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Randomized Controlled Trial
. 2019 Sep:64:92-98.
doi: 10.1016/j.jbtep.2019.03.003. Epub 2019 Mar 9.

Sudden gains in cognitive behavioral therapy among children and adolescents with obsessive compulsive disorder

Eric A Storch  1 , Joseph F McGuire  2 , Sophie C Schneider  3 , Brent J Small  4 , Tanya K Murphy  5 , Sabine Wilhelm  6 , Daniel A Geller  6
Affiliations
Randomized Controlled Trial

Sudden gains in cognitive behavioral therapy among children and adolescents with obsessive compulsive disorder

Eric A Storch et al. J Behav Ther Exp Psychiatry. 2019 Sep.

Abstract

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.

Keywords: Children; Cognitive-behavioral therapy; Obsessive-compulsive disorder; Sudden gains.

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Conflict of interest statement

Conflict of Interest

Dr. Storch receives research support from NIH, Red Cross, Rebuild Texas, Texas Higher Education Coordinating Board, and Greater Houston Community Foundation. He has received royalties from Elsevier Publications, Springer Publications, American Psychological Association, Wiley, Inc, and Lawrence Erlbaum. Dr. Storch is on the Speaker’s Bureau and Scientific Advisory Board for the International OCD Foundation. He is a consultant for Levo Therapeutics. Dr. Storch reports no other potential conflict of interest.

Dr. McGuire receives grant funding from the Tourette Association of America and National Institutes of Health. Dr. McGuire reports no other potential conflict of interest.

Dr. Small reports no financial disclosure and no potential conflict of interest.

Dr. Murphy reports research funding from Auspex Pharmaceuticals, National Institute of Mental Health, Shire Pharmaceuticals, Pfizer, Inc, F. Hoffmann-La Roche Ltd., AstraZeneca Pharmaceuticals, Centers for Disease Control, Massachusetts General Hospital, Sunovion Pharmaceuticals, Neurocrine Biosciences, PANDAS Network and Psyadon Pharmaceuticals. Dr. Murphy reports no other potential conflict of interest.

Dr. Wilhelm has received research support in the form of free medication and matching placebo from Forest Laboratories for a NIMH funded clinical trial. Dr. Wilhelm is a presenter for the Massachusetts General Hospital Psychiatry Academy in educational programs supported through independent medical education grants from pharmaceutical companies; she has received royalties from Elsevier Publications, Guilford Publications and New Harbinger Publications from Oxford University Press. Dr. Wilhelm has also received salary support from Novartis. Dr. Wilhelm has also received speaking honoraria from various academic institutions and foundations, including the International Obsessive Compulsive Disorder Foundation and the Tourette’s Syndrome Association. In addition, she received payment from the Association for Behavioral and Cognitive Therapies for her role as Associate Editor for the Behavior Therapy journal, as well as from John Wiley & Sons, Inc., for her role as Associate Editor on the journal Depression & Anxiety. Dr. Wilhelm reports no other potential conflict of interest.

Dr. Geller reports grant support from NIH and book honorarium from the American Academy of Child and Adolescent Psychiatry, speaking honoraria for Advanced Institute lectures from the American Academy of Child and Adolescent Psychiatry and Massachusetts General Hospital Psychiatry Academy in educational programs supported through independent medical education grants from pharmaceutical companies. Lifetime funding includes support from the Obsessive Compulsive Disorder Foundation, The Tourette Syndrome Association, The McIngvale Family Foundation, Eli Lilly, Pfizer, and Glaxo Smith Kline. Dr. Geller reports no other potential conflict of interest.

Figures

Figure A1.
Figure A1.. Consort Diagram of Original Study
Note: Details of original study recruitment and retention are shown (see Storch et al., 2016). CBT indicates cognitive behavior therapy; CY-BOCS, Children’s Yale-Brown Obsessive Compulsive Scale
See this image and copyright information in PMC

References

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