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Differential efficacy of cognitive-behavioral therapy and pharmacological treatments for pediatric obsessive–compulsive disorder: A meta-analysis

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... Child and Adolescent Psychiatry and Mental Health (2022) 16:99 Background The number of treatment outcome studies for pediatric obsessive-compulsive disorder (OCD) has increased in recent years. On the whole, the study findings demonstrate the efficacy of cognitive behavioral therapy (CBT) and pharmacotherapy in reducing OCD symptoms as well as the superiority of CBT compared to medication alone [1][2][3][4]. A combination of pharmacotherapy and CBT has also shown better results than pharmacotherapy as an individual treatment [2,5,6]. ...
... On the whole, the study findings demonstrate the efficacy of cognitive behavioral therapy (CBT) and pharmacotherapy in reducing OCD symptoms as well as the superiority of CBT compared to medication alone [1][2][3][4]. A combination of pharmacotherapy and CBT has also shown better results than pharmacotherapy as an individual treatment [2,5,6]. Based on these studies, CBT (in severe cases with additional pharmacotherapy) is considered as the first-line treatment according to internationally recognized guidelines [7,8]. ...
... Meta-analyses by Abramowitz et al. [9]), Sánchez-Meca et al. [2] and Rosa-Alcázar et al. [15] found that CBT also has effects on co-existing symptoms such as anxiety and depression as well as functional impairment. However, most research projects only evaluated the treatment effects on OCD symptoms, while the effects on comorbid symptoms or psychosocial impairment have been neglected. ...
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Background Based on the current state of research regarding the treatment in pediatric obsessive–compulsive disorder (OCD), cognitive behavioral therapy (CBT) (in severe cases with additional pharmacotherapy) is considered as the first-line treatment according to internationally recognized guidelines. Research is mostly based on randomized controlled trials (RCTs; efficacy research). Thus, examined treatment conditions, especially the treatment duration, and patients’ characteristics do not necessarily correspond to those found within routine care. Studies showed CBT packages as a whole to be efficacious, but less is known about the effects of individual CBT components. Furthermore, effects on comorbid symptoms or psychosocial impairment have been often neglected and different rater perspectives have been hardly considered in previous research. Methods This effectiveness study aimed to examine the effects of multimodal CBT in children, adolescents, and young adults (age 6–20 years) with OCD ( n = 38) within routine care. Effects on obsessive–compulsive and co-existing symptoms were evaluated in a within-subject design by comparing changes during the assessment phase with 12-week standard treatment and with individually tailored extended treatment. Additionally, within the standard treatment, non-exposure treatment was compared to exposure treatment. Multi-informant assessment was applied, and the analyses included multilevel modeling and t-tests for pre-post comparisons. Results During the standard treatment and extended treatment, obsessive–compulsive symptoms, strain, and functional impairment significantly decreased. Moreover, a significant reduction of overall comorbid symptoms emerged, particularly regarding internalizing symptoms, including anxiety and depression. Comparisons of treatment components indicated that adding exposure with response prevention (ERP) has an additional positive effect. Clinical improvement and remission rates increased considerably when more treatment sessions were provided. Conclusions These results suggest that improvement after an initial 12-week course of treatment may not allow for the prediction of non-responders/non-remitters and for the termination of treatment. Overall, the findings show that results from randomized controlled trials are transferrable to routine care. Trial registration number This study was registered retrospectively at the German Clinical Trials Register ( https://drks.de/search/de/trial/DRKS00030050 ).
... Similarly, meta-analyses provide ample support for the treatment of pediatric OCD with CBT. Specifically, the effect sizes from several meta-analytic studies yield mean effect sizes ranging from 1.21 to 1.74 with passive comparison groups (McGuire et al., 2015;Sánchez-Meca et al., 2014;Öst et al., 2016;Watson and Rees, 2008). Although both CBT and pharmacological interventions such as serotonin reuptake inhibitors (SRIs) have been identified as first-line, evidence-based treatments for youth with OCD, research suggests that CBT outperforms SRIs, and outcomes for youth receiving the combination of the two are not statistically different from outcomes for youth receiving CBT alone (Sánchez-Meca et al., 2014;Öst et al., 2016). ...
... Specifically, the effect sizes from several meta-analytic studies yield mean effect sizes ranging from 1.21 to 1.74 with passive comparison groups (McGuire et al., 2015;Sánchez-Meca et al., 2014;Öst et al., 2016;Watson and Rees, 2008). Although both CBT and pharmacological interventions such as serotonin reuptake inhibitors (SRIs) have been identified as first-line, evidence-based treatments for youth with OCD, research suggests that CBT outperforms SRIs, and outcomes for youth receiving the combination of the two are not statistically different from outcomes for youth receiving CBT alone (Sánchez-Meca et al., 2014;Öst et al., 2016). Cognitive-behavioral approaches to OCD in youth typically include a combination of psychoeducation and cognitive restructuring in addition to the central component of exposure and response prevention (ERP), in which youth are exposed to the feared stimulus (obsessions) and prevented from engaging in a compulsive response that intends to reduce the distress of the obsession (Sánchez-Meca et al., 2014). ...
... Although both CBT and pharmacological interventions such as serotonin reuptake inhibitors (SRIs) have been identified as first-line, evidence-based treatments for youth with OCD, research suggests that CBT outperforms SRIs, and outcomes for youth receiving the combination of the two are not statistically different from outcomes for youth receiving CBT alone (Sánchez-Meca et al., 2014;Öst et al., 2016). Cognitive-behavioral approaches to OCD in youth typically include a combination of psychoeducation and cognitive restructuring in addition to the central component of exposure and response prevention (ERP), in which youth are exposed to the feared stimulus (obsessions) and prevented from engaging in a compulsive response that intends to reduce the distress of the obsession (Sánchez-Meca et al., 2014). ERP has long been lauded as a key component of CBT for OCD; however, several recent meta-analyses were unable to detect a statistically significant advantage for ERP over cognitively-focused treatment approaches without ERP, all noting that this finding is to be interpreted with caution given methodological limitations and calling for more focused research dismantling components of CBT for OCD to determine their relative effectiveness (McGuire et al., 2015;Sánchez-Meca et al., 2014;Öst et al., 2016). ...
Chapter
Cognitive-behavioral therapy is an empirically supported treatment for youth with a range of disorders (e.g., anxiety, depression, trauma, chronic pain) and is widely practiced and taught in training programs. Cognitive-behavioral therapy is an integration of multiple theoretical approaches, including behavioral, cognitive, and developmental, that targets potential areas of vulnerability in each domain. Existing research has established its efficacy and supports its effectiveness, yet future research must further these gains through treatment personalization and implementation research.
... A meta-analysis suggested clomipramine to be more effective compared with SSRI for the treatment of OCD in children (11). That said, direct comparisons of clomipramine and SSRI have not shown any superiority for any of the two drugs for treating OCD in adults (12)(13)(14)(15)). ...
... To be familiar with the ground of research on OCD treatment, the reader is humbly referred to the previously conducted systematic reviews and meta-analyses concerning the abovementioned issues (7,11,(19)(20)(21)(22)(23). ...
... First, being superior over placebo does not yet advocate for the intervention's clinical implications, especially when an even more effective treatment option clearly exists. Such an option, exemplified herein by CBT, has been fairly validated, and its efficacy in children and adolescents has been confirmed multiple times by various studies (11,20,21,(40)(41)(42). Second, leaving the "placebo" arms of children untreated for the study duration would be somewhat unethical. ...
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Background: Obsessive-compulsive disorder (OCD) is a common behavioral disorder among adolescents and children. The selective serotonin reuptake inhibitors (SSRIs) are the first pharmacological choice for this condition due to mild adverse effect profile. Objective: This systematic review was performed to evaluate the efficacy of SSRI for OCD in adolescents and children. Methods: Search terms were entered into PubMed, PsycINFO, Scopus, CINAHL, and Google Scholar. The included studies were randomized, placebo-controlled trials of SSRIs conducted in populations of children and adolescents younger than 18 years. Change from baseline Children’s Yale-Brown Obsessive-Compulsive Scale (CY-BOCS), end-treatment CY-BOCS with respective SD, and response and remission rates were collected for continuous and dichotomous outcome assessment, respectively. Cochrane Rev Man software was used for meta-analyses, providing Forest plots where applicable. Results: SSRIs were superior to placebo with a small effect size. There was no additional benefit of combination treatment over cognitive behavioral therapy (CBT) alone, but CBT added substantial benefit to SSRI monotherapy. Fluoxetine and sertraline appear to be superior to fluvoxamine. Conclusion: The results of current systematic review and meta-analysis support the existing National Institute for Health and Care Excellence (NICE) guidelines for choosing CBT as first line of treatment and substituting it with SSRI, depending on patient preference. Adding CBT to current SSRI treatment is effective for non-responders and partial responders, but adding SSRI to ongoing CBT does not prove beneficial. The SSRIs have different effectiveness, and their relative efficacy remains to be investigated.
... Although limited, previous evidence suggests that CBT can reduce the impact of comorbid symptoms in pediatric OCD. For example, a meta-analysis (Sánchez-Meca et al., 2014) about the differential efficacy of CBT, pharmacological and combined treatment for pediatric OCD including 18 studies, concluded that all types of interventions were efficacious not only in reducing obsessive-compulsive symptoms, but also improved depression, anxiety, and other secondary responses, especially with CBT interventions. ...
... These techniques can also be beneficial for treating non-OCD anxiety symptoms, thereby improving comorbid symptoms. Our findings resonate with those from a large previous meta-analysis conducted by Sánchez-Meca et al. (2014), which reported improvements in depression, anxiety, and other secondary responses following treatment, irrespective of the modality (CBT, medication, or their combination), with CBT showing particular effectiveness. Another noteworthy improvement in emotional well-being in our study was the significant reduction in overall anxiety symptoms, as evidenced by the score of SCARED (both -C, Child report; -P, Parent report. ...
Article
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Background Obsessive-compulsive disorder (OCD) is a debilitating mental health condition usually presenting with a high degree of comorbid symptoms in the majority of cases. Although face-to-face cognitive-behavioral therapy (CBT) is considered the therapeutic golden standard for pediatric OCD, its accessibility, availability, and consistency in delivery are still limited. To address some of these challenges, an enhanced CBT (eCBT) package was created and introduced. This study explored eCBT’s broad-based impact on OCD-related comorbid symptoms, functional impairment, quality of life and family accommodation among youth with OCD. Methods This open trial involved 25 pediatric patients with OCD (7−17 years), assessed between January 2018 to February 2020. All patients received eCBT for 14 weeks. Secondary outcomes were assessed at baseline, post-treatment, and 3-, 6-, and 12-month follow-up co-occurring symptoms were evaluated using the Strengths and Difficulties Questionnaire (SDQ), Screen for Child Anxiety-Related Emotional Disorders (SCARED), and Mood and Feelings Questionnaire (MFQ). Quality of life was measured using the KINDL-R, functional impairment through the Child Obsessive-Compulsive Impact Scale Revised (COIS-R), and family accommodation by the Family Accommodation Scale (FAS). Linear mixed-effects models were applied to analyze treatment effects. Results Results indicated a significant decrease in OCD-related comorbid symptoms post-treatment, with SDQ mean reduce of 3.73 (SE = 1.10, child) and 4.14 (SE = 1.19, parent), SCARED mean reduce of 10.45 (SE = 2.52, child) and 8.40 (SE = 2.82, parent), MFQ mean reduce of 3.23 (SE = 1.11, child) and 2.69 (SE = 1.18, parent). Family accommodation declined with clinician scored FAS mean reduction of 13.25 (SE = 2.31). Quality-of-Life improved significantly post-treatment, with KINDL mean increase of 8.15 (SE = 2.87, children), and 10.54 (SE = 3.07, parents). These positive improvements were further amplified at the 3-month follow-up and remained consistent at the 12-month follow-up. Conclusion A significant reduction was observed in all secondary outcomes employed and OCD-related functional impairments from baseline to post-treatment, which was maintained through 12-month follow-up. These results imply that after receiving eCBT, children and adolescents experienced substantial decrease in the negative impacts of OCD-related symptoms on their daily life, including home, school, and social interactions.
