Cognitive-Behavioral Therapy for Pediatric Obsessive-Compulsive Disorder

New Study (1)

The efficacy of cognitive-behavioral therapy (CBT) for pediatric obsessive-compulsive disorder (OCD) has been the subject of much study over the past fifteen years. Building on a foundation of case studies and open clinical trials, the literature now contains many methodologically sound studies that have compared full CBT protocols to waitlist controls, pill placebo, psychosocial comparison conditions, active medication, combined treatments, and brief CBT. This review is part of a series commissioned by The Canadian Institute for Obsessive Compulsive Disorders (CIOCD) in an effort to publish in one place what is known about the efficacy of treatments for OCD. A total of fourteen studies were identified; collectively their findings support the efficacy of CBT for youth with OCD. CBT protocols that emphasized either strictly behavioral or cognitive conceptualizations have each been found efficacious relative to waitlist controls. Efforts to enhance CBT’s efficacy and reach have been undertaken. These trials provide guidance regarding next steps to be taken to maximize efficacy and treatment availability. Findings from studies in community clinics suggest that significant treatment benefits can be realized and are not reported only from within academic contexts. These findings bode well for broader dissemination efforts. Recommendations for future research directions are provided.

Franklin, M.E., Kratz, H.E., Freeman, J.B., Ivarsson, T., Heyman, I., Sookman,D.,…March, J. (2015). Cognitive-behavioral therapy for pediatric obsessive-compulsive disorder: Empirical review and clinical recommendations. Psychiatry Research, 227(1), 78-92. doi: 10.1016/j.psychres.2015.02.009

Telephone-CBT is Effective for Adolescents with OCD

OBJECTIVE: Many adolescents with obsessive-compulsive disorder (OCD) do not have access to evidence-based treatment. A randomized controlled non-inferiority trial was conducted in a specialist OCD clinic to evaluate the effectiveness of telephone cognitive-behavioral therapy (TCBT) for adolescents with OCD compared to standard clinic-based, face-to-face CBT.

METHOD: Seventy-two adolescents, aged 11 through 18 years with primary OCD, and their parents were randomized to receive specialist TCBT or CBT. The intervention provided differed only in the method of treatment delivery. All participants received up to 14 sessions of CBT, incorporating exposure with response prevention (E/RP), provided by experienced therapists. The primary outcome measure was the Children’s Yale-Brown Obsessive-Compulsive Scale (CY-BOCS). Blind assessor ratings were obtained at midtreatment, posttreatment, 3-month, 6-month, and 12-month follow-up.

RESULTS: Intent-to-treat analyses indicated that TCBT was not inferior to face-to-face CBT at posttreatment, 3-month, and 6-month follow-up. At 12-month follow-up, there were no significant between-group differences on the CY-BOCS, but the confidence intervals exceeded the non-inferiority threshold. All secondary measures confirmed non-inferiority at all assessment points. Improvements made during treatment were maintained through to 12-month follow-up. Participants in each condition reported high levels of satisfaction with the intervention received.

CONCLUSION: TCBT is an effective treatment and is not inferior to standard clinic-based CBT, at least in the midterm. This approach provides a means of making a specialized treatment more accessible to many adolescents with OCD. Clinical trial registration information-Evaluation of telephone-administered cognitive-behaviour therapy (CBT) for young people with obsessive-compulsive disorder (OCD);; ISRCTN27070832.

Turner, C. M., Mataix-Cols, D., Lovell, K., Krebs, G., Lang, K., Byford, S., & Heyman, I. (2014). Telephone Cognitive-Behavioral Therapy for Adolescents with Obsessive-Compulsive Disorder: A Randomized Controlled Non-inferiority Trial. Journal of the American Academy of Child and Adolescent Psychiatry, 53, 12, 1298-1307.

CBT is Effective for Pathological Gambling

OBJECTIVE: Clinicians lack adequate data on the effectiveness of treatment for pathological gambling in low- and middle-income countries.

METHODS: We evaluated a manualized treatment program that included components of cognitive-behavioral therapy, motivational interviewing, and imaginal exposure in a sample of 128 participants diagnosed with pathological gambling. Our team recruited participants via the helpline of the National Responsible Gambling Program (NRGP) of South Africa between May 2011 and February 2012. Eligible participants, who met the DSM-IV-TR criteria for pathological gambling as assessed by the Structured Clinical Interview for Pathological Gambling (SCI-PG), were referred to practitioners who had been trained in the intervention technique. We then compared pre- and post-treatment scores obtained on the Yale-Brown Obsessive-Compulsive Scale Adapted for Pathological Gambling (PG-YBOCS), the primary outcome measure, and the Sheehan Disability Scale (SDS), the secondary outcome measure.

RESULTS: Scores obtained on the PG-YBOCS and the SDS both decreased significantly from the first to the final session (t[127] = 23.74, P < .001, r = .9; t[127] = 19.23, P < .001, r = .86, respectively).

