Exposure and response prevention versus stress management training for adults and adolescents with obsessive compulsive disorder: A randomized clinical trial

被引:3
作者
Himle, Joseph A. [1 ,2 ]
Grogan-Kaylor, Andrew [1 ]
Hiller, Matthew A. [1 ]
Mannella, Kristin A. [2 ]
Norman, Luke J. [2 ]
Abelson, James L. [2 ]
Prout, Aileen [2 ]
Shunnarah, Angela A. [2 ]
Becker, Hannah C. [2 ]
Block, Stefanie R. Russman [2 ]
Taylor, Stephan F. [2 ]
Fitzgerald, Kate D. [3 ]
机构
[1] Univ Michigan, Sch Social Work, 1080 South Univ Ave, Ann Arbor, MI 48109 USA
[2] Univ Michigan, Sch Med, Dept Pathol, 1500 East Med Ctr Dr, Ann Arbor, MI 48109 USA
[3] Columbia Univ, Coll Phys & Surg, Dept Psychiat, 630 W 168th St, New York, NY 10032 USA
基金
美国国家卫生研究院;
关键词
Obsessive compulsive disorder; Exposure and response prevention; Stress management; Adults; Adolescents; COGNITIVE-BEHAVIORAL THERAPY; GENERALIZED ANXIETY DISORDER; PHARMACOLOGICAL-TREATMENTS; PSYCHOLOGICAL TREATMENT; PSYCHOMETRIC EVALUATION; QUICK INVENTORY; OCD; CHILDREN; SCALE; CREDIBILITY;
D O I
10.1016/j.brat.2023.104458
中图分类号
B849 [应用心理学];
学科分类号
040203 ;
摘要
Objective: Though exposure and response prevention (ERP) is a well-proven treatment for OCD across the lifespan, prior RCTs have not studied adolescent and adult patients with the same ERP protocol relative to an active comparator that controls for non-specific effects of treatment. This approach assesses differences in the effect of OCD-specific exposures in affected adolescents and adults and in response to ERP compared to a stress-management control therapy (SMT).Methods: This assessor-blinded, parallel, 2-arm, randomized, ambulatory clinical superiority trial randomized adolescents (aged 12-18) and adults (24-46) with OCD (N = 126) to 12 weekly sessions of ERP or SMT. OCD severity was measured before, during and after treatment using the child or adult version of the Yale-Brown Obsessive Compulsive Scale (C/Y-BOCS), depending on participant age. We predicted that ERP would produce greater improvement in OCD symptoms than SMT and that there would be no significant post-treatment differences across age groups.Results: ERP (n = 63) produced significantly greater improvements on C/Y-BOCS scores at post-treatment than SMT (n = 63) (Effect size = -0.72, CI = -0.52 to -0.91, p < .001). ERP also produced more treatment responders (ERP = 86%, SMT = 32%; chi(2) = 46.37, p < .001) and remitters than SMT (ERP = 39%, SMT = 7%; chi(2) = 16.14, p < .001). Finally, there were no statistically significant post-treatment differences in C/Y-BOCS scores between adolescents and adults assigned to ERP.Conclusion: A single ERP protocol is superior to SMT in treating both adolescents and adults with OCD. OCD-specific therapy is necessary across the lifespan for optimal outcomes in this highly disabling disorder, though non-specific treatments like SMT are still all-too-commonly provided.
引用
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页数:12
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