ARTICLES
Cognitive-Behavioral Family Treatment of Childhood Obsessive-Compulsive Disorder: A Controlled Trial

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ABSTRACT

Objective

To evaluate the relative efficacy of (1) individual cognitive-behavioral family-based therapy (CBFT); (2) group CBFT; and (3) a waitlist control group in the treatment of childhood obsessive-compulsive disorder (OCD).

Method

This study, conducted at a university clinic in Brisbane, Australia, involved 77 children and adolescents with OCD who were randomized to individual CBFT, group CBFT, or a 4- to 6-week waitlist control condition. Children were assessed before and after treatment and at 3 months and 6 months following the completion of treatment using diagnostic interviews, symptom severity interviews, and self-report measures. Parental distress, family functioning, sibling distress, and levels of accommodation to OCD demands were also assessed. Active treatment involved a manualized 14-week cognitive-behavioral protocol, with parental and sibling components.

Results

By an evaluable patient analysis, statistically and clinically significant pretreatment-to-posttreatment change occurred in OCD diagnostic status and severity across both individual and group CBFT, with no significant differences in improvement ratings between these conditions. There were no significant changes across measures for the waitlist condition. Treatment gains were maintained up to 6 months of follow-up.

Conclusions

Contrary to previous findings and expectations, group CBFT is as effective in reducing OCD symptoms for children and adolescents as individual treatment. Findings support the efficacy and durability of CBFT in treating childhood OCD.

Section snippets

METHOD

TREATMENT PROTOCOL

The treatment protocol (“Freedom From Obsessions and Compulsions Using Cognitive-Behavioral Strategies” [FOCUS]; Barrett et al., in preparation) used in the present study is a CBFT treatment protocol based on March and colleagues’ individual CBT protocol (“How I Ran OCD Off My Land”; March et al., 1994; March and Mulle, 1998). Adapted from March's original work, the FOCUS program includes a structured parent and sibling protocol, differentiating this CBFT protocol from typical CBT, and allows

PROCEDURE

Following referral, participants were screened for obsessive-compulsive symptomatology via a telephone interview with parents, and those children meeting the inclusion criteria were invited for an assessment at one of two university psychology clinics in the Brisbane and Gold Coast regions. On attending the clinic, the research aims were explained to all participants (parents and children) and written informed consent was gained from parents prior to assessments. Initial assessment interviews

Treatment Outcome

According to parents’ ADIS reports at posttreatment, 21 children (88% response rate) in the individual CBFT condition were without a diagnosis of OCD, compared to 22 children (76% response rate) in the group CBFT condition. All children in the waitlist condition continued to meet criteria for OCD at post-waitlist. A χ2 analysis was used to test differences in treatment response rates for individual and group conditions and revealed no significant difference in the frequency of children without

DISCUSSION

Both active CBFT conditions produced significant reductions in diagnostic status and severity ratings of obsessive-compulsive symptomatology in contrast to the waitlist control condition. Significant improvements occurred as early as week 6 in the treatment and continued across time to week 11, with improvements in child diagnostic status and obsessive-compulsive symptomatology maintained up to 6 months posttreatment. Measures of associated anxiety and depression in children declined for all

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    This study was supported by a National Health and Medical Research Council Grant. The authors acknowledge the assistance of Belinda Kelly in the preparation of this manuscript and the research assistance of Peta Hartmann, Rachelle O’Malley, Natalie Boulter, and Keri Pavia.

    Readers interested in obtaining a copy of the FOCUS treatment manuals may contact the authors or Australian Academic Press at [email protected]; 32 Jeays Street, Bowen Hills 4006, Brisbane, Australia.

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