... The study results showed that positivity training at the post-test stage promoted and improved academic well-being and its components in students with OCD (Table 5). These results are consistent with some previous results (19,28,(34)(35)(36)(37)(38)(39)(40)(41)(42). ...
... In this study, we evaluated the technique of evidence confirming and refuting the cognitions and beliefs related to OCD, defense of misconceptions, how the thoughts create emotions, how stress management and relaxation methods increase cognition of students with OCD and provide the situation for dealing appropriately with their negative thoughts caused by OCD. The feeling of well-being is a high-level cognitive process that affects how a person solves problems with life tensions and how to deal with them (42). Training positive thinking skills has encouraging effects and it can broaden action and thinking in education and lead to avoiding despair and increasing vitality. ...
Article
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Background: Today, the construct of well-being has influenced the field of education. In this regard, one of the important educational objectives in advanced societies is to provide psychological well-being for students. Obsessive-compulsive disorder (OCD) is considered as one of the most common mental disorders affecting all aspects of life with destructive effects in the long run on interpersonal and social relationships. Objectives: This study aimed to investigate the effectiveness of positivity on academic well-being in students with OCD. Methods: The population of this quasi-experimental study included all female students studying in secondary schools in Zahedan during the academic year 2020 - 2021. Using convenience sampling method, a total of 30 participants diagnosed with OCD were assigned into two equal groups of experimental and control (n = 15 in each). The experimental group received positivity training for eight sessions (each session 60 minutes). For data collection, Maudsley Obsessive-Compulsive Inventory (MOCI) and Academic Well-being Scale by Tuominen-Soini et al. were used. The data obtained from pre-test and post-test were analyzed by multivariate analysis of covariance (MANOVA). Results: The results of covariance showed that after training positivity, a significant difference was found between the mean scores of the control and experimental groups in the components of value of school, school burnout, academic satisfaction, involvement in school assignments, and academic well-being (P < 0.05). The difference in post-test scores related to the effect of positivity education according to ETA coefficients in the variables of school value, school burnout, academic satisfaction, school work integration, and academic well-being were 0.86, 0.52, 0.64, 0.77, and 0.81%, respectively. Conclusions: Considering the effectiveness of positivity training to promote the dimensions of academic well-being, practitioners are advised to use this kind of training to improve academic well-being of students with OCD.
... The following keywords were combined, in English and Spanish, in the electronic searches: ([obsessive-compulsive] , which should be in the title or abstract. Second, the references of some meta-analyses and systematic reviews were consulted (Barret et al., 2005;Himle et al., 2003;Iniesta-Sepúlveda et al., 2017;March et al., 2001;McGuire et al., 2015;Rosa-Alcázar et al., 2012;Sánchez-Meca et al., 2014;Thompson-Hollands et al., 2014;Torp et al., 2015;Turner, 2006;Turner et al., 2018;. Third, the references of the located studies were also reviewed. ...
... When the trim-and-fill method to assess the influence of publication bias was applied, a more conservative average effect size was found (dadj = 1.494), although still statistically significant and of large magnitude following Rubio-Aparicio et al. (2018) guidelines. This finding is consistent with previous meta-analyses showing that CBT is highly effective in reducing OCD symptoms (Meyer et al., 2014;Rosa-Alcázar et al., 2015;Sánchez-Meca et al., 2014). Follow-up analysis of outcomes was not possible as only 16 studies reported follow-up data. ...
Article
Background: Although some meta-analyses have identified potential moderators associated with treatment outcomes for pediatric obsessive-compulsive disorder (OCD), there is as yet no consensus regarding the influence of anxiety and depression symptoms on the recovery from pediatric OCD. A meta-analysis was conducted to investigate the effects of depression and anxiety symptoms and their comorbidities on the efficacy of CBT in pediatric OCD, as well as other potential moderators that may be associated with outcomes. Method: An exhaustive literature search from 1983 to March 2021 located 22 published articles that applied cognitive-behavioral therapy (CBT) to pediatric OCD, producing a total of 26 treatment groups. Some of the moderator variables analyzed included age, gender, comorbidity baseline in anxiety, depression and obsession, and methodological quality. Results: Results showed that the psychological treatment of OCD achieves clinically significant effectiveness, both for measures of obsessions and compulsions ( d + = 2.030), and for anxiety ( d + = 0.613) and depression ( d + = 0.451). An explanatory model for the CY-BOCS effect sizes showed that three moderator variables were statistically related: the mean of the CY-BOCS (Children´s Yale Brown Obsessive Compulsive Scale) in pretest, the effect size for anxiety, and the mean age of the sample. Conclusions: CBT reduced obsessive-compulsive symptoms and, to a lesser extent, anxiety and depression symptoms. Since anxiety symptoms are reduced with the same therapy, resources would be saved compared to other treatments.
... Network meta-analysis has been successfully applied to compare the efficacy of different treatments in children and adolescents with major depressive disorder and attention deficit hyperactivity disorder (Catalá-López et al., 2017;Zhou et al., 2017). Some studies have shown that SSRIs were statistically different from placebo, but might not be clinically significant, while clomipramine have shown greater efficacy than SSRIs (Ivarsson et al., 2015), but its adverse effects were more severe (Sánchez-Meca et al., 2014). And a systematic review of cognitive behavioral and pharmacological treatments for children with OCD showed that response rates and remission rates were higher with CBT than with serotonin reuptake inhibitors (Öst et al., 2016).However, an understanding of which particular treatments may be more effective is hampered by the fact that previous systematic reviews and meta-analyses have been limited to randomized controlled trials that directly compare only two types of treatments (Sánchez-Meca et al., 2014).Skapinakis et al. 's network meta-analysis of adult OCD suggests that CBT combined with drug therapy may be the best choice for children and adolescents with OCD (Skapinakis et al., 2016b). ...
... Some studies have shown that SSRIs were statistically different from placebo, but might not be clinically significant, while clomipramine have shown greater efficacy than SSRIs (Ivarsson et al., 2015), but its adverse effects were more severe (Sánchez-Meca et al., 2014). And a systematic review of cognitive behavioral and pharmacological treatments for children with OCD showed that response rates and remission rates were higher with CBT than with serotonin reuptake inhibitors (Öst et al., 2016).However, an understanding of which particular treatments may be more effective is hampered by the fact that previous systematic reviews and meta-analyses have been limited to randomized controlled trials that directly compare only two types of treatments (Sánchez-Meca et al., 2014).Skapinakis et al. 's network meta-analysis of adult OCD suggests that CBT combined with drug therapy may be the best choice for children and adolescents with OCD (Skapinakis et al., 2016b). However, as far as we know, network meta-analysis has not been applied to compare the efficacy of different treatments in children and adolescents with OCD. ...
Article
Background Studies have shown that pharmacological and psychological treatments are effective for children and adolescents with obsessive-compulsive disorder (OCD). However, few network meta-analyses have examined whether pharmacological or psychological treatments on their own, or combined, are most effective. Methods We conducted a database search and selected randomized controlled trials of pharmacological or psychological treatments, alone or in combination, for children and adolescents with OCD. The primary outcome was change in symptom severity as a result of treatment, as assessed using the Yale-Brown Obsessive Compulsive Scale (YBOCS) or Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS). Results We included 18 studies with 1353 participants and 12 kinds of treatments. In terms of efficacy, all pharmacological and psychotherapy treatments were more effective than placebo. Among the 12 treatments, the efficacy of pharmacological treatment combined with cognitive behavioral therapy (CBT) was more effective than pharmacological treatment alone. When pharmacological treatment was used alone, escitalopram was significantly more effective than clomipramine (CY-BOCS average change 3.42; 95% CI 2.11, 4.65), fluvoxamine (CY-BOCS average change 3.59; 95% CI 1.09, 6.20), paroxetine (CY-BOCS average change 2.80; 95% CI 0.01, 5.64) and sertraline (CY-BOCS average change 3.49; 95% CI 1.53, 5.64). Conclusions The available evidence suggests that the combination of pharmacological and psychological treatment is likely to be most effective for children and adolescents with OCD.
... For children and young people, CBT should always be the first-line approach (Sánchez-Meca et al., 2014;Skapinakis et al., 2016a), with ERP as core elements . ERP is both highly effective and also an acceptable intervention for youth ages 3-8 years with OCD . ...
... Key adaptations for younger children include extensive parental involvement targeting family accommodation and frequent family meetings while delivering a full course of ERP. According to the study of Sánchez-Meca et al. (2014), effect sizes were large for CBT (d+ = 1.742) and combined (medication plus CBT) interventions (d+ = 1.710) and moderate for pharmacological only treatments (d+ = 0.746). Familybased CBT (Piacentini et al., 2011;Freeman et al., 2014) is also effective for children and adolescents with OCD, especially when there is a high degree of accommodation. ...
Article
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In this position statement, developed by The International College of Obsessive-Compulsive Spectrum Disorders, a group of international experts responds to recent developments in the evidence-based management of obsessive-compulsive disorder (OCD). The article presents those selected therapeutic advances judged to be of utmost relevance to the treatment of OCD, based on new and emerging evidence from clinical and translational science. Areas covered include refinement in the methods of clinical assessment, the importance of early intervention based on new staging models and the need to provide sustained well-being involving effective relapse prevention. The relative benefits of psychological, pharmacological and somatic treatments are reviewed and novel treatment strategies for difficult to treat OCD, including neurostimulation, as well as new areas for research such as problematic internet use, novel digital interventions, immunological therapies, pharmacogenetics and novel forms of psychotherapy are discussed.
... 3 Meta analiz çalışmasına göre ise BDT'nin tek başına veya SSGİ ile kombine uygulanması SSGİ'nin tek başına uygulanmasından üstündür. 4 BDT sonrası ilk seçenek SSGİ olup, OKB tedavisinde etkili olduğu yapılan çalış-malarla gösterilmiştir. 4 Çocuklarda kullanımı için Food and Drug Administration (FDA) onayı olan ilaçlar; klomipramin, fluoksetin, sertralin ve fluvoksamin olarak bilinir. ...
... 4 BDT sonrası ilk seçenek SSGİ olup, OKB tedavisinde etkili olduğu yapılan çalış-malarla gösterilmiştir. 4 Çocuklarda kullanımı için Food and Drug Administration (FDA) onayı olan ilaçlar; klomipramin, fluoksetin, sertralin ve fluvoksamin olarak bilinir. FDA çocuk ve ergenlerde OKB tedavisinde maksimum doza 3-4 hafta içinde ...
