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Duholm CS, Jensen S, Rask CU, Thomsen PH, Ivarsson T, Skarphedinsson G, Torp NC, Weidle B, Nissen JB, Højgaard DRMA. Specific Contamination Symptoms are Associated with Experiencing a Limited Response of Cognitive-Behavioral Therapy in Pediatric Patients with OCD. Child Psychiatry Hum Dev 2024; 55:1135-1145. [PMID: 36510026 DOI: 10.1007/s10578-022-01480-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/05/2022] [Indexed: 12/14/2022]
Abstract
A recent study identified three distinct treatment-response trajectories in pediatric OCD where higher levels of contamination symptoms predicted a limited response to cognitive-behavioral therapy (CBT). This study extends these findings by examining which specific symptoms characterize limited CBT response from baseline to 3-year follow-up, with an emphasis on contamination symptoms. The study sample comprised 269 pediatric patients with OCD, all receiving stepped-care treatment with manualized CBT. Differences in single item-reporting between the three trajectory groups were examined using linear mixed-effect modeling. Limited responders displayed a higher symptom load across all OCD symptom categories at 3-year follow-up, dominated by contamination symptoms. Five of these (obsessions about dirt and germs, about bodily fluids, about the feeling of contamination and compulsions regarding handwashing and showering) showed persistence from baseline to 3-year follow-up. The results indicate that presence of specific contamination symptoms may influence long-term symptom severity trajectories in young patients with OCD.
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Affiliation(s)
- Charlotte Steen Duholm
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Denmark.
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
- Aarhus University Hospital, Psychiatry, Palle Juul-Jensens Boulevard 175, Entrance K, 8200, Aarhus, Denmark.
| | - Sanne Jensen
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Charlotte Ulrikka Rask
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Per Hove Thomsen
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Tord Ivarsson
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Nor Christian Torp
- Division of Mental Health and Addiction, Vestre Viken Hospital, Drammen, Norway
- Akershus University Hospital, Oslo, Norway
| | - Bernhard Weidle
- Regional Centre for Child and Youth Mental Health and Child Welfare Central Norway, Norwegian University of Science and Technology, Trondheim, Norway
| | - Judith Becker Nissen
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Davíð R M A Højgaard
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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2
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Stiede JT, Spencer SD, Onyeka O, Mangen KH, Church MJ, Goodman WK, Storch EA. Obsessive-Compulsive Disorder in Children and Adolescents. Annu Rev Clin Psychol 2024; 20:355-380. [PMID: 38100637 DOI: 10.1146/annurev-clinpsy-080822-043910] [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] [Indexed: 12/17/2023]
Abstract
Obsessive-compulsive disorder (OCD) in children and adolescents is a neurobehavioral condition that can lead to functional impairment in multiple domains and decreased quality of life. We review the clinical presentation, diagnostic considerations, and common comorbidities of pediatric OCD. An overview of the biological and psychological models of OCD is provided along with a discussion of developmental considerations in youth. We also describe evidence-based treatments for OCD in childhood and adolescence, including cognitive behavioral therapy (CBT) with exposure and response prevention (ERP) and pharmacotherapy. Finally, research evaluating the delivery of CBT in different formats and modalities is discussed, and we conclude with suggestions for future research directions.
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Affiliation(s)
- Jordan T Stiede
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA;
| | - Samuel D Spencer
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA;
| | - Ogechi Onyeka
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA;
| | - Katie H Mangen
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA;
| | - Molly J Church
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA;
| | - Wayne K Goodman
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA;
| | - Eric A Storch
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA;
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3
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Peris TS, Storch EA. Editorial: The Durable Long-Term Benefits of Evidence-Based Care for Children and Adolescents With Obsessive-Compulsive Disorder. J Am Acad Child Adolesc Psychiatry 2024; 63:502-504. [PMID: 38360347 DOI: 10.1016/j.jaac.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 02/06/2024] [Indexed: 02/17/2024]
Abstract
Pediatric obsessive-compulsive disorder (OCD) can be enormously taxing for affected youth and their families; the distress, impairment, and family upheaval that it brings are well documented.1 Both exposure-based cognitive-behavioral therapy (CBT) and pharmacological interventions are efficacious for reducing symptoms and functional impairment, producing mean effect sizes of g = 1.21 and g = 0.50 respectively.2 These treatments-whether administered alone or in combination-form the backbone of our current suite of interventions. They have helped countless young people to restore functioning and lead healthy, productive lives. Despite this encouraging picture, long-term outcomes for children and adolescents with OCD remain poorly understood. Even for youth who receive high-quality evidence-based care, it is unclear what to expect down the road, and this gap in understanding creates challenges for clinical decision making as well as angst for parents who, quite understandably, want to know what the future holds for their children. Although CBT often is recommended as the frontline intervention for pediatric OCD3 and parents routinely report preferring to begin with nonmedication options,4 data to help patients and families make fully informed treatment decisions are scarce. Most would like to know the long-term outcomes associated with various treatment options, and this is a challenge given that the typical length of follow-up in CBT trials for pediatric OCD is 3 to 6 months-well short of a typical school year. The study by Ivarsson et al.5 is therefore a much-needed advance for the field, offering a first view of long-term outcomes for youth with OCD treated with evidence-based treatments.
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Affiliation(s)
- Tara S Peris
- Jane and Terry Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at UCLA, Los Angeles, California.
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4
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Henderson RR, Nielsen AM, Fernandez AMP, Downing ST, McCarty RJ, Strekalova YA, Cobite-Njoh J, Mirhosseini T, Guzick AG, McNamara JPH, Mathews CA. Expectations and perspectives of cognitive behavioural therapy for childhood anxiety and related disorders. Behav Cogn Psychother 2024; 52:65-77. [PMID: 37699703 DOI: 10.1017/s1352465823000346] [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] [Indexed: 09/14/2023]
Abstract
BACKGROUND Anxiety disorders are the most frequently diagnosed psychiatric conditions in children and adolescents. Cognitive behavioural therapy (CBT) is a well-established and effective treatment for anxiety and related disorders across the lifespan. Expectations of psychotherapy have been demonstrated to affect outcomes, yet there is sparse existing literature on adolescent patient and parent perspectives of CBT prior to engagement with treatment. AIMS This study aimed to qualitatively explore the expectations and perceptions of CBT for anxiety and related disorders among adolescent patients and parents. METHOD Fourteen adolescent patients and 16 parents participated in semi-structured individual interviews or focus groups consisting of 2-3 participants. Interview transcripts were analysed using inductive analysis. RESULTS Three themes were identified: worries about CBT, expectations and knowledge of the CBT process, and the role of parents and families. Overall, we found that adolescents and parents had generally positive views of CBT. The outset of CBT saw adolescents and parents express concern about stigma as well as the ambiguity of CBT. Parents continued to express a lack of understanding of what CBT entailed during their child's treatment course. CONCLUSION These results suggest that both adolescents and parents would benefit from early discussion and reinforcement of expectations for CBT treatment. Further research efforts are warranted and should be directed towards determining appropriate expectations for parental involvement in a child's CBT course and effective communication of treatment expectations to both adolescents and parents.
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Affiliation(s)
| | - Alyssa M Nielsen
- College of Medicine, University of Florida, Gainesville, FL, USA
| | | | - Seth T Downing
- Department of Psychiatry, University of Florida, Gainesville, FL, USA
| | - Ryan J McCarty
- Department of Psychiatry, University of Florida, Gainesville, FL, USA
| | - Yulia A Strekalova
- College of Journalism and Communications, University of Florida, Gainesville, FL, USA
| | - Journa Cobite-Njoh
- Psychological, Health, and Learning Sciences, University of Houston, Houston, TX, USA
| | | | - Andrew G Guzick
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | | | - Carol A Mathews
- Department of Psychiatry, University of Florida, Gainesville, FL, USA
- Center for OCD, Anxiety, and Related Disorders, University of Florida, Gainesville, FL, USA
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5
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Wislocki K, Kratz HE, Martin G, Becker-Haimes EM. The Relationship Between Trauma Exposure and Obsessive-Compulsive Disorder in Youth: A Systematic Review. Child Psychiatry Hum Dev 2023; 54:1624-1652. [PMID: 35488083 DOI: 10.1007/s10578-022-01352-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/17/2022] [Indexed: 11/28/2022]
Abstract
Extant literature suggests a possible relationship between childhood trauma exposure and the development and trajectory of obsessive-compulsive symptoms (OCS) and obsessive-compulsive disorder (OCD); however, this relationship is poorly understood. We conducted a systematic review that examined trauma exposure and OCS/OCD in youth. Primary inclusion criteria were English-language articles that addressed a sample with participants under 18 years of age. 46 articles met criteria for review, and were categorized into three groups of overlap: Post-traumatic Stress Disorder (PTSD) and OCS or OCD (n = 3), clearly defined Criterion A event trauma exposure and OCS or OCD (n = 30), and less well-defined potential trauma exposure and OCS or OCD (n = 13). There was mixed evidence linking trauma exposure and the development of OCS or OCD in youth. Major methodological limitations preclude formal conclusions. More research on co-occurring trauma exposure and OCD/OCS in youth is needed to advance research and improve treatment.
