Behavior Therapy Urged for Kids with OCD

Combination with drugs most effective for compulsive behavior, finds study

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HealthDay Reporter

WEDNESDAY, Oct. 27, 2004 (HealthDayNews) -- If you have a child or teenager who suffers from obsessive-compulsive disorder, a new study strongly suggests that cognitive-behavior therapy should be part of any treatment plan.

The study, which appears in the Oct. 27 issue of the Journal of the American Medical Association, found that cognitive-behavior therapy was more effective at relieving the symptoms of obsessive-compulsive disorder than treatment solely with the antidepressant sertraline (Zoloft). However, the study also found a combination of the two was the most effective of all.

"We examined the relative benefit of three active treatments -- cognitive-behavior therapy alone, medication management alone, a combination of the two -- and a placebo over 12 weeks," said study author Dr. John March, chief of child and adolescent psychiatry at Duke University Medical Center.

"We found that the combination of cognitive-behavior therapy and medication was superior. The response rates were quite a bit more robust for both cognitive-behavior components," he said. "The best treatment for obsessive-compulsive disorder is cognitive-behavior therapy."

Obsessive-compulsive disorder is an anxiety disorder that affects as many as 4 million Americans, according to the American Psychiatric Association. About one in every 200 American children has the disorder, according to the study.

The disorder causes people to obsess over certain situations, such as being contaminated by germs, worrying about causing harm to themselves or others, or being concerned that they will act inappropriately by swearing or making unwanted sexual advances, according to the American Psychiatric Association. People with obsessive-compulsive disorder usually understand their fear is excessive.

The compulsion part of the disorder arises out of a need to lessen discomfort and anxiety over the obsessive thoughts. For example, someone worried about germs might spend hours cleaning their homes or themselves. Some people repeat words or phrases or a behavior over and over again, hoping that these activities will protect them.

One hundred and twelve children with obsessive-compulsive disorder who were between the ages of 7 and 17 were recruited for the study. They were evenly divided and randomly assigned to one of four groups: cognitive-behavior therapy alone, medication management alone, a combination of cognitive-behavior therapy and medication, or placebo.

Ninety-seven youngsters completed 12 weeks of treatment, including 25 from the cognitive-behavior therapy group, 26 from the medication-alone group, 25 from the combination group, and 21 from the placebo arm.

The combination group fared the best, with nearly 54 percent reporting no symptoms of the disorder at the end of treatment. Just over 39 percent of the cognitive-behavior therapy alone group reported remission, and slightly more than 21 percent of those on medication alone reported no symptoms. Just 3.6 percent of those on placebo said their symptoms had been significantly reduced.

March said this study means that "if you have a child with obsessive-compulsive disorder, it's no longer reasonable not to include cognitive-behavior therapy in treatment."

He added that it's especially important to treat obsessive-compulsive disorder in children as quickly as possible, before the ritualistic behavior is further ingrained in the brain.

"I think this is a really important study," said Dr. Anne Marie Albano, a child psychologist at the New York State Psychiatric Institute. "Cognitive-behavior therapy is paramount to overcoming obsessive-compulsive disorder and medication is the ancillary treatment."

Albano added, "Cognitive-behavior therapy can relieve your child of a heavy burden in a short period of time."

Unfortunately, she said, it can be difficult to get insurance reimbursement for such therapy. And, she emphasized that parents need to make sure they find a qualified therapist. She said the Obsessive-Compulsive Foundation and the Academy of Cognitive Therapy train and supervise practitioners in cognitive behavioral therapy.

March said he didn't know how long each treatment might last, but that "cognitive-behavior therapy seems to be a much more durable treatment. It teaches you a set of skills that should help you in relapse prevention."

Albano agreed that cognitive-behavior therapy helps prevent relapse, and said one reason why is that "kids feel that they are part of their own treatment and participating in their own wellness. With cognitive-behavior therapy, children are the agent of change, rather than having someone changing them."

More information

To learn more about obsessive-compulsive disorder, visit the Obsessive-Compulsive Foundation.

SOURCES: John March, M.D., M.P.H., chief, child and adolescent psychiatry, Duke University Medical Center, Durham, N.C.; Anne Marie Albano, Ph.D., child psychologist, New York State Psychiatric Institute, New York City; Oct. 27, 2004, Journal of the American Medical Association

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