Obsessive compulsive disorder (OCD) is a condition that is usually associated with obsessive thoughts and compulsive behaviour. It’s one of the most common mental health problems in young people, with an estimated 5% of children and teenagers suffering from the chronic condition.

Studies have shown that SSRI antidepressants and cognitive behavioural therapy (CBT) are both safe and effective treatments for OCD, but many young people continue to suffer from the symptoms of the condition because they don’t respond to a single treatment and lack access to combined treatment.

This randomised controlled trial conducted by researchers from the University of Pennsylvania School of Medicine, set out to examine the effects of augmenting SRIs (serotonin reuptake inhibitors) with CBT or a brief form of CBT, or instructions in CBT delivered in the context of medication management.

The 12 week trial involved 124 paediatric outpatients (aged 7-17) with a primary diagnosis of OCD and a Children’s Yale-Brown Obsessive Compulsive Scale score of 16 or higher despite an adequate SRI trial.

Patients were randomly assigned to one of three groups:

1. Medication management only
2. Medication management plus instructions in CBT (7 sessions of 45 mins)
3. Medication management plus CBT (14 sessions of 1 hour)

The main outcome of interest was a 30% or more improvement in OCD scores over the 12 weeks. The authors conducted an intention to treat analysis that included all of the participants.

Here’s what they found:

• ‘Medication management plus CBT’ increased response compared with ‘Medication management plus instructions in CBT’ or ‘Medication management only’ (68.6% with CBT vs 34.0% with instructions in CBT vs 30.0% with medication only; CBT vs medication only p<0.001, CBT vs instruction in CBT p=0.002)
• There was no significant difference between ‘Medication management plus instructions in CBT’ or ‘Medication management only’ (i.e. medication management alone; p=0.72)
• The number needed to treat to see one additional response at week 12 with ‘Medication management plus CBT’ compared with ‘Medication management plus instructions in CBT’ or ‘Medication management only’ was estimated as three
• Similar results were obtained when continuous measures of OCD symptoms were considered, with ‘Medication management plus CBT’ superior to ‘Medication management plus instructions in CBT’ or ‘Medication management only’ by week 12 (p≤0.001 for comparisons on the CY-BOCS and NIMH-GOCS)
• There was no significant difference between ‘Medication management plus instructions in CBT’ or ‘Medication management only’ in OCD symptoms on either the CY-BOCS (p=0.45) or the NIMH-GOCS (p=0.27)
• Results did not differ if adjusted for age differences between the groups
• There were no between group difference in reported adverse events

The authors concluded:

Among patients aged 7 to 17 years with OCD and partial response to SRI use, the addition of CBT to medication management compared with medication management alone resulted in a significantly greater response rate, whereas augmentation of medication management with the addition of instructions in CBT did not.

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 (POTS II) randomized controlled trial. JAMA 2011;306:1224–32.