The Pediatric Obsessive-Compulsive Disorder Treatment Study II: rationale, design and methods

This paper presents the rationale, design, and methods of the Pediatric Obsessive-Compulsive Disorder Treatment Study II (POTS II), which investigates two different cognitive-behavior therapy (CBT) augmentation approaches in children and adolescents who have experienced a partial response to pharmacotherapy with a serotonin reuptake inhibitor for OCD. The two CBT approaches test a "single doctor" versus "dual doctor" model of service delivery. A specific goal was to develop and test an easily disseminated protocol whereby child psychiatrists would provide instructions in core CBT procedures recommended for pediatric OCD (e.g., hierarchy development, in vivo exposure homework) during routine medical management of OCD (I-CBT). The conventional "dual doctor" CBT protocol consists of 14 visits over 12 weeks involving: (1) psychoeducation, (2), cognitive training, (3) mapping OCD, and (4) exposure with response prevention (EX/RP). I-CBT is a 7-session version of CBT that does not include imaginal exposure or therapist-assisted EX/RP. In this study, we compared 12 weeks of medication management (MM) provided by a study psychiatrist (MM only) with two types of CBT augmentation: (1) the dual doctor model (MM+CBT); and (2) the single doctor model (MM+I-CBT). The design balanced elements of an efficacy study (e.g., random assignment, independent ratings) with effectiveness research aims (e.g., differences in specific SRI medications, dosages, treatment providers). The study is wrapping up recruitment of 140 youth ages 7–17 with a primary diagnosis of OCD. Independent evaluators (IEs) rated participants at weeks 0,4,8, and 12 during acute treatment and at 3,6, and 12 month follow-up visits

Concordance Between Measures of Anxiety and Physiological Arousal Following Treatment of Panic Disorder in Adolescence

This study examined the concordance (or synchrony/desynchrony) between adolescents' self-reports of anxiety and physiological measures of arousal (heart rate) both prior to and after treatment for panic disorder. Results indicated a decline in reported subjective units of distress (SUDS) for the treatment group only at the post-treatment measurement for two of three tasks. Within the treatment group, heart rate changes during the Behavioral Approach Test (BAT) were observed following treatment for one task only. Implications of this apparent desynchrony between self-report and physiological measures in adolescent panic disorder are discussed, with cognitive changes in participants' perception of anxiety after treatment suggested as an important factor in recovery

Identifying Efficacious Treatment Components of Panic Control Treatment for Adolescents: A Preliminary Examination

Panic Control Treatment for Adolescents (PCT-A) is a developmentally sensitive and efficacious treatment for adolescents with panic disorder. The present study is a preliminary examination of the relative efficacy of individual treatment components in PCT-A in a sample of treatment completers; the study identified when rapid improvements in panic symptoms occurred over the course of treatment and which treatment components preceded these gains. Twenty-one adolescents (ages 13-17) completed weekly measures of panic-relevant symptoms, which were examined for between-session gains. Results indicate that psychoeducation may precede notable decreases in panic attacks while cognitive restructuring may contribute to rapid declines in overall anxiety and cognitive errors. The authors discuss the importance of future controlled dismantling studies to examine the relative contribution of PCT-A treatment components