Design and Rationale for a Randomized Controlled Trial Testing the Efficacy of Aerobic Exercise for Patients with Obsessive-Compulsive Disorder. Predictors of drug treatment response in obsessive-compulsive disorder. Cognitive behavior therapy in treatment-naive children and adolescents with obsessive-compulsive disorder: an open trial. A randomized controlled trial of self-directed versus therapist-directed cognitive-behavioral therapy for obsessive-compulsive disorder patients with prior medication trials. No Effect of Adding Brief Dynamic Therapy to Pharmacotherapy in the Treatment of Obsessive-Compulsive Disorder with Concurrent Major Depression Guidelines for the pharmacological treatment of anxiety disorders, obsessive–compulsive disorder and posttraumatic stress disorder in primary care Long-term course and outcome of obsessive-compulsive patients after cognitive-behavioral therapy in combination with either fluvoxamine or placebo: a 7-year follow-up of a randomized double-blind trial. A Randomized Controlled Trial of Japanese Patients with Obsessive-Compulsive Disorder – Effectiveness of Behavior Therapy and Fluvoxamine Cognitive and behavioral therapies alone versus in combination with fluvoxamine in the treatment of obsessive compulsive disorder. Cognitive behavior therapy augmentation of pharmacotherapy in pediatric obsessive-compulsive disorder: the Pediatric OCD Treatment Study II (POTS II) randomized controlled trial. Cognitive-behavioral therapy for medication nonresponders with obsessive-compulsive disorder: a wait-list-controlled open trial. Obsessive-Compulsive Symptom Dimensions as Predictors of Compliance with and Response to Behaviour Therapy: Results from a Controlled Trial Predictors of response to pharmacotherapy with citalopram in obsessive-compulsive disorder The Advantages of Choosing Antiobsessive Therapy According to Decision-Making Functioning World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Post-Traumatic Stress Disorders – First Revision Internet-based cognitive behavior therapy for obsessive compulsive disorder: A pilot study Cognitive therapy and exposure in vivo in the treatment of obsessive compulsive disorder.
BACKGROUND : Over the last two decades very few advances have been made in the development of new treatments for obsessive-compulsive disorder ( OCD ) . While patients with OCD improve with available treatments ( pharmacotherapy and /or cognitive-behavioral therapy ) , moderate levels of OCD symptoms often persist even with adequate doses and duration s of these treatments . Building on the growing body of evidence for the efficacy of exercise in the treatment of other psychiatric disorders , interventions to increase aerobic exercise in patients with OCD represent a potentially useful yet relatively unexplored strategy in OCD . METHODS / DESIGN : One hundred and two ( 102 ) patients with clinical ly significant OCD symptoms despite current engagement in recommended treatments ( pharmacotherapy and /or CBT ) will be r and omly assigned to receive either a 12-week moderate intensity aerobic exercise ( AE ) intervention or a health education control ( HEC ) intervention . Follow-up interviews will be conducted at the end of treatment and at 3- , 6- and 12-months post-intervention . They will assess OCD severity , nonspecific anxiety , depression , quality of life , cardiorespiratory fitness and cognition ( executive function ) . DISCUSSION : If efficacy is established , patients with OCD who have clinical ly significant residual symptoms despite current pharmacotherapy or CBT would gain a valuable and practical treatment augmentation option BACKGROUND Although a large body of evidence indicates the efficacy of pharmacotherapy in the treatment of obsessive-compulsive disorder ( OCD ) , a considerable percentage of these patients do not respond . Very few studies focus on factors related to treatment response of OCD . The purpose of this study was to investigate which clinical factors are related to drug treatment response in OCD . METHOD We examined 53 OCD patients treated with either clomipramine or fluoxetine for a period of 6 months , dividing the sample into " responders " and " nonresponders " to treatment . At admission , patients were evaluated using a semistructured clinical interview , the Yale-Brown Obsessive Compulsive Scale ( Y-BOCS ) , the Hamilton Rating Scale for Depression , and the Hamilton Rating Scale for Anxiety . We then compared acute-phase patient characteristics and response to drug treatment . Response was defined as a decrease of at least 40 % in the Y-BOCS total score and a rating of " improved " or " very improved " on the Clinical Global Impressions scale within 16 weeks of treatment and maintained over three consecutive evaluations . RESULTS By the sixth month of treatment , 31 patients ( 58.5 % ) responded to either clomipramine or fluoxetine . Nonresponders had lower age at onset and longer duration of the disorder ; in addition , they showed higher frequency of compulsions , washing