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Cervin M, McGuire JF, D'Souza JM, De Nadai AS, Aspvall K, Goodman WK, Andrén P, Schneider SC, Geller DA, Mataix-Cols D, Storch EA. Efficacy and acceptability of cognitive-behavioral therapy and serotonin reuptake inhibitors for pediatric obsessive-compulsive disorder: a network meta-analysis. J Child Psychol Psychiatry 2024; 65:594-609. [PMID: 38171647 DOI: 10.1111/jcpp.13934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/08/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Cognitive-behavioral therapy (CBT) and serotonin reuptake inhibitors (SRIs) are recommended treatments for pediatric obsessive-compulsive disorder (OCD), but their relative efficacy and acceptability have not been comprehensively examined. Further, it remains unclear whether the efficacy of in-person CBT is conserved when delivered in other formats, such as over telephone/webcam or as Internet-delivered CBT (ICBT). METHODS PubMed, PsycINFO, trial registries, and previous systematic reviews were searched for randomized controlled trials (RCTs) comparing CBT (in-person, webcam/telephone-delivered, or ICBT) or SRIs with control conditions or each other. Network meta-analyses were conducted to examine efficacy (post-treatment Children's Yale-Brown Obsessive Compulsive Scale) and acceptability (treatment discontinuation). Confidence in effect estimates was evaluated with CINeMA (Confidence in Network Meta-Analysis). RESULTS Thirty eligible RCTs and 35 contrasts comprising 2,057 youth with OCD were identified. In-person CBT was significantly more efficacious than ICBT, waitlist, relaxation training, and pill placebo (MD range: 3.95-11.10; CINeMA estimate of confidence: moderate) but did not differ significantly from CBT delivered via webcam/telephone (MD: 0.85 [-2.51, 4.21]; moderate), SRIs (MD: 3.07 [-0.07, 6.20]; low), or the combination of in-person CBT and SRIs (MD: -1.20 [-5.29, 2.91]; low). SRIs were significantly more efficacious than pill placebo (MD: 4.59 [2.70, 6.48]; low) and waitlist (MD: 8.03 [4.24, 11.82]; moderate). No significant differences for acceptability emerged, but confidence in estimates was low. CONCLUSIONS In-person CBT and SRIs produce clear benefits compared to waitlist and pill placebo and should be integral parts of the clinical management of pediatric OCD, with in-person CBT overall having a stronger evidence base. The combination of in-person CBT and SRIs may be most efficacious, but few studies hinder firm conclusions. The efficacy of CBT appears conserved when delivered via webcam/telephone, while more trials evaluating ICBT are needed.
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Affiliation(s)
| | | | | | | | - Kristina Aspvall
- Karolinska Institutet and Stockholm Health Care Services, Stockholm, Sweden
| | | | - Per Andrén
- Lund University, Lund, Sweden
- Karolinska Institutet and Stockholm Health Care Services, Stockholm, Sweden
| | | | | | - David Mataix-Cols
- Lund University, Lund, Sweden
- Karolinska Institutet and Stockholm Health Care Services, Stockholm, Sweden
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Becker HC, Beltz AM, Himle JA, Abelson JL, Block SR, Taylor SF, Fitzgerald KD. Changes in Brain Network Connections After Exposure and Response Prevention Therapy for Obsessive-Compulsive Disorder in Adolescents and Adults. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2024; 9:70-79. [PMID: 37820789 PMCID: PMC10842137 DOI: 10.1016/j.bpsc.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/08/2023] [Accepted: 09/26/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Functional alterations of tripartite neural networks during cognitive control (i.e., frontoparietal network [FPN], cingulo-opercular network, and default mode network) occur in patients with obsessive-compulsive disorder (OCD) and may contribute to illness expression. However, the degree to which changes in these networks are elicited by gold standard treatment (e.g., exposure and response prevention [EX/RP]) remains unknown. Understanding how EX/RP modulates network connectivity in adolescent versus adult patients with OCD may aid the identification of developmentally sensitive treatment targets that enhance cognitive control. METHODS Data from a total of 169 adolescents (13-17 years) and adults (25-40 years; 57% female) were analyzed, including healthy control participants (n = 58) and patients with OCD (n = 111) who were randomized to either EX/RP or an active control therapy (stress management training). Participants performed a flanker task during functional magnetic resonance imaging pre- and posttreatment. To retain sensitivity to individual differences in connectivity, group iterative multiple model estimation was used to assess functional connectivity (i.e., density) within and between brain networks. RESULTS Significant increases in FPN density and decreases in FPN-default mode network density were observed from pre- to posttreatment in patients who received EX/RP. The opposite patterns of change occurred in patients who received stress management training. These treatment-related changes in network density did not differ across age group. CONCLUSIONS Results suggest EX/RP-specific changes in task-based connectivity in patients with OCD. Given baseline differences between healthy control participants and patients by age group, these treatment-related changes may indicate restoration of healthy FPN and default mode network development across patients, providing targets for improving response to EX/RP.
