The role of treatment expectancy in youth receiving exposure-based CBT for obsessive compulsive disorder,

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Abstract

The purpose of this investigation was to examine correlates of parent, child, and therapist treatment expectations and their role in the exposure-based treatment of childhood obsessive compulsive disorder (OCD). Treatment expectations were assessed among 49 youth with primary OCD, their parents, and therapists as part of the baseline evaluation and post-treatment clinical outcomes were determined by blind evaluators. Baseline depressive symptoms, child/parent-rated functional impairment, externalizing behavior problems, number of comorbid psychiatric disorders, and a lower perception of control were associated with lower pre-treatment expectations. Parent expectation was associated with parental OCD symptoms, child depressive symptoms and child-reported impairment. Therapist expectations inversely correlated with child depressive symptoms, externalizing problems, and child-rated impairment. Pre-treatment OCD severity and prior treatment history were not linked to expectancy. Finally, higher treatment expectations were linked to better treatment response, lower attrition, better homework compliance, and reduced impairment.

Highlights

► We examined child, parent, and therapist expectancy for CBT for OCD. ► Increased child/therapist expectation correlated with greater improvement after CBT. ► Higher expectancy was linked to lower attrition and better homework compliance. ► Lower expectations were found in youth with depressive or externalizing symptoms. ► Pre-treatment OCD severity did not lower expectations for CBT.

Section snippets

Participants

Our sample consisted of 71 youth with OCD and their parents who participated in a randomized controlled treatment trial (registered on clinical trials.gov #NCT00000386) conducted at a university medical center-based OCD specialty program (Piacentini et al., under review). The current study focused on 49 youth (59% male) who received exposure-based CBT and the demographic data below correspond to these youth. Mean age for the sample was twelve years (SD = 2.6 years, range = 8–17 years) with an

Evaluation of study hypotheses

Are higher levels of OCD-symptom severity and functional impairment associated with lower expectations of treatment? Child ratings of OCD-specific functional impairment were negatively correlated with child and therapist expectancies. Expectancy was not correlated with baseline OCD severity. Data are presented in Table 1.

Are higher levels of comorbidity associated with reduced treatment expectations? Higher child-rated symptoms of depression (at baseline) were associated with lower expectancy

Discussion

The present investigation examined clinical and demographic correlates of parent, child, and therapist treatment expectations and links between expectancies and treatment outcome for youth receiving CBT for OCD. We hypothesized that higher levels of child OCD-symptom severity, comorbidity, parental OCD, and prior OCD treatment would be associated with lower expectations of treatment for all three respondents. As expected, parents endorsing their own OCD symptoms had lower expectations of their

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      Moreover, there does not currently exist a widely used, standardized measure of treatment homework completed outside of session (Mausbach, Moore, Roesch, Cardenas, & Patterson, 2010; Wheaton & Chen, 2021). Many past studies have measured this construct using clinician-rated Likert-type scales (e.g., Lewin, Peris, Bergman, McCracken, & Piacentini, 2011; Selles et al., 2018), although a few studies have used patient-report data (e.g., Westra, Dozois, & Marcus, 2007), and a few have used objective measures such as the number of homework assignments turned in (e.g., Woods, Chambless, & Steketee, 2002). In this study, we opt to use the term “homework adherence” rather than “homework compliance” to more clearly acknowledge the existence of barriers to homework completion and reduce undue emphasis on the motivation of patients and families.

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    This research was conducted at the UCLA Semel Institute, 760 Westwood Plaza, Los Angeles, CA 90024, USA.

    This research was funded by: NIMH R01MH 58459 (Piacentini), NIMH T-32 Fellowships (Lewin, Peris), grants from the Joseph Drown Foundation & Friends of the Semel Institute Fellowship (Lewin), NARSAD Young Investigator Awards (Lewin, Peris), and NIMH K23 MH085058 (Peris).

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