In this Papers Podcast, Dr. Matti Cervin discusses his JCPP paper ‘Efficacy and acceptability of cognitive-behavioral therapy and serotonin reuptake inhibitors for pediatric obsessive-compulsive disorder: a network meta-analysis’ (https://doi.org/10.1111/jcpp.13934). Matti is the lead author of the paper.
There is an overview of the paper, methodology, key findings, and implications for practice.
Discussion points include:
- The importance of examining efficacy and acceptability of cognitive-behavioural therapy and serotonin reuptake inhibitors in the context of the pediatric population.
- The two domains of treatments that have an evidence base for paediatric obsessive-compulsive disorder (OCD) – cognitive-behavioural therapy and medication.
- The difference between different forms of cognitive-behavioural therapy (CBT) delivery – traditional in-person, remote CBT, and internet-delivered CBT.
- Difference between in-person CBT and internet-delivered CBT.
- Implications for policymakers and child and adolescent mental health professionals.
In this series, we speak to authors of papers published in one of ACAMH’s three journals. These are The Journal of Child Psychology and Psychiatry (JCPP); The Child and Adolescent Mental Health (CAMH) journal; and JCPP Advances.
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I work as a senior clinical psychologist within the child and adolescent mental health services in Skåne (Southern Sweden) and as an associate professor at Lund University. I lead a research unit within CAMHS where we conduct large-scale projects of broad relevance to the field of pediatric mental health. The main aims of my research are to better understand what causes and maintains psychopathology in children and young people and how to most efficiently allocate available healthcare resources. I have a special interest in obsessive-compulsive disorder and anxiety disorders.
Transcript
[00:00:01.134] Jo Carlowe: Hello, welcome to the Papers Podcast series for the Association for Child and Adolescent Mental Health, or ACAMH for short. I’m Jo Carlowe, a Freelance Journalist with a specialism in psychology. In this series, we speak to authors of the papers published in one of ACAMH’s three journals. These are the Journal of Child Psychology and Psychiatry, commonly known as JCPP, the Child and Adolescent Mental Health, known as CAMH, and JCPP Advances.
Today, I’m interviewing Matti Cervin, a Senior Clinical Psychologist within the Child and Adolescent Mental Health Services in Skåne, Southern Sweden, and an Associate Professor of Child and Adolescent Psychiatry at Lund University. Matti is the first author of the paper, “Efficacy and Acceptability of Cognitive-Behavioral Therapy and Serotonin Reuptake Inhibitors for Pediatric Obsessive-Compulsive Disorder: a Network Meta-Analysis,” recently published in the JCPP. This paper will be the focus of today’s podcast.
If you’re a fan of our Papers Podcast series, please subscribe on your preferred streaming platform, let us know how we did, with a rating or review, and do share with friends and colleagues.
Matti, thank you for joining me. Can you start with an introduction about who you are and what you do?
[00:01:22.902] Dr. Matti Cervin: Yes, thanks for having me. My name is Matti, and I’m a Clinical Psychologist, or a General Psychologist from the beginning, but I have worked clinically for 15 years with children and adolescents within the psychiatric services here in Southern Sweden. And I’m also a Researcher, and my main focus is OCD, or obsessive-compulsive disorder, and mainly in children and adolescents, but, also, more and more across the lifespan.
As a Clinician I’ve worked broadly with children and adolescent, but mostly with OCD and anxiety disorders, and those kind of disorders. And, nowadays, I’m not seeing patients anymore, unfortunately, but I – so, I’m doing research full-time, so I am the PI of two large projects, ongoing, here at the clinic.
[00:02:06.908] Jo Carlowe: Thank you very much, and we’ll focus on some of your research today. So, we’re going to look at your JCPP paper, “Efficacy and Acceptability of Cognitive-Behavioral Therapy and Serotonin Reuptake Inhibitors for Pediatric Obsessive-Compulsive Disorder: a Network Meta-Analysis.” Before we go into the detail of the paper, Matti, can you explain why it is important to examine this in the context of the paediatric population?