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Affiliation(s)
- Katherine Wislocki
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market St., #3001, Philadelphia, PA, 19104, USA.
- Department of Psychological Science, University of California, Irvine, CA, USA.
| | - Hilary E Kratz
- Department of Psychology, La Salle University, Philadelphia, PA, USA
| | - Gerald Martin
- Department of Psychology, La Salle University, Philadelphia, PA, USA
| | - Emily M Becker-Haimes
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market St., #3001, Philadelphia, PA, 19104, USA
- Hall Mercer Community Mental Health, University of Pennsylvania Health System, Philadelphia, PA, USA
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6
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Mendez EM, Dahlsgaard KK, Hjelmgren JM, Mills JA, Suresh V, Strawn JR. What Is the Added Benefit of Combining Cognitive Behavioral Therapy and Selective Serotonin Reuptake Inhibitors in Youth with Obsessive Compulsive Disorder? A Bayesian Hierarchical Modeling Meta-Analysis. J Child Adolesc Psychopharmacol 2023; 33:203-211. [PMID: 37347947 PMCID: PMC10458367 DOI: 10.1089/cap.2023.0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
Background: Treatment of obsessive-compulsive disorder (OCD) in children and adolescents frequently involves cognitive behavioral therapy (CBT), selective serotonin reuptake inhibitors (SSRIs), or their combination. However, how adding CBT to SSRIs affects the trajectory and magnitude of improvement has not been evaluated meta-analytically. Methods: We performed a meta-analysis using weekly data from prospective randomized parallel group trials of CBT and SSRIs in pediatric patients with OCD. Response was modeled for the change in the Child Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) using a Bayesian hierarchical model over 12 weeks. Results: Fourteen studies included pharmacotherapy arms, 4 studies included combined pharmacotherapy and psychotherapy, and 10 studies included a placebo or control arm. The studies included 1146 patients (mean age 12.7 ± 1.3 years, mean 42.1% female). In the logarithmic model of response, statistically significant differences in treatment effects for CBT+SSRI and SSRI monotherapy were observed compared with placebo (SSRI β = -3.59, credible interval [95% CrI]: -4.13 to -3.02, p < 0.001; SSRI+CBT β = -4.07, 95% CrI: -5.05 to -3.04, p < 0.001). Adding CBT to an SSRI produced numerically (but not statistically significantly) greater improvement over 12 weeks. Greater improvement was observed in studies with more boys (p < 0.001), younger patients (p < 0.001), and in studies with greater baseline symptom severity (p < 0.001). Conclusions: In children and adolescents with OCD, compared with placebo, both SSRIs and SSRI+CBT produced early and sustained improvement over 12 weeks, although the improvement was also related to sample characteristics. Longer term studies are needed to determine when the additive benefit of CBT emerges relative to SSRI monotherapy.
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Affiliation(s)
- Eric M. Mendez
- Department of Psychiatry & Behavioral Neuroscience, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | | | - John M. Hjelmgren
- Department of Psychiatry & Behavioral Neuroscience, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Jeffrey A. Mills
- Department of Economics, Lindner College of Business, University of Cincinnati, Cincinnati, Ohio, USA
| | - Vikram Suresh
- Department of Economics, Lindner College of Business, University of Cincinnati, Cincinnati, Ohio, USA
| | - Jeffrey R. Strawn
- Department of Psychiatry & Behavioral Neuroscience, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
- Divisions of Child & Adolescent Psychiatry and Clinical Pharmacology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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7
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Leuchter JD, Kook M, Geller DA, Hertz AG, Garcia J, Trent ES, Dibbs T, Onyeka O, Goodman WK, Guzick AG, Wiese AD, Palo AD, Small BJ, Simpson HB, Havel LK, Nibras SA, Saxena K, Storch EA. Promoting OCD WEllness and resilience (POWER) study: Rationale, design, and methods. PSYCHIATRY RESEARCH COMMUNICATIONS 2023; 3:100111. [PMID: 37377947 PMCID: PMC10299759 DOI: 10.1016/j.psycom.2023.100111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
Obsessive-compulsive disorder (OCD) affects 1-2% of children and is associated with functional impairment and diminished quality of life. Several treatments are efficacious: cognitive behavioral therapy (CBT) with exposure and response prevention, serotonin reuptake inhibitor (SRI) monotherapy, and combined treatment (SRI + CBT). Expert clinician-informed practice parameters suggest that youth with mild to moderate OCD should be treated initially with CBT yet SRIs are frequently employed as the first-line intervention or in combination with psychotherapy in applied practice. Empirical data to guide SRI discontinuation in pediatric OCD are very limited. This study, Promoting OCD Wellness and Resiliency (POWER), aims to address this gap through a two phase, double-blinded, placebo-controlled, randomized controlled non-inferiority trial with the purpose of evaluating whether youth with OCD on an SRI can discontinue their medication after successful CBT augmentation and maintain wellness for a period of 24 weeks during which they receive maintenance CBT that models standard-of-care. In this paper we describe the rationale and methodological design of the POWER study.
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Affiliation(s)
- Jessica D. Leuchter
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Minjee Kook
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Daniel A. Geller
- Department of Pediatric Psychopharmacology, Massachusetts General Hospital, Boston, MA, USA
| | - Alyssa G. Hertz
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Jessica Garcia
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Erika S. Trent
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Tracey Dibbs
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Ogechi Onyeka
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Wayne K. Goodman
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Andrew G. Guzick
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Andrew D. Wiese
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Amanda D. Palo
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Brent J. Small
- School of Aging Studies, University of South Florida, Tampa, FL, USA
| | - H. Blair Simpson
- Department of Psychiatry, Columbia University Medical Center, USA
| | - Lauren K. Havel
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
- Texas Children’s Hospital, Houston, TX, USA
| | - Sohail A. Nibras
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
- Texas Children’s Hospital, Houston, TX, USA
| | - Kirti Saxena
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
- Texas Children’s Hospital, Houston, TX, USA
| | - Eric A. Storch
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
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8
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Schuberth DA, McMahon RJ, Best JR, McKenney K, Selles R, Stewart SE. Parent Management Training Augmentation to Address Coercive and Disruptive Behavior in Cognitive-Behavioral Therapy for Pediatric Obsessive-Compulsive Disorder. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01543-8. [PMID: 37209194 DOI: 10.1007/s10578-023-01543-8] [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] [Accepted: 05/06/2023] [Indexed: 05/22/2023]
Abstract
Coercive and disruptive behaviors commonly interfere with cognitive-behavioral therapy (CBT) trials among youths with obsessive-compulsive disorder (OCD). Although evidence supports parent management training (PMT) for reducing disruptive behavior, no group-based PMT interventions exist for OCD-related disruptive behaviors. We studied feasibility and effectiveness of group-based adjunctive PMT among non-randomized, OCD-affected families receiving family-based group CBT. Linear mixed models estimated treatment effects across OCD-related and parenting outcomes at post-treatment and 1-month follow-up. Treatment response for 37 families receiving CBT + PMT (Mage = 13.90) was compared to 80 families receiving only CBT (Mage = 13.93). CBT + PMT was highly accepted by families. Families who received CBT + PMT had improved disruptive behaviors, parental distress tolerance, and other OCD-related outcomes. OCD-related outcomes did not significantly differ between groups. Results support CBT + PMT as effective treatment for pediatric OCD that may not provide incremental benefits beyond CBT alone. Future research should determine feasible and effective ways to incorporate key PMT components into CBT-based interventions.
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Affiliation(s)
- David A Schuberth
- Department of Psychology, Simon Fraser University, Burnaby, BC, V5A 1S6, Canada.
