Top

Research on Child and Adolescent Psychopathology

Gepubliceerd in:

01-04-2015

Exposure and Response Prevention Process Predicts Treatment Outcome in Youth with OCD

Auteurs: Katharina Kircanski, Tara S. Peris

Gepubliceerd in: Research on Child and Adolescent Psychopathology | Uitgave 3/2015

Abstract

Recent research on the treatment of adults with anxiety disorders suggests that aspects of the in-session exposure therapy process are relevant to clinical outcomes. However, few comprehensive studies have been conducted with children and adolescents. In the present study, 35 youth diagnosed with primary obsessive-compulsive disorder (OCD; M age = 12.9 years, 49 % male, 63 % Caucasian) completed 12 sessions of exposure and response prevention (ERP) in one of two treatment conditions as part of a pilot randomized controlled testing of a family focused intervention for OCD. Key exposure process variables, including youth self-reported distress during ERP and the quantity and quality of ERP completed, were computed. These variables were examined as predictors of treatment outcomes assessed at mid-treatment, post-treatment, and three-month follow-up, partialing treatment condition. In general, greater variability of distress during ERP and completing a greater proportion of combined exposures (i.e., exposures targeting more than one OC symptom at once) were predictive of better outcomes. Conversely, greater distress at the end of treatment was generally predictive of poorer outcomes. Finally, several variables, including within- and between-session decreases in distress during ERP, were not consistently predictive of outcomes. Findings signal potentially important facets of exposure for youth with OCD and have implications for treatment. A number of results also parallel recent findings in the adult literature, suggesting that there may be some continuity in exposure processes from child to adult development. Future work should examine additional measures of exposure process, such as psychophysiological arousal during exposure, in youth.

vorige artikel Kindergarteners’ Self-Reported Social Inhibition and Observed Social Reticence: Moderation by Adult-Reported Social Inhibition and Social Anxiety Disorder Symptoms

volgende artikel Why Wait? The Effect of Wait-Times on Subsequent Help-Seeking Among Families Looking for Children’s Mental Health Services

Due to therapists not fully completing the Session Summary Sheet, there were missing values for initial distress (1 participant), decrease in distress across tasks within session through mid-treatment (1 participant), between-session decrease in distress through mid-treatment (4 participants) and post-treatment (2 participants), variability in distress through post-treatment (1 participant), and final distress through mid-treatment (6 participants) and post-treatment (3 participants). In addition, across the full sample a total of 39 sessions did not include ERP or associated therapist ratings. Twenty-two of these cases occurred in Sessions 3–11, and the majority were isolated sessions in which treatment focused on mastering associated skills (e.g., cognitive restructuring). The other 17 cases occurred in Session 12, in which treatment focused instead on relapse prevention.

Due to participants who completed one ERP task per session in all sessions, decrease in distress across tasks within session and variability in distress values were coded as missing through mid-treatment (4 participants) and post-treatment (3 participants).

Abramowitz, J. S. (1996). Variants of exposure and response prevention in the treatment of obsessive-compulsive disorder: A meta-analysis. Behavior Therapy, 27, 583–600.CrossRef

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders, text revision (4th ed.). Washington, DC: Author.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.CrossRef

Baker, A., Mystkowski, J., Culver, N., Yi, R., Mortazavi, A., & Craske, M. G. (2010). Does habituation matter? Emotional processing theory and exposure therapy for acrophobia. Behaviour Research and Therapy, 48, 1139–1143.CrossRefPubMedCentralPubMed

Benito, K. G., Conelea, C., Garcia, A. M., & Freeman, J. B. (2012). CBT specific process in exposure-based treatments: Initial examination in a pediatric OCD sample. Journal of Obsessive Compulsive and Related Disorders, 1, 77–84.CrossRefPubMedCentralPubMed

Bjork, R. A., & Bjork, E. L. (2006). Optimizing treatment and instruction: Implications of a new theory of disuse. In L.-G. Nilsson & N. Ohta (Eds.), Memory and society: Psychological perspectives (pp. 116–140). New York: Psychology Press.

Craske, M. G. (1999). Anxiety disorders: Psychological approaches to theory and treatment. Boulder: Westview Press.

Craske, M. G., Kircanski, K., Zelikowski, M., Mystkowski, J., Chowdhury, N., & Baker, A. (2008). Optimizing inhibitory learning during exposure therapy. Behaviour Research and Therapy, 46, 5–27.CrossRefPubMed

Culver, N. C., Stoyanova, M., & Craske, M. G. (2012). Emotional variability and sustained arousal during exposure. Journal of Behavior Therapy and Experimental Psychiatry, 43, 787–793.CrossRefPubMed

Faul, F., Erdfelder, E., Lang, A.-G., & Buchner, A. (2007). G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods, 39, 175–191.CrossRefPubMed

Foa, E. B., & Kozak, M. (1986). Emotional processing of fear: Exposure to corrective information. Psychological Bulletin, 99, 450–472.CrossRef

Foa, E. B., & McNally, R. J. (1996). Mechanisms of change in exposure therapy. In R. Rapee (Ed.), Current controversies in the anxiety disorders (pp. 329–343). New York: Guilford.

