Table 1. Evidence for psychotherapy treatments for pediatric OCD.
| Authors, country, year | N | Outcome measures | Subjects | Study design, duration | Outcomes |
|---|---|---|---|---|---|
| Therapy vs. waitlist/placebo control | |||||
| March, USA, 1998, (135) | 112 | CY-BOCS | Male and female patients ages 7–17 with DSM-IV diagnosis of OCD and CY-BOCS >16 | Randomized to pill placebo, CBT, sertraline, or CBT and sertraline combination for 12 weeks | The CBT, sertraline, and combination group had a statistically significant response over placebo group. Combination treatment was more efficacious than either only CBT or only sertraline. Results of CBT alone group did not differ significantly from sertraline alone group |
| Williams, UK, 2010, (137) | 21 | CY-BOCS | Male and female outpatients ages 9–18 with DSM-IV diagnosis of OCD | 10 sessions of manualized cognitive behavioral treatment with a 12-week waiting list. Assessments completed at baseline, 3 months, and 6 months | The group who received treatment improved more than the comparison group who waited for 3 months. The original waitlist group subsequently received the same treatment and made similar gains |
| Frequency/duration | |||||
| Storch, USA, 2007, (138) | 40 | CYBOCS, remission status, CGI-S, CGI-I | Male and female outpatients ages 7–17 with DSM-IV diagnosis of OCD and CY-BOCS >16 | Randomized to 14 sessions of either weekly or daily family-based CBT. Symptoms were evaluated before treatment, immediately after treatment, and at 3 months post-treatment | Daily and weekly CBT were equally effective with no statistical differences seen during follow-up and improvements in symptoms maintained over time |
| Bolton, UK, 2011, (139) | 96 | CY-BOCS | Male and female patients ages 8–17 with DSM-IV diagnosis of OCD | Randomized to full CBT course (12 sessions with therapist), brief CBT course (5 sessions with therapist, use of a therapist-guided workbook), or waitlist control group for 12 weeks | Compared to the waitlist group, both treatment groups experienced a statistically significant improvement in symptoms. Between the two treatment groups, there were no significant differences. At 14-week follow-up, improvement in symptoms was maintained |
| Torp, Norway, 2015, (136) | 50 | CYBOCS, remission status | Male and female outpatients ages 7–17, DSM-IV diagnosis of OCD who did not respond to initial 14-week course of individual CBT | Randomized to sertraline or ongoing CBT for an additional 16 weeks | No significant difference between the treatments (P=0.351). In CBT group, 50.0% response rate. In sertraline group, 45.4% response rate |
| Family involvement | |||||
| Piacentini, USA, 2011, (140) | 71 | CY-BOCS, CGI-I, Child Obsessive Compulsive Impact Scale-Revised (COIS-R) | Male and female outpatients ages 8–17 at pediatric OCD specialty clinic; primary DSM-IV diagnosis of OCD with CY-BOCS >15, on no medication | Randomized to 12 sessions of family CBT (FCBT) or PRT (psychoeducation + relaxation training) for 14 weeks | FCBT group had remission rate of 43%, while PRT remission rate was 18% |
| Peris, USA, 2013, (141) | 21 | CGI-I | Male and female patients ages 8-17 with DSM-IV diagnosis of OCD with CY-BOCS >15 and “high levels of family distress” defined by scales of measure for level of family cohesion, conflict, and blame | Randomized to individual child CBT (with weekly parent check-ins) or Positive Family Interaction Therapy (PFIT), which was structured as individual child CBT with six additional family sessions focused on family dynamics. Both treatments delivered for 12 weeks | Both treatment groups reported high level of satisfaction. 95% of the PFIT family sessions were attended by both parents. Patients in individual CBT only experienced a 40% response rate on their CGI-I, while those in PFIT arm experienced a 79% response rate. Improvement in symptoms was maintained at 3-month follow-up for both groups |
