Family accommodation in obsessive–compulsive disorder (OCD) is characterized by myriad behaviors, such as modifying family routines, facilitating avoidance, and engaging in compulsions to reduce ...obsessional distress. It has been linked to various deleterious outcomes including increased functional impairment and poorer treatment response for OCD. Although extant literature suggests a linear relationship between family accommodation and OCD symptom severity, the magnitude and statistical significance of this association has been inconsistent across studies, indicating that moderators may be influencing this relationship. The present study examined this relationship using meta-analytic techniques, and investigated sample-dependent (age, gender, comorbid anxiety/mood disorders) and methodological (administration method and number of items used in family accommodation measure, informant type, sample size, publication year) moderators. Forty-one studies were included in the present meta-analysis, and the overall effect size (ES) for the correlation between family accommodation and OCD symptom severity was moderate (r=.42). Moderator analyses revealed that the number of items on the family accommodation scale moderated the ES. No other sample-dependent or methodological characteristics emerged as moderators. In addition to being the first systematic examination of family accommodation moderators, these results highlight the moderate relationship between family accommodation and OCD severity that is influenced by measurement scales. Findings may be used to guide clinical care and inform future investigations by providing a more nuanced understanding of family accommodation in OCD.
•This meta-analysis synthesized an overall effect size (ES) across 41 studies.•The ES for family accommodation and OCD symptom severity was r=.42.•This is the first meta-analysis to examine purported moderators of this ES.•The number of items used in the family accommodation measures moderated the ES.•Despite adequate power, no sample-dependent variables significantly moderated the ES.
Anxiety is common among youth with autism spectrum disorder (ASD), often interfering with adaptive functioning. Psychological therapies are commonly used to treat school-aged youth with ASD; their ...efficacy has not been established.
To compare the relative efficacy of 2 cognitive behavioral therapy (CBT) programs and treatment as usual (TAU) to assess treatment outcomes on maladaptive and interfering anxiety in children with ASD. The secondary objectives were to assess treatment outcomes on positive response, ASD symptom severity, and anxiety-associated adaptive functioning.
This randomized clinical trial began recruitment in April 2014 at 3 universities in US cities. A volunteer sample of children (7-13 years) with ASD and maladaptive and interfering anxiety was randomized to standard-of-practice CBT, CBT adapted for ASD, or TAU. Independent evaluators were blinded to groupings. Data were collected through January 2017 and analyzed from December 2018 to February 2019.
The main features of standard-of-practice CBT were affect recognition, reappraisal, modeling/rehearsal, in vivo exposure tasks, and reinforcement. The CBT intervention adapted for ASD was similar but also addressed social communication and self-regulation challenges with perspective-taking training and behavior-analytic techniques.
The primary outcome measure per a priori hypotheses was the Pediatric Anxiety Rating Scale. Secondary outcomes included treatment response on the Clinical Global Impressions-Improvement scale and checklist measures.
Of 214 children initially enrolled, 167 were randomized, 145 completed treatment, and 22 discontinued participation. Those who were not randomized failed to meet eligibility criteria (eg, confirmed ASD). There was no significant difference in discontinuation rates across conditions. Randomized children had a mean (SD) age of 9.9 (1.8) years; 34 were female (20.5%). The CBT program adapted for ASD outperformed standard-of-practice CBT (mean SD Pediatric Anxiety Rating Scale score, 2.13 0.91 95% CI, 1.91-2.36 vs 2.43 0.70 95% CI, 2.25-2.62; P = .04) and TAU (2.93 0.59 95% CI, 2.63-3.22; P < .001). The CBT adapted for ASD also outperformed standard-of-practice CBT and TAU on parent-reported scales of internalizing symptoms (estimated group mean differences: adapted vs standard-of-practice CBT, -0.097 95% CI, -0.172 to -0.023, P = .01; adapted CBT vs TAU, -0.126 95% CI, -0.243 to -0.010; P = .04), ASD-associated social-communication symptoms (estimated group mean difference: adapted vs standard-of-practice CBT, -0.115 95% CI, -0223 to -0.007; P = .04; adapted CBT vs TAU: -0.235 95% CI,-0.406 to -0.065; P = .01); and anxiety-associated social functioning (estimated group mean difference: adapted vs standard-of-practice CBT, -0.160 95% CI, -0.307 to -0.013; P = .04; adapted CBT vs TAU: -0.284 95% CI, -0.515 to -0.053; P = .02). Both CBT conditions achieved higher rates of positive treatment response than TAU (BIACA, 61 of 66 92.4%; Coping Cat, 47 of 58 81.0%; TAU, 2 of 18 11.1%; P < .001 for each comparison).
