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Coercive and disruptive behaviors mediate group cognitive-behavioral therapy response in pediatric
David A Schuberth1, Robert R Selles2, S Evelyn Stewart2
1British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada; Institute for the Reduction of Youth Violence, Department of Psychology, Simon Fraser University, Burnaby, BC, Canada.
Insights
Reducing coercive and disruptive behaviors (CDBs) in pediatric obsessive-compulsive disorder (OCD) improves OCD severity and child/family functioning. Targeting CDBs in family therapy is crucial for meaningful treatment outcomes.
Area of Science:
- Child and Adolescent Psychiatry
- Behavioral Psychology
- Family Therapy
Background:
- Coercive and disruptive behaviors (CDBs) are frequent in pediatric obsessive-compulsive disorder (OCD).
- CDBs are linked to greater OCD impact and poorer treatment response.
- CDBs may mediate the link between family accommodation and OCD severity.
Purpose of the Study:
- To investigate the impact of reducing CDBs on treatment outcomes in pediatric OCD.
- To examine if reducing CDBs improves OCD severity, child impairment, and family impairment.
- To test the mediating role of CDBs in the relationship between family accommodation and treatment outcomes.
Main Methods:
- A 12-week group family-based cognitive-behavioral treatment was administered to 49 youth with OCD and their parents.
- Outcomes measured included parent-reported CDBs, family accommodation, OCD severity, and child/family impairment.
- Statistical analyses included correlations, regressions, and mediation analyses.
Main Results:
- Decreases in CDBs positively predicted reduced OCD severity and child/family impairment.
- Family accommodation reductions were not directly predictive of outcomes unless CDBs or symptoms also decreased.
- CDB changes mediated the effects of accommodation and OCD severity changes on impairment.
Conclusions:
- Reducing CDBs is essential in pediatric OCD treatment.
- Improvements in family functioning depend on reducing CDBs and/or OCD symptoms.
- Family-based treatments should incorporate components targeting CDBs within accommodation contexts.
Purpose:
Coercive and disruptive behaviors (CDBs) are commonplace in pediatric obsessive-compulsive disorder (OCD) and are associated with increased disorder impact and reduced treatment response. Prior research suggests that CDBs mediate the cross-sectional relationship between family accommodation and OCD symptom severity; however, the impact of reducing CDBs on other treatment outcomes has yet to be studied.
Methods:
Participants comprised 49 OCD-affected youth (42.9% male, Mage at baseline = 13.7) and their parent(s) who completed a 12-week, group family-based cognitive-behavioral treatment at an OCD specialty clinic. Outcomes included parent-report measures of CDBs, family accommodation, symptom severity, and both child- and family-level impairment. Descriptive, correlation, and regression analyses were followed by tests of indirect effects (mediation).
Results:
Changes in all outcome variables had moderate to strong correlations with each other. As hypothesized, CDB decreases predicted positive changes in OCD severity as well as in child and family impairment. Further, whereas improvement in OCD severity predicted changes in child and family impairment, improvements in family accommodation were not directly predictive of any outcomes. Consistent with hypotheses, changes in CDBs mediated relationships between changes in accommodation and child- and family-level impairment, as well as relationships between changes in OCD severity and both levels of impairment. Additional exploratory analyses found that changes in symptom severity significantly mediated relationships between changes in CDBs and both levels of impairments.
Conclusions:
Findings suggest that attention to reducing CDBs is warranted in the treatment of pediatric OCD, and that accommodation reductions lead to meaningful improvements in child and family functioning only when CDBs and/or symptoms are also reduced. Future family-based treatments may benefit from inclusion of components specifically targeting CDBs that occur within the context of accommodating OCD symptoms.
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