A randomized controlled study of brief family-based intervention in obsessive compulsive disorder

Background: Cognitive behaviour therapy (CBT) for Obsessive Compulsive Disorder (OCD) is therapist-intensive and prolonged making it less accessible to patients, particularly in resource-constrained situations. We examined the efficacy of a brief psychotherapeutic intervention as an adjunct to serotonin reuptake inhibitors (SRIs) in OCD. Method: We randomized 64 adult OCD patients stabilized on SRIs to either the 6-session brief family-based intervention (BFBI; n = 30) that included psychoeducation, exposure and response prevention and family intervention or to a control arm of relaxation exercises (RE). Assessments were conducted at baseline and at 1- and 3-months post-intervention. Primary outcome measure was response to treatment defined as >= 35% reduction in the Yale-Brown Obsessive Compulsive Scale total score relative to baseline score plus a Clinical Global Impression-Improvement rating of very much improved or much improved. Family accommodation and expressed emotions were also assessed. Results: At 3-month follow-up, the BFBI group responded better than the RE group (53% vs. 12%, p<0.001). Illness severity, family accommodation and expressed emotion declined significantly over time in the BFBI group compared to the RE group. The BFBI (OR = 13.17, p<0.001) and baseline illness severity (OR = 0.746, p<0.011) predicted treatment response. Limitations: Sample size was small and follow-up duration was short. Control group had less time with the therapist although number of sessions was identical in both the groups. Conclusion: Briefer intervention is effective in treating OCD. Briefer and inclusive format of intervention has important implications for clinical practice in resource-constrained circumstances.