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Cognitive behavior therapy plus meds most effective in treatment of pediatric OCD

Clinical Question:
Does augmenting pharmacotherapy with cognitive behavior therapy improve treatment response in children and adolescents with obsessive-compulsive disorder?

Bottom Line:
Augmenting pharmacotherapy with cognitive behavior therapy (CBT) administered by a qualified psychologist is superior to pharmacotherapy alone in children and adolescents with obsessive-compulsive disorder (OCD). (LOE = 1b)

Franklin ME, Sapyta J, Freeman JB, et al. Cognitive behavior therapy augmentation of pharmacotherapy in pediatric obsessive-compulsive disorder. The pediatric OCD treatment study II (POS II) randomized controlled trial. JAMA 2011;306(11):1224-1232.  [PMID:21934055]

Study Design:
Randomized controlled trial (double-blinded)



Outpatient (specialty)

These investigators identified children and adolescents, aged 7 years to 17 years, meeting standardized diagnostic criteria for primary OCD, who had been determined to already have experienced a partial response to pharmacotherapy with a serotonin reuptake inhibitor. Eligible patients (N = 124) with a score of 16 or higher on the previously validated Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS) were randomly assigned to (concealed allocation assignment) 1 of 3 treatment conditions: (1) continued medical management only; (2) continued medical management plus CBT, consisting of 14 one-hour visits conducted over 12 weeks by a qualified psychologist; or (3) continued medical management plus instructions in CBT administered by a pharmacotherapist assigned to manage medication, consisting of 7 visits for an average time of 45 minutes over 12 weeks. Instructions in CBT did not include therapist-assisted or imaginal exposure therapy. Families and clinicians were aware of treatment group assignment, but individuals masked to treatment group assignment evaluated outcomes. Complete follow-up occurred for 81.5% of participants for 12 weeks. Using intention-to-treat analysis, a 30% or more reduction in baseline CY-BOCS score occurred significantly more often in the plus-CBT group (68%) compared with the plus-instructions group (34.0%) and the medication-only group (30.0%) (numbers needed to treat= 2.9; 95% CI, 1.9 - 8.0 and 2.6; 1.8 - 6.0, respectively). There was no significant difference in response rate between the plus-instructions and medication-only groups. Adverse events occurred similarly in all treatment groups.


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