- BC Children's Hospital Research Institute, Vancouver, BC, Canada.
| | - Robert J McMahon
- Department of Psychology, Simon Fraser University, Burnaby, BC, V5A 1S6, Canada
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - John R Best
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Katherine McKenney
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Robert Selles
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - S Evelyn Stewart
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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9
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Spencer SD, Stiede JT, Wiese AD, Guzick AG, Cervin M, McKay D, Storch EA. Things that make you go Hmm: Myths and misconceptions within cognitive-behavioral treatment of obsessive-compulsive disorder. J Obsessive Compuls Relat Disord 2023; 37:100805. [PMID: 37193037 PMCID: PMC10168610 DOI: 10.1016/j.jocrd.2023.100805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
The past four decades have yielded a robust body of evidence supporting the efficacy and effectiveness of cognitive-behavioral therapy (CBT) as a gold-standard treatment for obsessive-compulsive disorder (OCD) across the lifespan. Exposure and response prevention (E/RP) has been identified as a key component of this approach. Despite robust research support for CBT with E/RP, several myths and misconceptions continue to proliferate in both research and practice settings. Such myths and misconceptions are concerning, as they lack empirical basis, may hinder widespread dissemination and implementation of CBT for OCD, and run contrary to the practice of evidence-based psychological medicine. Focusing on the importance of promoting evidence-based practice and generative clinical science, the present review article synthesizes relevant research within the field of treatments for OCD to address the following myths / misconceptions: (a) uncertainty exists concerning the evidence base supporting CBT for OCD, (b) E/RP attrition and dropout rates are unacceptably high due to excessive risk and perceived patient intolerability, and (c) alternative treatments for OCD need to be expeditiously developed due to major limitations of E/RP. Recommendations for future research and clinical dissemination and implementation to further advance a generative clinical science of OCD treatment are discussed.
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Affiliation(s)
- Samuel D. Spencer
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Jordan T. Stiede
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Andrew D. Wiese
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Andrew G. Guzick
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Matti Cervin
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
- Department of Clinical Sciences Lund, Lund University, Lund Sweden
| | - Dean McKay
- Department of Psychology, Fordham University, Bronx, NY, USA
| | - Eric A. Storch
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
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10
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Spencer SD, Stiede JT, Wiese AD, Goodman WK, Guzick AG, Storch EA. Cognitive-Behavioral Therapy for Obsessive-Compulsive Disorder. Psychiatr Clin North Am 2023; 46:167-180. [PMID: 36740350 PMCID: PMC11170287 DOI: 10.1016/j.psc.2022.10.004] [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] [Indexed: 12/27/2022]
Abstract
Obsessive-compulsive disorder (OCD) is characterized by the presence of debilitating obsessions and compulsions. Cognitive and behavioral models of OCD provide a strong theoretic and empirical foundation for informing effective psychotherapeutic treatment. Cognitive-behavioral therapy (CBT) for OCD, which includes a deliberate emphasis on exposure and response/ritual prevention, has consistently demonstrated robust efficacy for the treatment of pediatric and adult OCD and is the front-line psychotherapeutic treatment for OCD. Two case vignettes describing CBT for OCD in practice as well as recommendations for clinicians are provided.
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Affiliation(s)
- Samuel D Spencer
- Baylor College of Medicine, One Baylor Plaza, MS:350, Houston, TX 77030, USA.
| | - Jordan T Stiede
- Baylor College of Medicine, One Baylor Plaza, MS:350, Houston, TX 77030, USA
| | - Andrew D Wiese
- Baylor College of Medicine, One Baylor Plaza, MS:350, Houston, TX 77030, USA
| | - Wayne K Goodman
- Baylor College of Medicine, One Baylor Plaza, MS:350, Houston, TX 77030, USA
| | - Andrew G Guzick
- Baylor College of Medicine, One Baylor Plaza, MS:350, Houston, TX 77030, USA
| | - Eric A Storch
- One Baylor Plaza, MS:350, 1977 Butler Boulevard, Houston, TX 77030, USA
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11
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Gittins Stone DI, Elkins RM, Gardner M, Boger K, Sperling J. Examining the Effectiveness of an Intensive Telemental Health Treatment for Pediatric Anxiety and OCD During the COVID-19 Pandemic and Pediatric Mental Health Crisis. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01500-5. [PMID: 36749490 PMCID: PMC9902833 DOI: 10.1007/s10578-023-01500-5] [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] [Accepted: 01/23/2023] [Indexed: 02/08/2023]
Abstract
Despite research supporting the efficacy of weekly outpatient videoconferencing-based cognitive behavioral therapy (VCBT), limited evidence exists about the benefits of leveraging VCBT for brief intensive formats. We examined the effectiveness of an intensive outpatient VCBT targeting pediatric anxiety and OCD. Quasi-experimental design was used to compare outcomes of intensive, in-person, group-based cognitive-behavioral therapy with medication management and caregiver guidance pre-pandemic, to a similar VCBT peri-pandemic (n = 130). Pretreatment and posttreatment assessments included patient- and caregiver-report of anxiety and functional impairment. Analyses of covariance were conducted, examining changes in anxiety and impairment between treatment groups, controlling for admission levels. No significant differences in posttreatment anxiety or impairment were observed between conditions. This study illustrates that intensive, group-based treatment for pediatric anxiety and OCD using VCBT is associated with comparable reductions in anxiety and impairment. It marks a crucial step toward providing broader access to quality care for youth in need.
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Affiliation(s)
| | - R Meredith Elkins
- McLean Hospital Belmont, Belmont, MA, USA
- Harvard Medical School, Cambridge, MA, USA
| | | | - Kathryn Boger
- McLean Hospital Belmont, Belmont, MA, USA
- Harvard Medical School, Cambridge, MA, USA
| | - Jacqueline Sperling
- McLean Hospital Belmont, Belmont, MA, USA
- Harvard Medical School, Cambridge, MA, USA
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12
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Trajectory of Change in Parental Accommodation and Its Relation to Symptom Severity and Impairment in Pediatric OCD. Child Psychiatry Hum Dev 2023; 54:232-240. [PMID: 34519945 DOI: 10.1007/s10578-021-01240-4] [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] [Accepted: 09/04/2021] [Indexed: 01/25/2023]
Abstract
Family accommodation (FA) has been shown to relate to poorer treatment outcomes in pediatric obsessive compulsive disorder (OCD), yet few studies have examined the trajectory of change in FA throughout treatment and its relation to treatment outcomes. This study examined change in FA in relation to change in symptom severity and impairment in 63 youth receiving a family-based intervention for early-onset OCD. FA, symptom severity and functional impairment were assessed at baseline, week 5, week 9, and post-treatment (week 14). Results suggested that changes in FA in the beginning stages of treatment preceded global symptom improvement (but not OCD specific improvement) whereas changes in functional impairment preceded changes in FA. In the latter half of treatment, changes in FA preceded improvement in global and OCD specific symptom severity as well as functional impairment. These findings highlight the importance of reducing FA, especially in the later stages of treatment, in order to optimize treatment outcomes in early-onset OCD.
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McGrath CA, Abbott MJ, Mantz SC, O’Brien M, Costa DSJ, Waters F. Change Patterns During Family-Based Treatment for Pediatric Obsessive Compulsive Disorder. JOURNAL OF CHILD AND FAMILY STUDIES 2022; 32:1736-1752. [PMID: 36415311 PMCID: PMC9668710 DOI: 10.1007/s10826-022-02479-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/18/2022] [Indexed: 06/13/2023]
Abstract
Cognitive behavior therapy (CBT) for young people with obsessive compulsive disorder (OCD) has recently been enhanced to target family environment factors. However, the process of change for OCD symptoms and family factors during treatment is not well understood. Uniquely, we explored patterns of change for OCD symptoms and a range of family variables throughout Baseline, Early, Mid, and Late treatment phases of family-based CBT (FCBT) for 15 young people with OCD using multiple informants. We predicted a linear reduction in OCD symptom severity and family accommodation (FA) across treatment phases, however the investigation into other family factor change patterns was exploratory. OCD symptom severity, FA, parental distress tolerance (DT), and conflict all showed significant linear change patterns across treatment phases according to multiple informants. In addition, the largest proportion of change for these variables typically occurred during the first third of treatment, highlighting the importance of identifying participants with and without early gains in future research. Blame also showed a significant linear change pattern, although with small reductions between treatment phases. Preliminary bivariate analyses sought to better understand whether family factor change predicted subsequent OCD severity change or vice versa. Similar patterns emerged across informants, including identification of OCD severity as a significant predictor of change for Blame at subsequent treatment phases. Analyses also showed bi-directional effects for DT and OCD symptoms across informants, where DT predicted OCD severity at subsequent treatment phases and vice versa. These outcomes support further research aimed at understanding the role of family factors in pediatric OCD symptom change.
