27 Jan Cognitive Behavior Therapy Most Effective Treatment for OCD, Anxiety and PTSD
MedicalResearch.com Interview with:
David Mataix-Cols PhD
Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm Health Care Services, Stockholm County Council
MedicalResearch.com: What is the background for this study?
Response: Exposure-based Cognitive Behavior Therapy (CBT) is the treatment of choice for patients with anxiety, obsessive compulsive disorder (OCD) and post-traumatic stress disorders. Some patients do not respond sufficiently to such treatment. This has led researchers to find ways to augment (enhance) CBT with pharmacological agents, such as D-cycloserine (DCS).
Because CBT is such a powerful treatment for most patients, we suspected that the effects of DCS would probably be small. This means that very large samples of patients are needed to show statistically significant differences between groups. Previous studies and meta-analyses were underpowered to detect such small effects. Combining the raw data from all available studies to date gave us the power we needed to address the question of whether DCS is an efficacious augmenting strategy, over and above CBT.
We also had a second research question. Previous research from our group had suggested that there may be undesirable interactions between DCS and antidepressants, whereby patients taking both types of drugs would have significantly worse outcomes (see Andersson et al JAMA Psychiatry. 2015 Jul;72(7):659-67.
MedicalResearch.com: What are the main findings?
Response: The main findings were:
1- Cognitive Behavior Therapy is a very powerful treatment for anxiety, ocd and post-traumatic stress disorders
2- While DCS significantly augmented CBT, the effects were very small (less than 4 points difference between DCS and placebo on a scale ranging between 0-100).
3- We found no significant interactions between DCS and antidepressants
Note: as a rule of thumb, effect sizes of around 0.2 are considered small, around 0.5 are considered medium and over 0.8 as large effect sizes.
MedicalResearch.com: What should readers take away from this report?
Response: The main message is that all patients with anxiety, OCD and post-traumatic stress disorders should be offered, and have access to, good quality Cognitive Behavior Therapy, as this is the most effective treatment for these conditions.
In my opinion, patients should not rush to their doctors to get a DCS prescription, as this remains an experimental treatment. More research is needed to understand who may benefit from this treatment and in what format should it be delivered.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: The study suggests future avenues for research. While we have shown that the effects of DCS appeared to be very small for regular patients, it is unknown if the effects may be stronger for patients who have failed to respond to Cognitive Behavior Therapy (treatment resistant). Future studies should also explore if DCS may be more helpful if only administered after successful exposure sessions.
Disclosures: Full disclosures are available in the published report.
Mataix-Cols D, Fernández de la Cruz L, Monzani B, Rosenfield D, Andersson E, Pérez-Vigil A, Frumento P, de Kleine RA, Difede J, Dunlop BW, Farrell LJ, Geller D, Gerardi M, Guastella AJ, Hofmann SG, Hendriks G, Kushner MG, Lee FS, Lenze EJ, Levinson CA, McConnell H, Otto MW, Plag J, Pollack MH, Ressler KJ, Rodebaugh TL, Rothbaum BO, Scheeringa MS, Siewert-Siegmund A, Smits JAJ, Storch EA, Ströhle A, Tart CD, Tolin DF, van Minnen A, Waters AM, Weems CF, Wilhelm S, Wyka K, Davis M, Rück C, for the DCS Anxiety Consortium. D-Cycloserine Augmentation of Exposure-Based Cognitive Behavior Therapy for Anxiety, Obsessive-Compulsive, and Posttraumatic Stress DisordersA Systematic Review and Meta-analysis. JAMA Psychiatry. Published online January 25, 2017. doi:10.1001/jamapsychiatry.2016.3955
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