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Hermida-Barros L, Primé-Tous M, García-Delgar B, Forcadell E, Lera-Miguel S, Fernández de la Cruz L, Vieta E, Radua J, Lázaro L, Fullana MA. Family accommodation in obsessive-compulsive disorder: An updated systematic review and meta-analysis. Neurosci Biobehav Rev 2024; 161:105678. [PMID: 38621516 DOI: 10.1016/j.neubiorev.2024.105678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 03/12/2024] [Accepted: 04/12/2024] [Indexed: 04/17/2024]
Abstract
Family accommodation might play a crucial role in obsessive-compulsive disorder (OCD). Previous systematic reviews on family accommodation in OCD have focused on specific populations or variables or are outdated. We conducted a preregistered systematic review and meta-analysis on family accommodation in adults, children, and adolescents with OCD (CRD42021264461). We searched PubMed, Scopus, and Web of Science using the keywords "family accommodation" and "obsessive-compulsive disorder. One hundred-eight studies involving 8928 individuals with OCD were included. Our results indicate that levels of family accommodation in OCD are moderate, that there is a significant positive correlation between family accommodation and OCD severity (r = 0.42), that baseline family accommodation does not predict pre- to post-treatment change in OCD severity (g = -0.03), and that family accommodation decreases as a result of both individual and family-focused cognitive behavioral therapy for OCD (g = 2.00 and g = 1.17, respectively). Our findings highlight the relevance of family accommodation in OCD and may help guide assessment and treatment.
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Affiliation(s)
- Laura Hermida-Barros
- Child and Adolescent Psychiatry and Psychology Department, Institute of Neurosciences, Hospital Clínic, Barcelona 08036, Spain
| | - Mireia Primé-Tous
- Child and Adolescent Psychiatry and Psychology Department, Institute of Neurosciences, Hospital Clínic, Barcelona 08036, Spain
| | - Blanca García-Delgar
- Child and Adolescent Psychiatry and Psychology Department, Institute of Neurosciences, Hospital Clínic, Barcelona 08036, Spain
| | - Eduard Forcadell
- Child and Adolescent Psychiatry and Psychology Department, Institute of Neurosciences, Hospital Clínic, Barcelona 08036, Spain
| | - Sara Lera-Miguel
- Child and Adolescent Psychiatry and Psychology Department, Institute of Neurosciences, Hospital Clínic, Barcelona 08036, Spain
| | - Lorena Fernández de la Cruz
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm 17177, Sweden; Stockholm Health Care Services, Region Stockholm, Stockholm 10431, Sweden
| | - Eduard Vieta
- Adult Psychiatry and Psychology Department, Institute of Neurosciences, Hospital Clinic, Barcelona 08036, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Network Centre for Biomedical Research in Mental Health (CIBERSAM), Instituto de Salud Carlos III, Barcelona 08036, Spain; University of Barcelona, Barcelona 08007, Spain
| | - Joaquim Radua
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm 17177, Sweden; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Network Centre for Biomedical Research in Mental Health (CIBERSAM), Instituto de Salud Carlos III, Barcelona 08036, Spain.
| | - Luisa Lázaro
- Child and Adolescent Psychiatry and Psychology Department, Institute of Neurosciences, Hospital Clínic, Barcelona 08036, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Network Centre for Biomedical Research in Mental Health (CIBERSAM), Instituto de Salud Carlos III, Barcelona 08036, Spain; University of Barcelona, Barcelona 08007, Spain
| | - Miquel A Fullana
- Adult Psychiatry and Psychology Department, Institute of Neurosciences, Hospital Clinic, Barcelona 08036, Spain.
