The efficacy of medications, consisting of serotonin partial and specific reuptake blockers, and behavior therapy, consisting of exposure and response prevention in addition to social skills training, cognitive therapy, and habit reversal, in the treatment of obsessive-compulsive disorder are well documented. The purpose of the study was to explore if adding behavior therapy to medication would enhance treatment efficacy.
Ten children/adolescents who had not previously responded to behavior therapy were randomly assigned to two groups: fluvoxamine alone or fluvoxamine with behavior therapy. All 10 patients received fluvoxamine for 10 weeks-five continued solely on fluvoxamine for one year and five engaged in behavior therapy for 20 sessions along with fluvoxamine and then continued solely on medication until the end of the year.
Eight of 10 patients improved significantly on fluvoxamine at week 10 on the primary outcome variable, the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS). According to the other measurements-National Institute of Mental Health-Global Obses-sive-Compulsive Scale, Clinical Global Impression-Improvement (assessing level of im-provement from week to week), and Clinical Global Impression-Severity of Illness Scale (as-sessing how ill the patient is from week to week)-improvement was not as evident. According to the CY-BOCS, those who received a combination of fluvoxamine and exposure with response prevention showed significantly more improvement than those who only took medication. At two-year follow-up, all patients continued to improve, with those in the combined approach improving more than those in the medication-alone group.
Future studies should determine the specific effect of each treatment group, combined and singularly. Reasons for discrepancy in improvement ratings as noted by the different instruments are discussed. The addition of behavior therapy to fluvoxamine seems to enhance treatment efficacy, according to the CY-BOCS.
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"4. Zusammenfassung und Ausblick Die Entwicklung narrativ-verhaltenstherapeutischer und (meta-)kognitiver Interventionen haben die Behandlungsmöglichkeiten von Kindern und Jugendlichen mit Zwangsstörungen deutlich verbessert. Es gibt zudem erste Hinweise für die Überlegenheit eines kombinierten Vorgehens von kognitiver Verhaltenstherapie und Pharmakotherapie gegenüber einer Monotherapie (Neziroglu et al., 2000 "
[Show abstract][Hide abstract] ABSTRACT: The identification of efficacious psychological and psychiatric therapies is arguably one of the most significant achievements
in the pediatric anxiety disorders field. Controlled trials have supported the usefulness of psychological and pharmacological
monotherapies for pediatric obsessive–compulsive disorder, social anxiety disorder, panic disorder, agoraphobia, generalized
anxiety disorder, specific phobia, posttraumatic stress disorder, and separation anxiety disorder (Compton et al., 2004; Feeney,
Foa, Treadwell, & March, 2004; In-Albon & Schneider, 2007; Reinblatt & Riddle, 2007; Seidel & Walkup, 2006; Watson & Rees,
2008). Clinical practice guidelines, developed from a synthesis of research evidence and expert opinion, have recommended
cognitive-behavioral therapy (CBT) as the first line psychotherapy and treatment of choice (American Academy of Child and
Adolescent Psychiatry (AACAP), 2007; Canadian Psychiatric Association (CPA), 2006). The selective serotonin reuptake inhibitors
(SSRIs) are the recommended first-line pharmacological agents for pediatric anxiety disorders. Second or third-line pharmacotherapy
alternatives include noradrenergic antidepressants (tricyclic antidepressants (TCAs), venlafaxine), benzodiazepines, and buspirone.
[Show abstract][Hide abstract] ABSTRACT: Treatment outcome data for childhood social anxiety are scant. Studies that do exist support the efficacy of both pharmacological and psychotherapeutic interventions. Aside from case reports, studies assessing the efficacy of combined treatment approaches are even more limited. In the current study, we present preliminary findings from a combined psychoeducational and pharmacological treatment program for children and adolescents (ages 8-17 years) with generalized social anxiety disorder. Twelve participants received 12 weeks of citalopram treatment (maximum dose 40 mg/day) and eight brief counseling sessions (15 minutes each). Counseling sessions included education about social anxiety, skills coaching, and behavioral exercises; parents were included in these sessions. Based on clinician global ratings of change, 10 of 12 (83.3%) youths reported improvement: 41.7% (n = 5) of the participants were very much improved, and 41.7% (n = 5) were much improved. Significant changes were also found on self-report ratings of social anxiety, depression, and parents' perceptions of children's social skills during the course of treatment. Findings support the need for double-blind, placebo-controlled studies of combined treatments for youth with generalized social anxiety disorder.
Journal of Child and Adolescent Psychopharmacology 02/2002; 12(1):47-54. DOI:10.1089/10445460252943560 · 2.93 Impact Factor