Article
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ÖZET Obsesif kompulsif bozukluk (OKB); yineleyen obsesyon ve kompulsiyonların görüldüğü, dönemsel alevlenmelerle giden, psikososyal işlevsellik düzeyinde belirgin bir bozulmaya yol açabilen nörobiyolojik temeli olan ruhsal bir hastalıktır. Obsesyon; tekrarlayıcı, istenmeyen, mantık dışı kabul edilen intruzif (girici) düşünce ya da dürtüler; kompulsiyon ise obsesyonlara tepki olarak ortaya çıkan, anksiyeteyi geçici olarak azaltmaya yardımcı, kişinin yapmak zorunda hissettiği, tekrarlayan davranış ya da zihinsel eylemlerdir. Çocukluk çağı OKB’si, komorbidite, başlangıç yaşı ve cinsiyet gibi değişkenlerin çeşitliliğine bağlı oldukça heterojen bir klinik görünümdedir. Bu sunumda çocuk ve ergenlerde OKB’de ilaç tedavisi, tedavi yanıtı ve ilgili değişkenleri araştıran klinik çalışmaların gözden geçirilmesi ve güncel yaklaşımların özetlenerek klinisyenlere sunulması amaçlanmıştır.
... Currently, effective therapies for people of all ages with OCD include psychological counseling using preventative measures for exposure and response, and medication [10]. Nevertheless, OCD remains poorly understood in many those with the disorder due to many challenges to identity, making it difficult to provide such therapies to all those who are impacte [11]. These hurdles can include difficulties with multiple diagnoses (e.g., other forms of anxiety, diseases of the brain, and behavioural characteristics), patient unwillingness to communicate behaviours (due to potentially embarrassing material), and the heterogeneity of signs and symptoms. ...
Article
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Obsessive-compulsive disorder (OCD) requires careful evaluation due to underrecognition, difficulties in determining correct analyses, and the necessity for extensive therapy. We look at the approaches currently used to evaluate OCD in adults, such as quick or web-based screening tools, consistent investigative and other scientific meetings, unstandardized clinical interviews, and patient-family self-report assessments. Subjects on the subject, physicians, and researchers can select one of these techniques to measure obsessive-compulsive symptoms in a range of situations. Current OCD evaluation research has concentrated on fundamental sign sizes, implying that all symptom dimensions may have a distinct etiology and necessitate specific therapy. In the upcoming, research may show that a successful evaluation for OCD includes a determination of key indication size to aid in the selection of suitable therapies.
... However, other trials have found no additive value of family treatment over other psychotherapies (e.g., [71,72]). In a meta-analysis of randomized controlled trials of family-and non-family CBT, neither the degree of family involvement or the focus of treatment had an impact on treatment effect size [73]. When the comparison group is a robust intervention such as CBT, parent participation and family-focused treatments did not enhance youth's response to treatment. ...
Article
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Purpose of Review Cognitive-behavioral therapy (CBT) is the gold standard psychosocial treatment for pediatric OCD. However, many youth remain symptomatic following child-focused CBT. Interventions that actively involve parents and target negative family processes have the potential to improve treatment outcomes. In this review, we identify the key family-level variables implicated in pediatric OCD, describe the current landscape of family-focused interventions, and consider future directions to optimize care for complex families. Recent Findings Family correlates of youth OCD include symptom accommodation, expressed emotions, and negative parent–child interactions. Family-focused interventions that target these adverse processes have been shown to be effective in improving youth outcomes. However, less is known about the specific mechanisms of change, ideal treatment formats, and cultural differences in treatment response. Summary Family-focused interventions are an evidence-based treatment for pediatric OCD. Future research should identify optimal treatment targets, format of family involvement, and adaptations based on cultural considerations.
... One objective of behavior treatments is to try to break the connection that clients have formed in their minds between their obsessions and the anxiety that follows them. Another objective is to dismantle the link the patient perceives between satisfying their compulsion and experiencing relief from their worry [18]. The most important behavioral therapies include desensitization, modeling, exposure, muscular relaxation, and reaction avoidance [19]. ...
Article
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This research looks at a variety of aspects related to obsessive-compulsive disorder (OCD), such as symptoms, possible factors diagnosis, and treatment methods. OCD's distinctive ritualistic compulsions, which frequently manifest as uncontrollable thought and behavior patterns, are brought on by distressing obsessions. According to this study neurotransmitter and Corticostriatal circuits abnormalities have been linked to this disorder, although the exact cause is still unknown. Increased susceptibility among blood relations of sick individuals suggests a role for genetics. Obsessions and compulsions are diagnosed based on predetermined criteria that highlight their irrationality and disruptive nature. The connection between obsessive thoughts and anxiety can be broken by a number of treatments, the foundation of which is behavioral therapy. By gradually confronting anxiety-inducing circumstances, exposure and response prevention (ERP) has proven successful. According to this paper the main objectives of cognitive therapy are to address dysfunctional thought processes, such as overestimating threats or taking on excessive responsibility. This paper contends that by cognitive-behavioral therapy (CBT) combining behavioral and cognitive elements is both economical and efficient. The studies under review in this paper demonstrate differences in treatment effectiveness, accentuating the necessity for more studies with larger sample sizes in making definitive judgments on treatment outcomes.
... Different strategies, therefore, have been used for the therapy of the SSRI-resistant OCD. Combination of a SSRI with a typical neuroleptic such as chlorpromazine or the 5-HT inhibitor clomipramine seem to be efficacious to this end but is accompanied by severe side effects [16]. Further, co-administration of a SSRI with atypical antipsychotics (risperidone, aripiprazole) produced modest results [14]. ...
Article
Obsessive-compulsive disorder (OCD) is as serious devastating anxiety disorder. Selective serotonin reuptake inhibitors (SSRIs) are largely used for the treatment of this mental disease. This pharmacological approach presents consistent limitations including modest efficacy and important side effects. There is pressing need, therefore, to develop new molecules with higher efficacy and safety. Nitric oxide (NO) is an intra-and inter-cellular messenger in the brain. Its involvement in the pathogenesis of OCD has been proposed. In a series of preclinical studies, the anxiolytic profile of NO modulators has been emerged. In the present review I intended to critically evaluate advances in research of these molecules as potential novel agents for the treatment of OCD, comment their advantages over currently used pharmacological therapy as well remaining challenges. Up to now, few preclinical studies have been carried out to this end. Nonetheless, experimental evidence proposes a role for NO and its modulators in OCD. Additional research is mandatory aiming to definitively determine a role for NO modulators for the treatment of OCD. A note of caution, however, is needed on account of potential neurotoxicity and narrow therapeutic window of NO compounds.
... While 76% of children in our sample reportedly had suspected or diagnosed OCD, <14% of children received ERP therapy. Similarly, only 41% of the sample reported current or past treatment with SSRIs despite evidence that SSRIs, both along and in tandem with CBT, is efficacious in treating pediatric OCD (Sánchez-Meca et al, 2013). There are likely many factors that account for the low rates of these treatments within our sample, including cost, time, and geographic accessibility. ...
Article
Objective: Few large-scale studies of pediatric acute-onset neuropsychiatric syndrome (PANS) and pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections (PANDAS) have been conducted, and thus demographic data on these conditions are limited. The current study describes comorbid medical and psychiatric conditions in a self-referred cohort of children with PANS/PANDAS, along with treatment history, barriers to treatment, family medical and psychiatric history, and perceived caregiver burden in these conditions. Methods: A total of 441 primary caregivers of patients with infection-triggered PANS/PANDAS under the age of 18 were included in this online anonymous survey, reporting on a total of 490 children (due to some caregivers reporting multiple children in the family with PANS/PANDAS). Data were collected between July 2018 and May 2019. Primary caregivers completed questions pertaining to patient demographics, symptom presentation, disease course, family medical and psychiatric history, and severity of patients' obsessive-compulsive disorder (OCD) symptoms. Results: OCD was the most common psychiatric symptom reported in children at the onset of PANS/PANDAS (83.06%), along with a high percentage of medical and psychiatric comorbidities. Most psychiatric comorbidities began or worsened at the onset of PANS/PANDAS symptoms, while major depressive disorder was the most frequently reported psychiatric disorder to develop after PANS/PANDAS onset (10%). A high frequency of autoimmune and inflammatory conditions was reported in family members, with nearly 30% of mothers endorsing one or more autoimmune conditions (29.95%). Mean caregiver burden (Caregiver Burden Inventory; M = 44.0) fell above the "burnout" level, and standardized measures showed mildly elevated levels of depression, anxiety, and stress in caregivers (Depression, Anxiety, and Stress Scale-21; M = 11.85, 7.16, and 15.56, respectively). Conclusions: Primary caregivers of children with PANS/PANDAS reported a multitude of medical and psychiatric comorbidities in their children, along with a high frequency of autoimmune and psychiatric conditions in family members. Obsessive-compulsive symptoms were the most frequently reported psychiatric symptom. Caregivers of these patients experience elevated levels of burden, stress, anxiety, and depression. Further research is needed to better understand the varied disease course in PANS/PANDAS and to develop interventions to reduce caregiver burden in these disorders.
... The treatment of choice for OCD is cognitive behavioral therapy (CBT) and it should include exposure exercises with response prevention (E/RP) as a core element (13,14). In terms of reducing OCD symptoms, meta-analyses demonstrate between-group effect sizes (ES) for CBT of 1.20 (15) and higher (ES = 1.45) (16). It is recommended that the exercises are conducted accompanied by therapists and in the places where the OCD symptoms occur most frequently (13). ...
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Objectives Obsessive-compulsive disorder (OCD) in childhood and adolescence often leads to significant impairment in various areas of life and has a high risk of becoming chronic. Cognitive behavioral therapy (CBT) is the recommended first-line treatment, but it is too rarely implemented in accordance with guidelines and is often not available close to the patient’s home. Importantly, internet-based CBT could help to reduce this gap in care. Having previously successfully demonstrated the feasibility of an internet-based CBT approach, we aimed to assess its effectiveness in a waiting list controlled randomized trial. Methods Children and adolescents aged 6–18 years with a principal diagnosis of OCD received 14 sessions of therapist-delivered CBT via videoconference distributed over 16 weeks. After inclusion, participants were randomly assigned to either the treatment or waiting list group. Participants in the treatment group began treatment immediately after baseline diagnostics, and participants in the waiting list group began treatment after a 16-week waiting period. The primary outcome was a pre-post comparison of OCD symptoms as measured with the Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS). Additionally, remission was an important outcome measure. Follow-up assessments were conducted for all measures 16 and 32 weeks after completion of treatment. Results A total of 60 children and adolescents were included into the analyses. Over the course of the treatment, OCD symptoms according to the CY-BOCS significantly decreased in the treatment group compared to the waiting-list control group. Cohen’s d between groups was 1.63. After the patients in the waiting list group also received the treatment, the OCD symptoms decreased significantly in this group as well. This improvement of symptoms increased over the course of the follow-up assessments. Remission rate peaked at the 32-week follow-up, with 68% in the treatment group and 79% in the waiting list group. Importantly, patient satisfaction with treatment was high to very high. Conclusion In our study, OCD symptoms decreased significantly and remission rate was high after internet-based CBT. Those effects were comparable to those found in studies of face-to-face treatment. Although further evidence is needed, these are early indications that our approach may be a viable way to provide access to adequate treatment for children and adolescents affected by OCD. Clinical trial registration [www.ClinicalTrials.gov], identifier [NCT05037344].
... Cognitive behavioral therapy (CBT), including exposure with response prevention (ERP) (in the following: exposure-based CBT), in severe cases with additional pharma-cotherapy, is based on the current state of research (e. g., Franklin et al., 2011;McGuire et al., 2015;Öst et al., 2016; Pediatric OCD Treatment Study [POTS] Team, 2004;Rosa-Alcázar et al., 2015;Sánchez-Meca et al., 2014;Watson & Rees, 2008), considered as the first-line treatment included children and adolescents (see Babiano-Espinosa et al., 2019;Wolters et al., 2017). In particular, the potential of exposure-based CBT (including therapistguided ERP) via video teleconferencing (VTC) in pediatric OCD has been supported. ...
