Family-Based Cognitive-Behavioral Therapy for Pediatric Obsessive-Compulsive Disorder
To examine the relative efficacy of intensive versus weekly cognitive-behavioral therapy (CBT) for children and adolescents with obsessive-compulsive disorder (OCD).
Forty children and adolescents with OCD (range 7-17 years) were randomized to receive 14 sessions of weekly or intensive (daily psychotherapy sessions) family-based CBT. Assessments were conducted at three time points: pretreatment, posttreatment, and 3-month follow-up. Raters were initially blind to randomization. Primary outcomes included scores on the Children's Yale-Brown Obsessive-Compulsive Scale, remission status, and ratings on the Clinical Global Impression-Severity and Clinical Global Improvement scales. Secondary outcomes included the Child Obsessive Compulsive Impact Scale-Parent Rated, Children's Depression Inventory, Multidimensional Anxiety Scale for Children, and Family Accommodation Scale. Adjunctive pharmacotherapy was not an exclusion criterion.
Intensive CBT was as effective as weekly treatment with some advantages present immediately after treatment. No group differences were found at follow-up, with gains being largely maintained over time. Although no group x time interaction was found for the Children's Yale-Brown Obsessive-Compulsive Scale (F(1,38) = 2.2, p = .15), the intensive group was rated on the Clinical Global Impression-Severity as less ill relative to the weekly group (F(1,38) = 9.4, p < .005). At posttreatment, 75% (15/20) of youths in the intensive group and 50% (10/20) in the weekly group met remission status criteria. Ninety percent (18/20) of youths in the intensive group and 65% (13/20) in the weekly group were considered treatment responders on the Clinical Global Improvement (chi1(2) = 3.6, p = .06).
Both intensive and weekly CBT are efficacious treatments for pediatric OCD. Intensive treatment may have slight immediate advantages over weekly CBT, although both modalities have similar outcomes at 3-month follow-up.
Available from: İsmail seçer
- "Gökçakan (2005) defined OCD as a continuous and stubborn disorder which limits the life of the individual, affecting psychological adaptation and socialization, decreasing his productivity and preventing him to establish healthy relationships in his environment. Öner and Aysev (2001) defined OCD as a psychiatric disorder which can start during childhood and processes seriously, and stated It can be seen that the number of researches related to OCD in children has been increased recently (Barrett, Healy-Farrell, ve March, 2004; Foa, Kozak, Salkovskis, Coles and Amir, 1998; Foa et al. 2010; Storch et al. (2007). In spite of that, it is obvious that the number of instruments that would diagnose and identify OCD in children and adolescents is still quite limited in Turkey and international literature. "
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ABSTRACT: The purpose of this study is to adapt Child Version of obsessive
compulsive inventory developed by Foa, Coles, Huppert, Franklin
and March (2010) into Turkish culture. The work group of the
study is formed of 1187 secondary and high school students, 633
boys and 604 girls, who get educated in Erzurum city center and
were selected with appropriate sampling method. Experts’
opinions were asked for language validity of the scale in adaptation
process and after the language validity had been granted,
Confirmatory Factor Analysis was used to determine the scale’s
adaptation level to Turkish culture, and it was found that the
model fit indices of the six-factor structure of the scale are at good
level. The model fit of this six-factor structure of the scale was
tested with Confirmatory Factor Analysis and model fit indices
were found to be in good level. The internal consistency coefficient
was found as .86 for the total scale and .73, .76, .81, .78, .79 and .78,
respectively for the sub-dimensions. According to the evidence
obtained through the study, the child form of obsessive compulsive
symptoms scale is a valid and reliable assessment tool to use in the
analysis of factors related obsessive compulsive disorder.
Available from: Paulo A Graziano
- "Phobia treatment also has been successfully implemented within a very brief period ranging from two weeks to as little as three hours (Davis et al. 2009; Mörtberg et al. 2005, 2006). Indeed, intensive interventions ostensibly offer opportunity for massed practice and full mastery of intervention criteria prior to termination (Abramowitz et al. 2003), but within a condensed time frame, which may be more appealing to some families (Storch et al. 2007b). However, an intensive and brief intervention for EBP has not been examined in the literature. "
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ABSTRACT: The current pilot study examined the feasibility, acceptability, and initial outcome of an intensive and more condensed version of Parent-Child Interaction Therapy (90 minute sessions for 5 days/week over the course of 2 weeks).
Using an open trial design, 11 children (M child age = 5.01 years) and their mothers completed a baseline period of 2 weeks, a treatment period of 2 weeks, and a post-treatment evaluation. A follow-up evaluation was also conducted 4 months following treatment completion. Across all assessments, mothers completed measures of child behavior and parenting stress, and observational data was collected during three 5-minute standard situations that vary in the degree of parental control (child-led play, parent-led play, & clean-up).
All 11 families completed the intervention with extremely high attendance and reported high satisfaction. Results across both mother report and observations showed that: a) externalizing behavior problems were stable during the baseline period; b) treatment was effective in reducing externalizing behavior problems (ds = 1.67-2.50), improving parenting skills (ds = 1.93-6.04), and decreasing parenting stress (d = .91); and c) treatment gains were maintained at follow-up (ds = .53-3.50).
Overall, preliminary data suggest that a brief and intensive format of a parent-training intervention is a feasible and effective treatment for young children with externalizing behavior problems with clinical implications for improving children's behavioral impairment in a very brief period of time.
Available from: Bernhard Weidle
- "A cut-off score of 16 or more on the CY-BOCS has been used in previous treatment studies including a number of pharmacological studies [68-70]. In addition, a continuous measurement such as a 30% reduction on the CY-BOCS score is clinically meaningful in order to capture differences in OCD severity and in order to specifically look at subgroups with different responses to treatment within the area of severe, moderate, and mild OCD. "
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ABSTRACT: This paper describes and discusses the methodology of the Nordic long-term OCD-treatment study (NordLOTS). The purpose of this effectiveness study was to study treatment outcome of CBT, to identify CBT non- or partial responders and to investigate whether an increased number of CBT-sessions or sertraline treatment gives the best outcome; to identify treatment refractory patients and to investigate the outcome of aripiprazole augmentation; to study the outcome over a three year period for each responder including the risk of relapse, and finally to study predictors, moderators and mediators of treatment response.
Step 1 was an open and uncontrolled clinical trial with CBT, step 2 was a controlled, randomised non-blinded study of CBT non-responders from step 1. Patients were randomized to receive either sertraline plus CBT-support or continued and modified CBT. In step 3 patients who did not respond to either CBT or sertraline were treated with aripiprazole augmentation to sertraline.
This multicenter trial covering three Scandinavian countries is going to be the largest CBT-study for paediatric OCD to date. It is not funded by industry and tries in the short and long-term to answer the question whether further CBT or SSRI is better in CBT non-responders.
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