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Affiliation(s)
- Chloe A. McGrath
- School of Psychology, The University of Sydney, Sydney, NSW 2006 Australia
| | - Maree J. Abbott
- School of Psychology, The University of Sydney, Sydney, NSW 2006 Australia
| | - Sharlene C. Mantz
- School of Psychology, The University of Sydney, Sydney, NSW 2006 Australia
| | - Margot O’Brien
- Rivendell Child, Adolescent and Family Unit, Sydney Local Health District, Thomas Walker Estate, Hospital Road, Concord West, NSW 2138 Australia
| | - Daniel S. J. Costa
- School of Psychology, The University of Sydney, Sydney, NSW 2006 Australia
| | - Felicity Waters
- Rivendell Child, Adolescent and Family Unit, Sydney Local Health District, Thomas Walker Estate, Hospital Road, Concord West, NSW 2138 Australia
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Bertelsen TB, Hoffart A, Rekdal SS, Zahl-Olsen R. Bayes factor benefits for clinical psychology: review of child and adolescent evidence base. F1000Res 2022; 11:171. [PMID: 37809055 PMCID: PMC10558984 DOI: 10.12688/f1000research.76842.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/21/2022] [Indexed: 11/11/2023] Open
Abstract
Background: Statistical methods are a cornerstone of research in clinical psychology and are used in clinical trials and reviews to determine the best available evidence. The most widespread statistical framework, frequentist statistics, is often misunderstood and misused. Even when properly applied, this framework can lead to erroneous conclusions and unnecessarily prolonged trials. The implications for clinical psychology are difficulties in interpreting best available evidence and unnecessarily costly and burdensome research. An alternative framework, Bayesian statistics, is proposed as a solution to several issues with current practice. Methods: Statistical tests of primary outcome measures were extracted from 272 studies, which were cited in 11 recent reviews in the Evidence-based updates series in the Journal of Clinical Child and Adolescent Psychology. The extracted tests were examined regarding relevant features and re-analyzed using Bayes Factors. Results: When statistical tests were significant, the majority (98%) of re-analyzed tests agreed with such claims. When statistical tests were nonsignificant almost half (43%) of re-analyzed tests disagreed with such claims. Equally important for clinical research, an average of 13% fewer participants per study would have been required if the studies had used Bayes Factors. Conclusions: Bayes Factors offer benefits for research in clinical psychology through intuitive interpretations, and less costly trials.
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Affiliation(s)
- Thomas B. Bertelsen
- Department of Clinical Child and Adolescent Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
- Department of Child and Adolescent Mental Health, Sørlandet sykehus, Kristiansand, Agder, 4615, Norway
| | - Asle Hoffart
- Research institute of Modum Bad psychiatric hospital, Vikersund, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Sondre Sverd Rekdal
- Department of Child and Adolescent Mental Health, Sørlandet sykehus, Kristiansand, Agder, 4615, Norway
| | - Rune Zahl-Olsen
- Department of Child and Adolescent Mental Health, Sørlandet sykehus, Kristiansand, Agder, 4615, Norway
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Bertelsen TB, Hoffart A, Rekdal SS, Zahl-Olsen R. Bayes factor benefits for clinical psychology: review of child and adolescent evidence base. F1000Res 2022; 11:171. [PMID: 37809055 PMCID: PMC10558984 DOI: 10.12688/f1000research.76842.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/21/2022] [Indexed: 10/10/2023] Open
Abstract
Background: Statistical methods are a cornerstone of research in clinical psychology and are used in clinical trials and reviews to determine the best available evidence. The most widespread statistical framework, frequentist statistics, is often misunderstood and misused. Even when properly applied, this framework can lead to erroneous conclusions and unnecessarily prolonged trials. The implications for clinical psychology are difficulties in interpreting best available evidence and unnecessarily costly and burdensome research. An alternative framework, Bayesian statistics, is proposed as a solution to several issues with current practice. Methods: Statistical tests of primary outcome measures were extracted from 272 studies, which were cited in 11 recent reviews in the Evidence-based updates series in the Journal of Clinical Child and Adolescent Psychology. The extracted tests were examined regarding relevant features and re-analyzed using Bayes Factors. Results: When statistical tests were significant, the majority (98%) of re-analyzed tests agreed with such claims. When statistical tests were nonsignificant almost half (43%) of re-analyzed tests disagreed with such claims. Equally important for clinical research, an average of 13% fewer participants per study would have been required if the studies had used Bayes Factors. Conclusions: Bayes Factors offer benefits for research in clinical psychology through intuitive interpretations, and less costly trials.
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Affiliation(s)
- Thomas B. Bertelsen
- Department of Clinical Child and Adolescent Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
- Department of Child and Adolescent Mental Health, Sørlandet sykehus, Kristiansand, Agder, 4615, Norway
| | - Asle Hoffart
- Research institute of Modum Bad psychiatric hospital, Vikersund, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Sondre Sverd Rekdal
- Department of Child and Adolescent Mental Health, Sørlandet sykehus, Kristiansand, Agder, 4615, Norway
| | - Rune Zahl-Olsen
- Department of Child and Adolescent Mental Health, Sørlandet sykehus, Kristiansand, Agder, 4615, Norway
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Georgiadis C, Bose D, Wolenski R, Javadi N, Coxe S, Pettit JW, Comer JS. How Flexible are Treatments for Youth Internalizing Disorders? Examining Modification Guidelines Included across Supported Treatments. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2022; 51:593-609. [PMID: 36007223 DOI: 10.1080/15374416.2022.2109649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Treatment protocols for youth-internalizing disorders have been developed, however these protocols have yielded mixed findings in routine care settings. Despite increased recognition of the importance of flexibility when delivering evidence-based treatments (EBTs), little is known about the extent to which protocols offer guidance to providers in flexible EBT implementation. The current study examined the extent to which supported EBTs for youth internalizing disorders explicitly incorporate guidance for treatment modification. METHODS Supported treatment protocols for youth internalizing disorders were identified (N = 44), from which 4,021 modification guidelines were extracted and coded using a structured coding system to classify modification strategies (i.e., the forms that recommended modifications take), and associated tailoring factors (i.e., the rationale for which modifications are recommended). RESULTS Across all EBTs, modification guidelines were quite common, with the average protocol including almost 91 text passages providing guidance for modification. The majority of modification guidelines functionally increase session or treatment length by recommending the addition or repetition of material, whereas less than 5% of modification guidelines provided strategies for condensing or streamlining care. Strikingly, less than 2% of modification guidelines in EBT protocols address patient cultural factors, and rarely address provider or setting issues that can challenge standard implementation. CONCLUSIONS Findings highlight critical gaps in the available guidance to modify EBTs for youth internalizing disorders, and suggest EBT protocols may not be optimally poised to flexibly address the broad diversity of children and adolescents across varied settings in need of mental health care.
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Affiliation(s)
- Christopher Georgiadis
- Center for Children and Families, Department of Psychology, Florida International University
| | - Deepika Bose
- Center for Children and Families, Department of Psychology, Florida International University
| | - Rebecca Wolenski
- Center for Children and Families, Department of Psychology, Florida International University
| | - Natalie Javadi
- Center for Children and Families, Department of Psychology, Florida International University
| | - Stefany Coxe
- Center for Children and Families, Department of Psychology, Florida International University
| | - Jeremy W Pettit
- Center for Children and Families, Department of Psychology, Florida International University
| | - Jonathan S Comer
- Center for Children and Families, Department of Psychology, Florida International University
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Metcalfe RE, Pental P, Duke DC. Engaging Preschool and Early Elementary School-Aged Children in Exposure and Response Prevention (ERP). JOURNAL OF HEALTH SERVICE PSYCHOLOGY 2022; 48:117-125. [PMID: 35891963 PMCID: PMC9302218 DOI: 10.1007/s42843-022-00068-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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18
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Bertelsen TB, Wergeland GJ, Nordgreen T, Himle JA, Håland ÅT. Benchmarked effectiveness of family and school involvement in group exposure therapy for adolescent anxiety disorder. Psychiatry Res 2022; 313:114632. [PMID: 35597139 DOI: 10.1016/j.psychres.2022.114632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/05/2022] [Accepted: 05/11/2022] [Indexed: 10/18/2022]
Abstract
Although cognitive-behavioral therapy (CBT) is an effective treatment for adolescents with anxiety disorders, the majority remain impaired following treatment. We developed a group CBT program (RISK) with high degrees of exposure practice and family and school involvement delivered in a community-based setting and investigated its effectiveness. The treatment involved adolescents (N = 90), with a primary diagnosis of anxiety disorder (82%) or obsessive-compulsive disorder (18%), and their families who received 38 hours of group treatment over 10 weeks. Diagnostic status and symptom severity were assessed at pre- and post-treatment, and a 12-month follow-up and benchmarked against previous effectiveness studies. Our results showed that, at post-treatment, the RISK-treatment was comparably effective as benchmarks on measures of diagnostic status, parent-rated measures, adolescent-rated measures, and clinician-rated measures. At 12-month follow-up all outcomes were superior to benchmarks, including the proportion of participants in remission (79.5%, 95% Highest Posterior Density Interval [74.7, 84.2]), indicating that the RISK-treatment enhanced effectiveness over time. The combination of group format, a high degree of exposure practice, and school and family involvement is a promising format for real-world settings that may help sustain and increase treatment effectiveness. Trial registered at helseforskning.etikkom.no (reg. nr. 2017/1367).