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Affiliation(s)
- Hannah C Becker
- Department of Psychology, University of Michigan, Ann Arbor, Michigan; Department of Psychiatry, University of Michigan, Ann Arbor, Michigan.
| | - Adriene M Beltz
- Department of Psychology, University of Michigan, Ann Arbor, Michigan
| | - Joseph A Himle
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan; School of Social Work, University of Michigan, Ann Arbor, Michigan
| | - James L Abelson
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | | | - Stephan F Taylor
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Kate D Fitzgerald
- Columbia University and New York State Psychiatric Institute, New York, New York
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Himle JA, Grogan-Kaylor A, Hiller MA, Mannella KA, Norman LJ, Abelson JL, Prout A, Shunnarah AA, Becker HC, Russman Block SR, Taylor SF, Fitzgerald KD. Exposure and response prevention versus stress management training for adults and adolescents with obsessive compulsive disorder: A randomized clinical trial. Behav Res Ther 2024; 172:104458. [PMID: 38103359 DOI: 10.1016/j.brat.2023.104458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 11/24/2023] [Accepted: 12/06/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVE Though exposure and response prevention (ERP) is a well-proven treatment for OCD across the lifespan, prior RCTs have not studied adolescent and adult patients with the same ERP protocol relative to an active comparator that controls for non-specific effects of treatment. This approach assesses differences in the effect of OCD-specific exposures in affected adolescents and adults and in response to ERP compared to a stress-management control therapy (SMT). METHODS This assessor-blinded, parallel, 2-arm, randomized, ambulatory clinical superiority trial randomized adolescents (aged 12-18) and adults (24-46) with OCD (N = 126) to 12 weekly sessions of ERP or SMT. OCD severity was measured before, during and after treatment using the child or adult version of the Yale-Brown Obsessive Compulsive Scale (C/Y-BOCS), depending on participant age. We predicted that ERP would produce greater improvement in OCD symptoms than SMT and that there would be no significant post-treatment differences across age groups. RESULTS ERP (n = 63) produced significantly greater improvements on C/Y-BOCS scores at post-treatment than SMT (n = 63) (Effect size = -0.72, CI = -0.52 to -0.91, p < .001). ERP also produced more treatment responders (ERP = 86%, SMT = 32%; χ2 = 46.37, p < .001) and remitters than SMT (ERP = 39%, SMT = 7%; χ2 = 16.14, p < .001). Finally, there were no statistically significant post-treatment differences in C/Y-BOCS scores between adolescents and adults assigned to ERP. CONCLUSION A single ERP protocol is superior to SMT in treating both adolescents and adults with OCD. OCD-specific therapy is necessary across the lifespan for optimal outcomes in this highly disabling disorder, though non-specific treatments like SMT are still all-too-commonly provided.
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Affiliation(s)
- Joseph A Himle
- School of Social Work, University of Michigan, 1080 South University Ave, Ann Arbor, MI, 48109, USA; Department of Psychiatry, Medical School, University of Michigan, 1500 East Medical Center Dr., Ann Arbor, MI, 48109, USA.