rituals , chronic course , concomitant schizotypal personality disorder , and previous hospitalizations . A worse response to drug treatment was predicted in a stepwise multiple regression by ( 1 ) concomitant schizotypal personality disorder , ( 2 ) presence of compulsions , and ( 3 ) longer illness length . CONCLUSION Our findings suggest that there are distinct types of OCD with respect to drug treatment response . They provide indirect evidence of treatment specificity by identifying characteristics responsive to different modalities , which may be of value in the selection of patients for alternative treatments This work aims is to evaluate the therapeutic efficacy of cognitive behavior therapy ( CBT ) in pediatric patients with obsessive-compulsive disorder ( OCD ) who had not previously been treated with either pharmacotherapy or psychotherapy and who remained medication-free during CBT . Sixteen OCD out patients , 8 - 17 years of age , were treated in a 12-week open trial with manualized CBT . Target symptoms were rated at two-week intervals with the Children 's Yale-Brown Obsessive Compulsive Scale ( CY-BOCS ) , the National Institute of Mental Health Global Obsessive-Compulsive Scale ( NIMH Global ) , the Clinical Global Impression Scale ( CGI ) , and the Hamilton Anxiety Rating Scale ( Ham-A ) . Statistical analyses showed a significant benefit for treatment . Ten patients experienced at least a 50 % reduction in symptoms on the CY-BOCS ; seven were asymptomatic on the NIMH Global . These results build on previous reports that CBT may be effective in the acute treatment of pediatric OCD . Further , the results of this study suggest that CBT can be efficacious in alleviating OCD symptoms in the absence of pharmacotherapy . These results must be considered preliminary , given the small sample size and open administration of treatment Cognitive-behavioral therapy incorporating exposure and response prevention ( ERP ) is widely considered a first-line psychosocial treatment for patients with obsessive-compulsive disorder ( OCD ) . However , a number of obstacles prevent many patients from receiving this treatment , and self-administered ERP may be a useful alternative or adjunct . Forty-one adult out patients with a primary diagnosis of OCD , who reported at least 1 current or previous adequate medication trial , were r and omly assigned to self-administered or therapist-administered ERP . Patients in both treatment conditions showed statistically and clinical ly significant symptom reduction . However , patients receiving therapist-administered ERP showed a superior response in terms of OCD symptoms and self-reported functional impairment . We discuss several potential reasons for the superiority of therapist-administered treatment , and propose a stepped-care integration of self-administered and therapist-administered interventions for OCD Background : Until now no studies have investigated the benefits of adding brief dynamic therapy ( BDT ) to medication in obsessive-compulsive disorder ( OCD ) , while a number of recent investigations have demonstrated the efficacy of supplemental BDT among patients with major depressive disorders ( MDD ) . The objective of the present study was to explore the efficacy of BDT combined with pharmacotherapy in comparison with pharmacotherapy alone in the treatment of OCD with concurrent MDD . Methods : A 12-month r and omized clinical trial compared a st and ard selective serotonin reuptake inhibitor treatment with ( n = 27 ) or without  ( n = 30 ) supplemental BDT in patients with OCD and concurrent MDD .  Supplemental BDT was added during the first 16-week trial ; all patients continued to be treated with only pharmacotherapy in the following continuation phase . The primary efficacy assessment s were the Yale-Brown Obsessive Compulsive Scale and the 17-item Hamilton Rating Scale for Depression ; the secondary efficacy measures included the Clinical Global Impression scale and the Global Assessment of Functioning . The data analysis was conducted on the ‘ intent-to-treat ( ITT ) efficacy patient sample ’ . Results : Fifty patients completed the study . No difference between the 2 treatment groups was found at any point by any assessment method in the ITT study sample . Conclusions : Supplemental BDT in the treatment of patients with OCD with concurrent MDD who are receiving effective medication has no significant clinical effect on both obsessive and depressive symptoms Abstract Objective . Anxiety disorders are frequently under-diagnosed conditions in primary care , although they can be managed effectively by general practitioners . Methods . This paper is a short and practical summary of the World Federation of Biological Psychiatry ( WFSBP ) guidelines for the pharmacological treatment of anxiety disorders , obsessive – compulsive disorder ( OCD ) and posttraumatic stress disorder ( PTSD ) for the treatment in primary care . The recommendations were developed by a task force of 30 international experts in