title: A META-ANALYSIS OF COGNITIVE BEHAVIOR THERAPY AND MEDICATION FOR CHILD OBSESSIVE-COMPULSIVE DISORDER: MODERATORS OF TREATMENT EFFICACY, RESPONSE, AND REMISSION.
abstract: BACKGROUND
  Individual randomized controlled trials (RCTs) have demonstrated the efficacy of cognitive behavioral therapy (CBT) and serotonin reuptake inhibitors (SRIs) for the treatment of youth with obsessive-compulsive disorder (OCD). Although meta-analyses have confirmed these results, there has been minimal examination of treatment moderators or an examination of treatment response and symptom/diagnostic remission for these two treatment types. The present report examined the treatment efficacy, treatment response, and symptom/diagnostic remission for youth with OCD receiving either CBT or SRIs relative to comparison conditions, and examined treatment moderators.
  
  
  METHODS
  A comprehensive literature search identified 20 RCTs that met inclusion criteria, and produced a sample size of 507 CBT participants and 789 SRI participants.
  
  
  RESULTS
  Random effects meta-analyses of CBT trials found large treatment effects for treatment efficacy (g = 1.21), treatment response (relative risk [RR] = 3.93), and symptom/diagnostic remission (RR = 5.40). Greater co-occurring anxiety disorders, therapeutic contact, and lower treatment attrition were associated with greater CBT effects. The number needed to treat (NNT) was three for treatment response and symptom/diagnostic remission. Random effects meta-analyses of SRI trials found a moderate treatment effect for treatment efficacy (g = 0.50), treatment response (RR = 1.80), and symptom/diagnostic remission (RR = 2.06). Greater methodological quality was associated with a lower treatment response for SRI trials. The NNT was five for treatment response and symptom/diagnostic remission.
  
  
  CONCLUSIONS
  Findings demonstrate the treatment effects for CBT and SRIs across three important outcome metrics, and provide evidence for moderators of CBT across trials.
authors.affiliation: Department of Psychology, University of South Florida, Tampa, Florida.|Department of Pediatrics, University of South Florida, Tampa, Florida.|Semel Institute of Neuroscience and Human Behavior, University of California Los Angeles, California, Los Angeles.
authors.forename: Joseph F
authors.initials: JF
authors.lastname: McGuire
authors.affiliation: Semel Institute of Neuroscience and Human Behavior, University of California Los Angeles, California, Los Angeles.
authors.forename: John
authors.initials: J
authors.lastname: Piacentini
authors.affiliation: Department of Psychology, University of South Florida, Tampa, Florida.|Department of Pediatrics, University of South Florida, Tampa, Florida.|Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, Florida.
authors.forename: Adam B
authors.initials: AB
authors.lastname: Lewin
authors.affiliation: Department of Pediatrics, University of South Florida, Tampa, Florida.
authors.forename: Erin A
authors.initials: EA
authors.lastname: Brennan
authors.affiliation: Department of Pediatrics, University of South Florida, Tampa, Florida.|Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, Florida.
authors.forename: Tanya K
authors.initials: TK
authors.lastname: Murphy
authors.affiliation: Department of Psychology, University of South Florida, Tampa, Florida.|Department of Pediatrics, University of South Florida, Tampa, Florida.|Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, Florida.|Rogers Behavioral Health - Tampa Bay, Tampa, Florida.|All Children's Hospital, Johns Hopkins Medicine, Tampa, Florida.|Department of Health Policy and Management, University of South Florida, St. Petersburg, Florida.
authors.forename: Eric A
authors.initials: EA
authors.lastname: Storch
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003131:Combined Modality Therapy; D006801:Humans; D009771:Obsessive-Compulsive Disorder / Q000188:drug therapy / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D012074:Remission Induction; D017367:Selective Serotonin Reuptake Inhibitors / Q000494:pharmacology*
chemical_list: D017367:Selective Serotonin Reuptake Inhibitors
keywords: clomipramine; cognitive behavior therapy; diagnostic remission; obsessive-compulsive disorder; selective serotonin reuptake inhibitors; treatment outcome; treatment response