Increased Maintenance of Obsessive-Compulsive Disorder Remission after Integrated Serotonergic Treatment and Cognitive Psychotherapy Compared with Medication Alone

Abstract

Background: Both medication and psychotherapy are effective in obsessive-compulsive disorder (OCD). However, they both have disadvantages. We aimed at studying the long-term effectiveness of integrated treatment compared with medication alone. Methods: A private practice sample of 20 consecutive patients with OCD (DSM-III-R) who achieved remission or marked improvement [Yale-Brown Obsessive-Compulsive Scale (YBOCS) score ≤10 and Global Assessment of Functioning (GAF) scale score ≧70] after drug treatment (clomipramine or selective serotonin reuptake inhibitors for 12–24 months) with or without concurrent cognitive psychotherapy were followed up. In the integrated treatment group, psychotherapy was started on the second or third visit and was timed to end after medication. Efforts were applied to integrate treatments within a biopsychosocial theoretical framework. As randomisation was not feasible in the study setting, treatment allocation was based on patients’ preference. Patients were assessed before treatment, after treatment and at each follow-up contact with the YBOCS, the Hamilton Depression Rating Scale, and the GAF scale. Kaplan-Meier survival analysis was performed on the time to OCD relapse. Results: Of the factors studied (gender, age, duration of disorder, severity of OCD symptoms at baseline), only treatment was associated with outcome. Of 10 patients treated with medication alone, 8 relapsed. Of 10 patients who received integrated treatment, only 1 relapsed. The estimated mean survival time was significantly higher (p < 0.001) in the integrated treatment group (132 months, 95% CI 107–157) than in the medication group (25 months, 95% CI 12–38). Conclusions: Although our results need confirmation by further, more robust studies, the long-term superiority of integrated treatment over medication alone was large. Patients with OCD might have viable options other than long-term drug treatment.

Cognitive versus Behavior Therapy: Processes of Change in the Treatment of Obsessive-Compulsive Disorder

“…The limitations of behavior therapy, the presence of cognitive biases and errors, and the search for an alternative, less anxiety-provoking treatment have prompted some researchers to advocate a shift to a cognitive approach in the treatment of OCD [7,8,9]. Several studies have directly compared cognitive therapy (CT) with ERP [9,10,11,12,13,14] and found no differences in efficacy.…”

Course and outcome of obsessive–compulsive disorder

“…All except one of these studies have followed up treatment-seeking patients, over a duration varying from 1 to 15 years. A majority of studies report outcomes on treatment with a combination of SRIs and CBT,[30424346474849515354555658596061626365] only a few with SRIs alone[294445505264] and only one study with CBT alone. [57] Outcome has been assessed based on YBOCS ratings.…”

Current management of obsessive and phobic states

“…Both psychotherapy and medication differ in their strengths and weaknesses, thus it seems that a proper combination of the two might be more appropriate and effective than either treatment alone 95. In many trials, combining the two strategies has been found to be more useful and clinically superior to medication or psychotherapy alone 11,107.…”