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What is the difference between being treated with drugs or psychotherapy for obsessions?
20 January 2012
Journal of Psychotherapy and Psychosomatics
This study demonstrates the maintenance of efficacy of cognitive behavioral group therapy and sertraline for Obsessive Compulsive Disorder (OCD) after 5 years of follow-up. This was due to the fact that a portion of the patients from both initial groups sought continuation of the original treatment or made a natural ‘crossover’. As OCD is a chronic disorder, probably the continuation of any one of the treatment strategies is mainly responsible for the maintenance of outcomes in the long run.
Cognitive-behavioral therapy (CBT) and serotonin reuptake inhibitors (SRI) are the first-choice treatments for obsessive-compulsive disorder (OCD).
The aim of the present study was to investigate whether the reduction in severity of OCD symptoms obtained with 12-weekly sessions of CBGT (cognitive behavioral group therapy) or with sertraline (100 mg/day) during the same period, in a randomized clinical trial, would be sustained over a 5-year period, as well as to compare the differences between the 2 treatments in the long term.
Forty-six patients (92% of the initial sample) who were treated with CBGT (n = 21; 46%) or sertraline (n = 25; 54%) were evaluated 5 years after the end of the initial randomized clinical trial. All subjects provided written informed consent that was approved by the institutional review board. The Yale-Brown Scale for Obsessive-Compulsive Symptoms (Y-BOCS) and the Clinical Global Impression scale – Severity (CGI-S, adapted version) were used to assess the severity of OCD symptoms.
The Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) were used to assess depressive and anxiety symptoms, respectively. Both patients treated with CBGT and those treated with sertraline showed a significant reduction in the severity of symptoms at the end of the treatments, and they maintained therapeutic gains 5 years after. A significant group of patients who underwent CBGT (13; 62%) started taking antiobsessional medication (p<0.001); on the other hand, psychotherapy was given to the patients who had taken sertraline (8; 32%), but at a nonsignificant level (p =0.084).
A total of 10 patients (22%), 2 (9.5%) from the CBGT group and 8 (32%) from the sertraline group, had CBT in the 5-year follow-up period (p =0.084). Almost 62% of all patients continued using or started using medication, and 41.5% started or continued undergoing CBT in the 5-year follow-up period. There was a significant increase in remissive patients (partial or full remission) in the sertraline group (p = 0.046); the same did not occur in the CBGT group (p =0.083).
There was no statistical association between use of medication and full remission rates at the end of 5 years (p = 0.652) in both groups. Many patients used medication after the initial trial, which might have contributed to the maintenance of therapeutic gain, regardless of the type of treatment initially received. Medication treatment after CBGT was more frequently chosen, presumably due to its availability. These findings suggest that a portion of OCD patients needs additional therapeutic support to keep or reach an improvement in the long run.
The current study has several limitations. The small sample size compromises the statistical power to
find differences between these 2 OCD treatments, and thus we cannot draw definite conclusions from these findings. The main limitation is the naturalistic follow-up study, which prevents us from attributing the maintenance of the outcomes to the type of treatment carried out, CBGT or sertraline.
In conclusion, this study has demonstrated the maintenance of efficacy of CBGT and sertraline for
OCD after 5 years of follow-up. This was due to the fact that a portion of the patients from both initial groups sought continuation of the original treatment or made a natural ‘crossover’, as it was
observed. As OCD is a chronic disorder, probably the continuation of any one of the treatment strategies is mainly responsible for the maintenance of outcomes in the long run.