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Lumsdale GS, Frith H, Hale L. 'Cheering on from the side-lines': The perceived impact of romantic partner's commentary and behaviour on maintaining women's appearance anxiety. Psychol Psychother 2024. [PMID: 39268940 DOI: 10.1111/papt.12546] [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] [Received: 09/22/2023] [Accepted: 08/06/2024] [Indexed: 09/15/2024]
Abstract
OBJECTIVES Appearance anxiety (AA) is a probable risk factor for body dysmorphic disorder and a prevalent and debilitating concern. Extant literature suggests that romantic partners' commentary and accommodation behaviour may contribute to women's appearance concerns. The aim of this study is to explore how women experience and make sense of romantic partner feedback about their appearance. DESIGN Qualitative semi-structured interview study. METHODS Semi-structured interviews with 13 cis-gender women explored how they make sense of appearance anxiety in the context of romantic relationships. Reflexive thematic analysis with a hybrid inductive-deductive coding approach was utilised, drawing on cognitive behavioural theory (CBT) as a theoretical lens to interpret the data. RESULTS Four themes were created from the data: (1) 'Then he said to me … you could probably tone up a bit': Maintaining cycles; (2) 'I think those comments down the line do eventually help': breaking out of maintenance cycles, (3) 'It's like they're talking in a foreign language'; beliefs as a filter and (4) 'Cheering me on from the side-lines'; romantic partner a supportive coach. These themes highlight the perceived unhelpful (e.g. accommodation of behaviours) and helpful (e.g. affection) impact of romantic partners' behaviours and commentary on participants' AA. CONCLUSIONS Romantic partners are perceived by women to have a potent impact on their AA. Clinical practice implications include involving romantic partners in treatment, and clinicians using their formulation and CBT skills (e.g. Socratic questioning), to understand and target these possible maintenance processes within couples.
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Affiliation(s)
- Gemma Stephanie Lumsdale
- Department of Psychological Interventions, School of Psychology, University of Surrey, Guildford, Surrey, UK
| | - Hannah Frith
- Department of Psychological Interventions, School of Psychology, University of Surrey, Guildford, Surrey, UK
| | - Lucy Hale
- Department of Psychological Interventions, School of Psychology, University of Surrey, Guildford, Surrey, UK
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Onyeka OC, Spencer SD, Salloum A, Jiannetto K, Storch EA. The role of family accommodation in child posttraumatic stress symptoms and functional impairment in the context of cognitive behavioral therapy. J Affect Disord 2024; 346:252-259. [PMID: 37924982 PMCID: PMC10843667 DOI: 10.1016/j.jad.2023.10.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 10/21/2023] [Accepted: 10/25/2023] [Indexed: 11/06/2023]
Abstract
BACKGROUND Caregiver behaviors such as family accommodation (FA) are negatively reinforced by reduced distress in the short term, but ultimately maintain symptoms. It is important to explore the role of FA on symptoms and impairment. The current study examined the relationship among FA, posttraumatic stress symptoms (PTSS), and functional impairment in a sample of children and their caregivers who completed trauma treatment. METHOD Participants included 183 children and their caregivers (M age = 7.89; 55.19 % female; 73.22 % non-Hispanic; 51.37 % White). Data consisted of parent-reported measures collected at baseline, post-treatment, and 12-month follow-up from a randomized control trial (RCT) comparing Stepped Care CBT for Children after Trauma and Trauma-Focused Cognitive Behavior Therapy (TF-CBT). Correlational, mediation, and hierarchical linear regression analyses were conducted to test the interrelationships among FA, child PTSS, and child functional impairment. RESULTS FA was significantly, positively associated with total PTSS and functional impairment at baseline. Baseline FA partially mediated the relationship between baseline total PTSS and baseline functional impairment. Lastly, greater pre- to post-treatment changes in FA were mostly associated with relevant outcome variables at post-treatment and 12-month follow-up. LIMITATIONS Study limitations include use of a single informant, cross-sectional data analysis, lack of differentiation among trauma types, concerns regarding generalizability. CONCLUSION Assessing FA may be a helpful tool in better understanding how child PTSS relates to functional impairment following exposure to trauma. This study is clinically relevant it offers insight on the relationship among FA, PTSS, and functional impairment for families involved in trauma treatment.
