Sudden gains in cognitive behavioral therapy among children and adolescents with obsessive compulsive disorder.
Children
Cognitive-behavioral therapy
Obsessive-compulsive disorder
Sudden gains
Journal
Journal of behavior therapy and experimental psychiatry
ISSN: 1873-7943
Titre abrégé: J Behav Ther Exp Psychiatry
Pays: Netherlands
ID NLM: 0245075
Informations de publication
Date de publication:
09 2019
09 2019
Historique:
received:
14
02
2018
revised:
03
03
2019
accepted:
05
03
2019
pubmed:
17
3
2019
medline:
1
8
2020
entrez:
17
3
2019
Statut:
ppublish
Résumé
This study examined the occurrence of sudden gains (or reversal of gains) among children with obsessive-compulsive disorder (OCD) during the course of cognitive-behavioral therapy (CBT), as well as the association of sudden gains with treatment response, treatment group, and pre-treatment clinical characteristics. The sample consisted of 136 youth (ages 7-17) with a primary diagnosis of OCD who were randomized in a double-blinded fashion to 10 sessions of CBT with augmentation of either d-cycloserine or placebo. Sudden gain status was determined based on clinician-rated obsessive-compulsive symptom severity, which was collected on 9 occasions across the study period. 42.6% of youth experienced at least one sudden gain, which tended to occur either after starting exposure and response prevention or towards the end of treatment. After applying the Benjamini-Hochberg procedure for multiple comparisons, there were no significant pre-treatment predictors of sudden gains and only reduced insight predicted the reversal of gains. Individuals with at least one sudden gain had improved overall treatment outcomes, measured both by reduction in OCD symptom severity, and by global illness severity. Several clinical constructs were not examined. Symptomatology was not assessed at every treatment session. Differences in those who achieved sudden gains and those who did not may be obscured. There is the possibility that a sudden gain reflected a scoring error generated by an optimistic or inaccurate report. Finally, a relatively homogenous sample may limit the generalizability of results. The course of CBT for pediatric OCD is variable with many children experiencing sudden gains, but a sizable percentage experience a reversal of gains which was related to reduced insight. Sudden gains tended to occur after starting exposure and response prevention and towards the end of treatment. ClinicaltrialsgovRegistry:NCT00864123. https://www.clinicaltrials.gov/ct2/show/NCT00864123.
Sections du résumé
BACKGROUND AND OBJECTIVES
This study examined the occurrence of sudden gains (or reversal of gains) among children with obsessive-compulsive disorder (OCD) during the course of cognitive-behavioral therapy (CBT), as well as the association of sudden gains with treatment response, treatment group, and pre-treatment clinical characteristics.
METHODS
The sample consisted of 136 youth (ages 7-17) with a primary diagnosis of OCD who were randomized in a double-blinded fashion to 10 sessions of CBT with augmentation of either d-cycloserine or placebo. Sudden gain status was determined based on clinician-rated obsessive-compulsive symptom severity, which was collected on 9 occasions across the study period.
RESULTS
42.6% of youth experienced at least one sudden gain, which tended to occur either after starting exposure and response prevention or towards the end of treatment. After applying the Benjamini-Hochberg procedure for multiple comparisons, there were no significant pre-treatment predictors of sudden gains and only reduced insight predicted the reversal of gains. Individuals with at least one sudden gain had improved overall treatment outcomes, measured both by reduction in OCD symptom severity, and by global illness severity.
LIMITATIONS
Several clinical constructs were not examined. Symptomatology was not assessed at every treatment session. Differences in those who achieved sudden gains and those who did not may be obscured. There is the possibility that a sudden gain reflected a scoring error generated by an optimistic or inaccurate report. Finally, a relatively homogenous sample may limit the generalizability of results.
CONCLUSIONS
The course of CBT for pediatric OCD is variable with many children experiencing sudden gains, but a sizable percentage experience a reversal of gains which was related to reduced insight. Sudden gains tended to occur after starting exposure and response prevention and towards the end of treatment.
TRIALSREGISTRATION
ClinicaltrialsgovRegistry:NCT00864123. https://www.clinicaltrials.gov/ct2/show/NCT00864123.
Identifiants
pubmed: 30877851
pii: S0005-7916(18)30037-5
doi: 10.1016/j.jbtep.2019.03.003
pmc: PMC6520195
mid: NIHMS1523907
pii:
doi:
Substances chimiques
Neurotransmitter Agents
0
Cycloserine
95IK5KI84Z
Banques de données
ClinicalTrials.gov
['NCT00864123']
Types de publication
Journal Article
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
92-98Subventions
Organisme : NIMH NIH HHS
ID : R01 MH093381
Pays : United States
Organisme : NIMH NIH HHS
ID : R03 MH076775
Pays : United States
Informations de copyright
Copyright © 2019 Elsevier Ltd. All rights reserved.
Références
J Consult Clin Psychol. 1999 Dec;67(6):894-904
pubmed: 10596511
Psychiatry Res. 2004 Nov 30;129(1):91-8
pubmed: 15572188
J Consult Clin Psychol. 2005 Feb;73(1):59-67
pubmed: 15709832
J Clin Psychol. 2008 Jan;64(1):119-26
pubmed: 18161042
J Am Acad Child Adolesc Psychiatry. 2008 May;47(5):583-92
pubmed: 18356759
Behav Res Ther. 2008 Nov;46(11):1244-50
pubmed: 18804199
J Consult Clin Psychol. 1991 Feb;59(1):12-9
pubmed: 2002127
Behav Res Ther. 2010 Jun;48(6):555-60
pubmed: 20304385
J Am Acad Child Adolesc Psychiatry. 2010 Jul;49(7):708-17
pubmed: 20610140
J Am Acad Child Adolesc Psychiatry. 2010 Oct;49(10):1024-33; quiz 1086
pubmed: 20855047
Psychother Psychosom. 2012;81(1):44-51
pubmed: 22116471
J Consult Clin Psychol. 2012 Feb;80(1):93-101
pubmed: 22122290
J Consult Clin Psychol. 2013 Feb;81(1):177-82
pubmed: 23244366
Behav Res Ther. 2014 Mar;54:22-9
pubmed: 24468920
J Am Acad Child Adolesc Psychiatry. 2015 Mar;54(3):200-207.e1
pubmed: 25721185
Depress Anxiety. 2015 Aug;32(8):580-93
pubmed: 26130211
Behav Res Ther. 2016 Feb;77:170-6
pubmed: 26803276
Eur Child Adolesc Psychiatry. 2017 Jan;26(1):47-55
pubmed: 27209422
JAMA Psychiatry. 2016 Aug 1;73(8):779-88
pubmed: 27367832
Behav Res Ther. 2017 Jun;93:1-5
pubmed: 28342401
J Am Acad Child Adolesc Psychiatry. 1997 Jun;36(6):844-52
pubmed: 9183141
J Am Acad Child Adolesc Psychiatry. 1997 Jul;36(7):980-8
pubmed: 9204677