Kognitiv adfærdsterapi mod OCD: virker det?

I Danmark er det som bekendt ikke muligt at få hjælp til kognitiv adfærdsterapi hos en psykolog. I stedet har man fra politisk side valgt at opretholde brugerbetaling på dette område, dog har der på det sidste vist sig et muligt kursskifte efter at de konservative har skiftet standpunkt (det er lidt uklart om deres udspild vil indeholde psykologhjælp til psykisk syge børn og voksne). Venstre er dog stadig i mod (Se denne artikel), og spørgsmålet er om de konservative kan få overtalt finansministeren?

Et argument kunne være at se på om kognitiv adfærdsterapi overhovedet virker. Det ansete Cochrane Collaboration, der undersøger evidensbaseret behandling i hele verden, har publiceret en undersøgelse, hvor de gennegår forskellige undersøgelser for at se om en behandling virker. Forfatterne kom frem til følgende konklusion:

Although only based on a small number of studies, behavioural or cognitive-behaviour therapy appears to be a promising treatment for OCD in children and adolescents. It can lead to better outcomes when combined with medication compared to medication alone. Additional trials are needed to confirm these findings. In the interim, consideration should be given to the ways in which BT/CBT might be made more widely available as a treatment for OCD in children and adolescents.

Kilde: O’Kearney RT, Anstey KJ, von Sanden C. Behavioural and cognitive behavioural therapy for obsessive compulsive disorder in children and adolescents. Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No.: CD004856. DOI: 10.1002/14651858.CD004856.pub2. This version first published online: 18 October 2006 in Issue 4, 2006 Date of Most Recent Substantive Amendment: 22 August 2006 (Hvis du bor i Danmark har du adgang til Cochrane) Et andet væsentligt punkt er at det har vist sig at man i stedet for at henvise til kognitiv adfærdsterapi i stedet udskriver medicin i behandlingen af OCD, selvom kognitiv adfærdsterapi er mere effektiv sammen med medicin end medicin alene.

Carol A. Mathews, M.D., with the department of psychiatry at the University of California, San Francisco, called the systematic review ‘excellent’ and said it represents an important step forward in the understanding of the effectiveness of various types of treatment for pediatric OCD. Pediatric OCD is frequently underdiagnosed and undertreated, she said, and this could be because of limited treatment options parents have for their children. This study shows convincingly that CBT is superior to placebo, not only in reducing the number of OCD symptoms, but also in effecting remission in many cases. The study also shows that CBT plus medication is more effective than medication alone in children ‘an important confirmation of what has been believed clinically, but never proven,’ said Mathews, who was not involved with the study. ‘The results of this paper provide clinicians and parents with an additional effective treatment option – CBT or CBT plus medication – a treatment that involves only about 14 to 21 hours, in general,’ Mathews said. ‘Probably the most important issue related to our findings is that while the evidence suggests that CBT is as effective as medication, relatively few children and adolescents get CBT treatment,’ O’Kearney said. ‘Part of this is because of access and part is because primary care doctors often prescribe medicine before they refer patients to CBT. Hopefully this review will make them think more about this practice.’

Kilde: Newswise 15. oktober 2006 Se også: Medical News Today

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