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Affiliation(s)
- Ogechi Cynthia Onyeka
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.
| | - Samuel D Spencer
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Alison Salloum
- School of Social Work, University of South Florida, Tampa, FL, USA
| | - Katie Jiannetto
- School of Social Work, University of South Florida, Tampa, FL, USA
| | - Eric A Storch
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
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Tulacı RG, İzci Kasal M. The Relationship Between Family Accommodation and Anxiety Sensitivity in Obsessive-Compulsive Disorder. Cureus 2023; 15:e43793. [PMID: 37731418 PMCID: PMC10508192 DOI: 10.7759/cureus.43793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2023] [Indexed: 09/22/2023] Open
Abstract
Objective Anxiety sensitivity (AS) is an issue that has gained importance in obsessive-compulsive disorder (OCD) in recent years. Family accommodation (FA) is the participation of family members in compulsions and rituals. The objectives of this study were to (1) investigate the relationship between FA and AS in OCD and (2) determine the frequency and types of FA in a Turkish OCD sample. Methods This cross-sectional study was conducted with 81 OCD patients. The Yale-Brown Obsession Compulsion Scale (YBOCS), Family Accommodation Scale-Patient Form (FAS-PF), Anxiety Sensitivity Index-3 (ASI-3), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI) were administered to the patients. Results Family accommodation was extremely prevalent among family members of OCD patients. There were significant relationships between FA and ASI-3 total, ASI-3 cognitive subscale, ASI-3 psychical subscale, YBOCS, and BAI scores. In addition, ASI-3 total, ASI-3 cognitive subscale, and ASI-3 psychical subscale were significant predictors for family accommodation above and beyond the OCD severity. Conclusions The present study identified a significant association between anxiety sensitivity and family accommodation in OCD. Anxiety sensitivity is a relievable psychological trait. Alleviating anxiety sensitivity can decrease accommodating behaviors and may be beneficial in OCD treatment. Anxiety sensitivity may be a novel potential treatment target for OCD.
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Affiliation(s)
| | - Meltem İzci Kasal
- Psychiatry, Balıkesir Atatürk City Training and Research Hospital, Balikesir, TUR
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de Matos MB, Pires AJ, Trettim JP, Scholl CC, Tabeleão VP, Stigger RS, Rubin BB, Molina ML, Pinheiro RT, Quevedo LDA. Family perception of the symptoms of Obsessive-Compulsive Disorder patient and the family accommodation. Int J Soc Psychiatry 2022; 68:73-81. [PMID: 33295244 DOI: 10.1177/0020764020981107] [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: 11/15/2022]
Abstract
BACKGROUND Family members tend to modify their routine by assisting or participating in the patient's rituals. These behaviors have been identified as family accommodation (FA). AIMS The aim of this study was to describe the relationship between family accommodation of relatives of Obsessive-Compulsive Disorder (OCD) patients and their perceptions about the obsessions and compulsions of the patient. METHOD This was a cross-sectional study with family members of Obsessive-Compulsive Disorder in a Southern Brazilian city. The family perception of the OCD symptoms and their accommodation were assessed through the Family Accommodation Scale for Obsessive-Compulsive Disorder - Interviewer-Rated (FAS-IR). RESULTS The level of family accommodation was higher in those family members who lived with the patient when compared to those who did not live with them (p = .011). The obsessions associated with higher levels of family accommodation were: contamination (p < .001), hoarding/saving (p = .001), symmetry/exactness (p = .001), religious (p = .019), and diverse (p = .003). Regarding compulsions, the perception of all symptoms was associated with higher levels of family accommodation (p < .05). CONCLUSION The family accommodation is present in family members of Obsessive-Compulsive Disorder patients, regardless of the type of obsessive/compulsive symptom perceived.
