Comparison Of Psychological And Drug Treatments And Combinations Of Treatment

A meta-analysis by Cox et al. (1993) found that serotonin reuptake inhibitors and exposure-based behaviour therapy treatments were equally and significantly effective for reducing OCD symptoms. Another review found no significant difference between the effect sizes of serotonin reuptake inhibitors and behavioural therapy (Kobak et al. 1998).

One study showed a significantly greater improvement in obsessions with behavioural therapy plus the selective serotonin reuptake inhibitor drug fluvoxamine, compared to behavioural therapy plus placebo tablet (Hohagen et al., 1998). O'Connor et al. (1999) found that a combination of cognitive behavioural therapy and medication seemed to potentiate treatment efficacy. However other studies have not shown any additional benefit of combining behavioural therapy or cognitive therapy with a serotonin reuptake inhibitor drug, compared to using any of the three treatments alone (De Haan et al., 1997; Kobak et al., 1998; Van Balkom et al., 1998). De Haan et al. (1997) compared ERP, cognitive therapy, ERP plus fluvoxamine and cognitive therapy plus fluvoxamine and found no differences in efficacy between the four treatments. They found that a short-term positive response is a good predictor of long-term effect. However one-third of non-responders at post-treatment (16 weeks) had also become responders by follow-up (six months). Late responders had more severe complaints, had a history of previous treatment and a slower rate of change during treatment. They also noted that motivation was an important factor for successful outcome.

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