[00:02:33.542] Dr. Matti Cervin: Yes, I think one of the important questions is about treatment, so we know quite a lot about how to assess and screen for obsessive-compulsive, OCD, symptoms in children, and we know quite a lot about treatment. And the best way to learn about treatment, I think, is to do randomised control trials. So, to randomise patients or families to different forms of interventions, and then to compare the outcomes. So, that is, kind of, the highest form of evidence within our field, to say something about if a treatment works and how well it does. And meta-analysis, that we did here, is trying to find all the RCTs, the randomised control trials, and put them together to, kind of, get an even better view of what works and what does not work, and how effective or efficious are different interventions.
So, I think why it is important is that we want to know what to offer families and children and adolescents with OCD. So, the novel thing here was that we tried to mix different types of studies. So studies examining cognitive behavioural therapy, which is the leading form, psychological treatment, for OCD, but also medication, SSRIs. We wanted to pool everything in one single study, and that can be done using this form or meta-analysis that is called ‘network meta-analysis’. And by doing that, then we could get some clearer answers, for example, whether CBT or medication is most effective.
And, also, meta-analysis, new studies are coming all the time, so it’s important to continue to do meta-analysis to, kind of, update the evidence base. So, there are plenty of meta-analysis on this topic, but after a couple of years they are, kind of, missing new studies. So, I think it was our attempt to do the best we could to really paint the clearest picture we could, given the studies, about which treatments are there for paediatric OCD, and which treatments, in a sense, should we offer.
[00:04:43.908] Jo Carlowe: Right, and are there plenty of studies on the paediatric community or have most – have these mostly focused on adults?
[00:04:51.302] Dr. Matti Cervin: I think commonly in psy – within psychiatry, most research is done with adults. Some disorders can be, kind of, a child focus, like neurodevelopmental disorders, but, commonly, most research is done with adults, and the research often start with adults and then go back to children and adolescents. And I think that’s a bit strange, because childhood and adolescence are crucial period for the onset of different kinds of mental disorders, including OCD. So I think knowing more about these disorders, their onset, their maintenance, and their treatment, in youth populations is very important.
So, I would say that within the OCD field, we are quite lucky, because there are plenty of RCTs, compared to other disorders, but I think we’re still, in a sense, maybe not as many as in the adult – on the adult side.
[00:05:44.708] Jo Carlowe: Okay, let’s turn to the paper itself. Can you give us an overview to set the scene?
[00:05:50.462] Dr. Matti Cervin: The overview for this paper is our attempt to really answer the question, “Which treatments work for paediatric OCD, and what is their relative efficacy?” So, if we compare CBT to medication, can we say something about which of these treatments are better? Going into the study, I would say that there are two treatments that have an evidence base for paediatric OCD, and those two are CBT, and a special form of CBT that includes what we call exposure and response prevention, so we often call it exposure-based CBT. Then there is medication, and, nowadays, most commonly, medication with SSRIs, but a few decades ago there were also studies with SRIs. Nowadays, selective serotonin reuptake inhibitors, previously they were not selective, they were just serotonin reuptake inhibitors.
So, I would say largely these two domains of treatment exist, but very few studies have compared them to each other. And then we also have another development that CBT have traditionally been conducted in-person, so we see a patient at the clinic, and we do stuff, hopefully exposure. But with the technological development, the internet, and cell phones, access to internet I would say is maybe the main thing, new forms of delivery of CBT have emerged. For example, CBT delivered via webcam, like we do today, or over the telephone. So, it’s, kind of, you’re having, like, an in-person session with the patient, but you’re doing it from different places. So, that is a new form of CBT that has been tried out in a couple of trials.