the field and are based on r and omized controlled studies . Results . First-line pharmacological treatments for these disorders are  selective serotonin reuptake inhibitors  ( for all disorders ) ,  serotonin-norepinephrine reuptake inhibitors  ( for some ) and  pregabalin  ( for generalized anxiety disorder only ) . A combination of  medication and cognitive behavior/exposure therapy  was shown to be a clinical ly desired treatment strategy . Conclusions . This short version of an evidence -based guideline may improve treatment of anxiety disorders , OCD , and PTSD in primary care Longitudinal studies with very long follow-up periods of patients with obsessive-compulsive disorder ( OCD ) who have received adequate treatment are rare . In the current study , 30 of 37 in patients ( 81 % ) with severe OCD were followed up 6 - 8 years after treatment with cognitive-behavioral therapy ( CBT ) in combination with either fluvoxamine or placebo in a r and omized design . The significant improvements ( with large effectsizes ) in obsessive-compulsive symptoms from pre- to post-treatment ( 41 % reduction on the Y-BOCS ) remained stable at follow-up ( 45 % ) . Responder rates , defined as > or = 35 % reduction on the Y-BOCS , were 67 % and 60 % , respectively . Depressive symptoms decreased significantly not only from pre- to post-treatment but also during follow-up . Re-hospitalization , which occurred in 11 patients ( 37 % ) , was associated with more severe depressive symptoms at pre-treatment and living without a partner . Full symptom remission at follow-up , defined as both Y-BOCS total score < or = 7 and no longer meeting diagnostic criteria for OCD , was achieved by 8 patients ( 27 % ) . Patients without full remission at follow-up had a significantly longer history of OCD , assessed at pretreatment , compared to remitted patients . The shortterm treatment outcome had no predictive value for the long-term course . Throughout the naturalistic follow-up , nearly all patients ( 29 patients ) received additional  psychotherapy  and /or medication . This might indicate that such chronic OCD patients usually need additional therapeutic support after effective inpatient treatment to maintain their improvements over long periods Background : The aim of this study was to confirm and compare the efficacy of fluvoxamine ( the only licensed SSRI for treatment for OCD in Japan ) and behavior therapy in treating Japanese patients with OCD . In addition , we investigated predictors of these treatments . Methods : Thirty-one out patients meeting the DSM-III-R criteria for OCD without any axis I disorder were r and omly assigned to one of three treatment conditions : BT ( behavior therapy ± pill placebo ) , FLV [ autogenic training ( a psychological placebo for OCD ) ± fluvoxamine ] and control group [ autogenic training ( psychological placebo ) ± pill placebo ] for 12 weeks of treatment . The Yale-Brown Obsessive-Compulsive Scale ( Y-BOCS ) and the Clinical Global Impression-Improvement Scale ( CGI-I ) were administered blindly at baseline and week 4 , 8 and 12 . Results : Twenty-eight patients completed this study . Patients in the BT and FLV groups showed significantly more improvement than those in the control group in the mean score of total Y-BOCS ; moreover , the BT group showed significantly more reduction in total Y-BOCS score at the end of treatment than the FLV group ( BT > FLV , p < 0.01 ) . Patients with  lower baseline total Y-BOCS , past history of a major depressive episode and absence of cleaning compulsion improved more with fluvoxamine . Conclusions : We confirmed the effectiveness of behavior therapy and fluvoxamine for Japanese patients with OCD .  Behavior therapy improved the condition of OCD patients more than fluvoxamine The purpose of this treatment package design study was to investigate the differential efficacy of cognitive therapy or exposure in vivo with response prevention for obsessive compulsive disorder ( OCD ) versus the sequential combination with fluvoxamine .  Patients with OCD ( N = 117 ) were r and omized to one of the following five conditions : a ) cognitive therapy for weeks 1 to 16 , b ) exposure in vivo with response prevention for weeks 1 to 16 , c ) fluvoxamine for weeks 1 to 16 plus cognitive therapy in weeks 9 to 16 , d ) fluvoxamine for weeks 1 to 16 plus exposure in vivo with response prevention in weeks 9 to 16 , or e ) waiting list control condition for weeks 1 to 8 only . Assessment s took place before treatment ( pretest ) and after 8 ( midtest ) , and 16 weeks ( posttest ) . In the first 8 weeks , six treatment sessions were delivered . During weeks 9 to 16 , another 10 sessions were given . Thirty-one patients dropped out . Outcome was assessed by patient- , therapist- and assessor-ratings of the Anxiety Discomfort Scale , the Yale-Brown Obsessive Compulsive Scale , and the Padua Inventory-Revised . In contrast with the four treatments , after 8 weeks the waiting list control condition did not result in a significant