Foa, E., Steketee, G., Grayson, J., Turner, R., & Latimer, P. (1984). Deliberate exposure and blocking of obsessive compulsive rituals: Immediate and long-term effects. Behavior Therapy, 15, 450–472.CrossRef

Freeman, J., Garcia, A., Frank, H., Benito, K., Connolea, C., Walther, M., et al. (2014). Evidence base update for psychosocial treatments for pediatric obsessive-compulsive disorder. Journal of Clinical Child and Adolescent Psychology, 43, 7–26.CrossRefPubMed

Geller, D., & March, J. (2012). Practice parameter for the assessment and treatment of children and adolescents with obsessive-compulsive disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 51, 98–113.CrossRef

Green, B., Shirk, S., Hanze, D., & Wanstrath, J. (1994). The Children’s Global Assessment Scale in clinical practice: An empirical evaluation. Journal of the American Academy of Child and Adolescent Psychiatry, 33, 1158–1164.CrossRefPubMed

Groves, P. M., & Thompson, R. F. (1970). Habituation: A dual process theory. Psychological Review, 77, 419–450.CrossRefPubMed

Hayes, S. A., Hope, D. A., & Heimberg, R. G. (2008). The pattern of subjective anxiety during in-session exposures over the course of cognitive-behavioral therapy for clients with social anxiety disorder. Behavior Therapy, 39, 286–299.CrossRefPubMedCentralPubMed

Hedtke, K. A., Kendall, P. C., & Tiwari, S. (2009). Safety-seeking and coping behavior during exposure tasks with anxious youth. Journal of Clinical Child and Adolescent Psychology, 38, 1–15.CrossRefPubMed

Kendall, P., & Hedtke, K. (2006). Cognitive-behavioral therapy for anxious children: Therapist manual (3rd ed.). Ardmore: Workbook Publishing.

Kendall, P. C., Robin, J., Hedtke, K., Suveg, C., Flannery-Schroeder, E., & Gosch, E. (2005). Considering CBT with anxious youth? Think exposures. Cognitive and Behavioral Practice, 12, 136–148.CrossRef

Kircanski, K., Mortazavi, A., Castriotta, N., Baker, A. S., Mystkowski, J. L., & Yi, R. (2012). Challenges to the traditional exposure paradigm: Variability in exposure therapy for contamination fears. Journal of Behavior Therapy and Experimental Psychiatry, 43, 745–751.CrossRefPubMed

Kircanski, K., Wu, M., & Piacentini, J. (2014). Reduction of subjective distress in CBT for childhood OCD: Nature of change, predictors, and relation to treatment outcome. Journal of Anxiety Disorders, 28, 125–132.CrossRefPubMedCentralPubMed

Knox, L., Albano, A., & Barlow, D. (1996). Parental involvement in the treatment of childhood compulsive disorder: A multiple-baseline examination incorporating parents. Behavior Therapy, 27, 93–114.CrossRef

Lang, A. J., & Craske, M. G. (2000). Manipulations of exposure-based therapy to reduce return of fear: A replication. Behaviour Research and Therapy, 38, 1–12.CrossRefPubMed

Meyer, V. (1966). Modification of expectations in cases with obsessive rituals. Behavioral Research and Therapy, 4, 270–280.CrossRef

Moore, P. S., Mariaskin, A., March, J., & Franklin, M. E. (2007). Obsessive compulsive disorder in children and adolescents: Diagnosis, comorbidity, and developmental factors. In E. A. Storch, G. R. Geffken, & T. K. Murphy (Eds.), Handbook of child and adolescent obsessive-compulsive disorder (pp. 17–45). Mahwah: Lawrence Erlbaum Associates Publishers.

National Institute of Mental Health. (1985). Clinical global impression scale. Psychopharmacology Bulletin, 21, 839–843.

Norton, P. J., Hayes-Skelton, S. A., & Klenck, S. C. (2011). What happens in session does not stay in session: Changes within exposures predict subsequent improvement and dropout. Journal of Anxiety Disorders, 25, 654–660.CrossRefPubMedCentralPubMed

Peris, T. S., & Piacentini, J. C. (2013). Optimizing treatment for complex cases of childhood obsessive compulsive disorder: A preliminary trial. Journal of Clinical Child and Adolescent Psychology, 42, 1–8.CrossRefPubMedCentralPubMed

Peris, T. S., Sugar, C. A., Bergman, R. L., Chang, S., Langley, A., & Piacentini, J. (2012). Family factors predict treatment outcome for pediatric obsessive compulsive disorder. Journal of Consulting and Clinical Psychology, 80, 255–263.CrossRefPubMedCentralPubMed

Piacentini, J., Bergman, R. L., Keller, M., & McCracken, J. (2003). Functional impairment in children and adolescents with obsessive-compulsive disorder. Journal of Child and Adolescent Psychopharmacology, 13(Suppl. 1), 61–69.CrossRef

