Family-based cognitive-behavioral therapy for pediatric obsessive-compulsive disorder: comparison of intensive and weekly approaches.
OBJECTIVE
To examine the relative efficacy of intensive versus weekly cognitive-behavioral therapy (CBT) for children and adolescents with obsessive-compulsive disorder (OCD).


METHODS
Forty children and adolescents with OCD (range 7-17 years) were randomized to receive 14 sessions of weekly or intensive (daily psychotherapy sessions) family-based CBT. Assessments were conducted at three time points: pretreatment, posttreatment, and 3-month follow-up. Raters were initially blind to randomization. Primary outcomes included scores on the Children's Yale-Brown Obsessive-Compulsive Scale, remission status, and ratings on the Clinical Global Impression-Severity and Clinical Global Improvement scales. Secondary outcomes included the Child Obsessive Compulsive Impact Scale-Parent Rated, Children's Depression Inventory, Multidimensional Anxiety Scale for Children, and Family Accommodation Scale. Adjunctive pharmacotherapy was not an exclusion criterion.


RESULTS
Intensive CBT was as effective as weekly treatment with some advantages present immediately after treatment. No group differences were found at follow-up, with gains being largely maintained over time. Although no group x time interaction was found for the Children's Yale-Brown Obsessive-Compulsive Scale (F(1,38) = 2.2, p = .15), the intensive group was rated on the Clinical Global Impression-Severity as less ill relative to the weekly group (F(1,38) = 9.4, p < .005). At posttreatment, 75% (15/20) of youths in the intensive group and 50% (10/20) in the weekly group met remission status criteria. Ninety percent (18/20) of youths in the intensive group and 65% (13/20) in the weekly group were considered treatment responders on the Clinical Global Improvement (chi1(2) = 3.6, p = .06).


CONCLUSIONS
Both intensive and weekly CBT are efficacious treatments for pediatric OCD. Intensive treatment may have slight immediate advantages over weekly CBT, although both modalities have similar outcomes at 3-month follow-up.
Storch
Eric A
EA
Drs. Storch, Geffken, Merlo, Mann, Adkins, Murphy, and Goodman, Mr. Duke, and Ms. Munson are with the Department of Psychiatry; Drs. Storch and Geffken are with the Department of Pediatrics; and Ms. Grabill is with the Department of Clinical and Health Psychology, University of Florida, Gainesville. Electronic address: estorch@psychiatry.ufl.edu.
Geffken
Gary R
GR
Drs. Storch, Geffken, Merlo, Mann, Adkins, Murphy, and Goodman, Mr. Duke, and Ms. Munson are with the Department of Psychiatry; Drs. Storch and Geffken are with the Department of Pediatrics; and Ms. Grabill is with the Department of Clinical and Health Psychology, University of Florida, Gainesville.
Merlo
Lisa J
LJ
Drs. Storch, Geffken, Merlo, Mann, Adkins, Murphy, and Goodman, Mr. Duke, and Ms. Munson are with the Department of Psychiatry; Drs. Storch and Geffken are with the Department of Pediatrics; and Ms. Grabill is with the Department of Clinical and Health Psychology, University of Florida, Gainesville.
Mann
Giselle
G
Drs. Storch, Geffken, Merlo, Mann, Adkins, Murphy, and Goodman, Mr. Duke, and Ms. Munson are with the Department of Psychiatry; Drs. Storch and Geffken are with the Department of Pediatrics; and Ms. Grabill is with the Department of Clinical and Health Psychology, University of Florida, Gainesville.
Duke
Danny
D
Drs. Storch, Geffken, Merlo, Mann, Adkins, Murphy, and Goodman, Mr. Duke, and Ms. Munson are with the Department of Psychiatry; Drs. Storch and Geffken are with the Department of Pediatrics; and Ms. Grabill is with the Department of Clinical and Health Psychology, University of Florida, Gainesville.
Munson
Melissa
M
Drs. Storch, Geffken, Merlo, Mann, Adkins, Murphy, and Goodman, Mr. Duke, and Ms. Munson are with the Department of Psychiatry; Drs. Storch and Geffken are with the Department of Pediatrics; and Ms. Grabill is with the Department of Clinical and Health Psychology, University of Florida, Gainesville.
Adkins
Jennifer
J
Drs. Storch, Geffken, Merlo, Mann, Adkins, Murphy, and Goodman, Mr. Duke, and Ms. Munson are with the Department of Psychiatry; Drs. Storch and Geffken are with the Department of Pediatrics; and Ms. Grabill is with the Department of Clinical and Health Psychology, University of Florida, Gainesville.
Grabill
Kristen M
KM
Drs. Storch, Geffken, Merlo, Mann, Adkins, Murphy, and Goodman, Mr. Duke, and Ms. Munson are with the Department of Psychiatry; Drs. Storch and Geffken are with the Department of Pediatrics; and Ms. Grabill is with the Department of Clinical and Health Psychology, University of Florida, Gainesville.
Murphy
Tanya K
TK
Drs. Storch, Geffken, Merlo, Mann, Adkins, Murphy, and Goodman, Mr. Duke, and Ms. Munson are with the Department of Psychiatry; Drs. Storch and Geffken are with the Department of Pediatrics; and Ms. Grabill is with the Department of Clinical and Health Psychology, University of Florida, Gainesville.
Goodman
Wayne K
WK
Drs. Storch, Geffken, Merlo, Mann, Adkins, Murphy, and Goodman, Mr. Duke, and Ms. Munson are with the Department of Psychiatry; Drs. Storch and Geffken are with the Department of Pediatrics; and Ms. Grabill is with the Department of Clinical and Health Psychology, University of Florida, Gainesville.
D000293:Adolescent; D002648:Child; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003422:Critical Care; D005196:Family Therapy; D005260:Female; D006801:Humans; D008297:Male; D009771:Obsessive-Compulsive Disorder / Q000628:therapy*; D013997:Time Factors