Article under critique:
Sánchez-Meca, J., Rosa-Alcázar, A. I., Iniesta-Sepúlveda, M., & Rosa-Alcázar, Á. (2014). Differential efficacy of cognitive-behavioral therapy and pharmacological treatments for pediatric obsessive–compulsive disorder: A meta-analysis. Journal of Anxiety Disorders, 28(1), 31-44.
The paper presents a meta-analysis on the efficacy of interventions for obsessive-compulsive disorder (OCD) in children. OCD is a psychological disorder/condition that is associated with obsessions and compulsions which may lead to functional disorder in children. Pharmacological treatment and psychological treatment have been the main treatment aspects of OCD (Lack, 2012). The main issue the paper investigates is the treatment strategy that shows more effectiveness and greater efficacies in terms of reducing the OCD symptoms, with less severe side effects and addresses comorbid conditions. In the study, the efficacy of the psychological treatment approach, in particular, the cognitive behavioral therapy was found to be more efficient compared to the pharmacological treatment approach of OCD (Sánchez-Meca, Rosa-Alcázar, Iniesta-Sepúlveda, & Rosa-Alcázar, 2014). The paper’s findings recommend further research and investigation into the use of a combination of psychological and pharmacological treatment of OCD.
Applicable Variables and Constructs
The study presented focuses on the outcome, comorbidity, and process variables of psychological therapy. There is evidence that the outcome of psychological therapy is related to psychotherapeutic techniques where CBT and exposure response prevention (ERP) techniques have been highlighted. In regard to the patient process variables, changes in the focus of the psychological approach therapy were shown to correlate with symptom change (Sánchez-Meca et al., 2014). The comorbidity variable was highlighted as a moderator variable and was found to be related to poorer prognosis in the treatment approaches. A pattern of an ineffective treatment outcome was observed when comorbidity is present and the studies indicate that comorbid conditions have a negative impact on treatment outcome related to the pharmacological approach. The study included a control group for which comparability with the treatment approaches was developed by measures of initial differences. With regard to the outcome variable, the psychological and pharmacological treatment approaches were both effective. STPP and CBT were compared in relation to their efficacy in the treatment of OCD. It was found that CBT was significantly more effective in the improvement of OCD in children and reducing the cases of comorbidity or condition recurrence and with less severe side effects.
The paper discusses cognitive restructuring in relation to the therapeutic process derived from CBT based on the assumptions that OCD is associated with cognitive distortions in children. A major theoretic assumption in the paper is CBT incorporates intervention in a narrative context in which child-appropriate metaphors are used for cognitive restructuring (Sánchez-Meca et al., 2014). A key component of CBT is the focus on helping the child to recognize and reframe dysfunctional thoughts and to utilize the coping strategies for effectiveness in preventing recurrence. This highlights the humanistic approach to psychological treatment which explains the efficacy of the strategy in treating psychological conditions (Knapp & Beck, 2008). The cognitive-behavioral theory is associated with cognitive therapy and behavioral learning in relation to the assumption that psychological problems can be modified through teaching coping skills and a supportive therapeutic relationship. In the theory, psychological disorders can be mediated by cognitive and behavioral processes (Khazaal et al., 2012). Effective coping is found to be an element that is counteractive to feelings of helplessness that impairs functions and is associated with depression.
The study findings indicated that both the CBT therapy and the pharmacological studies exhibited differences in the methodological aspect. The major finding was that the attrition rates in the pharmacological studies of the posttests were 1.8% for treatment groups and 21.3% for control groups and those for the CBT studies 8.6% and 9.8% for the treatment and control groups respectively (Sánchez-Meca et al., 2014). This means that CBT is effective in the treatment of OCD in the children. In relation to the cognitive behavioral theory, the inclusion of parent support, exposure-response support, and coping strategies is based on supportive relationships and cognitive and behavioral therapies (Siddaway, Wood, & Cartwright-Hatton, 2014). In the practical sense, the child will learn about how to change perceptions about OCD and develop coping skills that can prevent future occurrence of the psychological disorder.
Strengths and Limitations of the Study
The major strength of the study was the use of an active control group which other studies on CBT’s effectiveness as a treatment approach in OCD do not. Due to the use of an active control group, a better mean effect size that was obtained by the pharmacological treatment in comparison to that of CBT treatment was confounded by the particular control group used. When it comes to investigating aspects that relate to psychological disorders there are several limitations that can affect the study. The major limitation of the study was the scarce number of previous studies that complied with the selection criteria chosen. This is because according to Velengtas, Mohr, and Messner (2012), there has been a critical problem in relation to the low number of experimental designs that incorporate control groups in the study of pediatric OCD. Another limitation was that due to the duration of the study it was not possible to analyze the long-term efficacy of the OCD treatment strategies thus the study was limited to short-term efficacy.
The main issue to be addressed in the study is improved methodology and controlled treatment outcome trials which relates to testing practical and theoretic aspects of the therapies. This can be achieved through a closer integration with theoretical approaches in the children population as a starting point to improve the consistency of theoretic underpinnings and to facilitate comparisons with other population groups considering that social learning and environmental influences may be different in children (Krishnan, 2010). This helps to develop a deeper understanding of the efficacy of CBT in totality and develop more precise theoretical definitions.
References
Khazaal, Y., Xirossavidou, C., Khan, R., Edel, Y., Zebouni, F., & Zullino, D. (2012). Cognitive-Behavioral Treatments for “Internet Addiction”. The Open Addiction Journal, 5(Suppl 1: M5), 30-35.
Knapp, P., & Beck, A. T. (2008). Cognitive therapy: foundations, conceptual models, applications and research. Revista Brasileira de Psiquiatria, 30(Suppl II), S54-S64.
Krishnan, V. (2010). Early Child Development: A Conceptual Model. In Early Childhood Council Annual Conference, 7-9 May 2010. ECMap: Christchurch, New Zealand.
Lack, C. W. (2012). Obsessive-compulsive disorder: Evidence-based treatments and future directions for research. World Journal of Psychiatry, 2(6), 86-90.
Sánchez-Meca, J., Rosa-Alcázar, A. I., Iniesta-Sepúlveda, M., & Rosa-Alcázar, Á. (2014). Differential efficacy of cognitive-behavioral therapy and pharmacological treatments for pediatric obsessive–compulsive disorder: A meta-analysis. Journal of Anxiety Disorders, 28(1), 31-44.
Siddaway, A. P., Wood, A. M., & Cartwright-Hatton, S. (2014). Involving Parents in Cognitive-Behavioral Therapy for Child Anxiety Problems: A Case Study. Clinical Case Studies, 13(4), 322-335.
Velengtas, P., Mohr, P., & Messner, D. A. (Eds.). (2012). Making informed decisions: Assessing the strengths and weaknesses of study designs and analytic methods for comparative effectiveness research. National Pharmaceutical Council.