| Reynolds, UK, 2013, (142) | 50 | CYBOCS | Male and female patients ages 12–17 with DSM-IV diagnosis of OCD | Randomized to individual CBT (with parental involvement in three sessions) or “parent-enhanced CBT” with parental involvement at all sessions. Treatments were delivered for 14 sessions | Both groups demonstrated improvement in OCDsymptoms |
| Group format | |||||
| Barrett, Australia, 2004, (143) | 77 | The Anxiety Disorders Interview Schedule for Children-Parent version (ADIS-P), The National Institute of Mental Health Global Obsessive-Compulsive Scale (NIMH GOCS), CY-BOCS | Male and female patients ages 7-17, with DSM-IV diagnosis of OCD, on stable medication regimen or no medications | Randomized to individual CBFT, group CBFT, or a 4- to 6-week waitlist control condition. Assessments completed pre- and post-treatment, 3-month follow-up, and 6-month follow-up | Individual CBFT demonstrated 88% response rate vs. 76% in group CBFT vs. 0% in waitlist group. There were no significant differences in symptom improvement between the two groups receiving treatment |
| Asbahr, Brazil, 2005, (133) | 40 | CY-BOCS | Male and female patients ages 9–17 years old with DSM-IV diagnosis of OCD with NIMH GOCS >7 | Randomized to receive group CBT or sertraline. Group CBT was manual-based program lasting 12 weeks. Assessments completed pre-treatment, during treatment, and post-treatment (1, 3, 6, and 9 months following treatment) | Both Group CBT and sertraline conditions had significant improvement CY-BOCS total scores (both groups: P<0.001) at conclusion of treatment. Those in group CBT experienced a significantly lower rate of symptom relapse at the 9-month follow-up compared to those in sertraline group |
| Telephone and web-based format | |||||
| Storch, USA, 2011, (144) | 31 | CY-BOCS, CGI-I, remission status | Male and female patients ages 7–16 with DSM-IV diagnosis of OCD and CY-BOCS >16 | Randomized to family-based CBT provided through web-camera (W-CBT) or waitlist control. Assessments performed before treatment, after treatment, and at 3-month follow-up | Those receiving W-CBT had statistically significant improvements in all outcome measures over those in waitlist control group. 56% of W-CBT vs. 13% of waitlist showed remission response, maintained at 3-month follow-up |
| Turner, UK, 2014, (145) | 72 | CYBOCS | Male and female outpatients ages 11–17 with DSM-IV diagnosis of OCD | Randomized to telephone-based or in-person CBT with exposure and response prevention for 14 sessions | There was no significant difference in response rate between the two groups at post-treatment (90.6% for in-person vs. 87.5% for TCBT) or at follow-ups (3-, 6-, 12-month) |
| Age of participants | |||||
| Freeman, USA, 2012, (146) | 127 | CGI-I, CY-BOCS. | Male and female outpatients ages 5–8, with DSM-IV diagnosis of OCD with CY-BOCS >16 | Randomized to FB-RT (family-based relaxation training) or FB-CBT (family-based CBT) with exposure and response prevention for 14 weeks | At 14 weeks, 72% of FB-CBT participants and 41% of FB-RT participants were scored as much improved or very much improved based on CGI-I |
| Variations on CBT format | |||||
| Merlo, USA, 2010, (147) | 16 | CY-BOCS | Male and female patients ages 6–17 with DSM-IV diagnosis of OCD with CY-BOCS >16 who were already participating in intensive family-based CBT for OCD | Randomized to CBT plus motivational interviewing (MI) or CBT plus extra psychoeducation (PE) sessions | Average CY-BOCS score for the CBT + MI group was significantly lower than the CBT + PE group at 4 weeks, but at post-treatment, these scores were not significantly different |
CY-BOCS, Children’s Yale-Brown Obsessive-Compulsive Scale; CGI-S, Clinical Global Impression-Severity scale; CGI-I, Clinical Global Impression -Improvement scale; NIMH GOCS: The National Institute of Mental Health Global Obsessive-Compulsive Scale; CBFT, cognitive-behavioral family therapy.