Using the Cochrane methodology , and as measures of effect size mean difference and Hedge 's g , SRIs proved to be superior to drug placebo , with a modest effect size .
From direct comparisons of CBT and SRI treatments , we conclude that CBT has the superior efficacy .
COMBO versus CBT shows that SRI treatment adds little to concomitant CBT , while COMBO shows favourable outcome versus SRI alone .
In pre-trial partial treatment responders , those who failed a SRI had better outcome from adding CBT as compared to continuing a SRI .
Those who failed CBT treatment did as well with continued CBT as with switching to a SRI .
Serotonin reuptake inhibiting drugs ( SRI ) have been used in the treatment of paediatric obsessive-compulsive disorder over the past 30 years .
Cognitive behavior therapy augmentation of pharmacotherapy in pediatric obsessive-compulsive disorder: the Pediatric OCD Treatment Study II (POTS II) randomized controlled trial.
CONTEXT The extant literature on the treatment of pediatric obsessive-compulsive disorder ( OCD ) indicates that partial response to serotonin reuptake inhibitors ( SRIs ) is the norm and that augmentation with short-term OCD-specific cognitive behavior therapy ( CBT ) may provide additional benefit . OBJECTIVE To examine the effects of augmenting SRIs with CBT or a brief form of CBT , instructions in CBT delivered in the context of medication management . DESIGN , SETTING , AND PARTICIPANTS A 12-week r and omized controlled trial conducted at 3 academic medical centers between 2004 and 2009 , involving 124 pediatric out patients between the ages of 7 and 17 years with OCD as a primary diagnosis and a Children 's Yale-Brown Obsessive Compulsive Scale score of 16 or higher despite an adequate SRI trial . INTERVENTIONS Participants were r and omly assigned to 1 of 3 treatment strategies that included 7 sessions over 12 weeks : 42 in the medication management only , 42 in the medication management plus instructions in CBT , and 42 in the medication management plus CBT ; the last included 14 concurrent CBT sessions . MAIN OUTCOME MEASURES Whether patients responded positively to treatment by improving their baseline obsessive-compulsive scale score by 30 % or more and demonstrating a change in their continuous scores over 12 weeks . RESULTS The medication management plus CBT strategy was superior to the other 2 strategies on all outcome measures . In the primary intention-to-treat analysis , 68.6 % ( 95 % CI , 53.9%-83.3 % ) in the plus CBT group were considered responders , which was significantly better than the 34.0 % ( 95 % CI , 18.0%-50.0 % ) in the plus instructions in CBT group , and 30.0 % ( 95 % CI , 14.9%-45.1 % ) in the medication management only group . The results were similar in pairwise comparisons with the plus CBT strategy being superior to the other 2 strategies ( P < .01 for both ) . The plus instructions in CBT strategy was not statistically superior to medication management only ( P = .72 ) . The number needed-to-treat analysis with the plus CBT vs medication management only in order to see 1 additional patient at week 12 , on average , was estimated as 3 ; for the plus CBT vs the plus instructions in CBT strategy , the number needed to treat was also estimated as 3 ; for the plus instructions in CBT vs medication management only the number needed to treat was estimated as 25 . CONCLUSIONS 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 result ed in a significantly greater response rate , whereas augmentation of medication management with the addition of instructions in CBT did not . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00074815
Using the Cochrane methodology , and as measures of effect size mean difference and Hedge 's g , SRIs proved to be superior to drug placebo , with a modest effect size .
From direct comparisons of CBT and SRI treatments , we conclude that CBT has the superior efficacy .
COMBO versus CBT shows that SRI treatment adds little to concomitant CBT , while COMBO shows favourable outcome versus SRI alone .
In pre-trial partial treatment responders , those who failed a SRI had better outcome from adding CBT as compared to continuing a SRI .
Those who failed CBT treatment did as well with continued CBT as with switching to a SRI .
Serotonin reuptake inhibiting drugs ( SRI ) have been used in the treatment of paediatric obsessive-compulsive disorder over the past 30 years .