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Controlled Comparison of Family Cognitive Behavioral Therapy and Psychoeducation/Relaxation Training for Child Obsessive-Compulsive Disorder

https://doi.org/10.1016/j.jaac.2011.08.003Get rights and content

Objective

To examine the efficacy of exposure-based cognitive-behavioral therapy (CBT) plus a structured family intervention (FCBT) versus psychoeducation plus relaxation training (PRT) for reducing symptom severity, functional impairment, and family accommodation in youths with obsessive-compulsive disorder (OCD).

Method

A total of 71 youngsters 8 to 17 years of age (mean 12.2 years; range, 8–17 years, 37% male, 78% Caucasian) with primary OCD were randomized (70:30) to 12 sessions over 14 weeks of FCBT or PRT. Blind raters assessed outcomes with responders followed for 6 months to assess treatment durability.

Results

FCBT led to significantly higher response rates than PRT in ITT (57.1% vs 27.3%) and completer analyses (68.3% vs. 35.3%). Using HLM, FCBT was associated with significantly greater change in OCD severity and child-reported functional impairment than PRT and marginally greater change in parent-reported accommodation of symptoms. These findings were confirmed in some, but not all, secondary analyses. Clinical remission rates were 42.5% for FCBT versus 17.6% for PRT. Reduction in family accommodation temporally preceded improvement in OCD for both groups and child functional status for FCBT only. Treatment gains were maintained at 6 months.

Conclusions

FCBT is effective for reducing OCD severity and impairment. Importantly, treatment also reduced parent-reported involvement in symptoms with reduced accommodation preceding reduced symptom severity and functional impairment.

Clinical Trials Registry Information

Behavior Therapy for Children and Adolescents with Obsessive-Compulsive Disorder (OCD); http://www.clinicaltrials.gov; NCT00000386.

Section snippets

Study Design

A total of 71 children and adolescents were randomly assigned to 12 sessions over 14 weeks of FCBT or PRT. An unbalanced randomization scheme (70:30) was employed to minimize the number of subjects receiving comparison treatment and to facilitate planned within-group secondary analyses examining therapeutic process in FCBT. The unbalanced randomization was taken into account in study power calculations. In total, 49 participants were randomized to FCBT and 22 to PRT. The trial was approved by

Sample Characteristics

A total of 76 youngsters completed the initial assessment, of whom 71 were deemed eligible and randomized to FCBT or PRT (Figure 1). The two groups did not differ on any demographic or clinical variables at baseline. The mean age of the participants was 12.2 years (SD = 2.5 years); 36.6% were male, and 77.5% were Caucasian. Approximately 25% of the sample had a prior history of psychotropic medication use, and six individuals (8.5%) were on stable regimens of non-OCD medications at study entry (

Discussion

This study tested the efficacy of a family-focused CBT protocol (FCBT) for pediatric OCD compared with a credible psychosocial comparison treatment involving OCD psychoeducation and relaxation training (PRT). As expected, primary analyses found that youth receiving FCBT demonstrated larger overall response rates and more rapid reduction of OCD symptom severity and child-reported functional impairment than those receiving PRT. Moreover, FCBT was associated with more rapid decreases in family

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  • Cited by (0)

    This article was reviewed under and accepted by Ad Hoc editor Daniel S. Pine, M.D.

    This study was funded by National Institute of Mental Health grant R01MH58549-01 (J.P.).

    The authors wish to acknowledge Tami Roblek, Ph.D, University of Colorado at Denver and Health Sciences Center, and all of the therapists, interviewers, research coordinators, and consultants who were part of this study. Special gratitude is also extended to the children and families who participated in this research.

    Disclosures: Dr. Piacentini has received grant support from the National Institute of Mental Health (NIMH), the Tourette Syndrome Association (TSA), and the Obsessive Compulsive Foundation. He has received royalties from Oxford University Press, including the manuals described in this paper, Guilford Press, and the American Psychological Association. He has served on the speakers' bureau for the TSA. He has served as a consultant to Bayer Schering Pharma. Dr. Bergman has received research support from the National Alliance for Research on Schizophrenia and Depression (NARSAD). Dr. Chang has received grant support from NIMH and the TSA. She has served on the speakers' bureau for the TSA. She has received royalties from Oxford University Press. Dr. Langley has received research support from NIMH and the Substance Abuse and Mental Health Services Administration. She has received royalties from Oxford University Press for the manuals described in this paper. Dr. Peris has received research support from NIMH and NARSAD. Dr. Wood has received grant support from NIMH, the Organization for Autism Research, and Autism Speaks. He has received royalties from WW Norton and Company. Dr. McCracken has received research support from NIMH, Bristol-Myers Squibb, Aspect, and Seaside Pharmaceuticals. She has served as a consultant to Novopharm and BioMarin. She has served on the speakers' bureau for the TSA, Veritas, and CME Outfitters.

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