Piacentini, J., Langley, A., & Roblek, T. (2007). Cognitive-Behavioral Treatment of Childhood OCD. New York: Oxford University Press.CrossRef

Piacentini, J., Bergman, R. L., Chang, S., Langley, A., Peris, T., Wood, J., et al. (2011). Controlled comparison of family cognitive behavioral therapy and psychoeducation=relaxation-training for child OCD. Journal of the American Academy of Child and Adolescent Psychiatry, 50, 1149–1161.CrossRefPubMedCentralPubMed

Rachman, S. (1994). The overprediction of fear: A review. Behaviour Research and Therapy, 32(7), 683–690.CrossRefPubMed

Rachman, S., & Bichard, S. (1988). The overprediction of fear. Clinical Psychology Review, 8, 303–312.CrossRef

Rescorla, R. A. (2006). Deepened extinction from compound stimulus presentation. Journal of Experimental Psychology: Animal Behavior Processes, 32, 135–144.PubMed

Rescorla, R. A., & Wagner, A. R. (1972). A theory of Pavlovian conditioning: Variations in the effectiveness of reinforcement and nonreinforcement. In A. H. Black & W. F. Prokasy (Eds.), Classical conditioning II: Current research and theory (pp. 64–99). New York: Appleton.

Rowe, M. K., & Craske, M. G. (1998). Effects of varied-stimulus exposure training on fear reduction and return of fear. Behaviour Research and Therapy, 36, 719–734.CrossRefPubMed

Scahill, L., Riddle, M. A., McSwiggan-Hardin, M. T., Ort, S. I., King, R. A., Goodman, W. K., et al. (1997). Children’s Yale–brown obsessive compulsive scale: Reliability and validity. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 844–852.CrossRefPubMed

Shaffer, D., Gould, M. S., Brasic, J., Ambrosini, P., Fisher, P., Bird, H., et al. (1983). A children’s global assessment scale (CGAS). Archives of General Psychiatry, 40, 1228–1231.CrossRefPubMed

Silverman, W., & Albano, A. M. (1996). Anxiety disorders interview schedule for DSM-IV: Parent version. San Antonio: Graywing.

Silverman, W., Saavedra, L., & Pina, A. (2001). Test-retest reliability of anxiety symptoms and diagnoses with anxiety disorders interview schedule for DSM-IV: Child and parent versions. Journal of the American Academy of Child and Adolescent Psychiatry, 40(8), 937–944.CrossRefPubMed

Stanley, M. A., & Turner, S. M. (1995). Current status of pharmacological and behavioral treatment of obsessive-compulsive disorder. Behavior Therapy, 26, 163–186.CrossRef

Storch, E., Murphy, T., Geffken, G., Soto, O., Sajid, M., Allen, P., et al. (2004). Psychometric evaluation of the children’s Yale-brown obsessive-compulsive scale. Psychiatry Research, 129, 91–98.CrossRefPubMed

Valleni-Basile, L. A., Garrison, C. Z., Jackson, K. L., Waller, J. L., McKeown, R. E., Addy, C. L., et al. (1994). Frequency of obsessive-compulsive disorder in a community sample of young adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 33, 782–791.CrossRefPubMed

Van Hout, W. J., & Emmelkamp, P. M. (1994). Overprediction of fear in panic disorder patients with agoraphobia: Does the (mis) match model generalize to exposure invivo therapy? Behaviour Research and Therapy, 32, 723–734.CrossRefPubMed

Wolpe, J. (1973). The practice of behavior therapy. London: Pergamon Press.

Titel: Exposure and Response Prevention Process Predicts Treatment Outcome in Youth with OCD
Auteurs: Katharina Kircanski
Tara S. Peris
Publicatiedatum: 01-04-2015
Uitgeverij: Springer US
Gepubliceerd in: Research on Child and Adolescent Psychopathology / Uitgave 3/2015
Print ISSN: 2730-7166
Elektronisch ISSN: 2730-7174
DOI: https://doi.org/10.1007/s10802-014-9917-2

Bohn Stafleu van Loghum

Deel dit onderdeel of sectie (kopieer de link)

Abstract

Log in om toegang te krijgen

Andere artikelen Uitgave 3/2015

Irritable and Defiant Sub-Dimensions of ODD: Their Stability and Prediction of Internalizing Symptoms and Conduct Problems from Adolescence to Young Adulthood

Physical and Sexual Abuse and Early-Onset Bipolar Disorder in Youths Receiving Outpatient Services: Frequent, but Not Specific

Re-visiting Internet Addiction among Taiwanese Students: A Cross-Sectional Comparison of Students’ Expectations, Online Gaming, and Online Social Interaction

Stress Sensitivity Interacts with Depression History to Predict Depressive Symptoms Among Youth: Prospective Changes Following First Depression Onset

Parental Perfectionism and Overcontrol: Examining Mechanisms in the Development of Child Anxiety

The Role of Individual and Collective Moral Disengagement in Peer Aggression and Bystanding: A Multilevel Analysis