And then we have a even newer development that is called ‘internet-delivered CBT’, and that is a form of CBT that approaches more of a selp – self-help approach to treatment. So, the problem is with ICBT I would say is that it’s – or internet-delivered CBT, is that if a Therapist maybe puts down 60 or 90 minutes per week, traditionally, in internet-delivered CBT that might be 15 minutes. If that form of treatment works, we can save a lot of resources, and deliver treatment to more patients. The patients do not have to come to the clinic, and that can be an obstacle for many families, to have to drive to the clinic, or take the bus or train. So, both these, kind of, remotely delivered forms of CBT, over the phone, webcam, and, also, internet-delivered CBT has that advantage, that the families don’t have to come to the clinic.
So, a lot of new RCTs have emerged, but those new forms of CBT have often been pooled with traditional CBT. But we wanted to know if there are differences between different forms of CBT delivery, and the – and we divided the studies into three groups of delivery. What we call traditional, in-person, CBT, and then remotely delivered CBT, where the full treatment is delivered by phone or by webcam, and that mirrors the traditional treatment protocol, you often have one session per week, 60 minutes per week.
And then we have this third form of CBT, that is the internet-delivered CBT, where the families and the patients themselves do almost all of the work, and they work in a platform digitally, and they get all the information in writing, and maybe small movie clips and quizzes, and then they have support by a Therapist, but that is often by chat. So, three forms of CBT, in-person, remotely delivered, and internet-delivered, so we want to see if there are any differences between them.
[00:09:27.828] Jo Carlowe: Very interested to get to your findings, but is there anything you – more you want to tell us about the methodology that you use?
[00:09:33.800] Dr. Matti Cervin: Maybe a bit about the meta-analysis. I always want to do meta-analysis, because you learn so much from them, and I always forget how hard they are to conduct. So, what you do is that you search for all possible articles that could be relevant for your research question. And in this case there – it was the treatment of paediatric OCD, and studies in the form of randomised controlled trials.
So, what you do is that you do a search, and we found 4,000 articles that could be relevant, and then you have to screen all of them, just go through them. And then we look at the titles and the abstract, and then we find – I think we found about 250 articles that seemed, kind of, relevant, and then we looked at the full paper, so that was the next step. And then, in the end, I think we found maybe 30, 32 artic – I can’t remember exactly, 32 articles that published results from randomised controlled trials of paediatric OCD, and those were then included in the meta-analysis.
And then you have to do a lot of more stuff when that is done, so that is quite a hard process. Then you have to, of course, extract all the results from all the papers, but then you also have to evaluate each study. So, in a meta-analysis, you want to estimate what you think are the effects of different treatments and how they compared to each other, but then you also have to evaluate how strong the evidence is. So the quality of the evidence, because there can be, in quotation marks, ‘good’ and ‘bad’ RCTs, and we trust bad RCTs not as much as good RCTS.
Then you really have to dig into each study and see across several aspects or domains, what is the quality of this work? And then everything should be, kind of, mixed together. It’s quite hard to do meta-analysis, but you learn a lot, and I hope the field can learn something from them. And you also get a good sense of the quality of the research, so a good meta-analysis can also provide some guidance about what future Researchers should think about when they design studies.
[00:11:38.508] Jo Carlowe: So, let’s focus on the findings, what are the key findings that you would like to highlight?
[00:11:43.742] Dr. Matti Cervin: Given that CBT, traditional in-person CBT, and medication are the two major, dominant treatments for paediatric OCD, I think the results for those two treatments are important. And I would say that the study show that both these treatments have efficacy, compared to traditional controlled conditions. So, what we often do in RCTs that we randomise families to either a treatment that we, kind of, believe in, or a control condition that often we don’t believe as much in.
So, in medication trials, the control condition is often pill placebo, so the patient does not know if he or she gets the active medicine, or just a pill placebo. And, a very good thing about medication trials, the people providing the treatment does not know either, so that is the traditional control condition in medication trials. For CBT it’s a – it’s harder, because you can’t blind the people giving the treatment, you need to know what you do. So, then in CBT trials, we randomise either the CBT, or often to waitlist, so they don’t get anything basically, or something that is called ‘treatment as usual’, which is often not much either, people on treatment as usual seldom get evidence-based treatment.
