Is it time to rethink standard dosage of exposure-based cognitive behavioral therapy for pediatric obsessive-compulsive disorder?

• Published in: Psychiatry research Vol. 281; p. 112600
• Main Authors: Torp, Nor Christian, Weidle, Bernhard, Thomsen, Per Hove, Skarphedinsson, Gudmundur, Aalberg, Marianne, Nissen, Judith Becker, Melin, Karin Holmgren, Dahl, Kitty, Valderhaug, Robert, Ivarsson, Tord
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01-11-2019
• Subjects: Adolescent; adolescents; age-children-present; cbt; Characteristics of early; Characteristics of early responds; Child; childhood ocd; Cognitive Behavioral Therapy - methods; Cognitive Behavioral Therapy - trends; Cognitive-behavior therapy; Combined Modality Therapy - methods; Combined Modality Therapy - trends; depression; family accommodation; Female; functional impairment; Health Resources - trends; Humans; Male; moderators; Obsessive-Compulsive Disorder - diagnosis; Obsessive-Compulsive Disorder - psychology; Obsessive-Compulsive Disorder - therapy; Pediatric OCD; predictors; Prospective Studies; Psychiatry; Psykiatri; responds; Retrospective Studies; scale; Treatment Outcome; Cognitive-behavior therapy; Pediatric OCD; Characteristics of early responds
• ISSN: 0165-1781; 1872-7123
• DOI: 10.1016/j.psychres.2019.112600

•This study examined baseline characteristics of children and adolescents with OCD experiencing early treatment response.•A high number of participants evidenced early treatment response, and a clear majority maintained their treatment gains. Younger children were more likely to respond early also when effects of age, duration of OCD, and their interaction were considered.•Standard CBT treatment programs should include an evaluation of response to treatment, after seven sessions, with an anticipation that a substantial number of patients, and especially the younger children with less severe OCD will respond early and can be referred to follow up programs.•Treatment planning in the future, should include stepped care models, starting with an initial brief intervention followed by an assessment to determine who is in need of further treatment.
Identifying factors associated with early treatment response is important, because it can help allocate limited resources in psychiatric care more appropriately. This study examined baseline characteristics of participants with early response to exposure-based cognitive behavior therapy (CBT) for pediatric obsessive-compulsive disorder (OCD).
269 participants with OCD, aged 7–17 years, were enrolled in a 14-weeks CBT program. We identified participants with early response to treatment, (CY-BOCS total score of ≤15), by the seventh session.
At week 7, 248 (92.2%) participants were assessed, 38.3% (95% CI 32.4–44.5%, n = 95) were identified as treatment responders. Univariate analyses showed that six baseline characteristics were significantly associated with early treatment response: young age, lower levels of symptom severity, functional impairment, internalizing- and externalizing problems, depressive symptoms, and family accommodation.
These results suggested that treatment plans for younger children with moderate OCD symptoms and no major comorbid disorder should include briefer and less resource demanding treatment formats than the commonly recommended and applied standard doses of 15 CBT sessions.