decrease of symptoms . After 16 weeks of treatment , all four treatment packages were effective on these OCD ratings , but they did not differ among each other in effectiveness . In OCD , the sequential combination of fluvoxamine with cognitive therapy or exposure in vivo with response prevention is not superior to either cognitive therapy or exposure in vivo alone CONTEXT The extant literature on the treatment of pediatric obsessive-compulsive disorder ( OCD ) indicates that partial response to serotonin reuptake inhibitors ( SRIs ) is the norm and that augmentation with short-term OCD-specific cognitive behavior therapy ( CBT ) may provide additional benefit . OBJECTIVE To examine the effects of augmenting SRIs with CBT or a brief form of CBT , instructions in CBT delivered in the context of medication management . DESIGN , SETTING , AND PARTICIPANTS A 12-week r and omized controlled trial conducted at 3 academic medical centers between 2004 and 2009 , involving 124 pediatric out patients between the ages of 7 and 17 years with OCD as a primary diagnosis and a Children 's Yale-Brown Obsessive Compulsive Scale score of 16 or higher despite an adequate SRI trial . INTERVENTIONS Participants were r and omly assigned to 1 of 3 treatment strategies that included 7 sessions over 12 weeks : 42 in the medication management only , 42 in the medication management plus instructions in CBT , and 42 in the medication management plus CBT ; the last included 14 concurrent CBT sessions . MAIN OUTCOME MEASURES Whether patients responded positively to treatment by improving their baseline obsessive-compulsive scale score by 30 % or more and demonstrating a change in their continuous scores over 12 weeks . RESULTS The medication management plus CBT strategy was superior to the other 2 strategies on all outcome measures . In the primary intention-to-treat analysis , 68.6 % ( 95 % CI , 53.9%-83.3 % ) in the plus CBT group were considered responders , which was significantly better than the 34.0 % ( 95 % CI , 18.0%-50.0 % ) in the plus instructions in CBT group , and 30.0 % ( 95 % CI , 14.9%-45.1 % ) in the medication management only group . The results were similar in pairwise comparisons with the plus CBT strategy being superior to the other 2 strategies ( P < .01 for both ) . The plus instructions in CBT strategy was not statistically superior to medication management only ( P = .72 ) . The number needed-to-treat analysis with the plus CBT vs medication management only in order to see 1 additional patient at week 12 , on average , was estimated as 3 ; for the plus CBT vs the plus instructions in CBT strategy , the number needed to treat was also estimated as 3 ; for the plus instructions in CBT vs medication management only the number needed to treat was estimated as 25 . CONCLUSIONS Among patients aged 7 to 17 years with OCD and partial response to SRI use , the addition of CBT to medication management compared with medication management alone result ed in a significantly greater response rate , whereas augmentation of medication management with the addition of instructions in CBT did not . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00074815 BACKGROUND Cognitive-behavioral therapy ( CBT ) is generally recommended for obsessive-compulsive disorder ( OCD ) patients who have failed to respond to approved medications . However , few studies of the efficacy of CBT have selected patients who did not respond to medications . METHOD We selected 20 adult OCD ( DSM-IV criteria ) patients with a history of inadequate response to adequate doses of multiple medications , as well as a high rate of comorbid disorders . After a 1-month wait-list period , patients received 15 sessions of outpatient CBT incorporating exposure and ritual prevention . RESULTS OCD severity ( as measured with the Yale-Brown Obsessive Compulsive Scale ) decreased significantly ( p < .05 ) after treatment , and gains appeared to have been maintained over a 6-month follow-up period . Analysis of clinical significance indicated that 53 % ( 8/15 ) of treatment completers met this criterion at posttreatment and 40 % ( 6/15 ) met the criterion at 6-month follow-up . The sample was characterized as having generally poor insight and putting low effort into CBT ; these factors significantly ( p < .05 ) predicted degree of improvement . CONCLUSION CBT is a useful treatment for OCD patients who have failed to respond adequately to multiple serotonin reuptake inhibitor medications . However , these results were attenuated compared with previous trials . Patients with a long history of poor response to medication may have poor insight and /or not put sufficient effort into treatment ; these factors are likely to diminish treatment outcome Background : Recent factor-analytic studies in obsessive-compulsive disorder ( OCD ) identified consistent symptom dimensions . Support for the validity of these dimensions comes from studies of psychiatric comorbidity , functional brain imaging , genetic transmission , and treatment