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Objective: Although there is clear evidence-based knowledge regarding state-of-the-art treatment for pediatric obsessive-compulsive disorder (OCD), two main issues remain in clinical practice: (1) Exposure-based cognitive behavioral therapy (CBT) is limited in terms of availability and accessibility or is not adequately provided, and (2) despite large effect sizes of exposure-based CBT, the achieved recovery rates of 50–60 % still show room for improvement. These issues have prompted an increasing focus on delivering exposure-based CBT in new and innovative ways. This study aims to evaluate an intensive therapist-administered online coaching program consisting of exposure with response prevention via video teleconferencing (VTC) as an add-on to weekly outpatient CBT (blended therapy). Method: The blended therapy is examined in n = 5 children and adolescents with OCD using an AB design and multi-informant ratings. Results: This single-case study shows promising results, indicating that a decrease in OCD severity and related functional impairment can be attributed to blended therapy. Moreover, satisfaction with online coaching was high. Conclusions: Despite some principal limitations, the results support the effectiveness and feasibility of blended therapy.
... However, only 40-60% of patients treated with SSRIs experienced a reduction in their obsessivecompulsive symptoms (4). Although tricyclic drugs (e.g., Chlorpromazine, Clomipramine, etc.) have better efficacy than SSRIs, their side effects are more pronounced and less endurable (5). Exposure and response prevention (ERP) is the first-line psychotherapy for OCD, and research indicates ERP-based therapy has comparable efficacy to SSRIs (4). ...
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Objective To systematically evaluate the effectiveness of exposure and response prevention (ERP) combined with medication on obsessive-compulsive disorder (OCD). Methods PubMed, Web of Science, EBSCO, Cochrane, Embase, and Science Direct databases were searched to include randomized controlled trials of ERP combined with medication for OCD that met the criteria. The Yale Brown Obsessive Compulsive Scale was used as the primary outcome indicator, and Depression scales were used as secondary outcome indicators. An evaluation of bias risk was conducted to identify possible sources of bias based on methodological and clinical factors. Review Manager 5.3 and Stata 16.0 software was used to perform meta-analysis of the extracted data. Results A total of 21 studies with 1113 patients were included. Meta-analysis showed that ERP combined with medication therapy was significantly better than medication therapy alone including selective serotonin reuptake inhibitors, clomipramine and risperidone (MD = –6.60, 95% CI: –8.35 to –4.84, P < 0.00001), but D-cycloserine (DCS) drugs do not enhance the effect of ERP intervention in patients with OCD (MD = 0.15, 95% CI: –0.87 to 1.17, P = 0.77). There is more significant maintenance by combined treatment method of medication plus ERP than medication treatment alone during the follow-up period (MD = –7.14, 95% CI: –9.17 to –5.10, P < 0.00001). DCS drugs did not enhance the effect of ERP intervention on depression in patients with OCD (SMD = –0.08, 95% CI: –0.31 to 0.15, P = 0.50). ERP combined with drug improved patients’ depression levels significantly better than providing drug alone (SMD = –0.40, 95% CI: –0.68 to –0.11, P = 0.006). Conclusion Patients with OCD have significant improvement in symptoms of obsessive-compulsive disorder and depression when ERP is combined with medication, however, not enough to prove that DCS can enhance ERP effectiveness.
... Whereas the adult Y-BOCS relies on interview data from the client, the CY-BOCS culls ratings from both the child and the parent or guardian. Further, the instructions specify that "sometimes, however, it may also be useful to interview the child or parent alone" [7]. Other instruments designed to assess pediatric OCD symptoms, namely the Leyton Obsessional Inventory-Child Version survey (LOI-CV), the Children's Obsessional Compulsive Inventory (CHOCI), the Obsessive-Compulsive Inventory-Child Version (OCI-CV), the Child Saving Inventory, and the Obsessive Beliefs Questionnaire-Children's Version are promising assessments for assessing symptoms and the severity of OCD, but they do not assess the obsessive-compulsive dimensionality [8]. ...
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Background: Obsessive Compulsive Disorder (OCD) is one of the common psychiatric disorders among children and adolescent. Prevalence of child and adolescent OCD is 2% in Bangladesh. Gold standard Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) is a clinician-rated and most widely used scale in measurement of OCD symptom severity and thereby treatment response in children and adolescent age group. A validated scale for children and adolescent patient with OCD is needed for measuring symptom severity as well as treatment outcome in Bangladesh. Aim of the study: The aim of this study was to develop a culturally adapted and psychometrically validated Bangla version Children's Yale Brown Obsessive Compulsive Scale for use in Bangla speaking child and adolescent patients with obsessive compulsive disorder in Bangladesh. Methods: This validation study was conducted in the period of July 2016 to September 2017 in the department of Psychiatry, Bangabandhu Sheikh Mujib Medical University, Dhaka. In this study researcher applied Bangla version of Children's Yale Brown Obsessive- Compulsive Scale in 47 child and adolescent with OCD and assessed the validity (Content validity, Face validity, Convergent validity and Factor analysis) and reliability (Internal consistency, Inter-rater reliability, Test-retest reliability). Results: Age of the respondents were ranging from 8-17 years. Content validity and face validity was maintained by following standard procedures. Good convergent validity was found with culturally adapted Developmental and Well Being Assessment (DWABA) Bangla by using spearman's rho. Factor analysis revealed 2 components in the construct. Communalities were above accepted level. In assessing internal consistency, Cronbach's Alpha (a) value was 0.91, which reflects good reliability. Inter rater reliability was excellent for CY-BOCS total and each individual 10 items as the range of intraclass correlation was 0.96 to 0.98 which represented very .........
... Other authors have also demonstrated a high prevalence of anxiety disorders, with panic disorder and simple phobia (44,66). It is evident that anxiety disorders, depression, and neurological development disorders such as attention deficit hyperactivity are, among other clinical manifestations, associated with JH (43,44). ...
Article
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Objectives To identify psychosocial and motor aspects related to joint hypermobility (JH) in a sample from almost all Brazilian states by age range and sex; to characterize JH by the Beighton total score ≥4, ≥5, and ≥6 according to sex and age and atypicality in the sitting position and in the hands; identify, in the total sample, manifestations of “growing pain” and its location, fatigue, attention deficit, anxiety, insomnia, drowsiness, apathy, depression, delay in walking, not crawling or crawling differently, school performance, spatial orientation and/or temporally impaired, social isolation, and being stigmatized as “lazy/clumsy/apathetic”. Methods This retrospective, observational, quantitative, and cross-sectional study used data obtained through analyses of descriptive and inferential crossings between 2012 and 2020 of 482 medical records of individuals between 1 and 76 years of age, from most Brazilian states. All patients previously diagnosed with “joint hypermobility syndrome” (JHS) and “Ehlers-Danlos syndrome hypermobility type” (EDS-HT) had their medical records reassessed, following the guidelines established in 2017. The analysis of GJH was performed using the updated method by Beighton method; atypical characteristics were investigated in the hands and the ability to sit in the “W” and the “concave” positions. The characteristics and manifestations of “growing pain” and its location were analyzed in the total sample, fatigue, insomnia, drowsiness, apathy, depression, social isolation, attention deficit, anxiety, stigmatization as “lazy,” clumsy/restless, impaired school performance, and spatial and/or temporal orientation. Descriptive and inferential statistical methods were used, such as Mean, Median, Mode, Standard Deviation, Standard Error, Maximum Value, Minimum Value, Komolgorov-Smirnov, Significance, Relative Value, Absolute Value, Mann-Whitney U, and Correlation of Spearman. Results JH in the total sample predominated in the upper limbs, the majority were women, represented by 352 (73.02%), 15 years old or older with 322 (66.80%), 312 (64.73%) had a Beighton total score ≥6, which decreased as the age increased. Always sitting in the “concave” position was represented by 54.15% and the ability to sit in the “W” position by 39.21%; signs on the hands totaled between 27.59 and 44.19% with a significant correlation between the variables. Among the characteristics, fatigue predominated, followed by an awkward/clumsy/restless individual, attention deficit, anxiety and stigmatized as “lazy,” insomnia, drowsiness, apathy, depression, impaired spatial and/or temporal orientation, and social isolation. From the total sample, pain in the lower limbs was reported by 55.81% and having or having had “growing pain” was reported by 36.93%, delay in walking occurred in 19.92%, 15.35% did not crawl or crawled differently, and for 12.86%, school performance was impaired. Higher Beighton total scores showed a trend towards motor implications and correlation between variables. Ability to still sit in the “concave” position was possible for 54.15% and to sit in the “W” position for 39.21%. Conclusion In the total sample, the JH characteristic prevails in the upper limbs of female children, adolescents and adults, with a total Beighton score ≥6. Most sit in the “concave” position and less than half also sit in the “W” position and with atypical hand postures. The higher Beighton scores, which include the upper limbs, show a tendency to not crawl or crawl differently, delayed ambulation, and impaired school performance. The predominance of JH in the upper limbs is suggestive of a justification for not crawling or crawling differently. Characteristics of atypical motor performance in hands and sitting posture, in addition to fatigue, pain since childhood, anxiety, apathy, depression, sleep disorders, stigmatization, attention deficit, spatial and/or temporal orientation impairment, and social isolation are characteristics. suggestive of psychosocial implications at different ages. Future studies with motor and psychosocial aspects of people with JH will help to identify the phenotype of this population and consequent guidance for clinical management based on the motor and psychosocial aspects of people with JH.
... ERP involves prolonged and repeated exposure to obsessional stimuli without acting out compulsions; this is thought to decrease distress and the perceived necessity to respond to triggering stimuli [29]. The effectiveness of ERP has been demonstrated in OCD children [30] and has been shown to be more effective than pharmacological monotherapy [49] and active psychotherapy (e.g., relaxation therapy) [15,42]. Currently, CBT with ERP as the core component is the most established and effective psychological treatment for pediatric OCD [14,15,37,44,59]. ...
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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.
... The characteristics extracted were: (1) year of the study; (2) geographical location; (3) sample size (total and by groups); (4) mean age (total and by groups); (5) sex distribution (total and by groups); (6) education level (primary, secondary or tertiary); (7) outcome; and (8) statistics reported to calculate the effect sizes. Finally, methodological quality was measured using an ad hoc 12-dichotomous item checklist (see Appendix 1) based on checklists previously used and in other methodological reviews (Lorz et al., 2013;Maher et al., 2003;Sánchez-Meca et al., 2014). ...
Article
Although some meta-analyses have investigated the effect of Entrepreneurship Education (EE), they mixed studies with high and low methodological quality. Thus, their results might overestimate the impact. This paper aims to examine the efficacy of the EE in student samples, attending to studies with a pre-posttest design and a control group. The results showed small effect sizes for EE in increasing Entrepreneurship Intention (EI) and Self-efficacy. Moreover, meta-regression confirmed that the duration of intervention programs predicted larger effect sizes for the EI. Finally, the practical implications of other potential moderator variables are discussed.
... Fortunately, both behavioral and pharmacological interventions have demonstrated efficacy for pediatric OCD. Cognitive-behavioral therapy (CBT) and the use of selective serotonin reuptake inhibitors (SSRIs) are two empirically supported treatments for pediatric OCD that have produced large treatment effects for symptom reduction and diagnostic remission (for reviews, see McGuire et al., 2015;Öst et al., 2016;Sánchez-Meca et al., 2014). CBT in the context of OCD encompasses principles of exposure plus response prevention (ERP), which involves systematic, graded exposure to an anxiety-provoking stimulus, thought, or situation (e.g., touching an unclean surface), and delaying or preventing the execution of a compulsion to alleviate the anxiety (e.g., handwashing). ...