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Affiliation(s)
- Thomas B Bertelsen
- Department of Child and Adolescence Mental Health, Sørlandet Sykehus, Kristiansand, Norway; Department of Clinical Child and Adolescent Psychology, Faculty of Psychology, University of Bergen, Norway.
| | - Gro Janne Wergeland
- Department of Child and Adolescent Psychiatry, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Norway
| | - Tine Nordgreen
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway; Department of Global Health and primary care, Faculty of Medicine, University of Bergen, Norway
| | - Joseph A Himle
- School of Social Work and Department of Psychiatry, University of Michigan, Ann Arbor, Michigan USA
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19
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Omkarappa DB, Rentala S, Nattala P. Effectiveness of psychosocial intervention for internalizing behavior problems among children of parents with alcohol dependence: Randomized controlled trial. World J Clin Cases 2022; 10:5306-5316. [PMID: 35812678 PMCID: PMC9210892 DOI: 10.12998/wjcc.v10.i16.5306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 08/23/2021] [Accepted: 04/30/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Parental drinking has a direct bearing on children. Behavioral problems such as anxiety and depression are common problems among children whose parents drink heavily. Psychosocial interventions have shown promising results for anxiety and depression among children; however, few studies have been conducted in the context of children of parents with alcohol dependence in India.
AIM To evaluate the efficacy of psychosocial intervention for internalizing behavioral problems among children of parents with alcohol dependence.
METHODS A randomized controlled trial with a 2 × 4 factorial design was adopted with longitudinal measurement of outcomes for 6 mo. Two-hundred and eleven children who met the eligibility criteria (at least one parent with alcohol dependence) at government high schools in Bangalore, India, were randomized to the experimental (n = 97) or control group (n = 98). The psychosocial intervention was administered to the experimental group in eight sessions (biweekly) over 4 wk after baseline assessment. The intervention focused on identifying and modifying negative thoughts, replacing thinking errors with realistic alternatives, modification of maladaptive behavior, developing adaptive coping skills and building self-esteem. The data was collected pre-intervention and at 1, 3 and 6 mo after the intervention. Data were analyzed using SPSS 28.0 version.
RESULTS Mean age of the children was 14.68 ± 0.58 years, 60.5% were male, 56% were studying in 9th standard, 70.75% were from nuclear families, and mean family monthly income was 9588.1 ± 3135.2 INR. Mean duration of parental alcohol dependence was 7.52 ± 2.94 years and the father was the alcohol-consuming parent. The findings showed that there were significant psychosocial intervention effects in terms of decreasing anxiety and depression scores, and increasing self-esteem level among experimental group subjects over the 6-mo interval, when compared with the control group (P < 0.001).
CONCLUSION The present study demonstrated that the psychosocial intervention was effective in reducing anxiety and depression, and increasing self-esteem among children of parents with alcohol dependence. The study recommends the need for ongoing psychosocial intervention for these children.
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Affiliation(s)
| | - Sreevani Rentala
- Department of Psychiatric Nursing, Dharwad Institute of Mental Health and Neurosciences, Dharwad 580008, Karnataka, India
| | - Prasanthi Nattala
- Department of Nursing, National Institute of Mental Health and Neuro Sciences, Bangalore 560029, Karnataka, India
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20
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Stallard P. Evidence-based practice in cognitive-behavioural therapy. Arch Dis Child 2022; 107:109-113. [PMID: 34266878 DOI: 10.1136/archdischild-2020-321249] [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: 03/17/2021] [Revised: 04/20/2021] [Accepted: 04/24/2021] [Indexed: 11/03/2022]
Abstract
Cognitive-behavioural therapy (CBT) is a practical, goal-focused approach that helps children understand the relationship between their thoughts, feelings and behaviours. The aim is to identify the dysfunctional and distorted cognitions associated with their psychological problems and to create more functional and balanced cognitive patterns that create less emotional distress and more helpful behaviours. CBT has strong evidence as an effective intervention for children and adolescents with emotional problems. The benefits for children with physical health and chronic conditions appear promising, although further research is required to substantiate these gains.
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Affiliation(s)
- Paul Stallard
- Department of Child and Adolescent Mental Health Services, University of Bath Faculty of Humanities and Social Sciences, Bath, Bath and North East Somer, UK
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21
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Barth AM, Meinert AC, Zopatti KL, Mathai D, Leong AW, Dickinson EM, Goodman WK, Shah AA, Schneider SC, Storch EA. A Qualitative Inquiry of Parents' Observations of Their Children's Mental Health Needs During the COVID-19 Pandemic. CHILDRENS HEALTH CARE 2022; 51:213-234. [PMID: 35530015 PMCID: PMC9071000 DOI: 10.1080/02739615.2021.2003196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Given that children and adolescents are at critical periods of development, they may be particularly vulnerable to the effects of the COVID-19 pandemic. Using a descriptive phenomenological approach, 71 parents' observations of their child's mental health difficulties were explored. Parents sought out treatment because their children were experiencing significant distress. Data used were transcribed from baseline questionnaires and therapy summaries. Data analysis revealed three themes: emotion regulation difficulties, hypervigilance, and despair. The search for strategies and tailored interventions to help mitigate the potential harmful and long-term mental health impacts of the pandemic should be at the forefront of research and clinical practice.
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Affiliation(s)
| | | | | | | | | | - Emily M. Dickinson
- Baylor College of Medicine,Florida International University School of Medicine
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22
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Fujisato H, Kato N, Namatame H, Ito M, Usami M, Nomura T, Ninomiya S, Horikoshi M. The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders Among Japanese Children: A Pilot Study. Front Psychol 2021; 12:731819. [PMID: 34899471 PMCID: PMC8654783 DOI: 10.3389/fpsyg.2021.731819] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 11/01/2021] [Indexed: 11/13/2022] Open
Abstract
At present, there is no established cognitive behavioral therapy (CBT) for treating emotional disorders in Japanese children. Therefore, we introduced the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Children (UP-C) in Japan and adapted it to the Japanese context. We then examined its feasibility and preliminary efficacy using a single-arm pretest, posttest, follow-up design. Seventeen Japanese children aged between 8 and 12 years (female n = 11; male n = 6; M = 10.06 ± 0.97 years) with a principal diagnosis of anxiety, obsessive-compulsive, or depressive disorders, and their parents were enrolled in the study. The primary outcome was the overall severity of emotional disorders as assessed by psychiatrists using the Clinical Global Impression-Severity Scale. Secondary outcomes included child- and parent-reported anxiety symptoms, depressive symptoms, and functional status. No severe adverse events were observed. The feasibility was confirmed by the low dropout proportion (11.76%), high attendance proportion (children: 95.6%; parents: 94.6%), and sufficient participant satisfaction. Linear mixed models (LMMs) showed that the overall severity of emotional disorders and child- and parent-reported anxiety symptoms improved from pre-treatment to post-treatment, and that these treatment effects were maintained during the 3-month follow-up period. Additionally, child- and parent-reported functional status improved from pre-treatment to the 3-month follow-up. In contrast, child-reported depressive symptoms improved from pre-treatment to follow-up, but there was no significant change in parent-reported depressive symptoms between pre-treatment and other time points. These findings demonstrate the feasibility and preliminary efficacy of the Japanese version of the UP-C, suggesting that future randomized controlled trials (RCTs) are warranted (Clinical trial registration: UMIN000026911).
