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Does d-Cycloserine Augmentation of CBT Improve Therapeutic Homework Compliance for Pediatric Obsessive–Compulsive Disorder?

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Abstract

Clinical studies in adults and children with obsessive–compulsive disorder (OCD) have shown that d-cycloserine (DCS) can improve treatment response by enhancing fear extinction learning during exposure-based psychotherapy. Some have hypothesized that improved treatment response is a function of increased compliance and engagement in therapeutic homework tasks, a core component of behavioral treatment. The present study examined the relationship between DCS augmented cognitive-behavioral therapy (CBT) and homework compliance in a double-blind, placebo controlled trial with 30 youth with OCD. All children received 10 CBT sessions, the last seven of which included exposure and response prevention paired with DCS or placebo dosed 1 h before the session started. Results suggested that DCS augmented CBT did not predict improved homework compliance over the course of treatment, relative to the placebo augmented CBT group. However, when groups were collapsed, homework compliance was directly associated with treatment outcome. These findings suggest that while DCS may not increase homework compliance over time, more generally, homework compliance is an integral part of pediatric OCD treatment outcome.

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Acknowledgments

This work was supported by grants to the last author from the National Institutes of Health (MH076775; L40 MH081950-02) and National Alliance for Research on Schizophrenia and Affective Disorders (Robidoux Foundation Young Investigator Award). The authors would like to acknowledge the contributions of the following individuals: Michael Bengtson, M.D., Alex De Nadai, Alyssa Faro, Gary Geffken, Ph.D., Wayne K. Goodman, M.D., Aude Henin, Ph.D., Marni Jacob, Mark Lewis, Ph.D., Elizabeth Mancuso, Jamie Micco, Ph.D., Emily Ricketts, Susan Sprich, Ph.D., Sabine Wilhelm, Ph.D., and Mark Yang, Ph.D.

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  1. Department of Psychology, University of South Florida, 4202 E Fowler Ave, PCD 4118G, Tampa, FL, 33611, USA

    Jennifer M. Park

  2. School of Aging Studies, University of South Florida, Tampa, FL, USA

    Brent J. Small

  3. Department of Pediatric Psychopharmacology, Massachusetts General Hospital, Boston, MA, USA

    Daniel A. Geller

  4. Departments of Pediatrics and Psychiatry, University of South Florida, St Petersburg, FL, USA

    Tanya K. Murphy, Adam B. Lewin & Eric A. Storch

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Park, J.M., Small, B.J., Geller, D.A. et al. Does d-Cycloserine Augmentation of CBT Improve Therapeutic Homework Compliance for Pediatric Obsessive–Compulsive Disorder?. J Child Fam Stud 23, 863–871 (2014). https://doi.org/10.1007/s10826-013-9742-1

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