Source Credit: ScienceDaily – Exposure/Ritual Prevention Therapy Boosts Antidepressant Treatment of OCD
READ THE COMPLETE ORIGINAL RESEARCH ARTICLE HERE
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.)
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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.
READ THE COMPLETE ORIGINAL RESEARCH ARTICLE HERE
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
April 12, 2010 — Mums who spank their 3-year-olds may be increasing their children’s risk of aggressive behavior, such as bullying, by the time they turn 5, a study shows.
The study, published in the May issue of Pediatrics, adds to evidence suggesting that spanking and other types of corporal punishment set kids up for aggressive behaviors later in life.
“Children need guidance and discipline; however, parents should focus on positive, non-physical forms of discipline and avoid the use of spanking,” study researcher Catherine A. Taylor, PhD, an assistant professor of community health sciences at Tulane University School of Public Health and Tropical Medicine in New Orleans, tells WebMD in an email. “This message is consistent with that of the American Academy of Pediatrics, which ‘strongly opposes striking a child for any reason.'”
Taylor and colleagues asked about 2,500 mothers how often they had spanked their 3-year-old child in the past month. Nearly half of the moms said they had not spanked their child during the previous month, 27.9% said they spanked their 3-year-old once or twice within the last month, and 26.5% percent said they spanked their child more than twice in the past month.
The researchers also asked moms questions about their child’s aggressive behavior, such as whether they were bullies, cruel, mean, destructive, and/or prone to getting into fights with others at age 3 and again at age 5.
Although other studies have shown a link between spanking and aggressive behavior, the new study solidifies the connection because the researchers controlled for other maternal risk factors that might have explained the link, such as neglect, maternal use of drugs and alcohol, maternal stress and depression, and the physical or psychological maltreatment of the child.
“This study reinforces that any kind of violence or physical aggression in the home is another risk factor for kids being more aggressive in the future,” says Patricia Hametz, MD, director of the Injury and Violence Prevention Center and assistant clinical professor of pediatrics at Columbia University and director of the general pediatrics inpatient service at New York-Presbyterian Morgan Stanley Children’s Hospital in New York City.
“The way you discipline depends on the age of the child, and pediatricians should give age-appropriate suggestions about how to discipline toddlers,” Hametz [says]. “Some people like time-outs, which remove a child from whatever it is that is overstimulating them.”
Another tactic is to reward good behavior. “Praising, pointing out, and literally rewarding good behavior is a better discipline strategy than punishing bad behavior after it happens,” she says.
Jennifer E. Lansford, PhD, a research scientist at the Duke University Center for Child and Family Policy in Durham, N.C., agrees. “These findings suggest that spanking has the unintended consequence of increasing children’s aggressive behavior, so the implication for parents would be that they should not use corporal punishment, but find other ways of managing their children’s misbehavior and promoting good behavior,” she says in an email.
This may include teaching about good and bad behavior and trying to prevent misbehavior rather than just reacting to it once it has occurred, she suggests. “Parents can use reward systems such as sticker charts, where a child earns a sticker or something else for good behavior, and special privileges such as extra time with mom or dad can be offered for completing the sticker chart.”s
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Learning Aggressive Attitudes
The new findings make sense to child psychologist Vincent J. Barone, PhD, an associate professor of pediatrics at the University of Missouri-Kansas City School of Medicine and the director of Developmental and Behavioral Sciences South Clinic at Children’s Mercy Hospital and Clinics, also in Kansas City.
“The findings in this research are consistent with what we know about violent experiences for children. Whether a violent video game or corporal punishment, children learn aggressive attitudes and act them out when they are exposed to violence,” he says. “Children don’t learn peaceful ways of solving conflict when they are exposed to violence.”
Barone usually suggests that parents briefly describe the inappropriate behavior and then use a time-out.
Also, he suggests, “use your attention and passion to describe and praise positive behaviors such as cooperation, thoughtfulness, and respect for others.”
American Academy of Pediatrics
Denise Mann WebMD Health News