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Skarphedinsson G, Torp NC, Weidle B, Jensen S, Ivarsson T, Hybel KA, Nissen JB, Thomsen PH, Højgaard DRMA. Family Accommodation in Pediatric Obsessive-Compulsive Disorder: Investigating Prevalence and Clinical Correlates in the NordLOTS Study. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01602-0. [PMID: 37684419 DOI: 10.1007/s10578-023-01602-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/21/2023] [Indexed: 09/10/2023]
Abstract
Family accommodation (FA) involves the actions taken by family members, particularly parents, to accommodate a child´s obsessive-compulsive disorder (OCD) symptoms, reducing distress or impairment. This behavior may maintain compulsive and avoidant behavior, preventing corrective learning or habituation. This study aims to investigate the prevalence and factors influencing FA in a large Scandinavian sample of children with OCD. We assessed 238 children using standardized diagnostic interviews, OCD symptom severity assessments and questionnaires evaluating functional impairment and internalizing and externalizing symptoms. FA was measured using the Family Accommodation Scale, a 12-item clinician-rated interview. Our results confirmed a high frequency of accommodation, with approximately 70% of primary caregivers reporting some accommodation daily and 98% at least once per week. FA was associated with increased OCD symptom severity, contamination/cleaning symptoms, internalizing and externalizing behavior, and functional impairment. Linear regression analysis showed that high levels of FA are specifically associated with lower age, higher OCD symptom severity, parent-reported impairment, internalizing, and externalizing symptoms. A path analysis revealed that FA partially mediated the relationship between OCD severity, externalizing symptoms, and child's age, highlighting the role of FA in the progression of OCD and related symptoms. The findings emphasize the importance of evaluating FA before initiating treatment and specifically addressing it during the therapeutic process.
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Affiliation(s)
| | - Nor Christian Torp
- Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway
- Division of Mental Health and Addiction, Department of Child and Adolescent Psychiatry, Vestre Viken Hospital, Drammen, Norway
| | - Bernhard Weidle
- Regional Centre for Child and Youth Mental Health and Child Welfare Central Norway, Trondheim, Norway
- Norwegian University of Science and Technology, Trondheim, Norway
| | - Sanne Jensen
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Aarhus, Denmark
| | - Tord Ivarsson
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Katja Anna Hybel
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Aarhus, Denmark
| | - Judith B Nissen
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Aarhus, Denmark
| | - Per Hove Thomsen
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Aarhus, Denmark
| | - Davíð R M A Højgaard
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Aarhus, Denmark
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Kindynis Z, Espie J, Volz C, Jassi A. Multifamily therapy for young people with OCD: An acceptability and satisfaction study. Bull Menninger Clin 2023; 87:25-45. [PMID: 36856478 DOI: 10.1521/bumc.2023.87.1.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
Individual cognitive-behavioral therapy (CBT) is the recommended first-line psychological treatment for young people with obsessive-compulsive disorder (OCD), with good outcomes. However, because some young people only partially respond to CBT, it is necessary to improve treatment outcomes. This is the first study to explore the acceptability and satisfaction of a new multifamily therapy (MFT). Three groups were attended by 16 young people with OCD, their parents, and siblings. Parents and young people completed questionnaires and focus groups. Thematic analysis was applied to transcripts of focus groups. The majority of young people and parents (93.9%) were satisfied or very satisfied. Thematic analysis identified benefits, including increased understanding of OCD, support from the group, and a feeling of not being alone. Further research is required to establish the group's effectiveness on OCD symptom severity and to identify the factors that MFT addresses. MFT shows promise as an acceptable and satisfactory treatment.