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Affiliation(s)
- Mariana Bonati de Matos
- Postgraduate Program in Health and Behavior, Universidade Católica de Pelotas, UCPel, Pelotas, RS, Brazil
| | - Andressa Jacondino Pires
- Postgraduate Program in Health and Behavior, Universidade Católica de Pelotas, UCPel, Pelotas, RS, Brazil
| | - Jéssica Puchalski Trettim
- Postgraduate Program in Health and Behavior, Universidade Católica de Pelotas, UCPel, Pelotas, RS, Brazil
| | - Carolina Coelho Scholl
- Postgraduate Program in Health and Behavior, Universidade Católica de Pelotas, UCPel, Pelotas, RS, Brazil
| | - Viviane Porto Tabeleão
- Postgraduate Program in Health and Behavior, Universidade Católica de Pelotas, UCPel, Pelotas, RS, Brazil
| | - Rafaelle Stark Stigger
- Postgraduate Program in Health and Behavior, Universidade Católica de Pelotas, UCPel, Pelotas, RS, Brazil
| | - Bárbara Borges Rubin
- Postgraduate Program in Health and Behavior, Universidade Católica de Pelotas, UCPel, Pelotas, RS, Brazil
| | - Mariane Lopez Molina
- Postgraduate Program in Health and Behavior, Universidade Católica de Pelotas, UCPel, Pelotas, RS, Brazil
| | - Ricardo Tavares Pinheiro
- Postgraduate Program in Health and Behavior, Universidade Católica de Pelotas, UCPel, Pelotas, RS, Brazil
| | - Luciana de Avila Quevedo
- Postgraduate Program in Health and Behavior, Universidade Católica de Pelotas, UCPel, Pelotas, RS, Brazil
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Reuman L, Thompson-Hollands J, Abramowitz JS. Better Together: A Review and Recommendations to Optimize Research on Family Involvement in CBT for Anxiety and Related Disorders. Behav Ther 2021; 52:594-606. [PMID: 33990236 PMCID: PMC8124087 DOI: 10.1016/j.beth.2020.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 07/25/2020] [Accepted: 07/29/2020] [Indexed: 11/20/2022]
Abstract
Anxiety and related disorders (ARDs) occur in an interpersonal context. Individuals with ARDs respond well to individual cognitive behavioral therapy (CBT); however, there is room for improvement. As such, family members may be included to "enhance" treatment outcomes, yet findings from studies examining family involvement in CBT for ARDs are equivocal. The present paper (a) identifies methodological considerations for explaining inconsistent outcomes among CBT for ARDs with family involvement, and (b) reviews factors that affect outcomes of CBT for ARDs with family involvement including levels of involvement in treatment (e.g., number, duration, and spacing of sessions) and characteristics of who is involved in treatment (e.g., family member cognitions and cultural factors). Limitations of the literature and recommendations for future research are discussed. Researchers should focus on conducting studies that can test not whether but for whom and how family involvement can contribute to improved outcomes above and beyond individual CBT for ARDs.
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Affiliation(s)
- Lillian Reuman
- University of North Carolina at Chapel Hill; Boston University School of Medicine; National Center for PTSD at VA Boston Healthcare System.
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Liao Z, You C, Chen Y, Zhang J, Ding L. Psychometric properties of the Chinese version of the family accommodation scale for obsessive-compulsive disorder interviewer-rated. Compr Psychiatry 2021; 105:152220. [PMID: 33348295 DOI: 10.1016/j.comppsych.2020.152220] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 11/03/2020] [Accepted: 11/13/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Family accommodation (FA) in obsessive-compulsive disorder (OCD) means that the relatives of patients are involved in, help or facilitate patients' ritual behaviors and avoidance, which is a frequent occurrence and underresearched phenomenon in China. Recent studies have suggested that FA is adversely associated with treatment response, contradictory to the goal of cognitive behavior therapy, a contributor to the maintenance of symptoms and increased symptom severity, and associated with low levels of family and social functioning. There is increasing interest and focus on establishing a family-based intervention for OCD treatment based on the inclusion of relatives by decreasing FA. The present study explored the psychometric properties of the Chinese version of the Family Accommodation Scale for OCD Interviewer-Rated (FAS-IR). METHOD A total of 109 patients with OCD and 91 primary relatives were assessed in corresponding patient and family measures, and the FAS-IR was administered to relatives by trained interviewers. RESULTS More than 90% of the relatives accommodated patients' symptoms with at least one kind of FA behavior over the previous week, and the incidence of extreme or everyday routines was as high as 59.3%. Exploratory factor analysis demonstrated two-factor structure for the whole scale, including (1) modification and facilitation, and (2) participation. Cronbach's alpha was 0.798 for the whole scale, and the interrater and test-retest reliability coefficients were 0.835 (95%CI: 0.603-0.937) and 0.882 (95%CI: 0.685-0.959), respectively. Convergent validity was supported in exploring FA and was associated with symptom severity, level of functional impairment and family functioning related to OCD. The FA was not significantly correlated with depressive symptoms rated by the patients, as evidence of acceptable divergent validity. There was no significant difference in FA total score based on patient gender, patient age, or relationship with patients. CONCLUSIONS The Chinese version of the FAS-IR demonstrated excellent psychometric properties for assessing the degree of FA, suggesting that it is a useful and valuable instrument in clinical and research settings.
