Cognitive Therapy versus Fluvoxamine as a Second-Step Treatment in Obsessive-Compulsive Disorder Nonresponsive to First-Step Behavior Therapy

Abstract

Background: To compare the effectiveness of second-step treatment with cognitive therapy (CT) versus fluvoxamine in patients with obsessive-compulsive disorder (OCD) who are nonresponsive to exposure in vivo with response prevention (ERP). Methods: A 12-week randomized controlled trial at an outpatient clinic in the Netherlands comparing CT with fluvoxamine in OCD. Of 118 subjects with OCD treated with 12 weeks of ERP, 48 appeared to be nonresponders (Y-BOCS improvement score of less than one third). These nonresponders were randomized to CT (n = 22) or fluvoxamine (n = 26). The main outcome measure was the Y-BOCS severity scale. Statistical analyses were conducted in the intention-to-treat sample (n = 45) on an ‘as randomized basis’ and in the per-protocol sample (n = 30). Due to selective dropout in the fluvoxamine group, two additional sensitivity analyses were performed. Results: Complete data could be obtained from 45 subjects (94%) after 12 weeks. Fifty percent of the patients refused fluvoxamine after randomization compared to 13% who refused CT [χ²(1) = 7.10; p = 0.01]. CT as a second-step treatment did not appear to be effective in this sample of nonresponders. Fluvoxamine was significantly superior to CT in the intention-to-treat sample, in the per-protocol sample and in the two separately defined samples in which the sensitivity analyses were performed. Conclusions: OCD patients who are nonresponsive to ERP may benefit more from a switch to treatment with an antidepressant instead of switching to CT. In clinical practice, it may be important to motivate this subgroup of patients to undergo psychopharmacological treatment, as this may improve their outcome considerably.

Second-Stage Treatments for Relative Nonresponders to Cognitive Behavioral Therapy (Cbt) for Panic Disorder With or Without Agoraphobia-Continued CBT Versus Ssri: A Randomized Controlled Trial

“…[16,19] One recent study found that, following nonresponse to a course of exposure and response prevention (ERP) in a sample of adults with obsessivecompulsive disorder, fluvoxamine was superior to cognitive therapy. [28] These findings further support the possibility of switching to medication after nonresponse to an initial course of CBT. However, careful consideration of risks and benefits in the context of available treatments as well as patient choice is needed in selecting second-stage treatments.…”

No Talking, Just Writing! Efficacy of an Internet-Based Cognitive Behavioral Therapy with Exposure and Response Prevention in Obsessive Compulsive Disorder

“…In the present study, a Y-BOCS score of 8 points or less constituted an exclusion criterion. The overall Y-BOCS SR score of 20.12 was lower than in other studies [65,66,67,68]. Therefore, participants with a low level of suffering were included, which did not leave much room for improvement.…”

Treating Treatment-Resistant Patients with Panic Disorder and Agoraphobia Using Psychotherapy: A Randomized Controlled Switching Trial

“…Empirical studies on treatment-resistant patients are rare [3,4], and empirically based guidelines to advise clinicians on how to help treatment nonresponders are lacking. Very few randomized controlled trials have examined the effects of switching from a psychotherapy that failed to adequately work to a different psychotherapy.…”