I would be writing an essay on the use of Cognitive Behaviour Therapy on the adolescent

and children with obsessive compulsive disorder. I would be looking into and reviewing

Journal and research studies dealing with the efficacy of using Cognitive Behaviour Therapy

(CBT) alone or using them with medication for children and adolescent with Obsessive-

compulsive disorder (OCD). This essay will aim to address a few questions relating to

Obsessive Compulsive Disorder, Cognitive Behavioural Therapy and Medication and also

review some journals, articles and systematic reviews.

I would briefly explain Obsessive-compulsive disorder (OCD) and Cognitive

Behaviour Therapy (CBT), making reference to the National Institute for Clinical

Excellence guideline and policies governing the use of Cognitive Behavioural

Therapy for treating Children and Adolescent with obsessive compulsive disorder

(OCD) with Cognitive Behaviour Therapy (CBT). Also, I plan to support this study by

reviewing one research review; one journal and article that looks into the efficacy of

treatment with only Cognitive Behaviour Therapy (CBT) and also combination of

using both Cognitive Behaviour Therapy (CBT) and medication. I am going to be

using abbreviation of CBT for Cognitive Behaviour Therapy and OCD for Obsessive

Compulsive Disorder.

I plan to do a computer search on the National Institute of Clinical Excellence (NICE);

Department of Health (DoH); MIND; Journal of the American Medical Association, Sainsbury

Centre for Mental Health (SCMH); Rethink, Mental Health Foundation (MHF), and Cochrane

Library. I did most of my Research on PUBMED and the Cochrane Library where I got one of

my systematic review studies. Electronic databases were used, including CINAHL, EBSCO

Host, Cochrane Library and Medline. A keyword search was performed. My Keywords

were cognitive; behaviour; cognitive behaviour; child AND adolescent; CBT; Cognitive
Behaviour Therapy, behaviour problem; OCD, AND Obsessive Compulsive Disorder. My

search produced about 68 results

(https://uhvpn.herts.ac.uk/sites/,DanaInfo=www.ncbi.nlm.nih.gov+entrez) which after going

through them I decided to review the search by looking at results within the last five years.

Also, I decided to filter the result by checking on journals and research report and studies by

Prof March and Dr. Richard O'Kearney who are both renowned researchers in this Field. My

searches were combined to find reports, journals or articles addressing one or more

keywords. This yielded numerous results. Inclusion criteria for selection of articles or journal

to review or look at were: Those ones that dealt only with Children and adolescent under the

age of 17years, the more recent ones from January 2005 to date, the ones that had to do

with reputable researchers like Prof John March and Rickard O Kearney. I also searched the

Journal of Clinical Psychiatry which has loads of resources regarding my topic. I also looked

at the Journal of American Medical Association where most of Prof. John March’s works

were published.

The National Institute for Health and Clinical Excellence (NICE, Nov, 2005a) describes

Obsessive Compulsive Disorder (OCD) as a person that has either a compulsion or

obsession and sometimes they could have both. It could present in an episodic or chronic

form. A compulsion is a repetitive behaviour or mental act performed in response to certain

rules while obsession is a recurrent and persistent idea or thought and it is sometimes linked

to compulsion. Obsessive Compulsive Disorder could present in forms of excessive washing

and cleaning, hoarding and repeatedly doing things in the same way. These actions could

affect anyone but when it starts preventing you from carrying out your daily activities, it

becomes a problem or disorder. According to the National Institute for Health and Clinical

Excellence (NICE, Nov 2005b) new press release, OCD is the fourth most common mental

health problem, occurring in 1% of all children in the United Kingdom.

The Royal College of Psychiatrists (2005), describes Cognitive Behavioural Therapy (CBT)

as how we think about ourselves and all that surrounds us and how this affects our thoughts

and feelings. The role of CBT is changing the way we view ourselves and how his change

can makes us feel better. It is also changing our perception of the how we see the world.

This way of caring was discovered by Prof. Aaron Beck, an American psychiatrist in the

1960s.

Significant disruption and impairment of the child's or adolescent family, social and academic

life, is often a big symptom of Obsessive Compulsive Disorder. Valderhaug & Ivarsson

(2005) asserts that OCD in children and adolescent can start as early as age 5 disrupting

normal development and imparting on the child’s life all through till adult age. This goes a

long way to disrupting their academic work in school.

The National Institute for Health and Clinical Excellence (Nov, 2005c, pg. 19), in its

guidelines for treating children and young adolescent with OCD, instructs that Cognitive

Behaviour Therapy (CBT) with ERP (exposure with response prevention) should be the first

line of treatment and medication should only be used when all avenues of CBT has been

used and it does not work or reduce the symptoms associated with the disease. The

American Academy of Child and Adolescent Psychiatry (King, Leonard, & March, 1998) also

recommends use of CBT as a first line treatment and it also recommends treating children

and adolescent with CBT and Medication depending on how serious it is.

John S March, a research Psychiatrist, in his paper, a review and recommendation for

treatment of children and adolescent with obsessive compulsive disorder (OCD), went

through thirty two investigations and researches and found out that all except one showed

big benefit of using CBT as first line treatment for children and adolescent with the disorder

with mild symptoms but he also found out that due to some problems like poor compliance

and inconsistency, the results varied. (March 1995). In his article in Child and Adolescent

Clinics of North America, Piacentini (1999) agreed with the research result of John March
but added that CBT would be more effective for Children and Adolescent with the disorder if

parent, family members and carers of the patient are involved in the therapy. March, J.,

Frances, A., Carpenter, D., & Kahn, D. (1997) also noted that most families would prefer

treatment with CBT and EPR rather than the use of medication. This research finding was

documented in the Expert Consensus Guidelines for the treatment of this disorder. In case

of very severe OCD in Children and Adolescent, medication may be required in combination

with CBT to improve their symptoms.