CONCLUSIONS: The urges and disability symptoms related to pathological gambling were significantly reduced among participants completing treatment. These preliminary results hold promise for individuals with pathological gambling in South Africa and other low- and middle-income countries.

Pasche, S. C., Stein, D. J., Sinclair, H., Sinclair, H., Collins, P., Pretorius, A., & Grant, J. E. (January 01, 2013). The effectiveness of a cognitive-behavioral intervention for pathological gambling: A country-wide study. Annals of Clinical Psychiatry, 25, 4, 250-256.

CBT is Effective for Body Dysmorphic Disorder

There are few effective treatments for body dysmorphic disorder (BDD) and a pressing need to develop such treatments. We examined the feasibility, acceptability, and efficacy of a manualized modular cognitive-behavioral therapy for BDD (CBT-BDD). CBT-BDD utilizes core elements relevant to all BDD patients (e.g., exposure, response prevention, perceptual retraining) and optional modules to address specific symptoms (e.g., surgery seeking). Thirty-six adults with BDD were randomized to 22 sessions of immediate individual CBT-BDD over 24 weeks (n=17) or to a 12-week waitlist (n=19). The Yale-Brown Obsessive-Compulsive Scale Modified for BDD (BDD-YBOCS), Brown Assessment of Beliefs Scale, and Beck Depression Inventory-II were completed pretreatment, monthly, posttreatment, and at 3- and 6-month follow-up. The Sheehan Disability Scale and Client Satisfaction Inventory (CSI) were also administered. Response to treatment was defined as ?30% reduction in BDD-YBOCS total from baseline. By week 12, 50% of participants receiving immediate CBT-BDD achieved response versus 12% of waitlisted participants (p=0.026). By posttreatment, 81% of all participants (immediate CBT-BDD plus waitlisted patients subsequently treated with CBT-BDD) met responder criteria. While no significant group differences in BDD symptom reduction emerged by Week 12, by posttreatment CBT-BDD resulted in significant decreases in BDD-YBOCS total over time (d=2.1, p

Wilhelm, S., Phillips, K. A., Didie, E., Buhlmann, U., Greenberg, J. L., Fama, J. M., & … Steketee, G. (2013). Modular cognitive-behavioral therapy for body dysmorphic disorder: A randomized controlled trial. Behavior Therapy, doi:10.1016/j.beth.2013.12.007


CBT for Treatment of Intolerance of Uncertainty

Intolerance of uncertainty usually involves negative emotional, cognitive, and behavioral reactions to uncertain situations, and it has often been associated with generalized anxiety disorder (GAD) and obsessive compulsive disorder (OCD). Studies show that intolerance of uncertainty may be the common feature within these various anxiety disorders.

The current study published in the Journal of Clinical Psychology aims to investigate the relationship between intolerance of uncertainty and emotional disorders such as GAD, OCD, panic disorder, and social phobia, and/or depressive disorders. Thirty-seven participants were randomly assigned to receive eighteen weeks of transdiagnostic cognitive-behavioral therapy intervention (Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders; UP) or were waitlisted for treatment.

Results indicated that intolerance of uncertainty was positively correlated with symptoms of depression and anxiety, and that intolerance of uncertainty decreased during CBT treatment. Additionally, reduced post treatment intolerance of uncertainty was associated with reduced post treatment symptoms of depression and anxiety. These results suggest that transdiagnostic treatment to target intolerance of uncertainty can help improve treatment outcomes across emotional disorders.

Boswell, J. F., Thompson-Hollands, J., Farchione, T. J., & Barlow, D. H. (2013). Intolerance of uncertainty: a common factor in the treatment of emotional disorders. Journal of Clinical Psychology, 69, 6, 630-45.

CBT Demonstrates Long-Term Effectiveness for Adults with Anxiety

According to a new study published in Behaviour Research and Therapy, research has demonstrated that cognitive behavior therapy (CBT) has long-term effectiveness for adults with anxiety disorders. The current study sought to examine the immediate and long-term effectiveness of CBT treatment within a naturalistic, outpatient setting. Participants (n=181) included individuals with the primary diagnoses of OCD, GAD, social phobia, panic disorder with agoraphobia, and specific phobia who had received at least 3 (and on average 14) CBT sessions with a therapist, using CBT interventions exclusively, in an outpatient, fee-for-service setting. At post-treatment, 113 participants (62%) were identified as “responders” or “remitters” (i.e., much or very much improved). Of these, 87 participants (77%) maintained their status as “responders” or” remitters” at one-year follow up. These findings suggest CBT outcomes for anxiety disorders among clinic patients are effective in both the short- and long-term.

DiMauro, J., Tolin, D. F., Domingues, J., & Fernandez, G. (2013). Long-term effectiveness of CBT for anxiety disorders in an adult outpatient clinic sample: A follow-up study. Behaviour Research and Therapy, 51, 2, 82-86.