response to medications . This study examined whether previously identified OCD symptom dimensions are associated with treatment compliance and response to behaviour therapy ( BT ) for OCD . Methods : One hundred and fifty-three OCD out patients who participated in a multi-centre r and omised controlled trial of computer- versus clinician-guided BT for OCD were included in the study . Logistic and multiple regression models tested for significant predictors of compliance with and response to BT and relaxation . Results : The patients studied were phenomenologically comparable ( including the presence of ‘ pure ’ obsessions and mental rituals ) to those in previous serotonin reuptake inhibitor ( SRI ) trials and those in clinical epidemiology studies . High scorers on the ‘ hoarding ’ dimension were more likely to drop out prematurely from the study and tended to improve less . For those completing treatment , the strongest predictor of outcome was pre-treatment severity . Initial depression scores were unrelated to outcome . After controlling for symptom severity , higher scores on the ‘ sexual/religious obsessions ’ factor predicted poorer outcome with BT , especially when computer-guided . Conclusions : BT is especially indicated for OCD patients with aggressive/checking , contamination/cleaning and symmetry/ordering symptoms .  Previous accounts of unsuccessful  BT  in patients with hoarding symptoms may be due in part to their propensity to drop out earlier from treatment . Patients with sexual/religious obsessions , but not those with mental rituals , might respond less well to traditional BT techniques . Existing treatments need to be refined and /or new treatments developed to improve these patients ’ adherence and response to treatment Although serotonin reuptake inhibitors ( SRIs ) are the medications of choice in the treatment of obsessive-compulsive disorder ( OCD ) , only 50 - 60 % of patients respond to a single trial of any of these agents . Improved knowledge of the predictors of response to treatment may have important clinical implication s. Data from a large r and omized placebo-controlled trial of citalopram in OCD was analysed using logistic regression to determine predictors of response . Demographic ( age , sex ) , clinical ( OCD severity and duration , depression severity , prior treatment ) and trial variables  ( citalopram dose , treatment duration ) were included . Subjects with longer duration of OCD , more severe OCD symptoms or previous selective SRI use were less likely to be responders in the citalopram trial . In contrast , subjects who received adequate medication doses for sufficient periods of time in the citalopram trial were more likely to be responders . Despite greater awareness of OCD in recent years , there is evidence that the disorder continues to be underdiagnosed and undertreated . The data here emphasize the crucial importance of early diagnosis and treatment of OCD , and of pharmacotherapy with appropriate dose and duration Objective : Previous studies stressed the role of decision-making functioning in predicting antiobsessive treatment outcome with serotonin reuptake inhibitors drugs in patients with obsessive-compulsive disorder . Nevertheless , the use of an augmentation strategy with atypical antipsychotic drugs has proved to be effective in obsessive-compulsive patients nonresponding to serotonin reuptake inhibitors treatment . We investigated whether the performance at the  Iowa Gambling Task ( IGT ) , a used neuropsychologic task which assesses decision-making , can be an effective criterion for pharmacologic treatment choice in these patients and whether the use of different treatment strategies , according IGT performance , can increase the rate of antiobsessive outcome . Method : Thirty patients with obsessive-compulsive disorder were treated in a single-blind design with fluvoxamine plus placebo or fluvoxamine plus risperidone according to their IGT performance . Treatment outcome was recorded after 6 and 12 weeks . Results : Patients with good IGT performance showed a good antiobsessive treatment outcome with fluvoxamine only , while only adopting an augmentation strategy with risperidone , the number of responders patients within the subjects with bad IGT performance increased . Conclusions : IGT performance may be considered an effective criterion for pharmacologic treatment choice in obsessive-compulsive patients given that antiobsessive treatment outcome is increased to 85 % of responders choosing an appropriate drug strategy according to the IGT performance In this report , which is an up date of a guideline published in 2002 ( B and elow et al. 2002 , World J Biol Psychiatry 3:171 ) , recommendations for the pharmacological treatment of anxiety disorder , obsessive-compulsive disorder ( OCD ) and post-traumatic stress disorder ( PTSD ) are presented . Since the publication of the first version of this guideline , a substantial number of new r and omized controlled studies of anxiolytics have been