| | - Andrew Grogan-Kaylor
- School of Social Work, University of Michigan, 1080 South University Ave, Ann Arbor, MI, 48109, USA
| | - Matthew A Hiller
- School of Social Work, University of Michigan, 1080 South University Ave, Ann Arbor, MI, 48109, USA
| | - Kristin A Mannella
- Department of Psychiatry, Medical School, University of Michigan, 1500 East Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Luke J Norman
- Department of Psychiatry, Medical School, University of Michigan, 1500 East Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - James L Abelson
- Department of Psychiatry, Medical School, University of Michigan, 1500 East Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Aileen Prout
- Department of Psychiatry, Medical School, University of Michigan, 1500 East Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Angela A Shunnarah
- Department of Psychiatry, Medical School, University of Michigan, 1500 East Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Hannah C Becker
- Department of Psychiatry, Medical School, University of Michigan, 1500 East Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Stefanie R Russman Block
- Department of Psychiatry, Medical School, University of Michigan, 1500 East Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Stephan F Taylor
- Department of Psychiatry, Medical School, University of Michigan, 1500 East Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Kate D Fitzgerald
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, 630 W 168th St, New York, NY, 10032, USA
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2023 Articles of Import and Impact. Am J Psychiatry 2024; 181:16-19. [PMID: 38161300 DOI: 10.1176/appi.ajp.24181001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
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Morand-Beaulieu S, Crowley MJ, Grantz H, Leckman JF, Sukhodolsky DG. Functional connectivity during tic suppression predicts reductions in vocal tics following behavior therapy in children with Tourette syndrome. Psychol Med 2023; 53:7857-7864. [PMID: 37485677 PMCID: PMC10755221 DOI: 10.1017/s0033291723001940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 06/06/2023] [Accepted: 06/23/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Comprehensive Behavioral Intervention for Tics (CBIT) is recommended as a first-line treatment for Tourette syndrome in children and adults. While there is strong evidence proving its efficacy, the mechanisms of reduction in tic severity during CBIT are still poorly understood. In a recent study, our group identified a functional brain network involved in tic suppression in children with TS. We reasoned that voluntary tic suppression and CBIT may share some mechanisms and thus we wanted to assess whether functional connectivity during tic suppression was associated with CBIT outcome. METHODS Thirty-two children with TS, aged 8 to 13 years old, participated in a randomized controlled trial of CBIT v. a treatment-as-usual control condition. EEG was recorded during tic suppression in all participants at baseline and endpoint. We used a source-reconstructed EEG connectivity pipeline to assess functional connectivity during tic suppression. RESULTS Functional connectivity during tic suppression did not change from baseline to endpoint. However, baseline tic suppression-related functional connectivity specifically predicted the decrease in vocal tic severity from baseline to endpoint in the CBIT group. Supplementary analyses revealed that the functional connectivity between the right superior frontal gyrus and the right angular gyrus was mainly driving this effect. CONCLUSIONS This study revealed that functional connectivity during tic suppression at baseline predicted reduction in vocal tic severity. These results suggest probable overlap between the mechanisms of voluntary tic suppression and those of behavior therapy for tics.
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Affiliation(s)
- Simon Morand-Beaulieu
- Department of Psychology, McGill University, Montreal, QC, Canada
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA
| | | | - Heidi Grantz
- Department of Psychology, McGill University, Montreal, QC, Canada
| | - James F. Leckman
- Department of Psychology, McGill University, Montreal, QC, Canada
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Kalin NH. Childhood- and Neurodevelopment-Related Psychiatric Disorders. Am J Psychiatry 2023; 180:1-4. [PMID: 36587272 DOI: 10.1176/appi.ajp.20220952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Ned H Kalin
- Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison
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Abdallah CG, Sheth SA, Storch EA, Goodman WK. Brain Imaging in Psychiatry: Time to Move From Regions of Interest and Interpretive Analyses to Connectomes and Predictive Modeling? Am J Psychiatry 2023; 180:17-19. [PMID: 36587267 DOI: 10.1176/appi.ajp.20220907] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Chadi G Abdallah
- Michael E. DeBakey Veterans Affairs Medical Center, Houston (Abdallah); Menninger Department of Psychiatry (Abdallah, Storch, Goodman), Core for Advanced Magnetic Resonance Imaging (Abdallah), Department of Neurosurgery (Sheth), Baylor College of Medicine, Houston
| | - Sameer A Sheth
- Michael E. DeBakey Veterans Affairs Medical Center, Houston (Abdallah); Menninger Department of Psychiatry (Abdallah, Storch, Goodman), Core for Advanced Magnetic Resonance Imaging (Abdallah), Department of Neurosurgery (Sheth), Baylor College of Medicine, Houston
| | - Eric A Storch
- Michael E. DeBakey Veterans Affairs Medical Center, Houston (Abdallah); Menninger Department of Psychiatry (Abdallah, Storch, Goodman), Core for Advanced Magnetic Resonance Imaging (Abdallah), Department of Neurosurgery (Sheth), Baylor College of Medicine, Houston
| | - Wayne K Goodman
- Michael E. DeBakey Veterans Affairs Medical Center, Houston (Abdallah); Menninger Department of Psychiatry (Abdallah, Storch, Goodman), Core for Advanced Magnetic Resonance Imaging (Abdallah), Department of Neurosurgery (Sheth), Baylor College of Medicine, Houston
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