Randomized, Placebo-Controlled Trial of Exposure and Ritual Prevention, Clomipramine, and Their Combination in the Treatment of Obsessive-Compulsive Disorder

Foa, Edna B.; Liebowitz, Michael R.; Kozak, Michael J.; Davies, Sharon; Campeas, Rafael; Franklin, Martin E.; Huppert, Jonathan D.; Kjernisted, Kevin; Rowan, Vivienne C.; Schmidt, Andrew B.; Simpson, Helen Blair; Tu, Xin

doi:10.1176/appi.ajp.162.1.151

Cited by 866 publications

(447 citation statements)

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“…This response rate is quite typical for prior studies of intensive, daily CBT for OCD. [23][24][25] For example, Foa et al 25 also studied OCD patients treated with intensive ERP for 4 weeks. Their intent-to-treat and completer response rates were 62 and 86%, respectively, similar to our response rates.…”

Section: Discussionmentioning

confidence: 99%

“…25 Sessions no. 1-3 included a comprehensive behavioral assessment, education for the patient in self-monitoring of obsessions, compulsions and triggers, and a discussion of the rationale and specific goals of CBT for each individual.…”

Section: Treatmentmentioning

confidence: 99%

“…22 Intensive CBT produces improvement in 60-80% of OCD patients in as little as 4 weeks, with symptom improvement ranging from 50-80%. [23][24][25] We sought to elucidate the brain mediation of response to brief intensive CBT in OCD by measuring cerebral glucose metabolism with PET before and after 4 weeks of intensive CBT, and to determine whether intensive CBT could rapidly induce the changes previously seen after much longer trials of pharmacotherapy or standard, weekly CBT. We hypothesized that normalized glucose metabolism in OFC, caudate and thalamus would decrease in OCD patients who responded to intensive CBT.…”

Section: Introductionmentioning

confidence: 99%

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Rapid effects of brief intensive cognitive-behavioral therapy on brain glucose metabolism in obsessive-compulsive disorder

Saxena

Gorbis²,

O’Neill³

et al. 2008

Mol Psychiatry

126

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Brief intensive cognitive-behavioral therapy (CBT) using exposure and response prevention significantly improves obsessive-compulsive disorder (OCD) symptoms in as little as 4 weeks. However, it has been thought that much longer treatment was needed to produce the changes in brain function seen in neuroimaging studies of OCD. We sought to elucidate the brain mediation of response to brief intensive CBT for OCD and determine whether this treatment could induce functional brain changes previously seen after longer trials of pharmacotherapy or standard CBT. [ 18 F]-fluorodeoxyglucose positron emission tomography brain scans were obtained on 10 OCD patients before and after 4 weeks of intensive individual CBT. Twelve normal controls were scanned twice, several weeks apart, without treatment. Regional glucose metabolic changes were compared between groups. OCD symptoms, depression, anxiety and overall functioning improved robustly with treatment. Significant changes in normalized regional glucose metabolism were seen after brief intensive CBT (P = 0.04). Compared to controls, OCD patients showed significant bilateral decreases in normalized thalamic metabolism with intensive CBT but had a significant increase in right dorsal anterior cingulate cortex activity that correlated strongly with the degree of improvement in OCD symptoms (P = 0.02). The rapid response of OCD to intensive CBT is mediated by a distinct pattern of changes in regional brain function. Reduction of thalamic activity may be a final common pathway for improvement in OCD, but response to intensive CBT may require activation of dorsal anterior cingulate cortex, a region involved in reappraisal and suppression of negative emotions.

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Section: Discussionmentioning

confidence: 99%

Section: Treatmentmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Rapid effects of brief intensive cognitive-behavioral therapy on brain glucose metabolism in obsessive-compulsive disorder

Saxena

Gorbis²,

O’Neill³

et al. 2008

Mol Psychiatry

126

View full text Add to dashboard Cite

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“…In one single-case experimental design intervention, clinicians made some progress, but only after 17 months of intensive behavior therapy (Hartl & Frost, 1999). This disappointing success rate differs markedly from behavioral or pharmacologic treatment of typical OCD cases, such as those involving contamination obsessions and washing compulsions, or doubting obsessions and checking compulsions (Foa et al, 2005). For example, Abramowitz and his colleagues found that only 31% of hoarders exhibited clinically significant improvement, whereas 70% of OCD patients with contamination obsessions did so (Abramowitz, Franklin, Schwartz, & Furr, 2003).…”

