Authors: Chloe A. McGrath; Maree J. Abbott; Sharlene C. Mantz; Margot O'Brien; Daniel S. J. Costa; Felicity Waters · Research

How Family Factors Change During OCD Treatment for Children and Teens

Study examines how OCD symptoms and family factors like accommodation change during cognitive behavioral therapy for youth.

Source: McGrath, C. A., Abbott, M. J., Mantz, S. C., O'Brien, M., Costa, D. S. J., & Waters, F. (2023). Change Patterns During Family-Based Treatment for Pediatric Obsessive Compulsive Disorder. Journal of Child and Family Studies, 32, 1736-1752. https://doi.org/10.1007/s10826-022-02479-8

What you need to know

  • Family-based cognitive behavioral therapy (CBT) can effectively reduce OCD symptoms in children and teens
  • OCD symptoms and family factors like accommodation tend to improve most in the first third of treatment
  • Reductions in OCD symptoms may lead to less parental blame, while increased parental distress tolerance may contribute to symptom improvement

Background on OCD and family factors

Obsessive-compulsive disorder (OCD) affects 1-4% of children and teens. It involves intrusive, distressing thoughts (obsessions) and repetitive behaviors (compulsions) that can significantly impair functioning. Family factors like accommodation of symptoms, blame, and conflict can contribute to maintaining OCD. Recent treatments have been developed to target both OCD symptoms and these family factors.

How the study was conducted

The study examined 15 youth with OCD and their families as they went through 12 weeks of family-based CBT. OCD symptoms and family factors were measured weekly throughout baseline, early treatment, mid treatment, and late treatment phases. This allowed researchers to track how different factors changed over the course of therapy.

Key findings on symptom and family factor changes

OCD symptom improvement

OCD symptoms showed significant linear reductions across treatment according to child, parent, and clinician reports. The largest improvements tended to occur in the first third of treatment (first 4 sessions).

Family accommodation decreases

Family accommodation of OCD symptoms (e.g. participating in rituals) also showed a significant linear decrease across treatment. Like OCD symptoms, the biggest reductions occurred early in treatment.

Parental distress tolerance increases

Parents’ ability to tolerate their child’s distress improved in a linear pattern, with the most change happening early in treatment.

Parental blame decreases

Both child and parent reports showed small but significant linear decreases in parental blame across treatment phases.

Family conflict reduces

Child-reported family conflict showed significant reductions, particularly between baseline and mid-treatment.

Relationships between factors

The study found some interesting relationships between changes in family factors and OCD symptoms:

  • Reductions in OCD symptoms early in treatment predicted less parental blame in subsequent treatment phases
  • Increases in parental distress tolerance early in treatment predicted OCD symptom reductions in later phases
  • There were some bi-directional effects, where OCD symptoms and distress tolerance each predicted changes in the other

Conclusions

  • Family-based CBT can lead to improvements in both OCD symptoms and family factors like accommodation and blame
  • The first third of treatment tends to produce the largest changes, highlighting the importance of early engagement
  • There are complex relationships between family factors and OCD symptoms, with changes in one area potentially influencing the other
  • Addressing family factors in treatment may help enhance outcomes for youth with OCD

These findings highlight the value of family involvement in OCD treatment for children and teens. Families can play an important role in reducing accommodation and blame while increasing distress tolerance to support symptom improvement.

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