Aftercare Treatment for Obsessive-Compulsive Disorder

Overseen By Maria Filippou-Frye, MD, MBS

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Stanford University

Disqualifiers: Children, Active suicidality

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

Duration: 14 weeks

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to support people with obsessive-compulsive disorder (OCD) by offering aftercare treatment options. Participants will receive either medication management (pharmacotherapy) with a psychiatrist or therapy sessions (psychotherapy) with a psychologist. The trial is designed for individuals who have already completed a related study at the Rodriguez Lab. Those who have finished a study there and speak English may be suitable candidates. As an unphased trial, it provides a unique opportunity to explore personalized aftercare options and contribute to ongoing research.

Do I need to stop my current medications for this trial?

The trial information does not specify whether you need to stop taking your current medications.

Is there any evidence suggesting that this trial's treatments are likely to be safe?

Research has shown that medication can help many people with OCD, with about 70% of patients experiencing improvement with the right medication. However, responses vary. Specifically, 40% to 60% of people respond well to drugs like clomipramine or SSRIs, a type of antidepressant, but predicting who will benefit from which drug remains challenging.

On the therapy side, treatments like exposure and response prevention (ERP) have proven effective. One review found that ERP reduces OCD symptoms more effectively than other treatments. Often, therapy is combined with medication for optimal results.

Both treatments are generally safe, and most people tolerate them well, though responses can differ. Consulting a healthcare provider is crucial to determine the best option. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the aftercare treatments for Obsessive-Compulsive Disorder (OCD) because they explore the combination of pharmacotherapy and psychotherapy in a unique aftercare setting. Unlike most current OCD treatments that often focus on either medication or therapy alone, this approach integrates both, potentially enhancing overall effectiveness. Pharmacotherapy involves personalized medication management by a psychiatrist, which may provide tailored medication adjustments post-primary treatment. Meanwhile, the psychotherapy component offers structured, evidence-based sessions with a trained psychologist, aiming to strengthen coping mechanisms and reduce relapse rates. By addressing OCD with this dual approach in an aftercare context, researchers hope to improve long-term outcomes for individuals managing this condition.

What evidence suggests that this trial's treatments could be effective for OCD?

This trial will compare pharmacotherapy and psychotherapy as aftercare treatments for obsessive-compulsive disorder (OCD). Research has shown that both medication and therapy effectively treat OCD. About 40% to 60% of patients improve with medications like clomipramine or selective serotonin reuptake inhibitors (SSRIs), though not everyone responds to the same medication. On the therapy side, cognitive-behavioral therapy (CBT), particularly exposure and response prevention (ERP), significantly reduces OCD symptoms for many. Studies indicate that ERP often surpasses other treatments in effectiveness. Combining medication and therapy typically yields the best results for managing the condition. ^{4 6 7 8 9}

Who Is on the Research Team?

Carolyn Rodriguez, MD, PhD

Principal Investigator

Assistant Professor, Stanford University

Are You a Good Fit for This Trial?

This trial is for adults with Obsessive Compulsive Disorder (OCD) who have finished a previous study at the Rodriguez Lab. They must understand the risks and benefits of this study, be able to consent, and speak English. It's not open to anyone under 18 or those currently having thoughts of suicide.

Inclusion Criteria

I understand the risks, benefits, and procedures of the study and can consent.

Ability to speak and understand English

Completed an active study protocol at the Rodriguez Lab at Stanford University

Exclusion Criteria

I am under 18 years old.

Active suicidality

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive either pharmacotherapy by a psychiatrist or evidence-based psychotherapy by a trained psychologist

14 weeks

Follow-up

Participants are monitored for safety and effectiveness after treatment

4 weeks

Open-label extension (optional)

Participants may opt into continuation of treatment long-term

What Are the Treatments Tested in This Trial?