Or, in the last decade within this field, we have also used a control condition that is relaxation training. So that we give the family something that has a content, that is based and directed towards OCD, but it’s not something that we actually think will help as much as the treatment, in this case, exposure-based CBT.
So, the big take home from the study, I would say that compared to these control conditions, pill placebo for medication, and waitlist, treatment as usual, and relaxation, it is quite clear that both CBT and medication yield better effects than those control conditions. So, that is, kind of, what we knew already. We could just show it that when we mix everything together and take all the studies that exist, and this is the largest meta-analysis by far that had been conducted, we can see this, CBT and medication are better than control conditions.
And, also, not just statistically significantly better, it’s also probably a difference that is clinically relevant. A benefit in this field is that all trials use the same measure to measure OCD, the Children’s Yale-Brown Obsessive-Compulsive Scale, CY-BOCS. So, we can really compare, so all studies use that measure, so we could see that medication compared to pill placebo, the families who got medication, I think they have, like – had, like a five-point lower score after treatment, or something like – I can’t remember exactly. But we also discussed that that is probably a clinically relevant difference, so it’s not only a statistically significant difference, the difference we found is probably also clinically relevant.
So, that is good, and in-person – traditional in-person CBT, yielded large differences compared to waitlist and pill placebo – waitlist and treatment as usual and pill placebo, I think, like, ten or 11 or 12 points lower on this score, which is a lot. That was good. We can see that these treatments that we work with every day, they are better than control conditions.
And then comes the question about are there – is there a difference between them? So, which is best, CBT or medication? And this is, kind of, highly debated, of course, it’s a complicated question why? But it’s something about the psychology part and psychiatry part, and – but there we found that in-person CBT appeared to have a better effect. They – people who got that treatment had lower scores on the severity measure after treatment than those with medication, but very few trials have directly compared it.
In network meta-analysis, you don – you can also do indirect comparisons. This is, kind of, a technical question, but if you have many trials, and some trials have compared CBT to waitlist, and other trials have compared CBT to medication, and some trials have compared medication to waitlist, for example, you can, kind of, mix everything together to see how each treatment fare against each other.
So, the CBT versus medication question was, kind of, left unclear. CBT yielded a three-point lower score on CY-BOCS, after treatment, but this difference was not statistical significant, so the uncertainty interval, or the confidence interval around this estimate included zero. And our confidence, that is an important thing in meta-analysis, our confidence in that estimate was also low. So we were a bit uncertain about what the ‘real’, between CBT and medication. I used a lot of words to explain this, but – so, in short, for the traditional treatments, in-person CBT and medication are efficious compared to control conditions. In-person CBT might be a little better than medication, don’t really know because there are too few trials.
[00:16:55.868] Jo Carlowe: Right, and did you find anything about the difference between in-person CBT and internet-delivered CBT?
[00:17:04.062] Dr. Matti Cervin: Yeah, and that was the other big domain, and this is novel in the study, this has never been done before. So, when we mixed all the data together, we also got comparisons when we compared traditional in-person CBT to these two forms of new delivery. So the remotely delivered, where the full treatment is delivered remotely, and the internet-based CBT.
And there we found that when the treatment was remotely delivered, it yielded very similar effects as traditional in-person CBT. But it was just a very small difference, and the confidence, I think it was a one or two-point difference after treatment, so that was, kind of, promising. It doesn’t look like you need to be in the same room as the patient to deliver the treatment. But, of course, also, quite – I think there are three, maybe four, trials, looking at remotely delivered CBT. So I think our confidence was not super high on that estimate, but I would still say that it’s promising, it looks like being in the same room is not necessary.
But then, of course, in the individual case, it might be necessary sometimes. In other cases, it’s probably better to not be in the same room. It’s better that the patient is in the place where they have their difficulties. That was the first finding, they don’t seem to differ in any meaningful way. When it comes to the comparison between in-person CBT and internet-delivered CBT, we found a significant difference between these two, indicating that in-person CBT was more effective.