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Affiliation(s)
- Zhenhua Liao
- Department of Research and Education, Xiamen Xianyue Hospital, Xiamen, Fujian, China; Department of Preventive Medicine, School of Public Health, Fujian Medical University, Fuzhou, Fujian, China
| | - Ciping You
- Department of Research and Education, Xiamen Xianyue Hospital, Xiamen, Fujian, China
| | - Ying Chen
- Department of Research and Education, Xiamen Xianyue Hospital, Xiamen, Fujian, China
| | - Jinli Zhang
- Department of Psychiatry Rehabilitation Medicine, Xuzhou Central Hospital, Xuzhou, Jiangsu, China
| | - Lijun Ding
- Department of Research and Education, Xiamen Xianyue Hospital, Xiamen, Fujian, China.
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Anxiety Sensitivity Accelerates the Temporal Changes in Obsessions and Compulsions During Cognitive Behavioral Therapy. COGNITIVE THERAPY AND RESEARCH 2020. [DOI: 10.1007/s10608-020-10121-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Abstract
Family accommodation describes changes that family members make to their own behavior, to help their relative who is dealing with psychopathology, and to avoid or alleviate distress related to the disorder. Research on family accommodation has expanded greatly in the past few years. The aim of this study was to provide a synthesized review of recent findings on family accommodation in psychopathology. Electronic databases were searched for available, peer-reviewed, English language papers, published between September 2015 and March 2018, cross-referencing psychiatric disorders with accommodation and other family-related terms. Ninety-one papers were identified and reviewed, of which 69 were included. In obsessive-compulsive disorder and anxiety disorders family accommodation has been linked to symptom severity, functional impairment, caregiver burden, and poorer treatment outcomes. Several randomized controlled trials explored the efficacy of treatments aimed at reducing family accommodation. A growing number of studies have reported family accommodation in eating disorders where it is associated with greater symptom severity and caregiver burden. Family accommodation has also been studied in other disorders, including autism spectrum disorders, tic disorders, and posttraumatic stress disorder. Research on family accommodation in psychopathology is advancing steadily, expanding across disorders. The study highlights the importance of addressing family accommodation in the assessment and treatment of various disorders.
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Affiliation(s)
| | - Basavaraj Shrinivasa
- Department of Psychiatric Social Work, Obsessive-Compulsive Disorder Clinic, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Anish V Cherian
- Department of Psychiatric Social Work, Obsessive-Compulsive Disorder Clinic, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
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La Buissonnière-Ariza V, Schneider SC, Højgaard D, Kay BC, Riemann BC, Eken SC, Lake P, Nadeau JM, Storch EA. Family accommodation of anxiety symptoms in youth undergoing intensive multimodal treatment for anxiety disorders and obsessive-compulsive disorder: Nature, clinical correlates, and treatment response. Compr Psychiatry 2018; 80:1-13. [PMID: 28892781 DOI: 10.1016/j.comppsych.2017.07.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 07/24/2017] [Accepted: 07/30/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Family accommodation is associated with a range of clinical features including symptom severity, functional impairment, and treatment response. However, most previous studies in children and adolescents investigated family accommodation in samples of youth with obsessive-compulsive disorder (OCD) or anxiety disorders receiving non-intensive outpatient services. AIMS In this study, we aimed to investigate family accommodation of anxiety symptoms in a sample of youth with clinical anxiety levels undergoing an intensive multimodal intervention for anxiety disorders or OCD. PROCEDURES We first assessed the internal consistency of the Family Accommodation Scale - Anxiety (FASA). We next examined family accommodation presentation and correlates. RESULTS The FASA showed high internal consistency for all subscales and total score, and good item and subscale correlations with the total score. All parents reported at least mild accommodation, and the mean levels of family accommodation were particularly high. Child age, anxiety severity, and comorbid depressive symptoms predicted baseline accommodation. However, the association between anxiety severity and family accommodation no longer remained significant after adding the other factors to the model. In addition, family accommodation partially mediated the relationship between anxiety severity and functional impairment. Finally, post-treatment changes in family accommodation predicted changes in symptom severity and functional impairment. CONCLUSIONS These findings suggest the FASA is an appropriate tool to assess family accommodation in intensive treatment samples. Further, they underline the importance of addressing family accommodation in this population given the particularly high levels of accommodating behaviors and the evidence for adverse outcomes associated with this feature.
