Family involvement in the psychological treatment of obsessive-compulsive disorder: a meta-analysis

Psychological treatments for obsessive-compulsive disorder (OCD) are increasingly aimed at improving outcomes by directly incorporating family members to address family disruption, dysfunction, or symptom accommodation. Much remains to be learned about the pooled effects of "family inclusive treatment" (FIT) for OCD and factors that may explain variation in response. Random-effects meta-analytic procedures were conducted to empirically evaluate the overall effect of FITs on OCD, and treatment moderators. Study search criteria yielded 29 studies examining FIT response in 1,366 OCD patients. Outcome variables included OCD symptoms and global functioning. Examined moderators included age group, gender, minority status, treatment length and format, and inclusion of specific family focused treatment elements. FITs for OCD demonstrated a large overall effect on OCD symptoms (pooled d = 1.68, SE = 0.14) and global functioning (pooled d = 0.98, SE = 0.14). Moderator analyses found that individual family treatments (vs. group) and FITs targeting family accommodation of symptoms (vs. those that did not target accommodation) were associated with greater improvements in patient functioning. Results indicate a robust overall response to FITs for OCD and clarify key moderators that inform optimal circumstances for effective treatment. Findings underscore the need for continued momentum in the development, evaluation, and dissemination of FITs for OCD.