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“[E]xtensive avoidance may mask a youth’s symptom severity at baseline … and prevent, or slow, youth’s engagement in [treatment],” wrote Robert R. Selles, Ph.D., of the University of British Columbia and colleagues. The findings point to the importance of accurately assessing these factors in youth with OCD before starting treatment and monitoring changes throughout therapy.
CBT that emphasizes exposure and response prevention—encouraging a patient to face thoughts, objects, and situations that trigger obsessions while not engaging in compulsive behavior—is a first-line approach to treating pediatric patients with OCD. To examine factors that may predict how youth with OCD respond to CBT, Selles and colleagues analyzed aggregated data from CBT trials involving 573 youth aged 7 to 19 who had been diagnosed with OCD.
As part of these trials, participants answered questions about avoidance behaviors (for example, how often they avoided doing things, going places, or being with people because of obsessions or compulsions) and insight (for example, if they believed their behaviors were reasonable) before and after receiving CBT. Participants also answered questions about the impact of OCD symptoms on daily activities; these responses were then compared with those given by their parents.
Selles and colleagues found that insight among youth before receiving CBT was not significantly related to response to CBT (defined as ≥35% reduction in Children’s Yale Brown Obsessive-Compulsive Scale score). In contrast, greater baseline avoidance and limited child recognition of impairment predicted reduced likelihood of achieving response to CBT. “Response rates steadily declined with worsening avoidance from a 71.9% (n = 69) response rate for youth with no avoidance down to a 48.3% (n = 14) response rate for youth with extreme avoidance,” they wrote. “Only 46.2% (n = 30) of youth with limited recognition of impairment (relative to the parent’s recognition) responded to treatment, in comparison to 62.3% to 66.8% of youth with either concordant or limited parent impairment recognition.” Insight and avoidance substantially improved with CBT.
“[A]voidance, insight, and parent-child concordance on impairment all appear to be variables relevant to CBT. As a result, it is recommended that clinicians assess and monitor these factors prior to and throughout treatment,” Selles and colleagues concluded. “[T]he use of more comprehensive and frequent assessment of these domains throughout the treatment process is recommended to identify reasons for lack of change in or worsening of insight and/or avoidance over treatment.”
For related information, see the Psychiatric News article “Report Highlights Alternative Treatment Options for OCD.”
(Image: iStock/izusek)
