Effects of Treatment Setting on Outcomes of Flexibly-Dosed Intensive Cognitive Behavioral Therapy for Pediatric OCD: A Randomized Controlled Pilot Trial

Robert R Selles, Zainab Naqqash, John R Best, Diana Franco-Yamin, Serene T Qiu, Jessica S Ferreira, Xiaolei Deng, Dagmar Kr Hannesdottir, Carla Oberth, Laura Belschner, Juliana Negreiros, Lara J Farrell, S Evelyn Stewart, Robert R Selles, Zainab Naqqash, John R Best, Diana Franco-Yamin, Serene T Qiu, Jessica S Ferreira, Xiaolei Deng, Dagmar Kr Hannesdottir, Carla Oberth, Laura Belschner, Juliana Negreiros, Lara J Farrell, S Evelyn Stewart

Abstract

Introduction: Optimizing individual outcomes of cognitive-behavioral therapy (CBT) remains a priority. Methods: Youth were randomized to receive intensive CBT at a hospital clinic (n = 14) or within their home (n = 12). Youth completed 3 × 3 h sessions (Phase I) and up to four additional 3-h sessions as desired/needed (Phase II). An independent evaluator assessed youth after Phase I, Phase II (when applicable), and at 1- and 6-months post-treatment. A range of OCD-related (e.g., severity, impairment) and secondary (e.g., quality of life, comorbid symptoms) outcomes were assessed. Results: Families' satisfaction with the treatment program was high. Of study completers (n = 22), five youth (23%) utilized no Phase II sessions and 9 (41%) utilized all four (Median Phase II sessions: 2.5). Large improvements in OCD-related outcomes and small-to-moderate benefits across secondary domains were observed. Statistically-significant differences in primary outcomes were not observed between settings; however, minor benefits for home-based treatment were observed (e.g., maintenance of gains, youth comfort with treatment). Discussion: Intensive CBT is an efficacious treatment for pediatric OCD. Families opted for differing doses based on their needs. Home-based treatment, while not substantially superior to hospital care, may offer some value, particularly when desired/relevant. Clinical Trial Registration: www.ClinicalTrials.gov; https://ichgcp.net/clinical-trials-registry/NCT03672565, identifier: NCT03672565.

Keywords: exposure and response prevention; family treatment; home-based treatment; stepped care; treatment trial.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2021 Selles, Naqqash, Best, Franco-Yamin, Qiu, Ferreira, Deng, Hannesdottir, Oberth, Belschner, Negreiros, Farrell and Stewart.

Figures

Figure 1
Figure 1
Flow chart of participants through study procedures.
Figure 2
Figure 2
Change in OCD-related outcomes across timepoints and between groups. See Table 1 for a list of all measure abbreviations.
Figure 3
Figure 3
Change in secondary outcomes across timepoints and between groups. See Table 1 for a list of all measure abbreviations.

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