A study or review carried out by the Dr. John March of the Paediatric Obsessive Compulsive

Disorder Treatment study (POTS) published in the October edition of Journal of American

Medical Association, found during a Research carried out on 112 patients with OCD with age

range of 7 to 17years at three different schools. They were placed into three different

groups. The groups were: those treated with CBT, those on medication (sertraline) alone

and those on CBT and medication. The rate of improvement of symptom after 12 weeks was

far better with the group that had the combined treatment at 53.6% compared to the group

that had just CBT alone at 39.3% and the group on Medication( sertraline ) alone on 21.4%.

(March, J, Foa, E, Gammon, P, Curry, J. & Franklin, M.(2004). From this research study by

the Paediatric Obsessive Compulsive Disorder Treatment study (POTS), Dr. March and his

team concluded that with the disparity of the three results, it is discovered that OCD in

Children and Adolescent should be treated with CBT alone or with CBT and Medication

because this is the only chance for patients to overcome this disorder.

This research was conducted independently though two of the researcher received support

from a drugs company. (Pfizer). Reading through the about research study, it shows that it

is very well written. Though this is clearly well written research study essay, the authors

never made mention of the limitation faced or identified throughout the study. The authors’
qualifications in the field of OCD in Children and adolescent made the research study

confidence in their findings the backgrounds of most of the authors of this research study

showed that they had good insight into the Topic of Obsessive Compulsive disorder and

CBT treatment and have a strong professional involvement with the topic (Byrne, 2001). ).

As Parahoo and Reid (1988) puts it, the title should not be too long, catchy and try to

present what the research is all about (CBT and OCD in Children and Adolescent). This was

reflected well in this Research Study. Another merit of this research study is that the authors

defined the variables well. i.e. the patients with treatment of CBT alone, CBT and mediation

and placebo. This situation was coined operation definition by Minichiello etal (2004). The

title clearly states the focus of the research study. However it is far better for the results to

be included in the title.

While this research was carried out as a masked randomized controlled trial, there are

setbacks involved in these RCT methods. These are the location of the trial, who are the

patients involved (disabled, sane), and cost (Van Spall HG, Toren A, Kiss A, Fowler RA

(2007). Randomized controlled trial has shown to be an effective method but its drawbacks

are that it’s expensive and time consuming. Also its selection criteria are often biased. i.e.,

who gets the CBT, Drugs or the placebo?

Though the writers stressed and made various recommendations for the future in treatment

of OCD with CBT, there is no mention of the cost involved in training staff to conduct the

CBT programs. Ethical issues were considered through the institutional review board and

parents of the volunteers gave their consent (Hamer & Collinson 1999). The conclusion was

also linked to the main objective of the research and some recommendations were given.

There was a clear reference list at the end of this research study. This study contributes to
nursing study by making visible the use of CBT with Medication to treat OCD in Children and

adolescent.

A systemic review titled: Behavioural and cognitive behavioural therapy for obsessive

compulsive disorder in children and Adolescent by four Australia authors looked at use of

cognitive behaviour therapy for children and adolescent with Obsessive Compulsive

Disorder and also the use of medication. They went through different studies from different

respected authors in the field of paediatric Obsessive Compulsive Disorder over a period of

time and came up with a certain result. The result outcome was also close to what the first

research study I mentioned above got. That CBT when used alone is as effective for the

symptoms of Obsessive Compulsive Disorder and should be the first line treatment for

children and adolescent with Obsessive Compulsive Disorder and that there is no evidence

that when combined with medication, there is a better overall result in the presentation of the

patient. The review concluded that there is still insufficient evidence to specify the method or

sequence of treatment for children and adolescent with Obsessive Compulsive disorder

(OCD). Recommendations made by the authors were that there should be adequate training

of nursing staff and other health professionals in the Area of Cognitive behavioural Therapy

since this is a method of treatment available to Young children and Adolescent and their

families can be involved in their treatment and that it should be assessable to most patients

needing it. (Kearney.RT, Anstey. K, Von Sanden.C and Hunt. A, 2010).

To review this, I have to check and weigh the evidence validity and how it can be applied to

practise (Sackett etal 1997). The background of the Authors of this systemic review was in

the field of this research. They had vast knowledge in the research of Paediatric Obsessive

Compulsive Disorder with treatment of CBT and medication. They have written or have been

involved in much high standard research. This review is difficult to read (not easy read). The
title was catchy but could not bring out what this systematic review was all about. The

abstract provided a clear insight into what the review was all about and also the positives

and negative of this review. (Muir Gray,2001, p.107-8). The authors did not tell us the

process the journals or studies used for this review went through before they were accepted

for publication (if the sources were good enough to be published)

It is important to note that all the participants in these studies have Obsessive Compulsive

Disorder which is of interest in this review. Also, they are in this study at a common point in

the course of their disease.

Going through the various studies combined in this one report, the status of the assessors

wasn't reported in this report. The studies were done by various authors in different settings

and they were bound to come forth with different results. It is also noted that all of the

studies answered different questions and were aimed at different results. Using the PICO

idea put forth in Sackett etal (pp 13-27, 2000), the population distribution of most patients

used in the studies was not mention. The differences in the intervention, duration and mode

of treatment used by some of the studies could alter the result of the studies. Also the

different ways of measuring the results of the Studies could also alter the results. Another

aspect is that of the quality of all the studies used in this review. Collating the results from all

the studies of different quality would give a biased result. Though this review is a deep

research and took a great deal of time, the studies couldn't answer or were not made to

answer the question of interest in this Research Study which is whether Cognitive Behaviour

Therapy(CBT) alone was good for Children and adolescent with Obsessive-compulsive

disorder(OCD) or whether the combination with Medication is better.