Interventions

• Pharmacotherapy
• Psychotherapy

Trial Overview The trial offers ongoing treatment options for OCD through pharmacotherapy (medication) and psychotherapy (counseling). It's designed for patients from prior studies at the Rodriguez Lab to continue receiving care and support.

How Is the Trial Designed?

Group I: Pharmacotherapy Active Control 1 Intervention

Participants will receive pharmacotherapy by a psychiatrist

Group II: Psychotherapy Active Control 1 Intervention

Participants will receive evidenced based psychotherapy by a trained psychologist

Who Is Running the Clinical Trial?

Stanford University

Lead Sponsor

Trials

2,527

Recruited

17,430,000+

Published Research Related to This Trial

This study will analyze adverse events in psychotherapy for youth with OCD by including at least 128 participants aged 8-17, comparing family-based cognitive behavioral therapy (FCBT) and family-based psychoeducation and relaxation training (FPRT).

The mixed methods approach will combine quantitative assessments of adverse events with qualitative interviews to better understand their nature and causes, aiming to improve the safety and effectiveness of psychotherapy for OCD.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Adverse events in cognitive behavioral therapy and relaxation training for children and adolescents with obsessive-compulsive disorder: A mixed methods study and analysis plan for the TECTO trial. Pretzmann, L., Christensen, SH., Bryde Christensen, A., et al.[2023]

A systematic review of 115 psychotherapy study protocols revealed that while 77 protocols explicitly addressed harm, there was a lack of standardization in how harm was conceptualized and assessed, particularly regarding adverse events.

The review highlighted that although serious adverse events were defined consistently, the definitions and considerations for adverse events varied widely, suggesting a need for more standardized approaches in clinical research to effectively monitor and report harm.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Defining and assessing adverse events and harmful effects in psychotherapy study protocols: A systematic review. Klatte, R., Strauss, B., Flückiger, C., et al.[2023]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC9520065/

The effectiveness of exposure and response prevention ... Patients with OCD have significant improvement in symptoms of obsessive-compulsive disorder and depression when ERP is combined with medication, ...

2. med.stanford.edu med.stanford.edu/ocd/treatment/pharma.html

Pharmacological Treatments - Stanford Medicine About 40% to 60% of patients will respond to clomipramine or to any particular SSRI, and one cannot predict which patient will respond to which drug. A trial of ...

3. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC9978117/

Therapies for obsessive-compulsive disorder: Current state ... The currently available psychotherapeutic and pharmacological approaches, when properly applied, prove ineffective in about 10% of cases.

4. sciencedirect.com sciencedirect.com/science/article/pii/S0010440X2400097X

Adequacy of treatment in outpatients with obsessive ... Patients with OCD are not being treated adequately according to the pharmacological guidelines. Poor pharmacological treatment may lead to increased duration ...

5. mayoclinic.org mayoclinic.org/diseases-conditions/obsessive-compulsive-disorder/diagnosis-treatment/drc-20354438

Obsessive-compulsive disorder (OCD) - Diagnosis and ... The two main treatments for OCD are psychotherapy and medicines. Psychotherapy also is known as talk therapy. Often, a mix of both treatments is most effective.

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC7495343/

Pharmacotherapy for Treatment-Resistant Obsessive- ... What constitutes “responsiveness” to OCD treatment remains controversial, though improvement from baseline of 25–35% on the Yale-Brown Obsessive-Compulsive ...

7. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC4143776/

Pharmacological treatment of obsessive-compulsive disorder Approximately 70% of patients can experience significant symptomatic relief with appropriate pharmacotherapy.

8. sciencedirect.com sciencedirect.com/science/article/abs/pii/S1876201823004045

Pharmacotherapy for obsessive-compulsive disorder Out of 1894 patients, 82.9% received at least one psychotropic medication, with prescription rates increasing over time.

9. frontiersin.org frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2023.1065812/full

Therapies for obsessive-compulsive disorder: Current state ... The currently available psychotherapeutic and pharmacological approaches, when properly applied, prove ineffective in about 10% of cases.