Aims of the POTS study

The POTS study, conducted by March et al. in 2004, aimed to evaluate the effectiveness of cognitive behavioural therapy (CBT) alone, medical management with sertraline alone, or a combination of CBT and sertraline, as initial treatments for children and adolescents with OCD.

Participants in the POTS study

The study involved a volunteer outpatient sample.

Key details about participants:

• Number and age range - 112 patients aged between 7 and 17 years.
• Diagnosis - All had a confirmed diagnosis of OCD according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV).
• Symptom severity - Participants scored 16 or higher on the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS).
• Recruitment - Participants were drawn from three academic centres in the United States.

Participants were randomly assigned by computer to one of four groups: CBT alone, sertraline alone, combined CBT and sertraline, or a pill placebo.

Method used in the POTS study

The POTS study used an experimental design to test the treatments over 12 weeks. Changes in OCD symptom severity were assessed using the CY-BOCS at baseline and at weeks 4, 8, and 12 by an independent evaluator.

Procedure for each treatment condition

The procedure varied by group but lasted 12 weeks for all. Treatments were delivered in outpatient settings.

CBT alone

• Consisted of 14 visits over 12 weeks.
• Involved psycho-education, cognitive training, mapping OCD target symptoms, and exposure and response prevention.
• Each session included setting goals, reviewing the previous week, providing new information, and assigning homework.
• Parents were fully involved in sessions 1, 7, and 11.

Sertraline alone (medical management)

• Participants met with one child and adolescent psychiatrist throughout the study.
• The psychiatrist monitored symptoms, medication effects, and offered general encouragement to resist OCD.
• Visits were weekly for the first six weeks, then every other week, totaling nine visits over 12 weeks.
• This condition focused on drug therapy without formal psychotherapy.

Combined CBT and sertraline

• Both CBT and medication management started at the same time.
• Visits were scheduled together to reduce inconvenience for patients and parents, improving adherence.
• Combined the elements of the CBT and sertraline procedures described above.

Placebo condition

• Similar to sertraline alone but with an inactive pill instead of the drug.
• Included the same visit schedule and supportive monitoring by a psychiatrist.

Results of the POTS study

The study produced clear findings on treatment effectiveness, with high completion rates.

Key results:

• Completion rate - Ninety-seven of 112 patients (87%) completed the full 12 weeks.
• Effectiveness compared to placebo - CBT alone, sertraline alone, and combined treatment all showed a statistically significant advantage over placebo.
• Comparison between active treatments - Combined treatment was superior to both CBT alone and sertraline alone. However, CBT alone and sertraline alone did not differ significantly from each other.
• Tolerability - All three active treatments were well tolerated and acceptable to participants, with no signs of treatment-related harm, such as self-harm or harm to others.

These results highlight that active interventions outperform placebo, with combination therapy often providing the best outcomes.

Conclusions from the POTS study

Based on the findings, the researchers drew important recommendations for treating OCD in young people.

Main conclusions

• Patients receiving CBT, either alone or combined with sertraline, had a higher chance of symptom improvement.
• Combination treatment generally offered the best results, showing an edge over CBT alone in one site, but not in another.

Recommendations

• Children and adolescents with OCD should start treatment with either a combination of CBT and a selective serotonin reuptake inhibitor, or CBT alone.