published . In particular , more relapse prevention studies are now available that show sustained efficacy of anxiolytic drugs . The recommendations , developed by the World Federation of Societies of Biological Psychiatry ( WFSBP ) Task Force for the Pharmacological Treatment of Anxiety , Obsessive-Compulsive and Post-traumatic Stress Disorders , a consensus panel of 30 international experts , are now based on 510 published r and omized , placebo- or comparator-controlled clinical studies ( RCTs ) and 130 open studies and case reports . First-line treatments for these disorders are selective serotonin reuptake inhibitors ( SSRIs ) , serotonin-noradrenaline reuptake inhibitors ( SNRIs ) and the calcium channel modulator pregabalin . Tricyclic antidepressants ( TCAs ) are equally effective for some disorders , but many are less well tolerated than the SSRIs/SNRIs . In treatment-resistant cases , benzodiazepines may be used when the patient does not have a history of substance abuse disorders . Potential treatment options for patients unresponsive to st and ard treatments are described in this overview . Although these guidelines focus on medications , non-pharmacological were also considered . Cognitive behavioural therapy ( CBT ) and other variants of behaviour therapy have been sufficiently investigated in controlled studies in patients with anxiety disorders , OCD , and PTSD to support them being recommended either alone or in combination with the above medicines Background Cognitive behavior therapy ( CBT ) is widely regarded as an effective treatment for obsessive compulsive disorder ( OCD ) , but access to CBT therapists is limited . Internet-based CBT ( ICBT ) with therapist support is a way to increase access to CBT but has not been developed or tested for OCD . The aim of this study was to evaluate ICBT for OCD . Method An open trial where patients ( N = 23 ) received a 15-week ICBT program with therapist support consisting of psychoeducation , cognitive restructuring and exposure with response prevention . The primary outcome was the Yale-Brown Obsessive Compulsive Scale ( Y-BOCS ) , which was assessed by a psychiatrist before and immediately after treatment . Secondary outcomes were self-rated measures of OCD symptoms , depressive symptoms , general functioning , anxiety and quality of life . All assessment s were made at baseline and post-treatment . Results All participants completed the primary outcome measure at all assessment points . There were reductions in OCD symptoms with a large within-group effect size ( Cohen 's d = 1.56 ) . At post-treatment , 61 % of participants had a clinical ly significant improvement and 43 % no longer fulfilled the diagnostic criteria of OCD . The treatment also result ed in statistically significant improvements in self-rated OCD symptoms , general functioning and depression .  Conclusions ICBT with therapist support reduces OCD symptoms , depressive symptoms and improves general functioning . R and omized trials are needed to confirm the effectiveness of this new treatment format . Trial Registration Clinical Trials.gov : The present study is the first controlled study that evaluates the effects of cognitive therapy along the lines of Beck ( 1976 ) [ Cognitive therapy and the emotional disorder . New York : International University Press ] and Salkovskis ( 1985 ) [ Behaviour Research and Therapy , 23 , 571 - 583 ] in obsessive compulsive disorder ( OCD ) and compares these effects with those of self-controlled exposure in vivo with response prevention . Seventy-one patients were r and omly assigned to either cognitive therapy or exposure in vivo . In each treatment condition seven patients dropped out . Both treatments consisted of 16 sessions . Cognitive therapy as well as exposure in vivo led to statistically significant improvement . Multivariate significant differences suggesting a superior efficacy of cognitive therapy in comparison to exposure in vivo on the obsessive compulsive measures and on the measures for associated psychopathology . However , no univariate differences were found . Further , in both treatment conditions a considerable percentage of the patients was rated as " recovered " . Significantly more patients were rated as " recovered " in the cognitive therapy . The results show that this form of  cognitive therapy  is an effective treatment for OCD and suggest that cognitive therapy may be even more effective than exposure in vivo
CONCLUSIONS The effects of treatment with clomipramine and selective serotonin reuptake inhibitors ( SSRIs : fluvoxamine , sertraline , fluoxetine , citalopram , and escitalopram ) proved to be similar , except for the lower adherence rate in case of clomipramine because of its side effects .
PURPOSE This systematic review examines the efficacy of pharmacological therapy for obsessive-compulsive disorder ( OCD ) , addressing two major issues : which treatment is most effective in treating the patient 's symptoms and which is beneficial for maintaining remission .