In this study, CBT was efficacious for children with ASD and interfering anxiety, and an adapted CBT approach showed additional advantages. It is recommended that clinicians providing psychological treatments to school-aged children with ASD consider developing CBT expertise.
ClinicalTrials.gov identifier: NCT02028247.
Objective
Beliefs that exposure with response prevention (ERP) is excessively distressing and will result in client dropout from treatment are commonly‐cited reasons for clinicians not providing ...evidence‐based treatment. This meta‐analysis examined treatment attrition for ERP for youth with obsessive compulsive disorder (OCD) compared with other treatment modalities.
Method
A systematic literature search identified 11 randomized controlled trials (RCTs) comparing ERP to active or waitlist control conditions, 9 comparing pharmacotherapy to control, and 3 comparing ERP to pharmacotherapy for youth with OCD.
Results
Attrition rates were low for ERP (10.24%) compared to pharmacotherapy (17.29%), active control (e.g., relaxation, metacognitive therapy; 20.63%), and pill placebo (23.49%). ERP had lower risk of attrition compared to active control conditions (RR = 0.60; p = .02), and was not significantly different to waitlist (RR = 0.80; p = .59). In head‐to‐head trials, there was no difference between the risk of attrition from ERP and pharmacotherapy (RR = 1.26; p = .74). Of the pharmacotherapy trials, risk of attrition from serotonin reuptake inhibitors treatment was not significantly different compared to placebo (RR = 0.94; p = .76), with no difference between antidepressants and clomipramine (p = .19). Attrition from ERP was primarily for logistical reasons, compared to lack of efficacy for relaxation and/or adverse reactions from pharmacotherapy.
Conclusions
Attrition from ERP is low, and is generally lower than non‐ERP interventions. Given favorable attrition and efficacy data, there is little justification for appropriately‐trained clinicians not to offer ERP as a first‐line treatment for youth with OCD.
Anxiety and depression are prevalent and impairing psychiatric problems for children and adolescents. In this review, the authors summarize information about their prevalence and impact, the most ...common assessment methods, the main components of cognitive behavioral therapy (CBT), and research on the effectiveness of CBT for these disorders. Future directions, including improving access to CBT through technology-based approaches and increasing personalization of treatment, are discussed.
•There is evidence of an association between antidepressant and dissociative/hallucinogenic effects of ketamine that is reflected in some but not all studies.•Many studies of ketamine in depression ...do not adequately measure nor explore the relevance of alterations in consciousness in treatment.•Current tools that are routinely used to capture ketamine's psychoactive effects are non-specific and limited.•Further study is needed to clarify the importance of ketamine's dissociative effects in treatment.
The relationship between ketamine's hallucinogenic- and dissociative-type effects and antidepressant mechanism of action is poorly understood. This paper reviewed the correlation between subjective effects defined by various psychometric scales and observed clinical outcomes in the treatment of patients with Major Depressive Disorder (MDD).
Based on PRISMA guidelines, we reviewed the dissociative and psychotomimetic mental state induced with ketamine during MDD treatment. Our selected studies correlated depression rating with validated scales collected at regular intervals throughout the study period such as the Clinician-Administered Dissociative States Scale (CADSS), Brief Psychiatric Rating Scale (BPRS), and the 5-Dimensional Altered States of Consciousness Rating Scale (5D-ASC). We excluded studies with bipolar depression or with repeated dosing and no single-dose phase. We included 8 of 556 screened reports.
Two of five CADSS studies found significant negative correlations between increases in CADSS scores and depression scores. One of six BPRS studies demonstrated correlations between BPRS scores and depression scores. The 5D-ASC's one study found no correlation with the MADRS.
Ketamine's dissociative and psychotomimetic effects were correlated with depression changes in 37.5% of studies, but most studies did not examine this relationship and future studies should consider this association since it appears important for MDMA and psilocybin therapies.
Trauma-focused cognitive-behavioral therapy (TF-CBT) is an evidence-based therapist-led treatment for children after trauma. Parents often experience barriers to treatment engagement, including cost. ...Stepped care TF-CBT (SC-TF-CBT) was developed as an alternative delivery system. Step One is a parent-led therapist-assisted treatment. Step Two provides therapist-led TF-CBT for children who did not benefit from Step One and require more intensive treatment. This study compared SC-TF-CBT to standard TF-CBT in a community-based non-inferiority trial.
A total of 183 children (aged 4-12 years) experiencing posttraumatic stress symptoms (PTSS) and their caregivers were randomly assigned to SC-TF-CBT or standard TF-CBT within 6 community clinics. Assessments occurred at baseline, mid- and posttreatment, and 6 and 12 months. Primary outcomes included PTSS and impairment. Secondary outcomes included severity, diagnostic status, remission, and response. Treatment cost, acceptability, and satisfaction were measured. Difference and non-inferiority tests were applied.
