Six-Month Outcomes From a Randomized Trial Augmenting Serotonin Reuptake Inhibitors With Exposure and Response Prevention or Risperidone in Adults With Obsessive-Compulsive Disorder
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OBJECTIVE: To compare outcomes after 6-month maintenance treatment of adults diagnosed with obsessive-compulsive disorder (OCD) based on DSM-IV criteria who responded to acute treatment with serotonin reuptake inhibitors (SRIs) augmented by exposure and response prevention (EX/RP) or risperidone. METHOD: A randomized trial was conducted at 2 academic sites from January 2007 through December 2012. In the acute phase, 100 patients on therapeutic SRI dose with at least moderate OCD severity were randomized to 8 weeks of EX/RP, risperidone, or pill placebo. Responders entered the 6-month maintenance phase, continuing the augmentation strategy they received acutely (n = 30 EX/RP, n = 8 risperidone). Independent evaluations were conducted every month. The main outcome was the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). RESULTS: Intent-to-treat analyses indicated that, after 6-month maintenance treatment, EX/RP yielded OCD outcomes that were superior to risperidone (Y-BOCS = 10.95 vs 18.70; t40 = 2.76, P = .009); more patients randomized to EX/RP met response criteria (Y-BOCS decrease ≥ 25%: 70% vs 20%; P < .001) and achieved minimal symptoms (Y-BOCS ≤ 12: 50% vs 5%; P < .001). During maintenance, OCD severity decreased slightly in both conditions (Y-BOCS decrease = 2.2 points, P = .020). Lower Y-BOCS at entry to maintenance was associated with more improvement in both conditions (r38 = 0.57, P < .001). CONCLUSIONS: OCD patients taking SRIs who responded to acute EX/RP or risperidone maintained their gains over 6-month maintenance. Because EX/RP patients improved more during acute treatment than risperidone-treated patients, and both maintained their gains during maintenance, EX/RP yielded superior outcomes 6 months later. The findings that 50% of patients randomized to EX/RP had minimal symptoms at 6-month maintenance, a rate double that of prior studies, suggests that EX/RP maintenance helps maximize long-term outcome. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT00389493.
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Individuals taking SRIs had lower OCD severity scores immediately and 6 months following additional treatment with ERP than those who had additional treatment with risperidone or placebo.
“individuals taking SRIs had lower OCD severity scores immediately[24] and 6 months[25] following additional treatment with ERP than those who had additional treatment with risperidone or placebo”
From Exposure and response prevention for obsessive-compulsive disorder: A review and new directions (2019) · cites this paper as [25]
The Abstract Results report lower OCD severity at six months with exposure and response prevention (EX/RP) than with risperidone (Y-BOCS 10.95 versus 18.70). The Method’s Data Analysis section says the six-month analyses excluded the placebo group, so this source does not support a six-month comparison with placebo. The immediate-treatment comparison is attached to a different citation [24]. Page numbers were not provided in our copy. (LLM, conf=0.88)
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Self-citation
- Authors
- Foa, E. B., Simpson, H. B., Rosenfield, D., Liebowitz, M. R., Cahill, S. P., Huppert, J. D., Bender Jr, J., McLean, C. P., Maher, M. J., Campeas, R., Hahn, C.-G., Imms, P., Pinto, A., Powers, M. B., Rodriguez, C. I., Van Meter, P. E., Vermes, D., & Williams, M. T.
- Affiliations
- University of Pennsylvania (US)
- New York State Psychiatric Institute (US)
- Southern Methodist University (US)
- Columbia University (US)
- University of Wisconsin–Milwaukee (US)
- Hebrew University of Jerusalem (IL)
- The University of Texas at Austin (US)
- University of Louisville (US)
- ORCID
- Venue
- The Journal of Clinical Psychiatry
- Publisher
- Physicians Postgraduate Press, Inc
- Published
- 2014-10-14
- Volume
- 76
- Issue
- 04
- Pages
- 440-446
- ISSN
- 0160-6689 (ISSN-L)
- PMC
- PMC4524354
- OpenAlex
- W1996493576
- Cited by
- 34
- References
- 29
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 5 · 2023: 2 · 2022: 4 · 2021: 4 · 2020: 3 · 2019: 4 · 2018: 3 · 2017: 3 · 2016: 3 · 2015: 1
- FWCI
- 2.76
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- The Journal of Clinical Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Bristol-Myers Squibb
- Yale University
- National Institute of Mental Health (R01MH045404, R01MH-45404, K23MH092434, R01MH045436, R01MH-45436)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
- Keywords
- obsessive-compulsive disorder, exposure and response prevention, risperidone, serotonin reuptake inhibitors, augmentation therapy, maintenance therapy, long-term outcomes, Yale-Brown Obsessive Compulsive Scale, atypical antipsychotics, treatment-resistant OCD, relapse prevention
- MeSH terms
- Adolescent, Adult, Aged, Combined Modality Therapy, Female, Follow-Up Studies, Humans, Implosive Therapy, Male, Middle Aged, Obsessive-Compulsive Disorder, United States, Selective Serotonin Reuptake Inhibitors, Risperidone, Young Adult
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