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Affiliation(s)
- Zoë Kindynis
- Highly Specialist Clinical Psychologist, Obsessive Compulsive Disorder, Body Dysmorphic Disorder and Related Disorders Clinic, National and Specialist CAMHS, South London and Maudsley NHS Foundation Trust, Michael Rutter Centre, Maudsley Hospital, De Crespigny Park, London, UK
| | - Jonathan Espie
- Principal Clinical Psychologist, Obsessive Compulsive Disorder, Body Dysmorphic Disorder and Related Disorders Clinic, National and Specialist CAMHS, South London and Maudsley NHS Foundation Trust, Michael Rutter Centre, Maudsley Hospital, De Crespigny Park, London, UK
| | - Chloë Volz
- Consultant Clinical Psychologists with the Obsessive Compulsive Disorder, Body Dysmorphic Disorder and Related Disorders Clinic, National and Specialist CAMHS, South London and Maudsley NHS Foundation Trust, Michael Rutter Centre, Maudsley Hospital, De Crespigny Park, London, UK
| | - Amita Jassi
- Consultant Clinical Psychologists with the Obsessive Compulsive Disorder, Body Dysmorphic Disorder and Related Disorders Clinic, National and Specialist CAMHS, South London and Maudsley NHS Foundation Trust, Michael Rutter Centre, Maudsley Hospital, De Crespigny Park, London, UK
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Quand aider devient nuire : une compréhension des implications de l’accommodation familiale sur l’efficacité des interventions psychologiques dans le TOC. ANNALES MÉDICO-PSYCHOLOGIQUES, REVUE PSYCHIATRIQUE 2022. [DOI: 10.1016/j.amp.2022.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Liao Z, Ding L, You C, Chen Y, Zhang W. The Chinese version of the family accommodation scale for obsessive-compulsive disorder self-rated: reliability, validity, factor structure, and mediating effect. Front Psychiatry 2022; 13:970747. [PMID: 36032239 PMCID: PMC9403002 DOI: 10.3389/fpsyt.2022.970747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 07/25/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Family accommodation (FA) in obsessive compulsive disorder (OCD) is a common phenomenon. Based on the cost of training interviewers and the time required to administer the scale, the Family Accommodation Scale for Obsessive-Compulsive Disorder Interviewer-Rated (FAS-IR) has been restricted to specific settings. A self-rated version of the family accommodation scale may solve these problems. The aim of this study was to examine the reliability, validity and factor structure of the Family Accommodation Scale Self-rated version (FAS-SR), and the relationship among FA, symptom severity and functional impairment. METHODS In total, 171 patients with OCD and 145 paired relatives participated in this study. The Sheehan Disability Scale (SDS), Obsessive-Compulsive Inventory Revised (OCI-R), Zung Self-Rating Depression Scale (Zung-SDS), 12-item Family Assessment Devices (FAD-12), Clinical Global Impression of Severity Scale (CGI-S), Global Assessment of Functioning (GAF), and Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) were used as tools for patients. The FAS-SR, FAS-IR, FAD-12, and the patients' symptom severity of Y-BOCS compulsion were used as tools for relatives. The psychometric properties of the FAS-SR were evaluated using Cronbach's alpha coefficient, test-retest reliability and validity. Mediation analysis was used to determine the relationship among FA, symptom severity and functional impairment. RESULTS A total of 97.9% of relatives of OCD patients reported at least one kind of FA behavior, and 56.6% of participants engaged in FA every day in the past week. The FAS-SR includes a three-factor structure: (1) providing reassurance and participation; (2) facilitation; and (3) modification. The scale's Cronbach's alpha and test-retest coefficients were 0.875 and 0.970, respectively. The total FAS-SR score was significantly positively associated with the Y-BOCS, FAD-12, CGI-S, FAS-IR, and SDS scores, and negatively associated with the total GAF score. FA partially mediated the relationship between symptom severity and functional impairment. CONCLUSION The FAS-SR was proven to have satisfactory psychometric properties, and can play an important role in the evaluation and early intervention of OCD. This result indicates the importance of assessing symptom severity in conjunction with FA when evaluating OCD patients' functional impairment.
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Affiliation(s)
- Zhenhua Liao
- School of Public Health, Fujian Medical University, Fuzhou, China
| | - Lijun Ding
- Xiamen Xianyue Hospital, Xiamen, China.,School of Health, Fujian Medical University, Fuzhou, China
| | | | - Ying Chen
- Xiamen Xianyue Hospital, Xiamen, China
| | - Wenchang Zhang
- School of Public Health, Fujian Medical University, Fuzhou, China
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Van Noppen B, Sassano-Higgins S, Appasani R, Sapp F. Cognitive-Behavioral Therapy for Obsessive-Compulsive Disorder: 2021 Update. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2021; 19:430-443. [PMID: 35747293 PMCID: PMC9063577 DOI: 10.1176/appi.focus.20210015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
In this update of a previous review, the authors discuss cognitive-behavioral therapy (CBT) with exposure and response prevention for obsessive-compulsive disorder (OCD). This efficacious modality avoids side effects common to psychotropic medication and reduces risk of relapse once treatment has ended. Psychotherapy involves identification and ranking of stimuli that provoke obsessions, exposure to these stimuli while preventing compulsions, and cognitive restructuring. The family of the OCD patient plays a significant role in treatment. This article includes expanded research on family-focused CBT and treatment of pediatric OCD. The family's accommodation and emotional response to a patient's symptoms may interfere with therapy and perpetuate the disorder. The treatment of pediatric OCD involves the same considerations. However, the form of obsessions and compulsions may differ and therapeutic techniques are modified to make them age appropriate.
