Sep. 12, 2013 — NIMH grantees have demonstrated that a form of behavioral therapy can augment antidepressant treatment of obsessive compulsive disorder (OCD) better than an antipsychotic. The researchers recommend that this specific form of cognitive behavior therapy (CBT) — exposure and ritual prevention — be offered to OCD patients who don’t respond adequately to treatment with an antidepressant alone, which is often the case. Current guidelines favor augmentation with antipsychotics.
(EDIT- FROM JOURNAL ARTICLE- description of CBT intervention:
Patients randomized to EX/RP received 17 twice-weekly 90- minute sessions delivered over 8 weeks by
a study therapist. Treatment included 2 introductory sessions, 15 exposure sessions (during which
patients faced their obsessional fears for a prolonged period without ritualizing), daily homework
(at least 1 hour of self-directed exposures daily), and between- session telephone check-ins.16 At least 2 sessions occurred outside the clinic to promote generalization to daily life. The goal was for patients to stop their rituals as early in treatment as possible; patients were asked to try refraining from ritualizing after the first exposure session. Formal cognitive therapy procedures were not used, but dysfunctional cognitions were discussed within the context of exposure.)
In the controlled trial with 100 antidepressant-refractory OCD patients, 80 percent of those who received CBT responded, compared to 23 percent of those who received the antipsychotic risperidone, and 15 percent of those who received placebo pills. Forty-three percent experienced symptoms reduced to a minimal level following CBT treatment, compared to 13 percent for risperidone and 5 percent for placebo.
The study, published September 11, 2013 in JAMA Psychiatry, was led by Helen Blair Simpson, M.D., of Columbia University, in New York City; and Edna Foa, Ph.D., of the University of Pennsylvania, Philadelphia.
In an accompanying editorial, grantees Kerry Ressler, M.D., and Barbara Rothbaum, Ph.D., of Emory University, Atlanta, note that antidepressants are effective in treating only a subset of OCD patients. They add that the targeted form of CBT works via different mechanisms — such as retraining the brain’s habit-forming circuitry to unlearn compulsive rituals.
Matthew Rudorfer, M.D., chief of the NIMH Somatic Treatments Program, which funded the study, said that in demonstrating how different patients respond best to different approaches, it helps to move the field toward the goal of more personalized treatment.
Journal Reference: Helen Blair Simpson. Cognitive-Behavioral Therapy vs Risperidonefor Augmenting Serotonin Reuptake Inhibitors in Obsessive-Compulsive DisorderA Randomized Clinical TrialSerotonin Reuptake Inhibitor Augmentation.JAMA Psychiatry, 2013; DOI: 10.1001/jamapsychiatry.2013.1932