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Affiliation(s)
- Valérie La Buissonnière-Ariza
- Department of Pediatrics, Rothman Center for Neuropsychiatry, University of South Florida, 880 6th Street South, Suite 460, Box 7523, St. Petersburg, FL 33701, USA
| | - Sophie C Schneider
- Department of Pediatrics, Rothman Center for Neuropsychiatry, University of South Florida, 880 6th Street South, Suite 460, Box 7523, St. Petersburg, FL 33701, USA
| | - Davíð Højgaard
- Center for Child and Adolescent Psychiatry, Aarhus University Hospital, Denmark
| | - Brian C Kay
- Rogers Memorial Hospital, 34700 Valley Road, Oconomowoc, WI 53066, USA
| | - Bradley C Riemann
- Rogers Memorial Hospital, 34700 Valley Road, Oconomowoc, WI 53066, USA
| | - Stephanie C Eken
- Rogers Behavioral Health - Nashville, 4230 Harding Road, Suite 707, Nashville, TN 37205, USA
| | - Peter Lake
- Rogers Memorial Hospital, 34700 Valley Road, Oconomowoc, WI 53066, USA
| | - Joshua M Nadeau
- Rogers Behavioral Health - Tampa, 2002, North Lois Ave, Tampa Bay, Tampa, FL, 33607, USA
| | - Eric A Storch
- Department of Pediatrics, Rothman Center for Neuropsychiatry, University of South Florida, 880 6th Street South, Suite 460, Box 7523, St. Petersburg, FL 33701, USA; Rogers Behavioral Health - Tampa, 2002, North Lois Ave, Tampa Bay, Tampa, FL, 33607, USA; Department of Psychology, University of South Florida, 4202 East Fowler Ave, PCD4118G, Tampa, FL 33620, USA; Department of Psychiatry and Behavioral Neurosciences, University of South Florida, 3515 E. Fletcher Ave., Tampa, FL 33613, USA; Department of Health Management and Policy, University of South Florida, 13201 Bruce B. Downs Blvd., MDC56, Tampa, FL 33612-3805, USA; Johns Hopkins All Children's Hospital, 501 6th Avenue South, St. Petersburg, FL 33701, USA.
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Albert U, Baffa A, Maina G. Family accommodation in adult obsessive-compulsive disorder: clinical perspectives. Psychol Res Behav Manag 2017; 10:293-304. [PMID: 29033617 PMCID: PMC5614765 DOI: 10.2147/prbm.s124359] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The term accommodation has been used to refer to family responses specifically related to obsessive-compulsive (OC) symptoms: it encompasses behaviors such as directly participating in compulsions, assisting a relative with obsessive-compulsive disorder (OCD) when he/she is performing a ritual, or helping him/her to avoid triggers that may precipitate obsessions and compulsions. At the opposite side, family responses to OCD may also include interfering with the rituals or actively opposing them; stopping accommodating OC symptoms or actively interfering with their performance is usually associated with greater distress and sometimes even with aggressive behaviors from the patients. This article summarizes progress of the recent research concerning family accommodation in relatives of patients with OCD. Family accommodation is a prevalent phenomenon both among parents of children/adolescents with OCD and relatives/caregivers of adult patients. It can be measured with a specific instrument, the Family Accommodation Scale, of which there are several versions available for use in clinical practice. The vast majority of both parents of children/adolescents with OCD and family members of adult patients show at least some accommodation; providing reassurances to obsessive doubts, participating in rituals and assisting the patient in avoidance are the most frequent accommodating behaviors displayed by family members. Modification of routine and modification of activities specifically due to OC symptoms have been found to be equally prevalent. Specific characteristics of patients (such as contamination/washing symptoms) and of relatives (the presence of anxiety or depressive symptoms or a family history positive for another anxiety disorder) are associated with a higher degree of family accommodation; these family members may particularly benefit from family-based cognitive-behavioral interventions. In recent years, targeting family accommodation has been suggested as a fundamental component of treatment programs and several interventions have been tested. Clinicians should be aware that family-based cognitive-behavior therapy incorporating modules to target family accommodation is more effective in reducing OC symptoms. Targeting family accommodation may be as well relevant for patients treated pharmacologically.
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Affiliation(s)
- Umberto Albert
- Rita Levi Montalcini Department of Neuroscience, A.O.U. San Luigi Gonzaga, University of Turin, Turino, Italy
| | - Alessandra Baffa
- Rita Levi Montalcini Department of Neuroscience, A.O.U. San Luigi Gonzaga, University of Turin, Turino, Italy
| | - Giuseppe Maina
- Rita Levi Montalcini Department of Neuroscience, A.O.U. San Luigi Gonzaga, University of Turin, Turino, Italy
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