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Affiliation(s)
- Barbara Van Noppen
- Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles (Van Noppen); private practice, Los Angeles (Sassano-Higgins, Appasani); OCD and Anxiety Psychological Services, Calgary, Alberta, Canada (Sapp)
| | - Sean Sassano-Higgins
- Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles (Van Noppen); private practice, Los Angeles (Sassano-Higgins, Appasani); OCD and Anxiety Psychological Services, Calgary, Alberta, Canada (Sapp)
| | - Raghu Appasani
- Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles (Van Noppen); private practice, Los Angeles (Sassano-Higgins, Appasani); OCD and Anxiety Psychological Services, Calgary, Alberta, Canada (Sapp)
| | - Felicity Sapp
- Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles (Van Noppen); private practice, Los Angeles (Sassano-Higgins, Appasani); OCD and Anxiety Psychological Services, Calgary, Alberta, Canada (Sapp)
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Rosa-Alcázar Á, Rosa-Alcázar AI, Parada-Navas JL, Olivares-Olivares PJ, Rosa-Alcázar E. Predictors of Parental Accommodation and Response Treatment in Young Children With Obsessive-Compulsive Disorder. Front Psychiatry 2021; 12:737062. [PMID: 34867529 PMCID: PMC8635098 DOI: 10.3389/fpsyt.2021.737062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 10/18/2021] [Indexed: 01/08/2023] Open
Abstract
Background: Cognitive-behavioral family-based treatment (CBFT) is the treatment standard in very young children with obsessive-compulsive disorder (OCD), which includes the same core components of cognitive-behavioral therapy (CBT) with significant family involvement. Although the latter reports high rates of remission, some children do not improve with treatments. Therefore, it is necessary to identify possible moderating variables such as comorbidity, severity of disorder, years of onset, parental anxiety, and parental accommodation. This study has two main aims: (1) to propose a predictive model on family accommodation (father and mother), taking into account variables related to the children (severity of obsessive-compulsive responses, internalizing and externalizing symptoms, and comorbidity) and with the parents before intervention (worry, accommodation of one parental member over the other) and (2) to examine the mediating role of externalizing symptoms and mother's accommodation in the relation between initial severity and improvement of severity of obsessive-compulsive responses in children aged 5-8 years. Methods: Participants comprised 56 children with OCD [mean = 6.61 (SD = 0.76)] and their parents; 79% of the sample was men. Treatment was implemented by two clinicians specialized in OCD (>15 years of experience). Clinicians were trained to administer CBT protocol in the same way. They were doctors of clinical psychology and researchers at the OCD. Results: Mother's accommodation was associated with child variables (Child Behavior Checklist-Externalizing and Initial Severity, Children's Yale-Brown Obsessive-Compulsive Scale). Father's accommodation could be explained by parent variables (mother's accommodation and worry). Simple mediation model tested using the SPSS macro PROCESS supported the relation of the initial severity of symptoms with that following intervention, through the simple indirect effect of externalizing symptoms of the child. Conclusions: Comorbidities with externalizing symptoms, father's worry, and mother's accommodation were variables that should be controlled in treatment of pediatric OCD.
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Affiliation(s)
| | - Ana I Rosa-Alcázar
- Department of Personality, Assessment and Psychological Treatment, University of Murcia, Murcia, Spain
| | | | - Pablo J Olivares-Olivares
- Department of Personality, Assessment and Psychological Treatment, University of Murcia, Murcia, Spain
| | - Encarnación Rosa-Alcázar
- Department of Personality, Assessment and Psychological Treatment, University of Murcia, Murcia, Spain
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