... Psychology has a lot to offer to the understanding and treatment of this incredibly disabling mental disorder. This is not only visible in the various contributions to this special issue, and in the many other studies on the psychological features of OCD, but also in the numerous meta-analyses evidencing how cognitive-behavioural therapy (CBT) is the first-line treatment both for adults and children/adolescents (Jónsson and Hougaard 2009, Jónsson et al. 2015, Olatunji et al. 2013, Öst et al. 2015, Sánchez-Meca et al. 2014, Simpson et al. 2013. ...
Article
From the first compelling psychoanalytic formulation at the beginning of last century by Sigmund Freud, to the latest cognitive-behavioural models, psychology has been at the forefront of the understanding of Obsessive-Compulsive Disorder (OCD). Psychological accounts of the disorder have been proven to be sound and accurate, explaining many facets of OCD, and having important implications for treatment. Psychology has a lot to offer to the understanding and treatment of this disabling mental illness. This is not only visible in the various contributions to this special issue, and in the many other studies on the psychological features of OCD, but also in the numerous meta-analyses evidencing how cognitive-behavioural therapy (CBT) is the first-line treatment both for adults and children/adolescents. The European Association of Behavioural and Cognitive Therapy's (EABCT) Special Interest Group (SIG) on OCD fosters research on the psychological mechanisms implied in obsessive-compulsive disorder, on new effective psychological treatments, and it is committed to the dissemination of this knowledge among the professionals of mental health and the public at large. This collection of papers provides an overview of some of the hot topics that are advancing our knowledge of obsessive-compulsive disorder, thus highlighting the pivotal role of psychology.
... When we look at these different data, treatment of TTM appears to resemble that of TS treatment, with antipsychotics seemingly effective and selective serotonin reuptake inhibitors (SSRI) [196][197][198][199][200][201][202] ineffective (while SSRIs are a well-established treatment for OCD [203][204][205][206][207][208][209][210][211][212][213][214]. A metaanalysis found serotonin reuptake inhibitors (SRI) to be effective in TTM, 215 contradicting a previous metaanalysis. ...
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Objective: Trichotillomania (TTM) is characterized by the pulling out of one's hair. TTM was classified as an impulse control disorder in DSM-IV, but is now classified in the obsessive-compulsive related disorders section of DSM-5. Classification for TTM remains an open question, especially considering its impact on treatment of the disorder. In this review, we questioned the relation of TTM to tic disorder and obsessive-compulsive disorder (OCD). Method: We reviewed relevant MEDLINE-indexed articles on clinical, neuropsychological, neurobiological, and therapeutic aspects of trichotillomania, OCD, and tic disorders. Results: Our review found a closer relationship between TTM and tic disorder from neurobiological (especially imaging) and therapeutic standpoints. Conclusion: We sought to challenge the DSM-5 classification of TTM and to compare TTM with both OCD and tic disorder. Some discrepancies between TTM and tic disorders notwithstanding, several arguments are in favor of a closer relationship between these two disorders than between TTM and OCD, especially when considering implications for therapy. This consideration is essential for patients.
Chapter
Obsessive-compulsive disorder (OCD) is defined by the presence of obsessions and/or compulsions and associated clinical impairment. The prevalence of pediatric OCD, or “early-onset” OCD, is 2–3%. First-line, gold standard treatments include cognitive behavioral therapy, specifically exposure response prevention (ERP), and selective serotonin reuptake inhibitors (SSRIs). Clomipramine, a tricyclic antidepressant, is an effective pharmacological monotherapy, albeit not first-line. Despite effective treatments, up to one-third of those with early-onset OCD do not respond to first-line interventions. Early-onset OCD is associated with high rates of co-occurring conditions. When there are co-occurring tics, OCD symptoms tend to be less responsive to SSRIs. Antipsychotic augmentation can be helpful, particularly in those with co-occurring tics, but should be used cautiously given the side effect profile and lack of randomized controlled data in pediatric patients. Augmentation with certain glutamate-modulating agents may show modest benefit. It is imperative to identify new treatments for pediatric OCD that are effective, safe, and well-tolerated.
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This study investigates dietary supplement use among rugby players and their general health, focusing on prevalence and underlying motivations. Involving 92 athletes, it examines the relationship between supplement usage, motivations, and health outcomes using the 36-item Short Form Health Survey and a 24-item ad hoc questionnaire. Findings reveal a high frequency of supplement usage, motivated by desires to enhance performance, appearance, and mood. Significant differences in health-related quality of life are found between users and non-users, particularly in mental health, social functioning, and emotional stability. Motivations like performance enhancement and body shape manipulation were linked to altered health perceptions, indicating the psychosocial impacts of supplementation. This study emphasizes the need to consider the holistic effects of supplements on athlete well-being, advocating for a balanced approach prioritizing both physical and mental health. It calls for increased awareness among athletes, coaches, and sports professionals about the potential risks and benefits of supplement use and the importance of informed decision-making. Additionally, it highlights the need for further research to understand the mechanisms of supplement use and its impact on athlete health, aiming to enhance sports science and promote overall athlete well-being in competitive environments.
Article
La terapia cognitivo conductual (TCC), con énfasis en la exposición y prevención de respuesta, es un tratamiento eficaz para el trastorno obsesivo compulsivo (TOC), pero enfrenta barreras de acceso como el costo, la estigmatización del paciente y la dificultad de encontrar terapeutas bien entrenados. La inclusión de tecnologías de la información (TICS) en estos tratamientos, ya sea mediante teleterapia, realidad virtual, aplicaciones móviles o intervenciones basadas en internet, busca vencer estas barreras, además de brindar la posibilidad de aumentar la eficiencia de los tratamientos. El objetivo del presente trabajo es analizar la evidencia comunicada en la literatura científica sobre el impacto de las tecnologías digitales en los tratamientos cognitivo conductuales para el TOC en población adulta. Se busca comprender cómo diferentes tipos de tecnologías digitales influyen en los resultados del tratamiento y cuáles son los beneficios y limitaciones de cada una. Para ello se realizó una revisión sistemática la cual incluyó 30 trabajos de investigación. Se concluye que la inclusión de tecnologías digitales puede resultar beneficiosa para el tratamiento del TOC ya que facilitan el acceso al tratamiento, además de tener la capacidad de potenciarlos y de ser bien aceptadas por los pacientes.
Article
Pediatric obsessive-compulsive disorder (OCD) affects approximately .25%–3% of children and if left untreated, can cause significant impairment for the child and family. Cognitive behavioral therapy with exposure and response prevention (ERP) is the gold-standard treatment for pediatric OCD. When using ERP with children and adolescents, it is essential to assess and target family factors in treatment in order to help the youth make therapeutic progress. The following case study illustrates the successful implementation of family-based ERP in a young female with contamination OCD. It further highlights strategies for targeting family accommodation and family conflict within the course of treatment.
Chapter
Obsessive–compulsive disorder (OCD) is a heterogeneous condition characterized by the presence of obsessions and/or compulsions. Clinical characteristics and consequences of the disorder in adolescent lives are described here, highlighting the great impairment OCD can cause in social and academic areas. The entry also addresses other psychopathological disorders that are frequently comorbid to OCD, increasing distress and complicating prognosis and treatment response. In addition, biological and psychological theoretical models of disorder etiology are described. Finally, the entry mentions the main assessment instruments and treatment strategies for OCD that have received empirical support, putting an emphasis on exposure, with response prevention as the first line of psychological treatment.
Article
Obsessive-compulsive disorder (OCD) frequently affects children and adolescents, with most cases beginning during this time. Symptoms of OCD in youth may present as exaggerated developmental concerns and excessive ritualistic behavior beyond what is part of normal development, yet low levels of insight may prevent recognition. Affected youth commonly have comorbid neurodevelopmental diagnoses, especially males. Early detection and intervention are critical to recovery and remission, as well as family involvement in treatment. Cognitive behavioral therapy and serotonin reuptake inhibitors are first-line treatments.
Article
In recent years, acceptance and commitment therapy (ACT) has become one of the most promising developments in the treatment of obsessive-compulsive disorder (OCD). Although cumulative evidence supporting the efficacy of individual ACT as a therapeutic intervention for OCD has been reported, research on the efficacy of group ACT (GACT) remains insufficient. In this study, 72 patients with OCD were randomly assigned equally to the GACT intervention and wait-list control (WLC) groups, and an 8-week program was administered to the GACT group. The symptoms and process measures of the GACT group (N = 34) were compared with those of the WLC group (N = 31) at pre-treatment, post-treatment, and the 8-week follow-up. The Yale-Brown Obsessive-Compulsive Scale scores indicated that GACT had a moderate and significant impact on reducing obsessive-compulsive (OC) symptoms over the treatment period. This continued through to the 8-week follow-up, which resulted in a 39.3% reduction in symptoms, whereas the WLC group did not show any improvement. Process measures, such as psychological flexibility and cognitive fusion, showed significant improvements only in the GACT group. Additionally, changes in cognitive fusion scores were significantly associated with changes in the OC symptoms. These findings support the efficacy of GACT as a treatment for OCD particularly by reducing OC symptoms through cognitive defusion. Our results provide crucial preliminary findings that can serve as a cornerstone for verifying the effectiveness of GACT in OCD treatment.
Article
Introduction: Childhood and adolescence represent critical stages for the development of obsessive-compulsive disorder (OCD), a chronic psychopathological condition characterized by distressful obsessions and/or compulsions that significantly impair the individual's quality of life. According to recent guidelines and evidence from meta-analyses, selective serotonin reuptake inhibitors (SSRIs) should be considered as the first-line pharmacological option for pediatric OCD presenting mild to moderate symptoms, and second-generation antipsychotic augmentation therapy should be regarded for severe resistant cases. Areas covered: The present paper aimed at providing an overview of the most recent evidence that should guide clinicians on the choice of the most appropriate first-line drugs and augmentation strategies for pediatric OCD, while considering their adverse effects and attrition rates associated with this complex condition. Additionally, this paper highlights the gaps of the literature on this topic and the future directions of research. Expert opinion: The current literature on the pharmacological treatments of pediatric OCD reveals a series of gaps, mainly deriving from the limited data available in this population that requires special attention, while considering the specificity of its developmental trajectory. In any case, although controversy still exists on whether psychotropic compounds should be used in children, scientific evidence is available on the detrimental effects of untreated OCD (and of several other psychopathological manifestations) in this critical period of the life span.
Article
Purpose of review: This article describes the phenomenology and clinical presentation of obsessive-compulsive disorder (OCD), a common but underdiagnosed psychiatric disorder. Guidance for effectively identifying obsessive-compulsive symptoms is provided, and treatment options, including psychotherapy, pharmacologic management, and neuromodulation approaches for treatment-resistant OCD, are discussed. Recent findings: OCD affects 2% to 3% of adults worldwide and is associated with substantial individual disability and societal costs. Lack of recognition of common OCD symptom types, in addition to shame and fear of stigma on the part of patients, has created an average delay in diagnosis by almost 10 years and a delay in effective treatment (ie, a treatment gap) of nearly 2 years. Cognitive-behavioral therapy (CBT), specifically a form of CBT that includes a type of behavioral intervention called exposure and response prevention, remains the most effective form of treatment for OCD. If CBT is not effective or not available, pharmacologic treatment with selective serotonin reuptake inhibitors (SSRIs) or clomipramine, a nonselective serotonin reuptake inhibitor, can also be of benefit. Neuromodulation approaches such as deep brain stimulation and transcranial magnetic stimulation are rapidly emerging as effective treatments for OCD, particularly for patients who have not experienced an adequate response to psychotherapy or pharmacologic management. Summary: OCD affects more than one in every 50 adults in the United States but is recognized and adequately treated in fewer than half of those affected. Early intervention and appropriate treatment can substantially reduce OCD symptom severity, improve quality of life, and minimize the functional disability associated with this chronic and often debilitating illness.
