دستاوردهای ناگهانی در درمان رفتاری شناختی کودکان مبتلا به اختلال وسواس فکری
Abstract
1- Introduction
2- Materials and methods
3- Results
4- Discussio
References
Abstract
Background and objectives
This study examined the occurrence of sudden gains (or reversal of gains) among children with obsessive-compulsive disorder (OCD) during the course of cognitive-behavioral therapy (CBT), as well as the association of sudden gains with treatment response, treatment group, and pre-treatment clinical characteristics.
Methods
The sample consisted of 136 youth (ages 7–17) with a primary diagnosis of OCD who were randomized in a double-blinded fashion to 10 sessions of CBT with augmentation of either d-cycloserine or placebo. Sudden gain status was determined based on clinician-rated obsessive-compulsive symptom severity, which was collected on 9 occasions across the study period.
Results
42.6% of youth experienced at least one sudden gain, which tended to occur either after starting exposure and response prevention or towards the end of treatment. After applying the Benjamini-Hochberg procedure for multiple comparisons, there were no significant pre-treatment predictors of sudden gains and only reduced insight predicted the reversal of gains. Individuals with at least one sudden gain had improved overall treatment outcomes, measured both by reduction in OCD symptom severity, and by global illness severity.
Limitations
Several clinical constructs were not examined. Symptomatology was not assessed at every treatment session. Differences in those who achieved sudden gains and those who did not may be obscured. There is the possibility that a sudden gain reflected a scoring error generated by an optimistic or inaccurate report. Finally, a relatively homogenous sample may limit the generalizability of results.
Conclusions
The course of CBT for pediatric OCD is variable with many children experiencing sudden gains, but a sizable percentage experience a reversal of gains which was related to reduced insight. Sudden gains tended to occur after starting exposure and response prevention and towards the end of treatment.
Introduction
Cognitive behavioral therapy (CBT) for pediatric obsessive-compulsive disorder (OCD) has demonstrated considerable efficacy with average response rates extending upwards to 70% and 50% of youth experiencing clinical remission (McGuire et al., 2015). However, few investigations have been conducted examining the course of improvement associated with CBT for pediatric OCD and, among children and adolescents, there has been limited attention into the construct of sudden treatment gains over a short period of time (i.e., significant improvements relative to symptom severity prior to the gain, and symptom fluctuations before/after gain; Aderka, Nickerson, Boe, & Hofmann, 2012a, b; Tang & DeRubeis, 1999). The current report aims to address these gaps in the literature. Investigating sudden gains could have significant clinical relevance. Sudden gains may indicate that the child/family has acquired a meaningful understanding of the treatment model and ability to utilize core therapeutic components (Tang & DeRubeis, 1999).