[00:18:32.268] Jo Carlowe: And internet-delivered CBT refers to things like Therapist guided self-help?
[00:18:37.342] Dr. Matti Cervin: Yeah, that’s more of that, like, the family works through the treatment, more on their own, from their homes, often in front of their computers, on – or their – or on their phones, read text and look at movie clips, and then they get exercises that they should do. And they have the support of a Therapist, but that support is mostly through text messages. And we found that there was a signif – statistically significant difference between in-person CBT and internet-delivered CBT, indicating superiority of in-person CBT. And this contrast findings from adults, not only in OCD, but from all over the field, there are seldom differences between internet-delivered treatment and traditional-delivered treatment.
However, there are only two trials of internet-delivered CBT for children and adolescents with OCD. So, this was a real problem for the meta-analysis, because the first trial, the effect was not very good. They did not good – get good effect of the treatment, but in the second trial, that was published two years ago, the effect was much larger. And both of these studies are from the same research team, in Stockholm, so that is a bit worrying, in a sense, because we often want independent evidence.
But it’s also interesting, because I know many of them, and they work quite hard to improve the effect of the treatment. They, for example, did separate treatments for younger children and adolescents. They included things in the treatment like a focus on a sense of incompleteness, that is emotional feeling that many patients with OCD get. They worked really hard to improve the treatment, and they – it looks like they were able to do that. Maybe if only that study was included, we probably wouldn’t have found any difference, but now we had one study with, kind of, poor results, and the study with results that mirrored the effect of traditional in-person CBT. So, I would say this is also a clear result from the study, that we really need more trials on internet-delivered CBT.
[00:20:35.320] Jo Carlowe: Hmmm, it’s probably therefore too soon to ask this question, but I was wondering what the implications are for policymakers who may favour internet-delivered CBT just for resource reasons?
[00:20:48.702] Dr. Matti Cervin: A very good question. As a Researcher, I would say that the implications would be that you should be quite cautious, but then I also know from the clinical side that we have waiting lists and resources are few. The second trial of internet-delivered CBT was a very well-conducted trial and it was a large trial, so then we have that evidence, that we can get results from this treatment that, kind of, mirrors traditional CBT. But then, also, a thing with internet-delivered CBT trials is that many participants are recruited from Facebook and social media. And we don’t really know if that group of patients or clients is representative of the families we see within the psychiatric services.
So, I would say that my conclusion would be, for policy, that traditional in-person CBT should be – you should be able to offer that to everybody, but then, given your resources, you might want to try internet-delivered CBT. But then I would really contact these Researchers in Stockholm and see if you can get their treatment, the way they did it, and then, like everything within the healthcare, if you do something that is a little bit unclear how it works, you need to evaluate it. So, just see, see how it works.
[00:22:03.388] Jo Carlowe: So, your paper finds the combination of in-person CBT and medication may be most beneficial. What are the implications of the findings for CAMH professionals?
[00:22:15.582] Dr. Matti Cervin: Yeah, I forgot to mention that we also looked at the combination of CBT and medication. And that type of combined treatment was the treatment that appeared to be most effective, but, again, our confidence in that was quite low, because there are very few trials. I would say for Clinicians, it’s probably reassuring in a sense, many Clinicians think that the combination treatment is very indicated and the best treatment, and at least we couldn’t see that they were wrong in believing that.
So – and I think meta-analyses really have their place for policy, but in the day-to-day work with families, you need to really make a decision also based on what are the specific information on this patient, and the specific context for this family, and what have you tried before. So, even though we now in a meta-analysis can show really the big picture, when you work with families, you need to be a little bit flexible. So, I would say the clinical implication of this study is that everybody, in the best of worlds, should get in-person CBT, or the full treatment protocol delivered remotely.