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Dieses Buch ist geschrieben für Kinder- und Jugendlichenpsychotherapeuten, Kinder- und Jugendpsychiater, in der Beratung und klinisch tätige Psychologen, Schulpsychologen, Psychologische Psychotherapeuten, Ärztliche Psychotherapeuten, Psychiater sowie Kinder- und Jugendlichenpsychotherapeuten und Psychologische und ärztliche Psychotherapeuten in Aus- und Weiterbildung. Bewährt für den Einstieg, als Nachschlagewerk, für die Supervision und Qualitätssicherung in der Verhaltenstherapie. In diesem Buch finden sich mit Blick auf die Praxis (1) allgemeine Grundlagen verhaltenstherapeutischen Arbeitens, (2) eine konkrete Beschreibung von verhaltenstherapeutischen Techniken, Einzelverfahren und Methoden, (3) störungsspezifische Behandlungspläne. Praxisnäher geht es nicht! Aus dem Inhalt Psycho- und verhaltenstherapeutische Methoden – Einzel- und Gruppentherapieprogramme – Behandlungsanleitungen für psychische und psychosomatische Störungen – Mit einheitlichem Kapitelaufbau – Indikationsstellung, technisches Vorgehen, Nebenwirkungen und Kontraindikationen, weiterführende Literatur. Die Herausgeber Univ.-Prof. Dr. sc. hum. Dipl. Psych. Manfred Döpfner, Leitender Psychologe an der Kinder- und Jugendpsychiatrie, Uniklinik Köln. Prof. Martin Hautzinger, Ordinarius für Klinische Psychologie und Psychotherapie, Eberhard Karls Universität Tübingen. Prof. Michael Linden, Medizinische Klinik m.S. Psychosomatik der Charité Universitätsmedizin Berlin und Institut für Verhaltenstherapie Berlin.
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This brief report examines the evidence for moderators of psychosocial treatment for youth with obsessive-compulsive disorder (OCD). Understanding treatment moderators can help clinicians select the most appropriate intervention for a particular patient and consequently increase the likelihood of initial response. A systematic search of the literature was conducted to identify randomized trials and meta-analyses reporting on moderators of psychosocial treatment for pediatric OCD. All studies included a comparison of cognitive-behavioral therapy (CBT) to active or control conditions. Few studies have evaluated moderators of psychosocial treatment for youth with OCD, and among those studies, few variables have demonstrated a differential effect on treatment response. Moderator analyses require large samples to garner the statistical power necessary to adequately evaluate differential responding in subgroups, and unfortunately, most reports of moderators in this review are post-hoc investigations of datasets from trials with relatively small sample sizes. Given the overwhelming number of CBT treatment variants and potential moderators, it would be impossible to conduct all the necessary head-to-head trials with sufficient sample sizes to develop helpful clinical guidelines. The best option for advancing the moderator literature is to utilize advanced statistical approaches for pooling existing data sets. Recommendations for leveraging emerging techniques in individual participant data meta-analysis (IPD-MA) are briefly discussed.
Chapter
Obsessive–compulsive disorder (OCD) is characterized by obsessions (persistent, intrusive, unwanted thoughts, images, or impulses) and compulsions (mental or physical acts performed to reduce the anxiety associated with obsessions). Neuroimaging and animal studies have implicated hyperactivation of frontal cortico–striato–thalamocortical (CSTC) circuits. Genetic studies have demonstrated a significant hereditary component to OCD, although the exact genetic risk factors for OCD have not been identified. Selective serotonin reuptake inhibitors and cognitive behavioral therapy are first-line, evidence-based treatments for OCD. Although a substantial majority of both children and adults with OCD improve with evidence-based treatments, approximately one-quarter of individuals with OCD do not respond to first-line treatments. Antipsychotic augmentation is an additional pharmacological treatment strategy with proven efficacy in treatment-refractory OCD. Other emerging treatments for OCD include deep brain stimulant, glutamate modulating agents, repetitive transcranial magnetic stimulation.
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Objective: To assess benefits and harms of cognitive behavioral therapy (CBT) versus no intervention or versus other interventions for pediatric obsessive-compulsive disorder (OCD). Method: We searched for randomized clinical trials of CBT for pediatric OCD. Primary outcomes were OCD severity, serious adverse events, and level of functioning. Secondary outcomes were quality of life and adverse events. Remission from OCD was included as an exploratory outcome. We assessed risk of bias and evaluated the certainty of the evidence with the Grading of Recommendations Assessment, Development and Evaluation. Results: We included nine trials (N=645) comparing CBT with no intervention and three trials (N=146) comparing CBT with selective serotonin reuptake inhibitors (SSRIs). Compared with no intervention, CBT decreased OCD severity (mean difference [MD]=-8.51, 95% CI -10.84 to -6.18, p<.00001, low certainty), improved level of functioning (patient-rated: standardized MD [SMD]=-0.90, 95% CI -1.19 to -0.62, p<.00001, very low certainty; parent-rated: SMD=-0.68, 95% CI -1.12 to -0.23, p=.003, very low certainty) had similar proportions of participants with adverse events (risk ratio=1.06, 95% CI 0.93 to 1.22, p=0.39, GRADE: low certainty), and was associated with reduced risk of still having OCD (risk ratio=0.50, 95% CI 0.37 to 0.67, p<.00001, very low certainty). We had insufficient data to assess the effect of CBT versus no intervention on serious adverse events and quality of life. Compared with SSRIs, CBT led to similar decreases in OCD severity (MD=-0.75, 95% CI -3.79 to 2.29, p=.63, GRADE: very low certainty) and was associated with similar risk of still having OCD (risk ratio=0.85, 95% CI 0.66 to 1.09, p=.20, very low certainty). We had insufficient data to assess the effect of CBT versus SSRIs on serious adverse events, level of functioning, quality of life, and adverse events. Conclusion: CBT may be more effective than no intervention and comparable to SSRIs for pediatric OCD, but we are very uncertain about the effect estimates.
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Se presentan los resultados de un estudio cualitativo de revisión de la eficacia de los tratamientos cognitivo-conductuales utilizados en el trastorno obsesivo-compulsivo en niños y adolescentes. Se localizaron y recuperaron un total de 84 estudios, de los cuales 17 consistían en informes de caso, 37 en diseños de caso único, 19 estudios pre-experimentales con diseño pre-postest, 6 estudios cuasi-experimentales y 5 estudios experimentales con grupo de control. El procedimiento más utilizado en los diferentes estudios ha sido la exposición con prevención de respuesta, siendo además el de mayor eficacia. Se constata la baja representación de estudios de comparación tanto cuasi-experimentales como experimentales, al igual que la escasez de medidas de seguimiento a medio y largo plazo, la falta de utilización de medidas observacionales y el escaso control de la sintomatología encubierta y trastornos comórbidos.
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Research in etiology, neurobiology, genetics, clinical correlates, and evidence-based treatments in children and adolescents with obsessive-compulsive disorder indicate a need for the revision of the Practice Parameters for the Assessment and Treatment of Children and Adolescents with Obsessive-Compulsive Disorder first published a decade ago. The present article highlights the clinical assessment and reviews and summarizes the evidence base for treatment. Based on this evidence, specific recommendations are provided for assessment, cognitive behavioral therapy, pharmacotherapy, combined treatment, and other interventions.
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The serotonin reuptake inhibitors are the treatment of choice for patients with obsessive-compulsive disorder; however, empirical support for this assertion has been weaker for children and adolescents than for adults. To evaluate the safety and efficacy of the selective serotonin reuptake inhibitor sertraline hydrochloride in children and adolescents with obsessive-compulsive disorder. Randomized, double-blind, placebo-controlled trial. One hundred eighty-seven patients: 107 children aged 6 to 12 years and 80 adolescents aged 13 to 17 years randomized to receive either sertraline (53 children, 39 adolescents) or placebo (54 children, 41 adolescents). Twelve US academic and community clinics with experience conducting randomized controlled trials. Sertraline hydrochloride was titrated to a maximum of 200 mg/d during the first 4 weeks of double-blind therapy, after which patients continued to receive this dosage of medication for 8 more weeks. Control patients received placebo. The Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS), the National Institute of Mental Health Global Obsessive Compulsive Scale (NIMH GOCS), and the NIMH Clinical Global Impressions of Severity of Illness (CGI-S) and Improvement (CGI-I) rating scales. In intent-to-treat analyses, patients treated with sertraline showed significantly greater improvement than did placebo-treated patients on the CY-BOCS (adjusted mean, -6.8vs -3.4, respectively; P=.005), the NIMH GOCS (-2.2 vs -1.3, respectively; P=.02), and the CGI-I (2.7 vs 3.3, respectively; P=.002) scales. Significant differences in efficacy between sertraline and placebo emerged at week 3 and persisted for the duration of the study. Based on CGI-I ratings at end point, 42% of patients receiving sertraline and 26% of patients receiving placebo were very much or much improved. Neither age nor sex predicted response to treatment. The incidence of insomnia, nausea, agitation, and tremor were significantly greater in patients receiving sertraline; 12 (13%) of 92 sertraline-treated patients and 3 (3.2%) of 95 placebo-treated patients discontinued prematurely because of adverse medical events (P=.02). No clinically meaningful abnormalities were apparent on vital sign determinations, laboratory findings, or electrocardiographic measurements. Sertraline appears to be a safe and effective short-term treatment for children and adolescents with obsessive-compulsive disorder.
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Several methods are available to estimate the total and residual amount of heterogeneity in meta-analysis, leading to different alternatives when estimating the predictive power in mixed-effects meta-regression models using the formula proposed by Raudenbush (1994, 2009). In this paper, a simulation study was conducted to compare the performance of seven estimators of these parameters under various realistic scenarios in psychology and related fields. Our results suggest that the number of studies (k) exerts the most important influence on the accuracy of the results, and that precise estimates of the heterogeneity variances and the model predictive power can only be expected with at least 20 and 40 studies, respectively. Increases in the average within-study sample size (N¯) also improved the results for all estimators. Some differences among the accuracy of the estimators were observed, especially under adverse (small k and N¯) conditions, while the results for the different methods tended to convergence for more optimal scenarios.
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Behavioral therapy utilizing exposure and response prevention (ERP) is considered the psychosocial treatment of choice for obsessive-compulsive disorder (OCD). Individual ERP treatment is the most common therapy format, and much of the empirical support for ERP is based upon studies of OCD subjects treated individually. However, there are numerous advantages of delivering this effective intervention in a group format, including cost savings to patients and time-efficiency for ERP therapists. This review summarizes the 12 adult trials and 4 adolescent trials of group behavioral therapy for OCD conducted to date. The paper also describes a typical group therapy protocol in detail and describes the costs and benefits of delivering ERP for OCD in a group format. [Brief Treatment and Crisis Intervention 3:217–229 (2003)] KEY WORDS: obsessive-compulsive disorder, CBT, group therapy. Individual behavioral exposure and response prevention (ERP) for obsessive-compulsive dis-order (OCD) is well established as an effective treatment method (Rachman & Hodgson, 1980; Foa, Franklin, & Kozak, 1998). However, the de-livery of such cognitive-behavioral treatment (CBT) in a group format is relatively new and is less well studied. The group format holds prom-ise in terms of cost-effectiveness, efficient use of the scarce resource of skilled CBT therapists for OCD, and the potential clinical advantages of the group milieu. Shortcomings to the group ap-proach may include the practical challenge of assembling groups, difficulties with group het-erogeneity, and the possible reluctance of some group candidates to share symptom details. This article reviews the literature to date on group behavioral interventions for OCD, provides a de-scription of typical group treatment protocols, and further highlights some of the advantages and disadvantages of this treatment delivery format.
