Efficacy of D-cycloserine augmented brief intensive cognitive-behavioural therapy for paediatric obsessive-compulsive disorder: A randomised clinical trial

Objective: To examine the efficacy of weight-adjusted D-cycloserine (DCS) (35 or 70 mg) relative to placebo augmentation of intensive exposure therapy for youth with obsessive-compulsive disorder (OCD) in a double-blind, randomised controlled trial, and examine whether antidepressant medication or patient age moderated outcomes. Methods: Youth (n = 100, 7–17 years) with OCD were randomised in a 1:1 ratio to either DCS + exposure (n = 49) or placebo + exposure (n = 51). Assessments occurred posttreatment, 1 month later, and at 3 and 6 months. Pills were ingested immediately before sessions. Results: Significant improvements on all outcomes were observed at posttreatment, and to 6-month follow-up. Treatment arms did not differ across time, with no significant time-by-medication interactions on symptom severity (T1 to T2 estimate: 9.3, 95% confidence interval [CI]: −11.2 to −7.4, and estimate −10.7, 95% CI: −12.6 to −8.7), diagnostic severity (T1 to T2 estimate: −2.0, 95% CI: −2.4 to −1.5 and estimate −2.5, 95% CI: −3.0 to −2.0) or global functioning (T1 to T2 estimate: 13.8, 95% CI: 10.6 to 17.0, and estimate 16.6, 95% CI: 13.2 to 19.9). Neither antidepressants at baseline nor age moderated primary outcomes. There were significantly fewer responders/remitters at 1- and 6-month follow-up among youth in the DCS condition stabilised on SSRIs, relative to youth not taking SSRIs. Conclusions: DCS augmented intensive exposure therapy did not result in overall additional benefits relative to placebo. Intensive exposure proved effective in reducing symptoms for the overall sample

When adolescents feel ugly: cognitive behavioral therapy for body dysmorphic disorder in youth

Adolescence is a critical time for physical development and maturation, and with these important physiological changes comes greater awareness of body image and appearance, which, for a proportion of young people can become excessive, signaling the onset of body dysmorphic disorder (BDD). BDD in adolescence is associated with significant impairment and suicidality, is poorly understood, and currently there is limited evidence for the effectiveness of psychological therapy. Cognitive behavioral therapy (CBT) is currently the most promising and best available psychological therapy for BDD in youth. The aim of this article is to provide clinicians with information on CBT treatment for BDD in young people and to provide guidance based on clinical experience of working with this complex population group. The article will include discussion of strategies including maximizing psychoeducation with parental involvement, the use of cognitive therapy techniques, exposure with response prevention, and perceptual visual training techniques, including attention training and mirror retraining

Treatment of aggressive obsessions in childhood obsessive-compulsive disorder

In this chapter, we discuss aggressive obsessions, which are obsessions related to violence or harm towards the self or others. Aggressive obsessions are highly distressing and prevalent, with reports of 30 to 70 % of youth obsessive-compulsive disorder (OCD) sufferers experiencing these symptoms. We outline the phenomenology and background literature on aggressive obsessions and then describe the case of a 16-year-old male experiencing aggressive obsessions. Case conceptualization, assessment, and treatment using cognitive behavioural therapy with exposure and response prevention are presented, followed by a discussion of complicating factors, conclusions, and key practice points.21 page(s

Long-term outcomes of cognitive-behavior therapy for adolescent body dysmorphic disorder

Emerging evidence suggests that cognitive-behavioral therapy (CBT) is an efficacious treatment for adolescent body dysmorphic disorder (BDD) in the short term, but longer-term outcomes remain unknown. The current study aimed to follow up a group of adolescents who had originally participated in a randomized controlled trial of CBT for BDD to determine whether treatment gains were maintained. Twenty-six adolescents (mean age = 16.2, SD = 1.6) with a primary diagnosis of BDD received a course of developmentally tailored CBT and were followed up over 12 months. Participants were assessed at baseline, midtreatment, posttreatment, 2-, 6-, and 12-month follow-up. The primary outcome measure was the clinician-rated Yale-Brown Obsessive-Compulsive Scale Modified for BDD. Secondary outcomes included measures of insight, depression, quality of life, and global functioning. BDD symptoms decreased significantly from pre- to posttreatment and remained stable over the 12-month follow-up. At this time point, 50% of participants were classified as responders and 23% as remitters. Participants remained significantly improved on all secondary outcomes at 12-month follow-up. Neither baseline insight nor baseline depression predicted long-term outcomes. The positive effects of CBT appear to be durable up to 12-month follow-up. However, the majority of patients remained symptomatic and vulnerable to a range of risks at 12-month follow-up, indicating that longer-term monitoring is advisable in this population. Future research should focus on enhancing the efficacy of CBT in order to improve long-term outcomes