TY - JOUR
T1 - Sudden gains in cognitive behavioral therapy among children and adolescents with obsessive compulsive disorder
AU - Storch, Eric A.
AU - McGuire, Joseph F.
AU - Schneider, Sophie C.
AU - Small, Brent J.
AU - Murphy, Tanya K.
AU - Wilhelm, Sabine
AU - Geller, Daniel A.
N1 - Funding Information:
This work was supported by grants to the first and last authors from the National Institutes of Health ( 1R01MH09338 and 5R01MH093402 ). We acknowledge the contributions of Ashley Brown, Noah Berman, Ph.D., Sandra Cepeda, Allison Cooperman, Alyssa Faro, Allison Kennel, ARNP, Adam Lewin, Ph.D., Jane Mutch, Ph.D., Nicole McBride, MPH; Kesley Ramsay, Andrew Mittelman, Abigail Stark, and Angelina Gomez.
Publisher Copyright:
© 2019 Elsevier Ltd
PY - 2019/9
Y1 - 2019/9
N2 - 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.
AB - 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.
KW - Children
KW - Cognitive-behavioral therapy
KW - Obsessive-compulsive disorder
KW - Sudden gains
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U2 - 10.1016/j.jbtep.2019.03.003
DO - 10.1016/j.jbtep.2019.03.003
M3 - Article
C2 - 30877851
AN - SCOPUS:85062708591
SN - 0005-7916
VL - 64
SP - 92
EP - 98
JO - Journal of Behavior Therapy and Experimental Psychiatry
JF - Journal of Behavior Therapy and Experimental Psychiatry
ER -