COGNITIVE AND BEHAVIORAL THERAPIES ALONE VERSUS IN COMBINATION WITH FLUVOXAMINE IN THE TREATMENT OF OBSESSIVE-COMPULSIVE DISORDER

The purpose of this treatment package design study was to investigate the differential efficacy of cognitive therapy or exposure in vivo wit h response prevention for obsessive compulsive disorder (OCD) versus t he sequential combination with fluvoxamine. Patients with OCD (N = 117 ) were randomized to one of the following five conditions: a) cognitiv e therapy for weeks 1 to 16, b) exposure in vivo with response prevent ion 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 expos ure in vivo with response prevention in weeks 9 to 16, or e) waiting L ist control condition for weeks 1 to 8 only. Assessments took place be fore 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 dr opped out. Outcome was assessed by patient-, therapist- and assessor-r atings of the Anxiety Discomfort Scale, the Yale-Brown Obsessive Compu lsive Scale, and the Padua Inventory-Revised. In contrast with the fou r treatments, after 8 weeks the waiting list control condition did not result in a significant decrease of symptoms. After 16 weeks of treat ment, all four treatment packages were effective on these OCD ratings, but they did not differ among each other in effectiveness. In OCD, th e sequential combination of fluvoxamine with cognitive therapy or expo sure in vivo with response prevention is not superior to either cognit ive therapy or exposure in vivo alone.