Articles
Cognitive-Behavioral Family Treatment of Childhood Obsessive-Compulsive Disorder: Long-Term Follow-up and Predictors of Outcome

https://doi.org/10.1097/01.chi.0000172555.26349.94Get rights and content

ABSTRACT

Objective

The aims were to (1) evaluate the long-term durability of individual and group cognitive-behavioral family therapy for childhood obsessive-compulsive disorder and (2) investigate pretreatment predictors of long-term outcome.

Method

Undertaken at a university-based clinic, this study involved 48 participants (8-19 years old) who had received individual or group cognitive-behavioral family therapy. Participants and parents were assessed at 12 and 18 months following treatment with standardized assessments, including diagnostic and symptom severity interviews, child self-report measures of anxiety and depression, and parental self-report of distress. Pretreatment data were used for the prediction of long-term outcome.

Results

Analyses indicated treatment gains were maintained, with a total of 70% of participants in individual therapy and 84% in group therapy diagnosis free at follow-up. There were no significant differences between the individual or group conditions across measures. Results indicated that higher pretreatment severity and higher family dysfunction predicted worse long-term outcome.

Conclusions

The results suggest that cognitive-behavioral family therapy for obsessive-compulsive disorder provides long-term relief that it is equally effective in individual and group-based therapy. Focusing on family dysfunction may improve long-term prognosis.

Section snippets

Participants

A total of 77 white children and adolescents (7-17 years old), diagnosed with OCD were involved in the original treatment study and the 3- to 6-month follow-up (Barrett et al., 2004). The sample was diverse in terms of socioeconomic background, with combined parental incomes ranging from <$21, 000 to >$91,000 (mean = $41,000-$51,000). The original sample comprised 24 participants who received individual CBFT, 29 participants who received group CBFT, and a final 24 involved in the waitlist

RESULTS

Because of the wide age range of participants involved in this study (i.e., 8-19 years), initial analyses were conducted using a 2 (treatment condition: individual, group) × 2 (age group: children, adolescents) × 3 (time: post, 12-month, 18-month) repeated-measures design. Results of these analyses indicated that there were no significant group × age × time interactions, and as such, results related to age are not reported here. Also, because of the large number of analyses undertaken in the

DISCUSSION

Treatment condition (individual versus group therapy) did not predict whether participants were more or less likely to meet diagnostic criteria at 12- and 18-month follow-up, suggesting that individual and group treatment delivery was equally effective long-term. Investigation of additional treatments commenced during the follow-up period indicated that the large majority of participants had not received or begun any additional therapy or medication since the completion of active treatment.

REFERENCES (50)

  • JS March et al.

    Test-retest reliability of the Multidimensional Anxiety Scale for Children

    J Anxiety Disord

    (1999)
  • J Piacentini et al.

    Obsessive-compulsive disorder in children

    Psychiatr Clin North Am

    (2000)
  • J Piacentini et al.

    Open trial of cognitive behaviour therapy for childhood obsessive-compulsive disorder

    J Anxiety Disord

    (2002)
  • J Piacentini et al.

    Outpatient behavioural treatment of child and adolescent obsessive compulsive disorder

    J Anxiety Disord

    (1994)
  • WK Silverman et al.

    Age differences in the reliability of parent and child reports of child anxious symptomatology using a structured interview

    Journal of Child and Adolescent Psychiatry

    (1992)
  • WK Silverman et al.

    The Anxiety Disorders Interview for Children

    J Am Acad Child Adolesc Psychiatry

    (1988)
  • G Steketee et al.

    Effects of Axis I and II comorbidity on behaviour therapy outcome for obsessive-compulsive disorder and agoraphobia

    Compr Psychiatry

    (2001)
  • M Thienemann et al.

    Manual-driven group cognitive-behavioral therapy for adolescents with obsessive-compulsive disorder: a pilot study

    J Am Acad Child Adolesc Psychiatry

    (2001)
  • TM Achenbach

    Manual for the Child Behaviour Checklist/4-18 and 1991 Profile

    (1991)
  • TM Achenbach et al.

    Manual for the Child Behaviour Checklist and Revised Child Behavior Profile

    (1983)
  • PM Barrett et al.

    Family treatment of childhood anxiety: a controlled trial

    J Consult Clin Psychol

    (1996)
  • Barrett PM, Farrell LJ (in press), FOCUS: Freedom from Obsessions and Compulsions Using Cognitive-Behavioural...
  • PM Barrett et al.

    The effect of obsessive-compulsive disorder on sibling relationships in late childhood and early adolescence: preliminary findings

    Aust Educ Dev Psychologist

    (2001)
  • AT Beck et al.

    BDI-II Manual

    (1996)
  • L Calvocoressi et al.

    Family accommodation of obsessive-compulsive disorder

    Am J Psychiatry

    (1995)

    • Cited by (0)

    This study was supported by a National Health and Medical Research Council grant.

    Disclosure: The FOCUS treatment manuals will be published by Australian Academic Press in 2005. Once published, royalties will be returned to Drs. Barrett and Farrell. The other authors have no financial relationships to disclose.

    View full text
    Copyright © 2005 The American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.