And then, if that does not work – and here we know too little. So all these studies just looked at, like, the first treatment, if that does not work, then I think you should maybe try to add the medication, but, also, probably continue with CBT. In many countries, there are guidelines that say that if a patient has very severe problems, then you should offer combined treatment, but to my knowledge, there are no evidence supporting that really. So, I think an implication of this work is also that I don’t think we need more of these traditional RCTs anymore in this field. Now we know that in-person CBT and medication are moderately effective, but we need to know much more about the most severe patients, how can we help them?
The focus has also been a lot of symptoms of OCD, but we know that young people with OCD often have a lot of different problems, stress symptoms and problems with peers and problems in school, and we know that just helping people with OCD symptoms are seldom enough to really give them back a good life. So, I would also say that we need to learn more about the broad picture of these patients, and what healthcare services are needed to help them go through life in a good way, finish school, be able to get a job, etc.
Yeah, and I think general implications, clinically, is, first of all, try to identify young people with OCD, because OCD is still often missed within healthcare services, and even in psychiatric services. Always screen for it. Probably about 10% of all young people seen in CAMHS will meet criteria for OCD. Not all of them maybe you should prioritise to give treatment for OCD, but many of them you should. So, identify them. It’s quite an easy disorder to identify, you just have to ask specifically, and, when you do, you need to build your services so you are able to offer in-person CBT, or CBT delivered remotely and, also, have resources to offer medication.
And if you’re modern, maybe you want to integrate some kind of first step of internet-based CBT, or maybe if the family themselves feel like this would be something that suits us, maybe internet-delivered CBT could be integrated within the service delivery model. And, of course, in all patient work, you should evaluate the effects, but when – if you’re implementing internet-based CBT, I would be a little bit more careful to really evaluate it, just to see, and ask – and that does not have to be hard, you can ask the families, and probably also do like the CY-BOCS before and after treatment.
So, that is also a, I would say, a more meta-implication of this work, that if you work with young people with OCD, try to learn the CY-BOCS. Do it before treatment, it takes 20 minutes, 25, and do it after treatment, and then you get a good sense of the effect you have gotten in the individual case. But then, also, when you do that with all patients, you can see how well can we treat OCD at this clinic, and now we have, with this study and other studies, benchmarks, you can almost compare to what we find in RCTs, how do we fare?
[00:26:37.228] Jo Carlowe: Great, some really useful guidance there for Clinicians. Matti, is there anything else in the paper that you would like to highlight?
[00:26:45.102] Dr. Matti Cervin: Just a very technical issue, for all the RCT Researchers out there, I think when we evaluated our confidence in our results, we look at something called ‘risk of bias’, and that is specific for the specific study, and one area of risk of bias that is important is missing outcome data. So, let’s say that you have 100 patients in a study, and 50 of them get CBT and 50 get relaxation training, and then the treatment is initiated and maybe 12 or 16 weeks after initiation, the treatment is over. And then comes the results – come the results, so you – then you interview the patients again and see how they are, and that is the result of the trial.
And, at that stage, it’s very important to try to collect data from all participants in the study. So, when you don’t do that, that is called ‘missing outcome data’, and that is a very important part of the risk of bias assessment. And a lot of trials in this field had a lot of missing outcome data, and I think that is worth noting, because it doesn’t have to be that way. In many trials, they have underestimated the negative consequences of missing outcome data.
So, when you do R – an RCT, design it in a good way, with everything should be correct randomisation, etc., but then really put in resources to get that follow-up interview, or that post-treatment interview. So, even though they can’t come to the clinic, do it by phone. Just ask for, “Okay, maybe we don’t have to do the full 90 minutes, can we do this half an hour?” Like, the CY-BOCS. Because there are no good ways to really address that afterwards, you really need the data.
So, in trials that have acknowledged that, we often have, like, 95% of all outcome data is included, so 95% of all patients, we get outcome data from. And that is not because 95% have continued the study, or continued the treatment, often dropout is a little bit higher, but it’s still very important to get that outcome data.
[00:28:45.988] Jo Carlowe: I think it’s a really important point to highlight, so, thank you. Are there any specific recommendations that emerged from your research?
