For youth with OCD, does cognitive behavioral therapy used with medication also help things like depression and functioning?
Community Summary of: Secondary outcomes from the pediatric obsessive compulsive disorder treatment study II
Authors of the article in the Journal of Psychiatric Research: Christine A. Conelea, Robert R. Selles, Kristen G. Benito, Michael M. Walther, Jason T. Machan, Abbe M. Garcia, Jeffrey Sapyta, Sarah Morris, Martin Franklin, and Jennifer B. Freeman
Published online: September 2017
Community summary posted on July 17, 2026
Word count: 624
Reading grade level: 12
Why does this matter?
We know that cognitive behavioral therapy (CBT) and medication can help obsessive-compulsive disorder (OCD) in youth. CBT and exposure with response prevention (ERP), either alone or with a serotonin reuptake inhibitor (SRI) medication, is the best choice for pediatric OCD.
In real-world settings, however, providers often use medications with SRI as the only treatment because CBT is not well known.
Between 2004 and 2009, researchers from different universities conducted the Pediatric Obsessive-Compulsive Disorder Treatment Study II (POTS II). These researchers were from the University of Pennsylvania, Duke University, and Brown University. Specifically, they wanted to know if CBT used with SRI medication would help youth ages 7-17.
POTS II found that OCD symptoms improved with a full course of CBT. However, the majority of youth with OCD also have additional symptoms. Most who receive SRI alone experience significant symptoms even after a full course of medication. Less is known about whether these treatments help these other conditions and quality of life.
What happened?
The current study looked at the same data as POTS II for secondary outcomes. Secondary outcomes included things like non-OCD anxiety, depression, inattention, hyperactivity, and quality of life.
One hundred twenty-four youth ages 7–17 years participated. They had a primary diagnosis of OCD and responded partially to using SRI medication. They were randomized to medication management (MM), medication management plus instructions in CBT (MM+iCBT), or medication management plus full CBT (MM+CBT).
In Medication Management (MM, n = 42), participants received 7 visits with a psychiatrist over 12 weeks. Pharmacotherapists offered encouragement but did not instruct participants or parents in specific OCD management. In Medication Management plus OCD-specific CBT (MM + CBT, n = 42), participants received the same medication management visits plus a full dose of CBT.
CBT included education, cognitive training, hierarchy development, therapist-assisted practice in the office, and homework. Parent training focused on differential attention, exposure procedures, reducing family accommodation, and reward systems.
In Medication Management plus Instruction in CBT skills (MM+iCBT, n = 40), participants received medication management visits in which the study psychiatrist provided instructions in CBT. iCBT included information about the full CBT protocol.
Researchers thought that the MM+CBT condition would provide the greatest benefit when compared to both MM and MM+iCBT. Researchers also wanted to know whether changes in these secondary outcomes were related to change in OCD symptoms.
What did the authors learn?
Improvement in all treatment was observed for non-OCD anxiety, inattention, hyperactivity, and quality of life. Changes were generally greater in the group receiving full CBT. Child-rated depression was not found to change. OCD-focused treatment led to improvement in other areas of psychopathology and functioning. For youth who are partial responders to SRI mono-therapy, adding full CBT may yield the greatest benefit on these secondary outcomes.
Interestingly, although improvements in non-OCD anxiety were observed to be better in MM+CBT, change in anxiety across the whole sample was not linked with change in OCD severity for both parents and children surveys. This suggests that non-OCD anxiety may not change simply when OCD symptoms are the treatment goal. Rather, it may be that anxiety only improves when the treatment includes interventions that generalize to anxiety symptoms.
What does this mean for treatment and future research?
This study supports the idea that treatments for pediatric OCD also help other symptoms and quality of life. Evidence suggests that MM+CBT treatment was most likely to be associated with the largest improvements. These results support the currently available treatment for youth with OCD, suggesting that those who receive treatment experience a more global benefit than simply OCD symptom improvement. Future research should attempt to examine predictors, individual differences, and mechanisms of improvement for secondary outcomes in the treatment of pediatric OCD.