Cognitive Behavioral Therapy Combined with a Common
Antidepressant Proven Effective
in Treating Adolescent Obsessive-Compulsive Disorder
Breakthrough Data Suggests Cognitive Behavioral Therapy Alone is Effective
when Provided by Expert Therapists
(Philadelphia, PA) – According to current epidemiological data,
approximately 1 in 200 young people suffer from obsessive-compulsive disorder
(OCD). OCD patients ‘obsess’ about thoughts of bad things
that can happen (obsessions) and perform repetitive, destructive actions
(compulsions) as a means of dealing with those thoughts. OCD can cripple
their lives, disrupt their learning, and drive a wedge through their families.
Now, University of Pennsylvania School of Medicine researchers,
in conjunction with a team of researchers from Duke University Medical
Center, have developed a scientifically conclusive treatment combination
– using Cognitive Behavior Therapy (CBT) and commonly prescribed
anti-depressant medication – to help pediatric patients overcome
OCD. Their conclusions – based on a five-year study – may
be found in the October 27th issue of the Journal of the American
Medical Association (JAMA).
Edna B. Foa, PhD, Professor of Psychology in Psychiatry;
Director, Center for the Treatment and Study of Anxiety; and Co-Principal
Investigator for Penn’s component of ‘The Pediatric OCD Treatment
Study (POTS)’ says, “This investigation shows that children
diagnosed with OCD respond better to a combination of CBT and Zoloft as
compared to placebo and either treatment alone. However, at the Penn site,
children responded equally well to CBT alone and to the combined treatment”.
Zoloft (sertraline) is a commonly prescribed selective serotonin reuptake
inhibitor (SSRI), which elicits its effects by increasing the activity
of serotnin in the brain. CBT includes helping the children confront anxiety-evoking
situations and refraining from performing compulsions in order to learn
their fears are exaggerated or unrealistic. This is the first study to
test the efficacy of combining the two treatments in pediatric patients.
One hundred twelve children, ages seven to 17, were enrolled in POTS.
The patients were randomly assigned to receive CBT plus sertraline, CBT
alone, sertraline alone, or a placebo for 12 weeks.
The researchers found that 53.6 percent of the participants in the combination
group (CBT plus sertraline) showed little or no symptoms by the end of
their treatment. For those only given CBT, 39.3 percent of participants
showed less severe OCD symptoms. Participants on sertraline alone saw
21.4 percent of their group with less severe OCD symptoms. Only 3.6 percent
of those receiving the placebo responded with greatly reduced OCD symptoms.
“According to the data, some children may respond to CBT alone,
and others to sertraline alone, but most patients did better with a combination
of the two, “ says Dr. Foa.
“However, the Penn specific data showed that CBT alone was more
effective than the medication, and as effective as the combined, “
added Dr. Foa. “This suggests that the manner in which the therapists
provide CBT is an important factor in determining the effectiveness of
the treatment.” Of the Penn patients, 64 percent of participants
in both the CBT alone and combination group showed little or no symptoms
by the end of treatment. “These findings suggest we must determine
which treatment works best for individual patients, and at the same time,
we need to teach therapists how best to conduct CBT. This study proves
that the effective use of CBT alone, and a combination of CBT with an
SSRI, will greatly improve the chance for decreasing the symptoms of OCD.”
Because most children who receive SSRIs continue to have clinical symptoms,
The Center for the Treatment and Study of Anxiety is conducting a second
study to investigate the efficacy of augmenting SSRIs with adjunctive
CBT. Martin Franklin, PhD, Associate Professor of Psychology
in Psychiatry is the Principal Investigator and Dr. Foa is the co-Principal
Investigator of the study at the Penn site.
This study was funded by the National Institute for Mental Health (NIMH).
Sertraline and the placebos were provided by Pfizer, Inc. Neither the
NIMH nor Pfizer participated in the design or implementation of this study.
Researchers also contributing to this effort include: Martin Franklin,
PhD, Jonathan Huppert, PhD, Moira Rynn, MD, Ning Zhao, PhD, Lori Zoellner,
PhD, and Xin Tu, PhD from Penn; John March, MD, Patricia Gammon, PhD,
Allan Chrisman, MD, John Curry, MD, David Fitzgerald, PhD, and Kevin Sullivan
from Duke University Medical Center; Jennifer Freeman, PhD, at Bradley/Hasbro
Children’s Research Center (Brown University).
Editor’s Notes: Dr. Foa has received speaker
and consultant fees, as well as research support from Pfizer, Inc., for
PENN Medicine is a $2.7 billion enterprise dedicated
to the related missions of medical education, biomedical research, and
high-quality patient care. PENN Medicine consists of the University of
Pennsylvania School of Medicine (founded in 1765 as the nation’s
first medical school) and the University of Pennsylvania Health System
(created in 1993 as the nation’s first integrated academic health
Penn’s School of Medicine is ranked #3 in the nation for receipt
of NIH research funds; and ranked #4 in the nation in U.S. News &
World Report’s most recent ranking of top research-oriented medical
schools. Supporting 1,400 fulltime faculty and 700 students, the School
of Medicine is recognized worldwide for its superior education and training
of the next generation of physician-scientists and leaders of academic
Penn Health System is comprised of: its flagship hospital, the Hospital
of the University of Pennsylvania, consistently rated one of the nation’s
“Honor Roll” hospitals by U.S. News & World Report; Pennsylvania
Hospital, the nation's first hospital; Presbyterian Medical Center; a
faculty practice plan; a primary-care provider network; two multispecialty
satellite facilities; and home health care and hospice.