It has been an intense week for those involved in the treatment of OCD in children and adolescents. Fabian Lenhard has successfully defended his thesis, congratulations Fabian! His opponent was Professor John Piacentini from University of California, Los Angeles. Professor Piacentini is an experienced clinician and researcher in pediatric OCD. Yesterday he gave a lecture on the research frontiers in this field.
Internet-delivered CBT for adolescents with OCD
The topic of Dr. Lenhard’s thesis is Internet-delivered Cognitive Behavior Therapy for Adolescents with Obsessive-Compulsive Disorder. You can find the thesis here: https://openarchive.ki.se/xmlui/handle/10616/45535
He has developed and tested the treatment in an open trial and a randomized controlled trial. Analyses on cost-effectiveness and predictors of outcome are underway.
The results from both the open trial and the randomized trial indicate that internet-delivered CBT is an effective treatment for adolescents with OCD. The pre-post within-group effect sizes were large in both trials.
Link to the open trial: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0100773
Link to the randomized trial: http://www.jaacap.com/article/S0890-8567(16)31857-3/abstract
Professor John Piacentini: Optimizing Outcomes for Pediatric OCD
During his visit to Sweden, Professor Piacentini talked about research that aims to optimize outcomes in pediatric OCD. After receiving CBT, around 40 % of patients are in remission. While our treatments are effective for some, we still have a long way to go in order to treat every child and adolescent with OCD. Looking into specific mechanisms of change might be a way to optimize the current treatments.
Some suggested mechanisms include expectations of recovery (which might be mediated by home work compliance), the ability of a therapist to push exposures, and affect labeling (”I feel scared”) rather than cognitive restructuring during exposure.
Professor Piacentini also discussed recent work on neurotransmitters that directly target the underlying brain correlates of OCD. For example, glutamate levels might serve as a possible moderator of treatment outcome. We are awaiting the results from trials that aim to change glutamate levels pre-treatment to enhance the outcomes of CBT.