Graduation Year

2011

Document Type

Thesis

Degree

M.A.

Degree Granting Department

Psychology

Major Professor

Eric A. Storch

Co-Major Professor

Vicky Phares

Keywords

Adolescents, Children, Exposure and Response Prevention, Psychotherapy, Treatment Adherence

Abstract

D-cycloserine (DCS), a partial agonist that acts on the N-methyl-D-aspartate (NMDA) receptor of the glutamatergic receptor complex, may enhance fear extinction learning during exposure-based therapy. Clinical studies in adults with obsessive-compulsive disorder (OCD) and non-OCD anxiety disorders - and a recent trial in pediatric OCD - have shown that DCS can improve treatment response to exposure therapy relative to placebo and exposure therapy. 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 and homework compliance in a 10-week, double-blind, placebo controlled DCS+CBT treatment trial with 30 children and adolescents with a primary diagnosis of OCD. D-cycloserine was dosed 25 or 50mg (depending on weight) one hour before therapy sessions 4-10. Group status (DCS or placebo) did not predict improved homework compliance over the course of treatment. However, significant group differences in homework compliance were found at the first exposure session. Additionally, homework compliance mediated the relationship between DCS and treatment outcome. When groups were collapsed, homework compliance was directly associated with treatment outcome. These findings suggest that outside the context of DCS, homework compliance is an integral part of OCD treatment.

Share

COinS