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The benefits of cognitive–behavioral treatment for obsessive–compulsive disorder (OCD) have been evidenced by several meta-analyses. However, the differential effectiveness of behavioral and cognitive approaches has shown inconclusive results. In this paper a meta-analysis on the effectiveness of psychological treatment for OCD is presented by applying random- and mixed-effects models. The literature search enabled us to identify 19 studies published between 1980 and 2006 that fulfilled our selection criteria, giving a total of 24 independent comparisons between a treated and a control group. The effect size index was the standardized mean difference in the posttest. The effect estimates for exposure with response prevention (ERP) alone (d+ = 1.127), cognitive restructuring (CR) alone (d+ = 1.090), and ERP plus CR (d+ = 0.998) were very similar, although the effect estimate for CR alone was based on only three comparisons. Therapist-guided exposure was better than therapist-assisted self-exposure, and exposure in vivo combined with exposure in imagination was better than exposure in vivo alone. The relationships of subject, methodological and extrinsic variables with effect size were also examined, and an analysis of publication bias was carried out. Finally, the implications of the results for clinical practice and for future research in this field were discussed.
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The extant literature on the treatment of pediatric obsessive-compulsive disorder (OCD) indicates that partial response to serotonin reuptake inhibitors (SRIs) is the norm and that augmentation with short-term OCD-specific cognitive behavior therapy (CBT) may provide additional benefit. To examine the effects of augmenting SRIs with CBT or a brief form of CBT, instructions in CBT delivered in the context of medication management. A 12-week randomized controlled trial conducted at 3 academic medical centers between 2004 and 2009, involving 124 pediatric outpatients between the ages of 7 and 17 years with OCD as a primary diagnosis and a Children's Yale-Brown Obsessive Compulsive Scale score of 16 or higher despite an adequate SRI trial. Participants were randomly assigned to 1 of 3 treatment strategies that included 7 sessions over 12 weeks: 42 in the medication management only, 42 in the medication management plus instructions in CBT, and 42 in the medication management plus CBT; the last included 14 concurrent CBT sessions. Whether patients responded positively to treatment by improving their baseline obsessive-compulsive scale score by 30% or more and demonstrating a change in their continuous scores over 12 weeks. The medication management plus CBT strategy was superior to the other 2 strategies on all outcome measures. In the primary intention-to-treat analysis, 68.6% (95% CI, 53.9%-83.3%) in the plus CBT group were considered responders, which was significantly better than the 34.0% (95% CI, 18.0%-50.0%) in the plus instructions in CBT group, and 30.0% (95% CI, 14.9%-45.1%) in the medication management only group. The results were similar in pairwise comparisons with the plus CBT strategy being superior to the other 2 strategies (P < .01 for both). The plus instructions in CBT strategy was not statistically superior to medication management only (P = .72). The number needed-to-treat analysis with the plus CBT vs medication management only in order to see 1 additional patient at week 12, on average, was estimated as 3; for the plus CBT vs the plus instructions in CBT strategy, the number needed to treat was also estimated as 3; for the plus instructions in CBT vs medication management only the number needed to treat was estimated as 25. Among patients aged 7 to 17 years with OCD and partial response to SRI use, the addition of CBT to medication management compared with medication management alone resulted in a significantly greater response rate, whereas augmentation of medication management with the addition of instructions in CBT did not. clinicaltrials.gov Identifier: NCT00074815.
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Cognitive behaviour therapy (CBT) for young people with obsessive compulsive disorder (OCD) has become the treatment of first choice. However, the literature is largely based on studies emphasising exposure and response prevention. In this study, we report on a randomised controlled trial of CBT for young people carried out in typical outpatient clinic conditions which focused on cognitions. A randomised controlled trial compares 10 sessions of manualised cognitive behavioural treatment with a 12-week waiting list for adolescents and children with OCD. Assessors were blind to treatment allocation. 21 consecutive patients with OCD aged between 9 and 18 years were recruited. The group who received treatment improved more than a comparison group who waited for 3 months. The second group was treated subsequently using the same protocol and made similar gains. In conclusion, CBT can be delivered effectively to young people with OCD in typical outpatient settings.
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ABSTRACT A 10-week double-blind, placebo-controlled design was employed to investigate the effectiveness of clomipramine (CMI) versus placebo in 16 outpatients (ages 10-18 years) with obsessive-compulsive disorder (OCD). While a trend favoring clomipramine was observed, the difference in efficacy between clomipramine (N=8) and placebo (N=8) did not reach statistical significance, partly due to small sample size (N = 6,8). Post-hoc exclusion of two clomipramine-resistant subjects with subtle neurological impairments did, however, yield a statistically significant improvement with drug treatment. Neurological impairments are commonly seen in children with OCD, and may be a risk factor for the disorder during childhood. Speculatively, subtle neurological impairments may also predict resistance to CMI therapy in some patients, and influence the outcome of clinical and research medication trials, depending on differences in neurological inclusion and exclusion criteria.
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To assess the distribution and severity of obsessions and compulsions in a nonclinical adolescent population. During preinduction military screening, 861 sixteen-year-old Israelis completed a questionnaire regarding the lifetime presence of eight obsessive-compulsive (OC) symptoms and three severity measures. The presence or absence of obsessive-compulsive disorder (OCD) or subclinical OCD was ascertained by an independent interview. Although only 8.0% and 6.3% of respondents reported disturbing and intrusive thoughts, respectively, 27% to 72% of subjects endorsed the six remaining OCD symptoms. Twenty percent of subjects regarded the symptoms they endorsed as senseless and 3.5% found them disturbing; 8% reported spending more than an hour daily on symptoms. OCD and subclinical OCD cases differed significantly from non-OCD cases, but not from each other, in distress and mean number of symptoms. Although the distribution of nine of the items differed for noncases, compared with OCD and subclinical OCD cases, the distributions for all items overlapped markedly across the three groups. OC phenomena appear to be on a continuum with few symptoms and minimal severity at one end and many symptoms and severe impairment on the other. Defining optimal cutoff points for distinguishing between psychiatric disorder and OC phenomena that are common in the general population remains an open question.
Chapter
This chapter provides an overview of software Comprehensive Meta‐Analysis (CMA) and shows how to use it to implement the ideas. The same approach could be used with any other program as well. The chapter also provides a sense for the look‐and‐feel of the program. CMA features a spreadsheet view and a menu‐driven interface. As such, it allows a researcher to enter data and perform a simple analysis in a matter of minutes. At the same time, it offers a wide array of advanced features, including the ability to compare the effect size in subgroups of studies, to run meta‐regression, to estimate the potential impact of publication bias, and to produce high‐resolution plots. The program is designed to work with studies that compare an outcome in two groups or that estimate an outcome in one group.
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This article discusses the results of a meta-analysis of the effectiveness of psychological treatment, by itself or in combination with drugs, of the obsessive-compulsive disorder. Twenty-three European articles meeting the selection criteria were included, offering a total of 43 independent studies. Standardized mean difference was calculated between the pretest and postest means. The global mean effect size, d+ = 1.443, showed a clear efficacy for reducing obsessions and compulsions as well as symptoms of depression, anxiety, and social adjustment, although the latter was reduced to a lesser extent. The most effective treatments consisted of combining exposition and response prevention techniques or cognitive restructuring with antidepressants (d+ = 2.044 and d+ = 2.953, respectively), such as clomipramine or fluvoxamine. A predictive model of the efficacy is proposed as a function of the different treatments and the methodological quality of studies. Finally, the practical, clinical, and research implications of the results are discussed.
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This paper presents the results a qualitative review study on effectiveness of cognitive-behavioural therapy for obsessive-compulsive disorder in children and adolescents. A total of 84 studies were located and retrieved, of which 17 were case reports, 37 were single case designs, 19 were quasi-experimental one-group studies, 6 were quasi-experimental comparison studies and 5 randomized controlled trials. The most widely treatment procedure, in the studies, was exposure with response prevention, which also was the most effective. We found a low representation of comparison studies, both quasi-experimental and experimental designs, as well as a lack of medium and long-term follow-ups, observational measures and a poor control of covert symptomatology and comorbidity.
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Introduction: Childhood obsessive-compulsive disorder (OCD) is a prevalent, distressing, and impairing illness that extends through adolescence and into adulthood. The lifetime prevalence rate of OCD in youth is estimated to be between 2 and 3% (Rapoport et al. 2000), which is more common than expected. Childhood OCD resembles adult-onset OCD in the symptom picture and in its waxing and waning course. Like adults, children report obsessions pertaining to fears of germs or contamination, followed by fears of harm to self or others, as well as excessive focus on moral or religious themes. Not all obsessions are anxiety provoking, however. Some children and adults describe vague feelings of discomfort that something is not “just right” until there is a sense of symmetry, closure, or completion. Common rituals experienced by children include washing, repeating, checking, touching, counting, and ordering (Swedo et al. 1989). The mean age of onset for childhood OCD may range from 6 to 11 years, as indicated by clinic (Hanna 1995) and community-based (Rapoport et al. 2000) studies. Children who have an onset of OCD before the age of 7 years are more likely to be male and to have a family history of OCD than those with OCD of a later onset, suggesting that genetics may play a role in early-onset OCD (Swedo et al. 1989).
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IntroductionIndividual studiesThe summary effectHeterogeneity of effect sizesSummary points
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Previous research has recommended several measures of effect size for studies with repeated measurements in both treatment and control groups. Three alternate effect size estimates were compared in terms of bias, precision, and robustness to heterogeneity of variance. The results favored an effect size based on the mean pre-post change in the treatment group minus the mean pre-post change in the control group, divided by the pooled pretest standard deviation.
Article
Because as many as 50% of obsessive–compulsive disorder (OCD) cases have had onset by age 15, interest in its detection in childhood is strong. Clinical experience indicates that children often try to keep their OCD secret and that parental report may give marked underestimates. The authors examined the prevalence of childhood OCD in the NIMH Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study, a four-site community survey which allowed comparison of both parent and child report of the child's OCD and related symptoms and disorders. OCD cases, based on structured interviews (DISC-2.3 with DSM-III-R criteria) with 1,285 caretaker-child pairs, were identified separately for parent and child (aged 9 through 17) informants from the MECA database. Cases were then examined for demographic characteristics, for obsessive–compulsive symptoms and other diagnoses reported in cases “missed” by one reporter, and for comorbid disorders. Of a total of 35 (2.7%) identified cases, four (0.3%) were identified by the parent and 32 (2.5%) were identified by the child, with only one overlapping case. In general, when OCD cases were “missed” by one reporter, that reporter did not substitute another disorder. These findings support clinical data that children with OCD often hide their illness and underscore the importance of child interviews for its detection.
Article
Research on the effectiveness of cognitive-behavioral therapy, and in particular, exposure with response prevention for Obsessive-Compulsive Disorder (OCD), has only been systematically evaluated in children and adolescents ages 7–17. These treatments do not address the unique characteristics of young children with OCD. This paper discusses clinical considerations for treating OCD in young children (ages 5–8), including cognitive developmental differences, family context, unique symptom correlates, and initial contact with the mental health system. A family-based treatment program consisting of psychoeducation about OCD in young children, parent education, and exposure with response prevention for young children and their parents is described. Issues to consider regarding implementation of this treatment, research with a young population, and future directions for research are presented.
