View Single Post
Old July 30th, 2008, 01:35 PM   #20
Tears & Smiles
Sapphire's Forum Picture
Join Date: March 22, 2005
Location: UK
Gender: Female
Blog Entries: 3
Default Re: are you born with ocd?

Originally Posted by IAMSAM View Post
I appreciate this information, but since I cannot access the original versions I still cannot assess the credibility of these results. How were the samples chosen?, how was the diagnosis of OCD derived?, what instruments were used to determine 'improvement'? Citing journals as references or the statistical significance doesn't necessarily answer these important questions, you should know that. Something having a 2% statistical error variance is only valid if the subjects were properly selected in the first place!
The way these are done (as far as I am aware) is the psychologists contact hospitals/doctors surgeries etc and enquire whether they have any patients who meet their criteria. These people are then contacted and asked if they would mind participating.
I cannot access the full articles or book so these will have to suffice.

Simpson & Liebowitz:
(from the chapter) Two monotherapies are efficacious for adults with OCD: pharmacotherapy with serotonin reuptake inhibitors (SRIs, ie, clomipramine and the selective serotonin reuptake inhibitors) and cognitive-behavioral therapy (CBT) consisting of exposure and response prevention (ERP). Expert consensus treatment guidelines for adults with OCD (March, Frances, Carpenter, & Kahn, 1997) recommend ERP monotherapy be offered to every OCD patient when available and that it be the first treatment used with patients with milder OCD. Serotonin reuptake inhibitor monotherapy or SRI + ERP treatment is recommended for adults with more severe OCD. In this chapter, we examine data supporting the premise that combining SRI and ERP treatment is more effective than either treatment alone. We conclude that for adults with OCD, combination therapy (SRI + ERP) is warranted in specific clinical situations. (PsycINFO Database Record (c) 2007 APA)

Reviews 32 studies (published 1967-1994) on cognitive-behavioral psychotherapy (CBP) for obsessive-compulsive disorder (OCD) in children and adolescents, addressing empirical documentation, acceptability of treatment, and exportability, among other issues. Despite differences in terminology and theoretical framework, all but 1 showed some benefit for CBP interventions. Graded exposure and response prevention form the core of treatment; anxiety management training and OCD-specific family interventions may play an adjunctive role. Clinical and emerging empirical evidence suggest that CBP, alone or in combination with pharmacotherapy, is an effective treatment for OCD in children and adolescents. (PsycINFO Database Record (c) 2007 APA)

Watson & Rees:
Objective: To conduct a meta-analysis on randomized, controlled treatment trials of pediatric obsessive-compulsive disorder (OCD). Method: Studies were included if they employed randomized, controlled methodology and treated young people (19 years or under) with OCD. A comprehensive literature search identified 13 RCTs containing 10 pharmacotherapy to control comparisons ( N = 1016) and five cognitive-behavioral therapy (CBT) to control comparisons ( N = 161). Results: Random effects modeling yielded statistically significant pooled effect size (ES) estimates for pharmacotherapy (ES = .48, 95% CI = .36 to .61, p < .00001) and CBT (ES = 1.45, 95% CI = .68 to 2.22, p = .002). The results were robust to publication bias. Conclusions: This is the first meta-analysis of treatment RCTs for pediatric OCD. CBT and pharmacotherapy were the only treatments effective beyond control in alleviating OCD symptoms. CBT showed a greater ES than pharmacotherapy. Previous meta-analyses that included uncontrolled trials exaggerated the efficacy of both treatments. [ABSTRACT FROM AUTHOR]

Originally Posted by IAMSAM View Post
If you were to talk with professionals who are trained to diagnose and treat OCD, what you'd hear is that OCD, like many disorders, occurs on a continuum, that the symptoms go from 'mild' to 'severe'. And as the symptoms become more significant, as they interfere more with ADL's, that medication becomes the more valuable tool in treatment. You cannot 'talk' someone out of something like OCD that is basically biologically determined, it would be like talking someone out of having a seizure. I suspect those that respond to therapy as well as meds probably had a more mild form, or OCD-like features.
I never said that someone could be "talked out of" OCD. CBT is a combined approach to therapy and addresses cognitive (thoughts) and behavioural modification.
No one can be sure whether it is or isn't fundamentally biological. There is no conclusive evidence to say that biochemical imbalances cause all cases of OCD. It could be an effect of OCD for all anyone knows.
Also, if you care to read one of my previous posts (and the abstracts above) you can clearly see that it is evident that in severe cases a combined approach is effective. Not just medication. This surely makes sense seeing as both forms of treatment help alleviate symptoms that combining them would help that bit more.

Originally Posted by IAMSAM View Post
CBT (or any other form of properly administered psychotherapy), is a valuable tool in treatment, regardless of how serious the disorder is. However, only those who have never actually worked with severe OCD (properly diagnosed, btw) would say that CBT alone is as effective as medication. Go find a professional who has some experience with this and ask them.
I have quoted and referenced the published work of qualified professionals. I have shown you the support for the statements I have made.

Where is your evidence that it is "basically biological" and "impossible to treat without medication"? Where are the professionals publishing saying these things?

Originally Posted by IAMSAM View Post
Perhaps what I'm also responding to is more personal, you're entirely too confrontational and nasty for my tastes, I don't do well with arrogance in the absence of excellence, in the very short time you've been here what i've read from you confirms the former without having the benefit of the latter. Perhaps as you're here more that might change. But until then, you might consider toning your attitude down and tucking your ego in a bit, at least around me. We're here to help others, not confront eachother. You are entitled to share an opinion with the OP, it is their choice who to believe.
I have not been as confrontational, gotten personal or started insulting you as you have towards me. You have, however, demanded to see the evidence of which I spoke and then claimed that wasn't enough. You demanded references, so I got you them. But they weren't good enough either so you demanded more information which I have given you. You have called me names, made slurs against my character and acted as if I am an ignorant child trying to join in an adults coversation.

~ The journey of a thousand miles begins with a single step ~

* Nothing in the world has ever been accomplished without passion *

Last edited by Sapphire; July 30th, 2008 at 01:41 PM.
Sapphire is offline