[00:28:53.902] Dr. Matti Cervin: Kind of boring recommendations that are already in place, like, young people with OCD should get offered CBT and/or medication. I would say if we look at the – not only this study, but the broader picture, for example, long-term outcomes, that we know too little about, and that is much more needed I think than ten new RCTs to see how these young people fare in the long-term. But if we look at long-term outcomes of treatments, I think we know that CBT effects appear to continue, so people who have responded to CBT seldom goes back and get a lot of OCD symptoms again. While we know too little about medication, and maybe medication that when you discontinue treatment that your symptoms can come back. Given everything, I would say that CBT’s – appears to be a very important treatment to be able to give to young people with OCD.
I would also say the remotely delivered in-person CBT is a new finding. That was, kind of, clear, in a sense, that it seemed to be conserved the effect of CBT delivered remotely. And that I feel as a Clinician, or as – ah, I just felt – that felt, kind of, good to know, okay, so we have always done that in specific cases, but now we know, okay, there are also studies that really show that this is a feasible way to deliver CBT.
[00:30:19.428] Jo Carlowe: So, important validation for that.
[00:30:22.485] Dr. Matti Cervin: Hmmm.
[00:30:22.508] Jo Carlowe: Are you planning any follow-up research, or is there anything else in the pipeline that you would like to share with us?
[00:30:27.960] Dr. Matti Cervin: My main interest in OCD research now is to, kind of, try to broaden the scope, to try to understand how it is delivered, OCD, and how OCD symptoms can affect different areas of life and quality of life and everyday functioning. And, actually, how important are the OCD symptoms and how important are other, kind of, mental health symptoms. I’ve worked so – for so many years within psychiatry, and we often get very focused on symptoms and severity. So we, kind of, forget that symptoms is just a very narrow part of a human being, that is the only one aspect.
Like, it’s almo – often not symptoms that matter the most, it’s, like, how is my life going? You can have a good life with symptoms, and you can have a very poor life without symptoms. But then, of course, mental health symptoms are always, kind of, a burden, but – so I’m interested in that more and more. Then I’m the PI of a very large longitudinal project that – where we follow children of parents with mental illness. So, that is a very large project, and it’s not specifically about OCD, but because I come from the OCD field, I think we will have a little bit extra focus in OCD in that.
So, that is about the development of mental disorders during childhood and adolescence. So we will follow children from age 8 to age 18, and half of the children in the study have two biological parents with mental disorders. And our guess is that a lot of these kids – or we know that a lot of these kids will develop a lot of difficulties.
[00:32:01.668] Jo Carlowe: Finally, what is your take home message for our listeners?
[00:32:05.582] Dr. Matti Cervin: If you work within health services where you see young people, and specifically if you work within mental health services, screen for OCD. It’s very easy to do. If you do it, clearly, you will find a lot of young people who needs help for OCD. And if you find it, try to have someone, or a little team, that learns how to do good exposure-based CBT, but it’s, kind of, a special treatment, it’s – exposure, many Clinicians are not very used to working with exposure.
So, try to find one or two or three persons that are interested in really getting to learn that, and there are often people you can just email or call, and they can have a little bit of education and so, do that. Identify the kids, try to give them some form of structured exposure-based CBT, evaluate how the young people – the effects of the treatment, using the CY-BOCS, and after three month, if there is not a clear response, offer medication as an addition to CBT. I would say that is my recommendation. And if a family lives far from the clinic, ask them how they want to receive the treatment. Say, “You can – we can do – we can have – we can meet here,” sometimes that’s good, to see a family in the office, or, “We can talk by phone, or by video.”
[00:33:24.228] Jo Carlowe: Brilliant. Matti, thank you ever so much. For more details on Matti Cervin, please visit the ACAMH website, www.acamh.org, and Twitter @ACAMH. ACAMH is spelt A-C-A-M-H, and don’t forget to follow us on your preferred streaming platform, let us know if you enjoy the podcast, with a rating or review, and do share with friends and colleagues.
