Combining Pharmacotherapy and Psychological Treatments for OCD

This chapter reviews the outcome literature on the efficacy of combined pharmacotherapy and cognitive-behavioral therapy (CBT) for obsessive compulsive disorder (OCD). Quantitative review of randomized studies, in which treatments were combined simultaneously, indicated that combined therapy shows a small but significant advantage over exposure and response prevention (ERP) monotherapy, and a moderate advantage over serotonin reuptake inhibitor (SRI) monotherapy. Studies of sequential treatment combination, in which CBT was added after a trial of SRI monotherapy, suggest a significant...

This chapter reviews the outcome literature on the efficacy of combined pharmacotherapy and cognitive-behavioral therapy (CBT) for obsessive compulsive disorder (OCD). Quantitative review of randomized studies, in which treatments were combined simultaneously, indicated that combined therapy shows a small but significant advantage over exposure and response prevention (ERP) monotherapy, and a moderate advantage over serotonin reuptake inhibitor (SRI) monotherapy. Studies of sequential treatment combination, in which CBT was added after a trial of SRI monotherapy, suggest a significant incremental benefit of CBT, including for patients who show minimal response to SRI monotherapy. The chapter concludes by discussing new possibilities for combined therapy, including the use of pharmacologic strategies explicitly intended to potentiate the mechanisms of CBT.