Document Detail

Cognitive-behavioral therapy for medication nonresponders with obsessive-compulsive disorder: a wait-list-controlled open trial.
MedLine Citation:
PMID:  15291681     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Cognitive-behavioral therapy (CBT) is generally recommended for obsessive-compulsive disorder (OCD) patients who have failed to respond to approved medications. However, few studies of the efficacy of CBT have selected patients who did not respond to medications. METHOD: We selected 20 adult OCD (DSM-IV criteria) patients with a history of inadequate response to adequate doses of multiple medications, as well as a high rate of comorbid disorders. After a 1-month wait-list period, patients received 15 sessions of outpatient CBT incorporating exposure and ritual prevention. RESULTS: OCD severity (as measured with the Yale-Brown Obsessive Compulsive Scale) decreased significantly (p <.05) after treatment, and gains appeared to have been maintained over a 6-month follow-up period. Analysis of clinical significance indicated that 53% (8/15) of treatment completers met this criterion at posttreatment and 40% (6/15) met the criterion at 6-month follow-up. The sample was characterized as having generally poor insight and putting low effort into CBT; these factors significantly (p <.05) predicted degree of improvement. CONCLUSION: CBT is a useful treatment for OCD patients who have failed to respond adequately to multiple serotonin reuptake inhibitor medications. However, these results were attenuated compared with previous trials. Patients with a long history of poor response to medication may have poor insight and/or not put sufficient effort into treatment; these factors are likely to diminish treatment outcome.
David F Tolin; Nicholas Maltby; Gretchen J Diefenbach; Scott E Hannan; Patrick Worhunsky
Publication Detail:
Type:  Clinical Trial; Controlled Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The Journal of clinical psychiatry     Volume:  65     ISSN:  0160-6689     ISO Abbreviation:  J Clin Psychiatry     Publication Date:  2004 Jul 
Date Detail:
Created Date:  2004-08-04     Completed Date:  2004-09-13     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  7801243     Medline TA:  J Clin Psychiatry     Country:  United States    
Other Details:
Languages:  eng     Pagination:  922-31     Citation Subset:  IM    
Anxiety Disorders Center, The Institute of Living/Hartford Hospital, Hartford, CT 06106, USA.
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MeSH Terms
Ambulatory Care
Cognitive Therapy* / methods
Diagnostic and Statistical Manual of Mental Disorders
Follow-Up Studies
Mental Disorders / epidemiology,  psychology
Obsessive-Compulsive Disorder / epidemiology,  psychology,  therapy*
Patient Acceptance of Health Care
Patient Selection
Psychiatric Status Rating Scales
Serotonin Uptake Inhibitors / therapeutic use
Severity of Illness Index
Treatment Outcome
Waiting Lists
Reg. No./Substance:
0/Serotonin Uptake Inhibitors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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