POTS (2004) contemporary

• aim?

  compare 3 treatments in order to see which is most effective in treating young people with OCD

  • CBT on its own
  • an SSRI (sertraline) on its own
  • CBT and sertraline combined
• procedure?

  required children to attend 6 weekly sessions then 1 every other week (9 in total). dosage would be established and changed during clinical session. during the weeks parents would monitor which meds were taken keeping a diary

  • any adverse reactions would mean a change or stop in medication
• results? (NOTE, BASELINE MEASUREMENT -> FINAL MEASUREMENT)

  CBT alone: 26 -> 14

  drug alone: 23.5 -> 16.5

  combination: 23.8 -> 11.2

  placebo: 25.2 -> 21.5

  • measured by CY-BOCS (childrens yale- brown OC scale), measures severity of symptoms measured.
• conclusions?

  • clearly shows CBT leads to more improvement than drugs, first line of treatment should be CBT
  • minimal gain can be added by including drugs where effective CBT is provided, drug may compensate for less effective therapy.
  • drugs require careful monitoring if used, SSRI's have been linked to suicidal ideation in young people
  • early intervention= effective for children with OCD
• generalisability?

  • good: large sample (112 children) and age range of average 11.7 so target population of children is reached. analysis of sample= no difference seen in groups
  • bad: 3 areas in the US, other countries may respond differently to CBT and medication so ethnocentric bias seen. excluded children who were co=morbid so target population not fully reached but changed in future study.
• reliability?

  • good: evaluators who assessed symptoms were trained to a reliable standard. scale used to assess symptoms were standardised, all P's used the CY- BOCS.
  • bad: study in 3 centres and 1 had better results in CBT- only. therapist effects can be seen here
• applications?

  useful since strong evidence about most effective treatments for OCD in children seen. cause and effect links can be established, showing value of clinical treatments.

  findings show effectiveness of CBT and sertraline combination and usefulness of psychological therapies seen, however take into account therapy might need to be tailored to specific person and how SSRI's can cause suicidal ideation
• validity?

  • good, CY- BOCS= accurate measurement for OCD symptoms. assessors are also blind to conditions the Ps are in, so no bias is seen and confounding variables are controlled due to removal of Ps who could have co-morbid depression or ADHD. this ensures any change was due to treatment alone. Ps also allocated randomly, and no demand characteristics seen as Ps in placebo were unaware the drug wasn't active
• ethics?

  • good: all Ps gave written consent and volunteered and each Ps were monitored by an assigned psychiatrist. those within the drug treatment were regularly checked and doses were changed to be protected from harm.
  • bad: if children already gave consent then wanted to withdraw would their parents let them? deception also seen in placebo but can be argued to be necessary, didn't exactly cause more distress