title: 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).
  
  
  METHODS
  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.
authors.affiliation: Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA, USA. foa@mail.med.upenn.edu
authors.forename: Edna B
authors.initials: EB
authors.lastname: Foa
authors.forename: Helen Blair
authors.initials: HB
authors.lastname: Simpson
authors.forename: Michael R
authors.initials: MR
authors.lastname: Liebowitz
authors.forename: Mark B
authors.initials: MB
authors.lastname: Powers
authors.forename: David
authors.initials: D
authors.lastname: Rosenfield
authors.forename: Shawn P
authors.initials: SP
authors.lastname: Cahill
authors.forename: Raphael
authors.initials: R
authors.lastname: Campeas
authors.forename: Martin
authors.initials: M
authors.lastname: Franklin
authors.forename: Chang-Gyu
authors.initials: CG
authors.lastname: Hahn
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Hembree
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Huppert
authors.forename: Andrew B
authors.initials: AB
authors.lastname: Schmidt
authors.forename: Donna
authors.initials: D
authors.lastname: Vermes
authors.forename: Monnica T
authors.initials: MT
authors.lastname: Williams
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001521:Behavior Therapy / Q000379:methods*; D002562:Ceremonial Behavior; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007171:Implosive Therapy / Q000379:methods; D008297:Male; D008875:Middle Aged; D009771:Obsessive-Compulsive Disorder / Q000188:drug therapy / Q000628:therapy*; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D017367:Selective Serotonin Reuptake Inhibitors