Exposure and ritual prevention was superior to stress management training in reducing OCD symptoms. At week 8, significantly more patients receiving exposure and ritual prevention than patients receiving stress management training had a decrease in symptom severity of at least 25% (based on Yale-Brown Obsessive Compulsive Scale scores) and achieved minimal symptoms (defined as a Yale-Brown Obsessive Compulsive Scale score ≤12).Conclusions-Augmentation of SRI pharmacotherapy with exposure and ritual prevention is an effective strategy for reducing OCD symptoms. However, 17 sessions were not sufficient to help most of these patients achieve minimal symptoms.Obsessive-compulsive disorder (OCD) is a severe and disabling illness (1). Serotonin reuptake inhibitors (SRIs) (e.g., clomipramine and various selective serotonin re-uptake inhibitors [SSRIs]) and cognitive-behavioral therapy (CBT) involving exposure and ritual NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript prevention have both been found to be efficacious in randomized, controlled trials (2). In clinical practice, SRIs are used most frequently (3), but because they typically yield only a 20%-40% reduction in OCD symptoms (4), many SRI responders continue to have clinically significant symptoms.The only SRI augmentation strategy with proven efficacy in multiple randomized, placebocontrolled trials involves the addition of antipsychotics (e.g., haloperidol, risperidone, olanzapine, or quetiapine) (5). However, at most only half of the patients respond (i.e., experience ≥25% reduction in OCD severity) (6, 7) and antipsychotics can cause significant adverse effects (8).Because of the efficacy of exposure and ritual prevention as monotherapy for OCD (9) and promising findings from our open SRI augmentation trial using exposure and ritual prevention (10), we conducted a randomized, controlled trial to compare the effects of augmenting SRIs with exposure and ritual prevention versus stress management training, another form of CBT. Stress management training teache...

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Section: Generalizabilitysupporting

confidence: 78%

“…Additional data, published since the trial's initiation in 2000, indicate that exposure and ritual prevention can augment SRIs in the treatment of OCD (13)(14)(15)(16). In the only prior randomized, controlled trial, Tenneij et al (17) compared the effects of just continuing medication (paroxetine or venlafaxine) versus adding exposure and ritual prevention.…”

mentioning

confidence: 99%

A Randomized, Controlled Trial of Cognitive-Behavioral Therapy for Augmenting Pharmacotherapy in Obsessive-Compulsive Disorder

Simpson

Foa²,

Liebowitz³

et al. 2008

AJP

247

101

View full text Add to dashboard Cite

show abstract

“…63 It is interesting that, for example, the observation that CBT seems to be efficient even in patients who do not respond or partially respond to pharmacological treatment. [64][65][66] A recent study performed with children and adolescents has verified that the combination of CBT and medications presented better results than the use of medications alone. 67 A similar result was found in adult patients.…”

Section: The Addition Of Cognitive Techniquesmentioning

confidence: 99%

A terapia cognitivo-comportamental no transtorno obsessivo-compulsivo

Cordioli¹

2008

Rev. Bras. Psiquiatr.

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“…However, there was no control condition for CBT (Tenneij et al 2005). Drug non-responders showed improvement with CBT in an uncontrolled study (Tolin et al 2004).…”

Section: )(E)mentioning

confidence: 99%

World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Post-Traumatic Stress Disorders – First Revision

Bandelow

Zohar

Hollander

et al. 2008

The World Journal of Biological Psychiatry

718

410

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In this report, which is an update of a guideline published in 2002 (Bandelow et al. 2002, recommendations for the pharmacological treatment of anxiety disorder, obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD) are presented. Since the publication of the first version of this guideline, a substantial number of new randomized controlled studies of anxiolytics have been published. In particular, more relapse prevention studies are now available that show sustained efficacy of anxiolytic drugs. The recommendations, developed by the World Federation of Societies of Biological Psychiatry (WFSBP) Task Force for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Post-Traumatic Stress Disorders, a consensus panel of 30 international experts, are now based on 510 published randomized, placebo-or comparator-controlled clinical studies (RCTs) and 130 open studies and case reports. First-line treatments for these disorders are selective serotonin reuptake inhibitors (SSRIs), serotonin-noradrenaline reuptake inhibitors (SNRIs) and the calcium channel modulator pregabalin. Tricyclic antidepressants (TCAs) are equally effective for some disorders, but many are less well tolerated than the SSRIs/ SNRIs. In treatment-resistant cases, benzodiazepines may be used when the patient does not have a history of substance abuse disorders. Potential treatment options for patients unresponsive to standard treatments are described in this overview. Although these guidelines focus on medications, non-pharmacological were also considered. Cognitive behavioural therapy (CBT) and other variants of behaviour therapy have been sufficiently investigated in controlled studies in patients with anxiety disorders, OCD, and PTSD to support them being recommended either alone or in combination with the above medicines.

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Cognitive-Behavioral Therapy for Medication Nonresponders With Obsessive-Compulsive Disorder

Cited by 134 publications

References 46 publications

A Randomized, Controlled Trial of Cognitive-Behavioral Therapy for Augmenting Pharmacotherapy in Obsessive-Compulsive Disorder

A Randomized, Controlled Trial of Cognitive-Behavioral Therapy for Augmenting Pharmacotherapy in Obsessive-Compulsive Disorder

A terapia cognitivo-comportamental no transtorno obsessivo-compulsivo

World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Post-Traumatic Stress Disorders – First Revision

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