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Affiliation(s)
- Hiroko Fujisato
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Noriko Kato
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Hikari Namatame
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan.,Faculty of Human Sciences, University of Tsukuba, Ibaraki, Japan
| | - Masaya Ito
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Masahide Usami
- Kohnodai Hospital, National Center for Global Health and Medicine, Chiba, Japan
| | - Tomoko Nomura
- Kohnodai Hospital, National Center for Global Health and Medicine, Chiba, Japan.,Graduate School of Humanities and Sciences, Ochanomizu University, Tokyo, Japan
| | - Shuzo Ninomiya
- Kohnodai Hospital, National Center for Global Health and Medicine, Chiba, Japan
| | - Masaru Horikoshi
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan
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Demaria F, Pontillo M, Tata MC, Gargiullo P, Mancini F, Vicari S. Psychoeducation focused on family accommodation: a practical intervention for parents of children and adolescents with obsessive-compulsive disorder. Ital J Pediatr 2021; 47:224. [PMID: 34742338 PMCID: PMC8572476 DOI: 10.1186/s13052-021-01177-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 10/23/2021] [Indexed: 01/20/2023] Open
Abstract
Obsessive-compulsive disorder (OCD) is a neuropsychiatric disorder that is frequently diagnosed in children and adolescents. In pediatric OCD, family plays an important role in the development and maintenance of the disease. In this relationship, both genetic and behavioral factors, such as parental modeling and family accommodation, are significant. Parental modeling concerns the daily enactment of dysfunctional behavioral patterns by a parent with OCD, which may influence children. Family accommodation, in contrast, describes the direct participation of parents in their child's compulsive rituals, by modifying daily routines or by facilitating avoidance of OCD triggers, to decrease the child's distress and time spent executing compulsions. Approximately 80-90% of the relatives of OCD patients actively participate in patients' rituals. The literature demonstrates that a high level of family accommodation is associated with OCD symptom severity, reduced response to cognitive-behavioral treatment (CBT), and a higher risk of therapy dropout.Despite this, no studies have aimed at delineating practical guidance for psychotherapists to support parents in reducing family accommodation.The main aim of this paper is to propose a psychoeducation intervention focused on cognitive-behavioral strategies to help families to manage their child's OCD behaviors without enacting dysfunctional family accommodation behaviors in order to support their child's successful therapy.
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Affiliation(s)
- Francesco Demaria
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, IRCCS, Viale Ferdinando Baldelli 41, 00146 Rome, Italy
| | - Maria Pontillo
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, IRCCS, Viale Ferdinando Baldelli 41, 00146 Rome, Italy
| | - Maria Cristina Tata
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, IRCCS, Viale Ferdinando Baldelli 41, 00146 Rome, Italy
| | - Prisca Gargiullo
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, IRCCS, Viale Ferdinando Baldelli 41, 00146 Rome, Italy
| | - Francesco Mancini
- Scuola di Psicoterapia Cognitiva APC-SPC, Viale Castro Pretorio, 116, 00185 Rome, Italy
| | - Stefano Vicari
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, IRCCS, Viale Ferdinando Baldelli 41, 00146 Rome, Italy
- Scuola di Psicoterapia Cognitiva APC-SPC, Viale Castro Pretorio, 116, 00185 Rome, Italy
- Department of Life Sciences and Public Health, Catholic University of the Sacred Heart, 00168 Rome, Italy
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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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25
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Diagnosis and Treatment of Obsessive-Compulsive and Related Disorders. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2021; 19:455-456. [PMID: 35747304 PMCID: PMC9063580 DOI: 10.1176/appi.focus.19408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
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Schreck M, Georgiadis C, Garcia A, Benito K, Case B, Herren J, Walther M, Freeman J. Core Motivations of Childhood Obsessive-Compulsive Disorder: The Role of Harm Avoidance and Incompleteness. Child Psychiatry Hum Dev 2021; 52:957-965. [PMID: 33044664 DOI: 10.1007/s10578-020-01075-5] [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] [Accepted: 10/02/2020] [Indexed: 10/23/2022]
Abstract
In an effort to improve patient conceptualization and targeted treatment, researchers have sought to accurately classify OCD subtypes. To date, the most common form of OCD classification has used the content of symptom topography as opposed to functional links between symptoms to categorize OCD. The aim of the current study was to explore the associations between these two forms of OCD classification. Participant topographical symptoms were self-reported using the Obsessive-Compulsive Inventory-Child Version (OCI-CV). Clinicians assessed whether participant symptoms were motivated by harm avoidance and/or incompleteness. Structural equation modeling was employed to explore the associations between harm avoidance and incompleteness and symptom dimensions in youth with OCD. Results showed that harm avoidance was significantly associated with doubting/checking, obsessing, and neutralizing symptoms, whereas incompleteness was associated with doubting/checking, ordering, and neutralizing symptoms. Findings are consistent with child and adult literature and highlight the importance of assessing the underlying function of OC behaviors.
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Affiliation(s)
- Meghan Schreck
- Obsessive-Compulsive Disorder Institute, McLean Hospital/Harvard Medical School, 115 Mill St., Belmont, MA, 02478, USA.
| | | | - Abbe Garcia
- Pediatric Anxiety Research Center, Bradley Hospital, Alpert Medical School of Brown University, East Providence, RI, USA
| | - Kristen Benito
- Pediatric Anxiety Research Center, Bradley Hospital, Alpert Medical School of Brown University, East Providence, RI, USA
| | - Brady Case
- Pediatric Anxiety Research Center, Bradley Hospital, Alpert Medical School of Brown University, East Providence, RI, USA
| | - Jennifer Herren
- Pediatric Anxiety Research Center, Bradley Hospital, Alpert Medical School of Brown University, East Providence, RI, USA
| | - Michael Walther
- Pediatric Anxiety Research Center, Bradley Hospital, Alpert Medical School of Brown University, East Providence, RI, USA
| | - Jennifer Freeman
- Pediatric Anxiety Research Center, Bradley Hospital, Alpert Medical School of Brown University, East Providence, RI, USA
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Piacentini J, Wu M, Rozenman M, Bennett S, McGuire J, Nadeau J, Lewin A, Sookman D, Lindsey Bergman R, Storch E, Peris T. Knowledge and competency standards for specialized cognitive behavior therapy for pediatric obsessive-compulsive disorder. Psychiatry Res 2021; 299:113854. [PMID: 33765492 DOI: 10.1016/j.psychres.2021.113854] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 03/01/2021] [Indexed: 02/07/2023]
Abstract
Although exposure-based cognitive behavior therapy (CBT) and pharmacotherapy have demonstrated efficacy for obsessive-compulsive disorder (OCD), the lack of clinicians effectively trained in these treatments significantly limit effective intervention options for affected youth. This is very unfortunate since child onset is reported by 50% of adults with OCD. To ameliorate this serious global issue the 14 nation International Obsessive-Compulsive Disorders Accreditation Task Force (ATF) of The Canadian Institute for Obsessive Compulsive Disorders (CIOCD) has developed knowledge and competency standards recommended for specialized treatments for OCD through the lifespan. Currently available guidelines are considered by experts to be essential but insufficient because there are not enough clinicians with requisite knowledge and competencies to effectively treat OCD. This manuscript presents knowledge and competency standards recommended for specialized cognitive behavior therapy (CBT) for pediatric OCD, derived from comprehensive literature review and expert synthesis. In addition to standards covering the elements of individual CBT-based assessment and treatment, family and school interventions are addressed given the critical role these domains play in the psychosocial development of youths. The ATF standards presented in these phase two papers will be foundational to the upcoming development of certification (individuals) and accreditation (sites) for specialized treatments in OCD through the lifespan.
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Affiliation(s)
- John Piacentini
- Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA USA.
| | - Monica Wu
- Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA USA.
| | | | - Shannon Bennett
- Department of Psychiatry, Weill Cornell Medical College, NY, NY USA
| | - Joseph McGuire
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Josh Nadeau
- Department of Pediatrics, University of South Florida, St. Petersburg, FL, and Rogers Memorial Hospital, Oconomowoc, WI, USA
| | - Adam Lewin
- Departments of Psychiatry and Behavioral Neurosciences and Pediatrics, University of South Florida, St. Petersburg, FL, USA
| | - Debbie Sookman
- Department of Psychology, McGill University Health Center, and Department of Psychiatry, McGill University, Montreal, Quebec, CANADA
| | | | - Eric Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX USA
| | - Tara Peris
- Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA USA
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28
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Benito KG, Machan J, Freeman JB, Garcia AM, Walther M, Frank H, Wellen B, Stewart E, Edmunds J, Sapyta J, Franklin ME. Therapist Behavior During Exposure Tasks Predicts Habituation and Clinical Outcome in Three Randomized Controlled Trials for Pediatric OCD. Behav Ther 2021; 52:523-538. [PMID: 33990231 PMCID: PMC8124089 DOI: 10.1016/j.beth.2020.07.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 07/07/2020] [Accepted: 07/12/2020] [Indexed: 12/13/2022]
Abstract
This study measured therapist behaviors in relation to subsequent habituation within exposure tasks, and also tested their direct and indirect relationships (via habituation) with clinical outcomes of exposure therapy. We observed 459 videotaped exposure tasks with 111 participants in three clinical trials for pediatric obsessive-compulsive disorder (POTS trials). Within exposure tasks, therapist behaviors and patient fear were coded continuously. Outcomes were habituation and posttreatment change in symptom severity, global improvement, and treatment response. More therapist behaviors that encourage approach-and less use of accommodation, unrelated talk, and externalizing language-predicted greater subsequent habituation during individual exposure tasks (exposure-level), and also predicted improved patient clinical outcomes via higher "total dose" of habituation across treatment (patient-level indirect effect). For six of seven therapist behaviors analyzed, the relationship with subsequent habituation within exposure differed by patient fear (low, moderate, or high) at the time the behavior was used. Two therapist behaviors had direct effects in the opposite direction expected; more unrelated talk and less intensifying were associated with greater patient symptom reduction. Results shed light on the "black box" of in-session exposure activities and point to specific therapist behaviors that may be important for clinical outcomes. These behaviors might be best understood in the context of changing patient fear during exposure tasks. Future studies should test whether therapist behaviors can be experimentally manipulated to produce improvement in clinical outcomes.
