Six-month follow-up of a randomized controlled trial augmenting serotonin reuptake inhibitor treatment with exposure and ritual prevention for obsessive-compulsive disorder

Abstract

Objective: This article describes the long-term effects of augmenting serotonin reuptake inhibitors (SRIs) with exposure and ritual prevention or stress management training in patients with DSM-IV obsessive-compulsive disorder (OCD).

Method: Between November 2000 and November 2006, 111 OCD patients from 2 academic outpatient centers with partial SRI response were randomized to the addition of exposure and ritual prevention or stress management training, delivered twice weekly for 8 weeks (acute phase); 108 began treatment. Responders (38 of 52 in the exposure and ritual prevention condition, 11 of 52 in the stress management training condition) entered a 24-week maintenance phase. The Yale-Brown Obsessive Compulsive Scale (YBOCS) was the primary outcome measure.

Results: After 24 weeks, patients randomized to and receiving exposure and ritual prevention versus stress management training had significantly better outcomes (mean YBOCS scores of 14.69 and 21.37, respectively; t = 2.88, P = .005), higher response rates (decrease in YBOCS scores ≥ 25%: 40.7% vs 9.3%, Fisher exact test P < .001), and higher rates of excellent response (YBOCS score ≤ 12: 24.1% vs 5.6%, Fisher exact test P = .01). During the maintenance phase, the slope of change in YBOCS scores was not significant in either condition (all P values ≥ .55), with no difference between exposure and ritual prevention and stress management training (P > .74). Better outcome was associated with baseline variables: lower YBOCS scores, higher quality of life, fewer comorbid Axis I diagnoses, and male sex.

Conclusions: Augmenting SRIs with exposure and ritual prevention versus stress management training leads to better outcome after acute treatment and 24 weeks later. Maintenance outcome, however, was primarily a function of OCD severity at entrance. Greater improvement during the acute phase influences how well patients maintain their gains, regardless of treatment condition.

Trial registration: ClinicalTrials.gov NCT00045903.

© Copyright 2013 Physicians Postgraduate Press, Inc.

Figures

Figure 1

Patient Flow Diagram (CONSORT) for a Trial of EX/RP or SMT Augmenting SRI Treatment in Obsessive-Compulsive Disorder Abbreviations: CONSORT = consolidated standards of reporting trials, EX/RP = exposure and ritual prevention, SMT = stress management training, SRI = serotonin reuptake inhibitor.

Figure 2

Discontinuous Growth Curve for Patients Receiving Either SMT or EX/RP (n = 54 per treatment condition) Added to SRI Treatment for Obsessive-Compulsive Disordera aDifferences between SMT and EX/RP were significant for the slope of change during acute treatment (b = 0.93, P < .001) and for the level of Yale-Brown Obsessive Compulsive Scale (YBOCS) scores at end of acute treatment (week 8: b = 8.14, P < .001) and at the end of maintenance treatment (week 32: b = 6.68, P = .005). Abbreviations: EX/RP = exposure and ritual prevention, SMT = stress management training, SRI = serotonin reuptake inhibitor.