Cognitive-behaviour therapy and medication in the treatment of obsessive-compulsive disorder: A controlled study

Objective: To evaluate the effect of combining cognitive-behaviour therapy (CBT) and medication in the treatment of obsessive-compulsive disorder (OCD ). Method: Twenty-nine subjects diagnosed with OCD according to Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R) criteria were recruited through the Anxiety Clinic of Louis-H Lafontaine Hospital. They were evalu ated at baseline and after treatment on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) by a psychiatrist who was blind to treatment modality. Subj ects rated their degree of resistance to their rituals and the strength of their obsessional beliefs. Subjects then received I of 4 treatments: medica tion and CBT simultaneously (n = 9), CBT only (n = 6), medication while on a wait-list for CBT (n = 6), or no treatment while on a wait-list for CBT ( n = 5). Results: Multivariate analysis revealed that Y-BOCS scores and clinical rat ings significantly improved posttreatment in all groups except the nontreat ment wait-list control group. Subjects in the 2 active treatment groups rec eiving CBT showed reduced strength in their obsessional beliefs. The subseq uent administration of CBT to those groups on the wait-list also decreased the strength of their primary obsessional beliefs and beliefs about the con sequences of not performing the rituals. Conclusions: Our results suggest that either CBT or medication alone is mor e effective than no treatment. The combination of CBT and medication seems to potentiate treatment efficacy, and we found it more clinically beneficia l to introduce CBT after a period of medication rather than to start both t herapies simultaneously.