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Preliminary Predictors of Within-Session Adherence to Exposure and Response Prevention in Pediatric Obsessive–Compulsive Disorder

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Abstract

Background

Cognitive-behavioral therapy with exposure and response prevention (ERP) is an effective treatment for pediatric OCD; however, up to 30 % of children are treatment non-responders and as many as 40 % are partial responders. Although poor treatment adherence has been linked to attenuated response in adults with OCD, little research has examined treatment adherence in pediatric OCD.

Objective

This study aimed to identify predictors of within-session treatment adherence in pediatric OCD.

Method

Independent raters coded 20 audiotaped psychotherapy sessions to assess for in-session adherence to ERP across three separate constructs: willingness to engage in exposure, response prevention, and within-session habituation. A number of baseline predictors were examined in relation to overall in-session adherence, including obsessive–compulsive symptom severity, family accommodation, and externalizing behavior.

Results

Higher levels of family accommodation and obsessive–compulsive symptom severity, but not externalizing behavior, were directly linked to poor in-session adherence, and the child’s willingness to participate in exposure drove these relationships. Mediational analyses suggested that obsessive–compulsive symptom severity mediated the relationship between family accommodation and in-session adherence to ERP.

Conclusions

Findings are preliminary but suggest that targeting family accommodation could increase compliance with exposure tasks, thus improving treatment outcome.

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Notes

  1. Hereinafter referred to as ERP, as this paper explores adherence to behavioral components of CBT specifically.

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Authors and Affiliations

  1. Department of Psychology, Georgia State University, Atlanta, GA, USA

    Jessica Morgan

  2. Department of Psychology, Temple University, Weiss Hall, 1701 N. 13th Street, Philadelphia, PA, 19122, USA

    Nicole E. Caporino

  3. Department of Psychology, University of South Florida, Tampa, FL, USA

    Alessandro S. De Nadai, Jennifer M. Park & Eric A. Storch

  4. Department of Pediatrics, University of South Florida, Tampa, FL, USA

    Tatyana Truax, Adam B. Lewin, Leah Jung, Yasmeen Ali Khan, Tanya K. Murphy & Eric A. Storch

  5. Department of Psychiatry, University of South Florida, Tampa, FL, USA

    Tanya K. Murphy & Eric A. Storch

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  1. Jessica Morgan
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  2. Nicole E. Caporino
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  3. Alessandro S. De Nadai
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  4. Tatyana Truax
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  5. Adam B. Lewin
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  10. Eric A. Storch
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Correspondence to Nicole E. Caporino.

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Morgan, J., Caporino, N.E., De Nadai, A.S. et al. Preliminary Predictors of Within-Session Adherence to Exposure and Response Prevention in Pediatric Obsessive–Compulsive Disorder. Child Youth Care Forum 42, 181–191 (2013). https://doi.org/10.1007/s10566-013-9196-z

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