A META-ANALYSIS OF COGNITIVE BEHAVIOR THERAPY AND MEDICATION FOR CHILD OBSESSIVE-COMPULSIVE DISORDER: MODERATORS OF TREATMENT EFFICACY, RESPONSE, AND REMISSION.
paper
Cited
Public
- Authors
- McGuire, Joseph F; Piacentini, John; Lewin, Adam B; Brennan, Erin A; Murphy, Tanya K; Storch, Eric A
- Year
- 2015
- Journal
- Depression and anxiety
- PMID
- 26130211
- DOI
- 10.1002/da.22389
- PMCID
- PMC4515191
BACKGROUND: Individual randomized controlled trials (RCTs) have demonstrated the efficacy of cognitive behavioral therapy (CBT) and serotonin reuptake inhibitors (SRIs) for the treatment of youth with obsessive-compulsive disorder (OCD). Although meta-analyses have confirmed these results, there has been minimal examination of treatment moderators or an examination of treatment response and symptom/diagnostic remission for these two treatment types. The present report examined the treatment efficacy, treatment response, and symptom/diagnostic remission for youth with OCD receiving either CBT or SRIs relative to comparison conditions, and examined treatment moderators. METHOD: A comprehensive literature search identified 20 RCTs that met inclusion criteria, and produced a sample size of 507 CBT participants and 789 SRI participants. RESULTS: Random effects meta-analyses of CBT trials found large treatment effects for treatment efficacy (g = 1.21), treatment response (relative risk [RR] = 3.93), and symptom/diagnostic remission (RR = 5.40). Greater co-occurring anxiety disorders, therapeutic contact, and lower treatment attrition were associated with greater CBT effects. The number needed to treat (NNT) was three for treatment response and symptom/diagnostic remission. Random effects meta-analyses of SRI trials found a moderate treatment effect for treatment efficacy (g = 0.50), treatment response (RR = 1.80), and symptom/diagnostic remission (RR = 2.06). Greater methodological quality was associated with a lower treatment response for SRI trials. The NNT was five for treatment response and symptom/diagnostic remission. CONCLUSIONS: Findings demonstrate the treatment effects for CBT and SRIs across three important outcome metrics, and provide evidence for moderators of CBT across trials.
Study Selection and Rationale For Exclusion.
Forest plots of treatment efficacy in CBT trials (A) and SRI trials (B)
Forest plots of treatment response in CBT trials (A) and SRI trials (B)
Forest plots of symptom/diagnostic remission in CBT trials (A) and SRI trials (B)
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| Name | Type |
|---|---|
| active comparison condition local | cohort |
| active comparison trials local | cohort |
| active-comparison trials local | cohort |
| Active treatment attrition local | phenotype |
| active treatment condition local | cohort |
| ADHD | phenotype |
| adolescents | cohort |
| adults | cohort |
| anxiety | phenotype |
| attention deficit hyperactivity disorder | phenotype |
| Behavioral Experiments local | drug |
| CBT participants local | cohort |
| children | cohort |
| Clinically meaningful response local | phenotype |
| clomipramine local | drug |
| Clomipramine local | drug |
| CMA local | cohort |
| CMI local | drug |
| CMI trials local | cohort |
| Cognitive behavioral therapy | drug |
| Cognitive Therapy local | drug |
| Combined Randomized Controlled Trials local | cohort |
| comparison condition local | cohort |
| control conditions local | cohort |
| CT local | drug |
| CTD local | phenotype |
| depression | phenotype |
| Desipramine | drug |
| diagnostic remittance local | phenotype |
| dysthymia | phenotype |
| ERP | phenotype |
| Exposure and response prevention | drug |
| Exposures local | drug |
| Exposure Sessions local | drug |
| Exposure with response prevention local | drug |
| fluoxetine | drug |
| fluvoxamine local | drug |
| generalized anxiety disorder | phenotype |
| homework compliance local | phenotype |
| major depressive disorder | phenotype |
| medication adherence local | phenotype |
| methodological quality local | phenotype |
| Methodological Quality local | phenotype |
| non-active comparison condition local | cohort |
| non-active comparison trials local | cohort |
| obsessive-compulsive disorder | phenotype |
| Obsessive-compulsive severity | phenotype |
| OCD | phenotype |
| oppositional defiant disorder | phenotype |
| panic disorder | phenotype |
| paroxetine | drug |
| Pediatric Obsessive-Compulsive Disorder local | phenotype |
| Placebo-controlled trial local | cohort |
| RCTs | cohort |
| Relaxation training local | drug |
| remission | phenotype |
| selective serotonin reuptake inhibitors | drug |
| separation anxiety disorder | phenotype |
| Serotonin reuptake inhibitors | drug |
| sertraline | drug |
| social phobia | phenotype |
| SRI medication local | drug |
| SRI participants local | cohort |
| SRI trials local | cohort |
| SSRI trials local | cohort |
| symptom/diagnostic remission local | phenotype |
| Symptom/diagnostic remission local | phenotype |
| Symptom/Diagnostic Remission local | phenotype |
| symptom remission | phenotype |
| symptom remittance local | phenotype |
| Symptoms/diagnostic remission local | phenotype |
| symptom severity | phenotype |
| Therapeutic Contact local | phenotype |
| Therapeutic contact hours local | phenotype |
| tics | phenotype |
| Tourette syndrome/Chronic Tic Disorder local | phenotype |
| Tourette Syndrome / Chronic Tic Disorder local | phenotype |
| Treatment-as-usual local | drug |
| Treatment Attrition local | phenotype |
| treatment efficacy | phenotype |
| treatment response | phenotype |
| TS/CTD local | phenotype |
| Waitlist local | drug |
| youth with obsessive-compulsive disorder local | cohort |
| Youth with obsessive-compulsive disorder local | cohort |
| Youth with OCD local | cohort |
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In this knowledge base
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|---|---|---|
| Post-GWAS in Psychiatric Genetics: A Developmental Perspective on the "Other" Next Steps. | 2018 | 29227573 |
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