SC-TF-CBT participants changed at rates comparable to participants in TF-CBT for primary and secondary measures. SC-TF-CBT was non-inferior to TF-CBT for PTSS, impairment, and severity at all time points except for impairment at the 6-month assessment. Attrition did not differ between treatment arms (132 participants were completers). Baseline treatment acceptability was lower for SC-TF-CBT parents, although there was no difference in expected treatment improvements or treatment satisfaction at posttreatment. Based on regression estimates, total costs were 38.4% lower for SC-TF-CBT compared to TF-CBT, whereas recurring costs were 53.7% lower.
Stepped Care TF-CBT provides an alternative way to deliver treatment for some children and parents, with reduced cost for providers and parents.
Stepped Care for Children after Trauma: Optimizing Treatment; https://clinicaltrials.gov; NCT02537678.
Abstract Individuals with misophonia present with sensitivity to selective sounds and, may experience negative psychological and physiological reactions when exposed to triggers. Previous studies ...have examined the clinical correlates and phenomenology of misophonia; however, further research is warranted to extend findings beyond samples from Western cultures. Accordingly, this study investigated the incidence and phenomenology of misophonia in a sample of Chinese college students ( N =415; M age =19.81; SD =1.16) through the use of self-report measures. Approximately 6% of the sample exhibited clinically significant misophonia symptoms with associated impairment. In addition, misophonia symptoms were associated with impairment across work, school, social, and family domains. Medium to strong relationships were observed with general sensory sensitivities, obsessive-compulsive, anxiety, and depressive symptoms. Anxiety significantly mediated the relationship between misophonia and anger outbursts. This study indicates that symptoms of misophonia are common and directly associated with multiple domains of psychopathology.
Background
Individual randomized controlled trials (RCTs) have demonstrated the efficacy of cognitive behavioral therapy (CBT) and serotonin reuptake inhibitors (SRIs) for the treatment of youth with ...obsessive–compulsive disorder (OCD). Although meta‐analyses have confirmed these results, there has been minimal examination of treatment moderators or an examination of treatment response and symptom/diagnostic remission for these two treatment types. The present report examined the treatment efficacy, treatment response, and symptom/diagnostic remission for youth with OCD receiving either CBT or SRIs relative to comparison conditions, and examined treatment moderators.
Method
A comprehensive literature search identified 20 RCTs that met inclusion criteria, and produced a sample size of 507 CBT participants and 789 SRI participants.
Results
Random effects meta‐analyses of CBT trials found large treatment effects for treatment efficacy (g = 1.21), treatment response (relative risk RR = 3.93), and symptom/diagnostic remission (RR = 5.40). Greater co‐occurring anxiety disorders, therapeutic contact, and lower treatment attrition were associated with greater CBT effects. The number needed to treat (NNT) was three for treatment response and symptom/diagnostic remission. Random effects meta‐analyses of SRI trials found a moderate treatment effect for treatment efficacy (g = 0.50), treatment response (RR = 1.80), and symptom/diagnostic remission (RR = 2.06). Greater methodological quality was associated with a lower treatment response for SRI trials. The NNT was five for treatment response and symptom/diagnostic remission.
Conclusions
Findings demonstrate the treatment effects for CBT and SRIs across three important outcome metrics, and provide evidence for moderators of CBT across trials.
Objective: To examine the efficacy of a modular cognitive-behavioral therapy (CBT) protocol relative to treatment as usual (TAU) among children with high-functioning autism spectrum disorders (ASD) ...and clinically significant anxiety. Method: A total of 45 children (7-11 years of age) with high-functioning ASD and clinically significant anxiety were randomized to receive 16 sessions of weekly CBT or TAU for an equivalent duration. After screening, assessments were conducted at baseline, post-treatment, and 3-month follow-up. Raters were blind to treatment condition. Results: Youth receiving CBT showed substantial improvement relative to TAU on primary anxiety outcomes. Of 24 children randomized to the CBT arm, 18 (75%) were treatment responders, versus only 3 of 21 children (14%) in the TAU arm. Gains were generally maintained at 3-month follow-up for CBT responders. Conclusions: Relative to usual care, CBT adapted for anxious youth with high-functioning ASD demonstrates large effects in reducing anxiety symptoms. This study contributes to the growing literature supporting adapted CBT approaches for treating anxiety in youth with ASD. Clinical trial registration information--Cognitive-Behavioral Treatment for Anxiety Disorders in Children With Autism Spectrum Disorders; http://clinicaltrials.gov; NCT01178385. (Contains 1 figure and 3 tables.)
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