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day of citalopram, fluoxetine, and paroxetine, 6 100 mg/day of clomipramine, 6 20 mg/day of escitalopram, 6 200 mg/day of fluvoxamine and sertraline, and 6 250 mg/day of venlafaxine. Exclusion criteria were a lifetime diagnosis of schizophrenia or other psychotic disorders, mental retardation, or an organic brain syndrome. All patients gave written informed consent, and a local ethical committee approved the research project. Patients maintained the same drug and dosage while CBT was added (exposure and response prevention; cognitive therapy and other ad hoc interventions were used when necessary). Patients were treated in a naturalistic setting in the sense that manualized guidelines [18] were adapted to each patient by taking due account of the insight level into the senselessness of OCD symptoms, treatment adherence, and the presence of Axis I disorders. The therapist and the patient scheduled therapy sessions flexibly and jointly. CBT duration was not fixed in advance. The primary outcome was Y-BOCS change from the beginning of CBT to the endpoint. CGI-S and GAF scores (although poorly validated) were also used. Response was defined as a Y-BOCS decrease 6 25% and remission as a Y-BOCS decrease

Effectiveness of Cognitive-Behavioral Therapy Addition to Pharmacotherapy in Resistant Obsessive-Compulsive Disorder: A Multicenter Study