Videoconference and Cell Phone-Based CBT Improves OCD Symptoms

According to a recent study published in the Journal of Anxiety Disorders, videoconference- and cell phone-based cognitive behavior therapy (CBT) may improve obsessive-compulsive symptoms in patients with limited access to face-to-face therapy. In the current study, researchers in Norway partnered with researchers at the University of Michigan to study the efficacy of CBT via electronic means. Six OCD patients received fifteen therapy sessions via electronic forms during a 12-week period. Nine sessions were conducted via cell phone, and six were conducted via videoconference. Patients completed self-report measures at pretreatment, throughout treatment, post treatment, and at a three month follow-up. Five of the patients were female; ages ranged from 24-44 years.

Results indicate that all participants achieved at least 50% reductions in all measures of OCD, depression, and anxiety. When compared to previous studies, these reductions are consistent with face-to-face therapy. These findings provide preliminary support for CBT via electronic means as an alternative treatment approach for OCD patients with limited access to treatment facilities.

Vogel, P. A., Launes, G., Moen, E. M., Solem, S., Hansen, B., Haland, A. T., & Himle, J. A. (2012).  Videoconference– and cell phone-based cognitive behavioral therapy of obsessive-compulsive disorder: A case series. Journal of Anxiety Disorders, 26(1), 158-164.

CBT Reduces Obsessive-Compulsive Symptoms in Postpartum Women

According to a recent study published in the Journal of Psychiatric Research, cognitive behavior therapy (CBT) can help reduce obsessive-compulsive symptoms (OCS) in postpartum women. In the current study, expectant mothers, at-risk for OCS, were divided into two groups: (1) A CBT prevention program and (2) a credible control program. Results indicate that women who received the CBT prevention program had reductions in obsessions and compulsions at one, three and six months postpartum. They also reported a decrease in cognitive distortions compared to the control condition.

Timpano K, Abramowitz J, Mahaffey B, Mitchell M, Schmidt N. Efficacy of a prevention program for postpartum obsessive–compulsive symptoms. Journal of Psychiatric Research [serial online]. November 2011;45(11):1511-1517.

Suppressing Thoughts and Obsessions

Dr. Aaron Beck explains the research on suppressing thoughts and obsessions. He explains how taking a negative stance towards thoughts can ultimately make them worse in frequency and severity of the negativity of the thoughts themselves. For more information about CBT training directed by Drs. Judith and Aaron Beck visit our CBT Workshops page.

MRSI Correlates of CBT in Pediatric OCD

A recent study published in Progress in Neuro-Psychopharmacological & Biological Psychiatry found that Cognitive Behavior Therapy (CBT) is effective in altering metabolic hyperactivity of neurochemicals associated with OCD symptoms in pediatric obsessive-compulsive disorder (OCD) patients. OCD is an anxiety disorder in which individuals experience obsessive, anxiety producing thoughts and seek relief through engaging in repetitive, compulsive behaviors. The current study investigated effects of CBT on neurochemicals in pediatric OCD. A variation of magnetic resonance imaging (MRI) was used to study the effects of CBT on specific neurochemicals in specific areas of the brain that are associated with OCD.

The participants included five, medication-free patients with diagnosed OCD and no prior exposure to CBT. The average age of the participants was 13. Each participant underwent exposure-based CBT once a week for 12 weeks. OCD symptom severity was assessed before and after the 12-week intervention using the Children’s Yale-Brown Obsessive-Compulsive Scale (CY-BOCS). MRIs were also conducted on each patient before and after the study to measure neurochemical levels.

Certain neurochemicals associated with OCD significantly contribute to the obsessive thoughts and ritualistic behaviors characteristic of the disorder. Normally, these chemicals work in tandem in a specific neural pathway to moderate the initiation, sustainability and eventual ending of behavioral routines. In individuals with OCD, however, there is increased activity in this pathway, creating an imbalance in activity. When patients adhere to exposure-based CBT techniques, the chemicals have a chance to correct the imbalance, allowing the brain, body and behaviors to synchronize. In this study, four of the five participants had significant post-CBT decreases in the chemicals known to negatively affect the behavioral routine cycle. Though not statistically significant, participants also had a 32.8% decline in symptom severity based on their post-CBT CY-BOCS score. It is evident that CBT, which is based on modifying maladaptive thoughts and behaviors, can actually alter abnormal brain chemistry in OCD patients which helps reduce symptoms of the disorder.

O’Neill, J., Piacentini, J.C., Chang, S., Levitt, G. J., Rozenman, M., Bergman, L.,…McCraken, J.T. (2011). MRSI correlates of cognitive-behavioral therapy in pediatric obsessive- compulsive disorder. Progress in Neuro-Psychopharmacology & Biological Psychiatry, 36 (2012) 161-168.