2022 Breakthrough Award

CBT augmentation to promote medication discontinuation in pediatric OCD

Eric Storch, PhD

Baylor College of Medicine (Houston, TX)

Award Amount: $499,891

Several treatments have shown efficacy for treating pediatric OCD: cognitive behavioral therapy (CBT), medication with a serotonin reuptake inhibitor (SRI), and their combination (SRI+CBT). Although best practice suggests using CBT to treat children with mild-to-moderate OCD, SRIs are still typically prescribed first regardless of severity – even though they have modest therapeutic effects, a range of serious side effects, and potentially damaging outcomes. An adult trial demonstrated that gradual SRI discontinuation resulted in noninferior outcomes relative to SRI continuation across 24 months of follow-up after SRI+CBT, suggesting that SRI treatment can be safely discontinued with the help of CBT. This study will examine SRI tapering for 141 children with at least moderate OCD receiving CBT across 24 weeks of follow-up, to assess whether this will reduce OCD symptoms and ultimately lead to successful SRI discontinuation. These results will be used to inform policy and practice regarding maximizing outcomes among children, lessening exposure to unnecessary treatments, and returning youth to everyday living. Beyond pediatric OCD, this project hopes to serve as a possible model for other conditions, such as anxiety disorders.