Section: Introductionmentioning

confidence: 99%

Cognitive aspects of nonclinical obsessive–compulsive hoarding

Luchian

McNally

Hooley

2007

Behaviour Research and Therapy

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Research on the cognitive variables associated with obsessive-compulsive hoarding is scarce. In this study, we investigated cognitive variables that may contribute to the maintenance and possibly etiology of hoarding. College students who characterized themselves as either ''packrats'' (nonclinical hoarders; n ¼ 21) or not (control participants; n ¼ 20) completed questionnaires assessing hoarding behavior and beliefs about hoarding, and completed a task requiring them to categorize diverse objects and trinkets of minimal value into groups. The results revealed that nonclinical hoarders, relative to control participants, rated the categorization task as significantly more stressful and difficult. Relative to control participants, hoarders took longer to complete the task and sorted objects into more categories. These findings suggest that underinclusiveness and indecisiveness, characteristic of clinical hoarders, are evident in nonclinical hoarders as well. r

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“…We chose this trial for two reasons: 1) in design and sample size, it is typical of psychiatric trials that compare medications and psychotherapy; and 2) because of the paucity of such trials in OCD, the inferences drawn from this specific study are likely to have public health impact. In the original analyses of these data (Foa et al, 2005), MEMs were used to compare outcome, as measured by the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score (Goodman et al, 1989a;Goodman et al, 1989b). All active treatments were superior to placebo and both EX/RP&CMI and EX/RP, although not different from each other, were superior to CMI.…”

Section: Introductionmentioning

confidence: 99%

Statistical choices can affect inferences about treatment efficacy: A case study from obsessive–compulsive disorder research

Simpson

Petkova

Cheng

et al. 2008

Journal of Psychiatric Research

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Longitudinal clinical trials in psychiatry have used various statistical methods to examine treatment effects. The validity of the inferences depends upon the different method's assumptions and whether a given study violates those assumptions. The objective of this paper was to elucidate these complex issues by comparing various methods for handling missing data (e.g., last observation carried forward [LOCF], completer analysis, propensity-adjusted multiple imputation) and for analyzing outcome (e.g., end-point analysis, repeated-measures analysis of variance [RM-ANOVA], mixed-effects models [MEMs]) using data from a multi-site randomized controlled trial in obsessive-compulsive disorder (OCD). The trial compared the effects of 12 weeks of exposure and ritual prevention (EX/RP), clomipramine (CMI), their combination (EX/RP&CMI) or pill placebo in 122 adults with OCD. The primary outcome measure was the Yale-Brown Obsessive Compulsive Scale. For most comparisons, inferences about the relative efficacy of the different treatments were impervious to different methods for handling missing data and analyzing outcome. However, when EX/RP was compared to CMI and when CMI was compared to placebo, traditional methods (e.g., LOCF, RM-ANOVA) led to different inferences than currently recommended alternatives (e.g., multiple imputation based on estimation-maximization algorithm, MEMs). Thus, inferences about treatment efficacy can be affected by statistical choices. This is most likely when there are small but potentially clinically meaningful treatment differences and when sample sizes are modest. The use of appropriate statistical methods in psychiatric trials can advance public health by ensuring that valid inferences are made about treatment efficacy.

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Randomized, Placebo-Controlled Trial of Exposure and Ritual Prevention, Clomipramine, and Their Combination in the Treatment of Obsessive-Compulsive Disorder

Abstract: Clomipramine, exposure and ritual prevention, and their combination are all efficacious treatments for OCD. Intensive exposure and ritual prevention may be superior to clomipramine and, by implication, to monotherapy with the other SRIs.

Cited by 866 publications

References 47 publications

Rapid effects of brief intensive cognitive-behavioral therapy on brain glucose metabolism in obsessive-compulsive disorder

Rapid effects of brief intensive cognitive-behavioral therapy on brain glucose metabolism in obsessive-compulsive disorder

Cognitive aspects of nonclinical obsessive–compulsive hoarding

Statistical choices can affect inferences about treatment efficacy: A case study from obsessive–compulsive disorder research

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