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Affiliation(s)
| | - Jason Machan
- Lifespan Biostatistics Core, Lifespan Hospitals; Warren Alpert Medical School of Brown University; University of Rhode Island
| | | | | | | | | | | | | | - Julie Edmunds
- Massachusetts General Hospital, Harvard Medical School
| | | | - Martin E Franklin
- Perelman School of Medicine, University of Pennsylvania, & Rogers Behavioral Health
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29
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McKay D, Abramowitz JS, Storch EA. Mechanisms of harmful treatments for obsessive–compulsive disorder. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2021. [DOI: 10.1111/cpsp.12337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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30
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Innovations in the Delivery of Exposure and Response Prevention for Obsessive-Compulsive Disorder. Curr Top Behav Neurosci 2021; 49:301-329. [PMID: 33590457 DOI: 10.1007/7854_2020_202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Obsessive-Compulsive Disorder is an important cause of global health-related disability. In the last several decades, exposure and response prevention (EX/RP) has emerged as one of the most evidence-based treatments for adult and pediatric OCD. Recommended as a first-line treatment in practice guidelines for OCD, EX/RP, when expertly delivered, can be superior to serotonin reuptake inhibitor (SRI) medications alone and superior to adding antipsychotic medication to augment SRI treatment response. Despite a robust evidence base, EX/RP is not widely available. Moreover, although effective, only about half of patients who receive a standard course of EX/RP will achieve remission.This chapter will review innovations in delivering EX/RP, focusing on technology-based methods designed to increase access to EX/RP and translational neuroscience approaches to personalizing and optimizing EX/RP. Technology-based innovations to deliver EX/RP include video conferencing, internet-based treatment, and smartphone apps. Of these, internet-based, clinician-supported treatment has the most evidence base to date. Relevant to all technology-based innovations are the need for advances in the ethical, regulatory and financial aspects of understanding how access to EX/RP may be delivered to individuals of diverse socioeconomic backgrounds in accordance with professional standards and regulations and covered by healthcare.Advances in our understanding of the neural processes underlying learning and memory have led to new ways to combine EX/RP with medications, behavioral interventions, or neuromodulatory methods, with the goal of enhancing the functioning of brain circuits that subserve fear processing and cognitive control. Among the pharmacological approaches to enhancing EX/RP outcome, both ketamine and cannabinoids show promise in small open trials but are in need of further study. Studies to train cognitive control are at an early stage of development yet provide preliminary evidence that training neural processes may be a new path to personalize treatment. How best to combine EX/RP with different types of neuromodulation is being actively studied.Together these innovations in the delivery of EX/RP for OCD hold great promise for improving outcomes of care for individuals with OCD by increasing the availability and the individual treatment effects of this already effective treatment.
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31
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Selles RR, Naqqash Z, Best JR, Franco-Yamin D, Qiu ST, Ferreira JS, Deng X, Hannesdottir DK, Oberth C, Belschner L, Negreiros J, Farrell LJ, Stewart SE. Effects of Treatment Setting on Outcomes of Flexibly-Dosed Intensive Cognitive Behavioral Therapy for Pediatric OCD: A Randomized Controlled Pilot Trial. Front Psychiatry 2021; 12:669494. [PMID: 34079488 PMCID: PMC8165233 DOI: 10.3389/fpsyt.2021.669494] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 04/16/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Optimizing individual outcomes of cognitive-behavioral therapy (CBT) remains a priority. Methods: Youth were randomized to receive intensive CBT at a hospital clinic (n = 14) or within their home (n = 12). Youth completed 3 × 3 h sessions (Phase I) and up to four additional 3-h sessions as desired/needed (Phase II). An independent evaluator assessed youth after Phase I, Phase II (when applicable), and at 1- and 6-months post-treatment. A range of OCD-related (e.g., severity, impairment) and secondary (e.g., quality of life, comorbid symptoms) outcomes were assessed. Results: Families' satisfaction with the treatment program was high. Of study completers (n = 22), five youth (23%) utilized no Phase II sessions and 9 (41%) utilized all four (Median Phase II sessions: 2.5). Large improvements in OCD-related outcomes and small-to-moderate benefits across secondary domains were observed. Statistically-significant differences in primary outcomes were not observed between settings; however, minor benefits for home-based treatment were observed (e.g., maintenance of gains, youth comfort with treatment). Discussion: Intensive CBT is an efficacious treatment for pediatric OCD. Families opted for differing doses based on their needs. Home-based treatment, while not substantially superior to hospital care, may offer some value, particularly when desired/relevant. Clinical Trial Registration: www.ClinicalTrials.gov; https://clinicaltrials.gov/ct2/show/NCT03672565, identifier: NCT03672565.
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Affiliation(s)
- Robert R Selles
- British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada.,Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Zainab Naqqash
- British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada.,Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - John R Best
- British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada.,Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,Gerontology Research Centre, Simon Fraser University, Vancouver, BC, Canada
| | - Diana Franco-Yamin
- British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada.,Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Serene T Qiu
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | | | - Xiaolei Deng
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | | | - Carla Oberth
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
| | - Laura Belschner
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
| | - Juliana Negreiros
- British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Lara J Farrell
- School of Applied Psychology, Griffith University, Gold Coast, QLD, Australia
| | - S Evelyn Stewart
- British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada.,Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,Provincial Health Services Authority, British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada
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32
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Cognitive behavior therapy for internalizing disorders in children and adolescents in routine clinical care: A systematic review and meta-analysis. Clin Psychol Rev 2020; 83:101918. [PMID: 33186776 DOI: 10.1016/j.cpr.2020.101918] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 08/13/2020] [Accepted: 09/08/2020] [Indexed: 01/08/2023]
Abstract
Cognitive behavioral therapy (CBT) has received considerable empirical support for internalizing disorders including anxiety, depression, obsessive-compulsive disorder, and post-traumatic stress disorder in children and adolescents. However, there is less knowledge regarding how CBT performs when delivered in routine clinical care. A systematic review and meta-analysis was conducted of CBT for internalizing disorders in children and adolescents in routine clinical care. Ovid MEDLINE, Embase OVID, and PsycINFO were systematically searched for articles published until October 2019. The effectiveness of CBT, methodological quality, and moderators of treatment outcome were examined. The effects of CBT in routine clinical care were benchmarked by comparing with efficacy studies for the same disorders. Fifty-eight studies were included, comprising 4618 participants. Large effect sizes for outcome were detected at post-treatment (g = 1.28-2.54), and follow-up (g = 1.72-3.36). Remission rates across diagnoses ranged from 50.7% - 77.4% post-treatment, to 53.5% -83.3% at follow-up. Attrition rate across the disorders was 12.2%. Quality of the included studies was fair, and heterogeneity was high. Similarities between the effectiveness and efficacy studies were greater than the differences in outcome. CBT delivered in routine clinical care is efficacious in reducing internalizing disorders and symptoms. The outcomes are comparable with results obtained in efficacy studies. PROSPERO registration: ID CRD42019128709.
