Lifetime Potentially Traumatic Events and Cognitive-Behavioral Therapy Outcomes in Pediatric Obsessive-Compulsive...

This study evaluated impacts of traumatic stress, a social determinant of health, on cognitive-behavioral therapy (CBT) outcomes in pediatric obsessive-compulsive disorder (OCD). Closing this literature gap is crucial for optimizing individual treatment approaches in pediatric OCD and limiting misinterpretation of OCD symptoms in the context of a trauma history.

An evidence-based CBT group program was completed by 98 OCD-affected youths (8-19 years old). Lifetime potentially traumatic events (PTEs) were assessed at baseline by type and cumulative load with the Traumatic Events Screening Inventory-Parent Report Revised. Longitudinal treatment outcome measures assessed OCD-related symptom severity, functional and family impairment, and family accommodation at baseline, treatment midpoint, end of treatment, and 1-month follow-up. Specifically, functional impairment was assessed via the Child OCD Impact Scale-Revised.

Lifetime PTE load was not associated with any CBT outcomes (ps > .218). In exploratory analyses, associations of specific trauma types with timing and directionality of functional impairment changes were as follows: physical abuse was associated with differences in early treatment response (β = 12.2, 95% CI [2.0, 22.4], p = .020); emotional abuse was associated with differences in maintenance of gains at 1-month follow-up (β = 10.0, 95% CI [1.6, 18.4], p = .021); and the death of someone close was associated with differences in outcomes at midpoint (β = -9.1, 95% CI [-15.3, -3.1], p = .006) and end point (β = -6.9, 95% CI [-13.4, -0.4], p = .040). Emotional abuse was also associated with reduced maintenance of family functioning improvement at 1-month follow-up (β = 7.8, 95% CI [0.5, 15.1], p = .040).

Preliminary results suggest that cumulative trauma exposure did not significantly impact CBT outcomes in pediatric OCD. Exploratory analyses suggest that specific trauma types may be associated with different patterns of functional improvement during treatment phases, highlighting potential areas for future research in the pediatric OCD literature.

We worked to ensure that the study questionnaires were prepared in an inclusive way. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science.