Controlled comparison of family cognitive behavioral therapy and psychoeducation/relaxation training for child obsessive-compulsive disorder.
OBJECTIVE
To examine the efficacy of exposure-based cognitive-behavioral therapy (CBT) plus a structured family intervention (FCBT) versus psychoeducation plus relaxation training (PRT) for reducing symptom severity, functional impairment, and family accommodation in youths with obsessive-compulsive disorder (OCD).


METHODS
A total of 71 youngsters 8 to 17 years of age (mean 12.2 years; range, 8-17 years, 37% male, 78% Caucasian) with primary OCD were randomized (70:30) to 12 sessions over 14 weeks of FCBT or PRT. Blind raters assessed outcomes with responders followed for 6 months to assess treatment durability.


RESULTS
FCBT led to significantly higher response rates than PRT in ITT (57.1% vs 27.3%) and completer analyses (68.3% vs. 35.3%). Using HLM, FCBT was associated with significantly greater change in OCD severity and child-reported functional impairment than PRT and marginally greater change in parent-reported accommodation of symptoms. These findings were confirmed in some, but not all, secondary analyses. Clinical remission rates were 42.5% for FCBT versus 17.6% for PRT. Reduction in family accommodation temporally preceded improvement in OCD for both groups and child functional status for FCBT only. Treatment gains were maintained at 6 months.


CONCLUSIONS
FCBT is effective for reducing OCD severity and impairment. Importantly, treatment also reduced parent-reported involvement in symptoms with reduced accommodation preceding reduced symptom severity and functional impairment. CLINICAL TRIALS REGISTRY INFORMATION: Behavior Therapy for Children and Adolescents with Obsessive-Compulsive Disorder (OCD); http://www.clinicaltrials.gov; NCT00000386.
University of California-Los Angeles Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA 90024, USA. jpiacentini@mednet.ucla.edu
John
J
Piacentini
R Lindsey
RL
Bergman
Susanna
S
Chang
Audra
A
Langley
Tara
T
Peris
Jeffrey J
JJ
Wood
James
J
McCracken
D000293:Adolescent; D002648:Child; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D005196:Family Therapy; D005260:Female; D006801:Humans; D007171:Implosive Therapy; D008297:Male; D009771:Obsessive-Compulsive Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D010290:Parents / Q000523:psychology; D011569:Psychiatric Status Rating Scales; D012064:Relaxation Therapy; D012720:Severity of Illness Index; D016037:Single-Blind Method; D016896:Treatment Outcome