Article
We aimed to assess the prevalence (at three levels of severity) and other epidemiological data of OCD in a sample of 1,514 Spanish non-referred children. The estimated prevalence was 1.8% for OCD, 5.5% for subclinical OCD and 4.7% for OC symptomatology. We did not find significant differences between genders or academic grade regarding OC symptoms and OCD, but more subclinical prevalence was found in males than in females. Socio-demographic variables were not related to any level of OCD, but academic performance was significantly lower in clinical OCD. The co-morbidity between OCD and any psychiatric disorder was high (85%) and higher for emotional disorders than for behavioral disorders. The impairment was associated with comorbidity and was worse for OCD with comorbid emotional problems. The results suggest that OCD is not rare in school children and adolescents and that it has an impact on their personal functioning. We suggest the possibility of an early diagnosis and treatment.
Cognitive behaviour therapy (CBT) and selective serotonin reuptake inhibitors have both been established as effective interventions for paediatric obsessive-compulsive disorder (OCD), with CBT being the recommended first-line treatment in most cases. While the majority of young people respond well to these treatments, a significant proportion remain symptomatic. Although the research on treatment-resistant OCD remains limited, increasing empirical attention is being paid to predictors of treatment outcome in young people with OCD, and efforts are being made to identify the factors that hinder recovery. This article outlines potential barriers in treatment and highlights strategies for optimising outcome, with particular focus on cognitive behavioural techniques.
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IntroductionDefinition of the Failsafe NExamplesAssumptions of the Failsafe NVariations on the Failsafe NSummary of the ExamplesApplications of the Failsafe NConclusions AcknowledgementReferences
Article
The last decade has seen a noticeable increase in the number of treatment outcome studies for pediatric obsessive-compulsive disorder (OCD). The present article describes a meta-analysis of this literature with the aim of quantifying treatment effects and examining the extent to which various patient or treatment variables are related to outcome. Results showed that pharmacotherapy with serotonergic antidepressants and cognitive-behavioral therapy involving exposure and response prevention are each effective in reducing OCD symptoms. Cognitive-behavioral therapy produced larger effect sizes and greater rates of clinically significant improvement compared to medication, although there were methodological differences between medication and psychotherapy studies.
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Parental accommodation of pediatric OCD is common and is associated with negative affect in parents. Qualitative accounts of caring for a child with OCD are limited and no studies have assessed differences between mothers and fathers in accommodation, coping and distress. The current study used a mixed methods approach to understand parental accommodation, negative affect and coping. Forty-one mothers and 29 fathers of 43 children with OCD were asked to write narratives about their understanding and management of OCD and to complete measures of accommodation, coping, and distress. Symptom accommodation was high with almost half of the parents watching the child complete rituals or waiting for the child on a daily basis. Analysis of parental narratives indicated a distressing struggle between engaging in and resisting accommodation in order to manage their own and their child's anger and distress. T-tests and correlation analysis indicated that accommodation did not differ significantly between mothers and fathers but was more strongly associated with negative affect in mothers. Analyses indicated that mothers reported using all types of coping strategy more often than fathers, particularly escape-avoidance, taking responsibility and using social support. Escape-avoidance coping was positively correlated with accommodation and negative affect in both mothers and fathers. Interventions that target parental constructions of OCD and their behavioural and emotional responses to it may assist in reducing the occurrence of accommodation, avoidant coping and parental distress.
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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). 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. 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. 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.
Article
The purpose of this open clinical trial was to examine the efficacy of cognitive-behavioral treatment involving exposure and ritual prevention for pediatric obsessive-compulsive disorder (OCD). Children and adolescents with diagnosed OCD (N = 14) received cognitive-behavioral treatment, seven patients received intensive treatment (mean = 18 sessions over 1 month) and seven received weekly treatment (mean = 16 sessions over 4 months). Eight of these patients received concurrent treatment with serotonin reuptake inhibitors and six received cognitive-behavioral treatment alone. Outcome was assessed via interviewer ratings on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Obsessive Compulsive Rating Scales for Main Fear and Main Ritual, and Hamilton Depression Rating Scale. Cognitive-behavioral treatment was effective in ameliorating OCD symptoms. Twelve of the 14 patients were at least 50% improved over pretreatment Y-BOCS severity, and the vast majority remained improved at follow-up; mean reduction in Y-BOCS was 67% at posttreatment and 62% at follow-up (mean time to follow-up = 9 months). Results suggest that cognitive-behavioral treatment by exposure and ritual prevention is effective for pediatric OCD. Controlled studies with random assignment to conditions are warranted to evaluate the relative efficacy of cognitive-behavioral pharmacological, and combined treatments.
Article
This study reports a waitlist controlled randomized trial of family-based cognitive-behavioral therapy delivered via web-camera (W-CBT) in children and adolescents with obsessive-compulsive disorder (OCD). Thirty-one primarily Caucasian youth with OCD (range=7-16years; 19 male) were randomly assigned to W-CBT or a Waitlist control. Assessments were conducted immediately before and after treatment, and at 3-month follow-up (for W-CBT arm only). Primary outcomes included the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS), clinical global improvement rates, and remission status. When controlling for baseline group differences, W-CBT was superior to the Waitlist control on all primary outcome measures with large effect sizes (Cohen's d≥1.36). Thirteen of 16 youth (81%) in the W-CBT arm were treatment responders, versus only 2/15 (13%) youth in the Waitlist arm. Similarly, 9/16 (56%) individuals in the W-CBT group met remission criteria, versus 2/15 (13%) individuals in the Waitlist control. Gains were generally maintained in a naturalistic 3-month follow-up for those randomized to W-CBT. This preliminary study suggests that W-CBT may be helpful in reducing obsessive-compulsive symptoms in youth with OCD. Given considerable access issues, such findings hold considerable promise for treatment dissemination.
Article
Reviews and practice guidelines for paediatric obsessive-compulsive disorder (OCD) recommend cognitive-behaviour therapy (CBT) as the psychological treatment of choice, but note that it has not been sufficiently evaluated for children and adolescents and that more randomized controlled trials are needed. The aim of this trial was to evaluate effectiveness and optimal delivery of CBT, emphasizing cognitive interventions. A total of 96 children and adolescents with OCD were randomly allocated to the three conditions each of approximately 12 weeks duration: full CBT (average therapist contact: 12 sessions) and brief CBT (average contact: 5 sessions, with use of therapist-guided workbooks), and wait-list/delayed treatment. The primary outcome measure was the child version of the semi-structured interviewer-based Yale-Brown Obsessive Compulsive Scale. Clinical Trial registration: http://www.controlled-trials.com/ISRCTN/; unique identifier: ISRCTN29092580. There was statistically significant symptomatic improvement in both treatment groups compared with the wait-list group, with no significant differences in outcomes between the two treatment groups. Controlled treatment effect sizes in intention-to-treat analyses were 2.2 for full CBT and 1.6 for brief CBT. Improvements were maintained at follow-up an average of 14 weeks later. The findings demonstrate the benefits of CBT emphasizing cognitive interventions for children and adolescents with OCD and suggest that relatively lower therapist intensity delivery with use of therapist-guided workbooks is an efficient mode of delivery.
Article
To evaluate the feasibility and outcomes of evidence-based (EB) manualized, cognitive-behavioral treatment (CBT) for childhood obsessive-compulsive disorder (OCD), when delivered in an outpatient community-based specialist clinic. This study, conducted in an outpatient private clinic in South-East Queensland Australia, involved thirty-three children and adolescents with OCD. Children were assessed at pre- and post-treatment, by means of diagnostic interviews, symptom severity interviews, and self-report. Treatment involved 12 sessions CBT delivered either individually or in small groups and included parental involvement. Manualized CBT could be transported to the community setting effectively, with 63% of the current sample responding positively, based on post-treatment diagnosis. Significant change was evident across a wide-range of outcomes; including, diagnostic severity, symptom severity, child reported depression and anxiety, and both child and parent reported OCD functional impairment. This study provides evidence for the transportability of manualized CBT in clinical community practice for pediatric OCD. The next important step is larger community based dissemination and effectiveness studies to advance both research and clinical practice outcomes.
Article
The current study examined factors associated with obsessive-compulsive disorder (OCD) related functional impairment among 99 youth with OCD. A trained evaluator administered the Children's Yale-Brown Obsessive-Compulsive Scale, items assessing family accommodation, and a version of the Brown Assessment of Beliefs Scale that was modified for children. Youth completed the Child Obsessive-Compulsive Impact Scale-Child Version, Obsessive-Compulsive Inventory-Child Version, Multidimensional Anxiety Scale for Children, and Children's Depression Inventory-Short Form. The child's parent completed the Child Obsessive-Compulsive Impact Scale-Parent Version. Results indicated that OCD symptom severity, depressive symptoms, and family accommodation were directly related to impairment, while insight was inversely related to functional impairment. Insight, family accommodation, and depressive symptoms predicted parent- and/or child-rated functional impairment above and beyond OCD symptom severity. Among symptom dimensions, contamination/cleaning and aggressive/checking symptoms were the only dimensions significantly associated with impairment. Assessment and treatment implications are discussed; specifically, we highlight how the variables of interest may impact clinical presentation and treatment course.
Article
Cognitive-behaviour therapy (CBT) is the recommended psychological treatment for obsessive compulsive disorder (OCD) in young people. Access to CBT may be limited by a number of factors, including lack of trained therapists, and geographic or financial factors preventing access to a specialized service. Telephone delivery of CBT represents one way of overcoming some of these accessibility issues. This pilot study describes outcomes for a telephone-based cognitive-behavioural treatment for obsessive-compulsive disorder (OCD) in young people. Ten participants, aged 13 to 17 years, and their parents received up to 16 sessions of telephone CBT (TCBT). Measures of OCD symptoms were obtained using multiple informants and a repeated measures design. Assessments were conducted at pre-treatment, post-treatment, and at 6- and 12-month follow-up. Improvements were found for OCD symptoms across all informants. Family satisfaction with treatment over the telephone was high. The findings suggest that TCBT is a clinically effective, feasible and acceptable means of service delivery that offers the potential to make CBT a more accessible treatment for young people. TCBT requires further evaluation in randomized, controlled trials to compare effectiveness with face-to-face CBT, which currently represents the usual care model.
Article
Rigorously designed clinical trials have demonstrated the efficacy and safety of fluoxetine in adults with major depressive disorder and obsessive-compulsive disorder (OCD) but not in patients below 18 years old. This report describes a randomized, double-blind, placebo-controlled, fixed-dose (20 mg qd) trial of fluoxetine in 14 children and adolescents with OCD, ages 8 to 15 years old; the study was 20 weeks long with crossover at 8 weeks. Obsessive-compulsive symptom severity was measured on the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS) and the Clinician's Global Impression-Obsessive Compulsive Disorder scale (CGI-OCD). The CY-BOCS total score decreased 44% (N = 7, p = .003) after the initial 8 weeks of fluoxetine treatment, compared with a 27% decrease (N = 6, p = .13) after placebo. During the initial 8 weeks, the magnitude of improvement for the fluoxetine group significantly exceeded that for the placebo group as measured by the CGI-OCD (p = .01) but not by the CY-BOCS (p = .17). The most common drug side effects were generally well tolerated. The results suggest that fluoxetine is a generally safe and effective short-term treatment for children with OCD.