ocd contemporary study: POTS

Question 1

what was the aim of The Paediatric OCD Treatment Study (POTS)?

Answer 1

• evaluate three treatments for OCD in young people
• compare the effectiveness of CBT alone, drug treatment, and a combination of CBT & drug treatment
• assess which treatment is most effective for treating young people with OCD
• funded by the National Institute for Mental Health (USA) to find the best early intervention

Question 2

what was the sample used in The Paediatric OCD Treatment Study (POTS)?

Answer 2

• 112 children, aged between 7 and 17 years old, with an average age of 11.7 years
• recruited from those diagnosed with OCD using DSM IV
• volunteer sample

Question 3

how were the children’s OCD symptoms measured in The Paediatric OCD Treatment Study (POTS)?

Answer 3

• severity measured using CY-BOCS (Children’s Yale-Brown Obsessive-Compulsive Scale)
• only children with a score of 16 or above were included in the study

Question 4

what were the inclusion and exclusion criteria for children in The Paediatric OCD Treatment Study (POTS)?

Answer 4

• children with comorbid disorders like Tourette’s and major depression were excluded to avoid interaction effects
• children with ADHD were included as long as they were on stable stimulant medication
• children were not on any anti-obsessional medication at the start of the study

Question 5

how were participants allocated and what was the structure of The Paediatric OCD Treatment Study (POTS)?

Answer 5

• children randomly allocated to one of 4 groups:
  
  • drugs only
  • placebo pill only
  • CBT-only
  • combination of CBT and drug
• baseline measure taken using CY-BOCS and an interview
• study lasted 12 weeks
• each child had a specialist psychiatrist to monitor progress and offer support

Question 6

what was the procedure for the drugs-only and placebo conditions in The Paediatric OCD Treatment Study (POTS)?

Answer 6

• children attended weekly for the first 6 weeks, then every other week (9 sessions total)
• kept a medication diary to track dosages
• dosages were adjusted as needed during clinical sessions
• parents helped monitor medication adherence
• any adverse reactions led to stopping the medication

Question 7

what was the procedure for the CBT-only condition in The Paediatric OCD Treatment Study (POTS)?

Answer 7

• required 14 clinical sessions over 12 weeks
• based on a CBT manual
• involved psychological education, cognitive training, and mapping OCD target symptoms
• included exposure and response ritual prevention
• sessions included goal setting, weekly reviews, therapist-assisted practice, homework, and monitoring

Question 8

what was the procedure for the combined condition in The Paediatric OCD Treatment Study (POTS)?

Answer 8

• involved both drug and CBT sessions
• sessions were time-linked and provided simultaneously

Question 9

how were participants assessed during The Paediatric OCD Treatment Study (POTS)?

Answer 9

• ppts were assessed at weeks 4, 8, and 12
• assessments were done by independent evaluators trained to a reliable standard
• supervision and review of assessments were conducted to ensure reliability

Question 10

what were the conclusions of The Paediatric OCD Treatment Study (POTS)?

Answer 10

• CBT led to a higher improvement rate than drugs, suggesting CBT should be the first line of treatment
• minimal gain from adding drugs to effective CBT
• drugs may compensate for less effective CBT therapy

Question 11

what were the results of The Paediatric OCD Treatment Study (POTS)?

Answer 11

• 97 out of 112 ppts completed the study
• all conditions showed improvement at 12 weeks on the CY-BOCS, but placebo improvement wasn’t significant
• CBT-only condition: 39.3% entered remission (CY-BOCS score below 10)
• drugs-only condition: 21.4% entered remission
• remission rate rose marginally in the combined condition

Question 12

strength - gen

Answer 12

• large sample size
• representative of the target population (children and young people with OCD)

Question 13

weakness - gen

Answer 13

• the sample was mostly white (92%)
• the study was conducted in the USA, which may limit its generalisability to other cultures

Question 14

weakness - reliability

Answer 14

• the study was conducted over 3 centres
• one centre had better results in the CBT-only condition
• this may have been due to the therapist effect, where some therapists were more proficient at delivering CBT

Question 15

application

Answer 15

• the CBT and medication treatments used were acceptable to ppts and well-tolerated
• the treatments were highly practical, using well-established and easily accessible protocols (e.g., March and Mulle’s CBT manual)
• findings support the routine use of combined CBT-medication treatment
• this approach would benefit both young people with OCD and wider society

Question 16

strengths - val

Answer 16

• assessors were blind to which condition the ppts were in, preventing biased evaluations
• ppts in the placebo condition were unaware the drug was not active
• therapists were also unaware of which condition the participants were in, ensuring unbiased treatment delivery

Question 17

weaknesses - val

Answer 17

• not all procedures were rigorously standardised
  
  • 12 ppts and clinicians knew combined-treatment ppts were receiving medication, meaning ‘masking’ was imperfect
  • knowledge of group membership may have influenced expectations and outcomes
• combined-treatment ppts completed more CBT sessions than those in the CBT-only group (14 vs. 12)
  
  • combined group received a lower daily dose of medication compared to the sertraline-only group (133 mg vs. 170 mg)
  • these differences make it harder to make valid comparisons between treatment groups

Question 18

strength - ethics

Answer 18

• the lead researcher (John March) ensured confidentiality and data security
• written consent was obtained from all ppts (and at least one parent)
• ppts who received the placebo could choose a genuine treatment at the end of the study
• these ethical considerations improved the study’s credibility with ppts and the public

Question 19

strength - reliability

Answer 19

• several techniques were used to increase reliability
• procedures were standardised (e.g., strict drug dose schedule, established CBT protocols)
• controls ensured similarity between groups
  
  • both medication groups had regular meetings with a professional
  • both sertraline and placebo groups took tablets they believed would help
• variations within groups were likely due to individual differences, and differences between groups were due to the treatments rather than procedural variations

Question 20

weakness - ethics

Answer 20

• deception was used in the placebo condition, as ppts were unaware they were receiving a non-active treatment