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33
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Jensen S, Højgaard DRMA, Hybel KA, Mortensen EL, Skarphedinsson G, Melin K, Ivarsson T, Nissen JB, Weidle B, Valderhaug R, Torp NC, Dahl K, Compton S, Thomsen PH. Distinct trajectories of long-term symptom severity in pediatric obsessive-compulsive disorder during and after stepped-care treatment. J Child Psychol Psychiatry 2020; 61:969-978. [PMID: 31736082 DOI: 10.1111/jcpp.13155] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 09/02/2019] [Accepted: 10/09/2019] [Indexed: 01/25/2023]
Abstract
BACKGROUND First-line treatments for pediatric obsessive-compulsive disorder (OCD) include exposure-based cognitive-behavioral therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs). No studies have thus far identified distinct classes and associated predictors of long-term symptom severity during and after treatment. Yet, these could form the basis for more personalized treatment in pediatric OCD. METHOD The study included 269 OCD patients aged 7-17 years from the Nordic Long-term OCD Treatment Study (NordLOTS). All participants received stepped-care treatment starting with 14 weekly sessions of manualized CBT. Nonresponders were randomized to either prolonged CBT or SSRIs. Symptom severity was assessed using the Children's Yale-Brown Obsessive-Compulsive Scale at seven time points from pre- to post-treatment and over a three-year follow-up. Latent class growth analysis (LCGA) was performed to identify latent classes of symptom severity trajectories. Univariate and multivariate analyses were used to detect differences between classes and identify predictors of trajectory class membership including several clinical and demographic variables. TRIAL REGISTRY Nordic Long-term Obsessive-Compulsive Disorder (OCD) Treatment Study; www.controlled-trials.com; ISRCTN66385119. RESULTS Three LCGA classes were identified: (a) acute, sustained responders (54.6%); (b) slow, continued responders (23.4%); and (c) limited long-term responders (21.9%). Class membership was predicted by distinct baseline characteristics pertaining to age, symptom severity, contamination/cleaning and anxiety symptoms. CONCLUSIONS The LCGA suggests three distinct trajectory classes of long-term symptom severity during and after treatment in pediatric OCD with different clinical profiles at pretreatment. The results point to required clinical attention for adolescent patients with contamination/cleaning and anxiety symptoms who do not show convincing responses to first-line treatment even though they may have reached the established cutoff for treatment response.
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Affiliation(s)
- Sanne Jensen
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Aarhus, Denmark
| | - Davíð R M A Højgaard
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Aarhus, Denmark
| | - Katja A Hybel
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Aarhus, Denmark
| | - Erik Lykke Mortensen
- Department of Public Health and Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | | | - Karin Melin
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Child and Adolescent Psychiatry, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Tord Ivarsson
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Regional Centre for Child and Youth Mental Health and Child Welfare Central Norway, Norwegian University of Science and Technology, Trondheim, Norway
| | - Judith Becker Nissen
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Aarhus, Denmark
| | - Bernhard Weidle
- Regional Centre for Child and Youth Mental Health and Child Welfare Central Norway, Norwegian University of Science and Technology, Trondheim, Norway
| | - Robert Valderhaug
- Regional Centre for Child and Youth Mental Health and Child Welfare Central Norway, Norwegian University of Science and Technology, Trondheim, Norway
| | - Nor Christian Torp
- Division of Mental Health and Addiction, Department of Child and Adolescent Psychiatry, Vestre Viken Hospital, Drammen, Norway
| | - Kitty Dahl
- Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Scott Compton
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Per Hove Thomsen
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Aarhus, Denmark
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Kemp J, Barker D, Benito K, Herren J, Freeman J. Moderators of Psychosocial Treatment for Pediatric Obsessive-Compulsive Disorder: Summary and Recommendations for Future Directions. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2020; 50:478-485. [DOI: 10.1080/15374416.2020.1790378] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Joshua Kemp
- Pediatric Anxiety Research Center, Alpert Medical School of Brown University
| | - David Barker
- Pediatric Anxiety Research Center, Alpert Medical School of Brown University
| | - Kristen Benito
- Pediatric Anxiety Research Center, Alpert Medical School of Brown University
| | - Jennifer Herren
- Pediatric Anxiety Research Center, Alpert Medical School of Brown University
| | - Jennifer Freeman
- Pediatric Anxiety Research Center, Alpert Medical School of Brown University
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35
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Peris TS, Rozenman MS, Bai S, Perez J, Thamrin H, Piacentini J. Ethnicity moderates outcome in family focused treatment for pediatric obsessive compulsive disorder. J Anxiety Disord 2020; 73:102229. [PMID: 32361032 DOI: 10.1016/j.janxdis.2020.102229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 03/23/2020] [Accepted: 04/17/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVE This study examined predictors and moderators of treatment outcome in a randomized controlled trial (RCT) comparing two active interventions for pediatric obsessive compulsive disorder that differed with respect to the focus and format of family intervention. We had a particular interest in the role of race/ethnicity in shaping outcomes given our relatively diverse sample composition and the limited prior work in this area. METHOD A total of 62 youths (Mean age = 12.71 years; 57 % male; 34 % non-white) were assigned to either a standard cognitive behavioral therapy (CBT) family intervention (ST) or to a tailored intervention designed for cases of OCD complicated by poor family functioning (Enhanced Family Therapy; ET). Treatment in both arms involved 12 sessions of exposure therapy; the family interventions differed. Predictor and moderator variables were chosen based on the extant literature. RESULTS Minority status did not predict outcome, suggesting that overall, white and non-white youth had comparable treatment response. Race/ethnicity did, however, moderate response with non-white youth faring better in the ET arm of the study. In particular, minority youth in ET had, on average, post-treatment CYBOCS scores consistent with clinical remission whereas their ST counterparts were left with symptoms considered moderately severe. There were no predictors of treatment outcome. CONCLUSIONS Minority status predicts poorer response to standard CBT across disorders, suggesting the need for possible treatment adaptations. The present findings highlight one avenue for matching patients to treatments that might optimize outcomes and underscore the value of family involvement in OCD treatment.
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Affiliation(s)
- Tara S Peris
- Jane and Semel Institute for Neuroscience and Human Behavior, United States.
| | | | - Sunhye Bai
- Pennsylvania State University, United States
| | - Jocelyn Perez
- Jane and Semel Institute for Neuroscience and Human Behavior, United States
| | | | - John Piacentini
- Jane and Semel Institute for Neuroscience and Human Behavior, United States
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36
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Selles RR, Højgaard DRMA, Ivarsson T, Thomsen PH, McBride NM, Storch EA, Geller D, Wilhelm S, Farrell LJ, Waters AM, Mathieu S, Stewart SE. Avoidance, Insight, Impairment Recognition Concordance, and Cognitive-Behavioral Therapy Outcomes in Pediatric Obsessive-Compulsive Disorder. J Am Acad Child Adolesc Psychiatry 2020; 59:650-659.e2. [PMID: 31228561 PMCID: PMC7179819 DOI: 10.1016/j.jaac.2019.05.030] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 05/10/2019] [Accepted: 06/13/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Insight and avoidance are commonly discussed factors in obsessive-compulsive disorder (OCD) that have demonstrated associations with increased severity as well as reduced treatment response in adults, but these factors have not been sufficiently examined in pediatric OCD. This study examined the impacts of avoidance, insight, and impairment recognition concordance on cognitive-behavioral therapy (CBT) outcomes as well as impacts of CBT on insight and avoidance in a large sample of youths affected by OCD. METHOD Data from 573 OCD-affected youths enrolled in CBT trials were aggregated. Children's Yale-Brown Obsessive-Compulsive Scale items measured treatment response, insight, and avoidance. Standardized differences between child and parent ratings of impairment were used to calculate impairment recognition concordance. Binary logistic regression was used to identify variables associated with treatment response. RESULTS Greater avoidance, limited child recognition of impairment, older age, and lower baseline severity predicted reduced likelihood of treatment response, but insight did not. Both insight and avoidance improved significantly following CBT. Response rates were lower when posttreatment insight and avoidance were worse. CONCLUSION Contrasting with prevailing belief, poor insight does not appear to limit CBT response potential in pediatric OCD. Avoidance and impairment recognition are understudied CBT response predictors and warrant further consideration in pediatric OCD. Clinicians should attend to these factors to optimize outcomes for children affected by this common, debilitating illness.
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Affiliation(s)
- Robert R Selles
- University of British Columbia and BC Children's Hospital, Vancouver, BC, Canada.
| | | | | | | | | | | | - Daniel Geller
- Harvard Medical School and Massachusetts General Hospital, Boston, MA
| | - Sabine Wilhelm
- Harvard Medical School and Massachusetts General Hospital, Boston, MA
| | | | | | | | - S Evelyn Stewart
- University of British Columbia and BC Children's Hospital, Vancouver, BC, Canada
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37
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Family-Based Psychological Treatment for Obsessive Compulsive Disorder in Children and Adolescents: A Meta-analysis and Systematic Review. Clin Child Fam Psychol Rev 2019; 22:478-501. [DOI: 10.1007/s10567-019-00296-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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