Jennifer Adkins

Intensive Cognitive Behavioral Therapy for Pediatric Obsessive-Compulsive Disorder: A Treatment Protocol for Mental Health Providers

The authors describe a protocol for intensive cognitive behavioral therapy (I-CBT) for children and adolescents with obsessive–compulsive disorder (OCD). After a review of pediatric OCD and efficacious treatments, the rationale for an intensive approach to treatment is provided along with findings in the extant literature. Subsequently, a session by session outline of I-CBT for pediatric OCD is provided. Finally, a case example of this treatment approach is discussed.

Current Directions in Pediatric Obsessive-compulsive Disorder

Pediatric OCD, a chronic and impairing condition, is not uncommon. Diagnosis is often difficult given the secrecy of many patients and co-occurring psychopathology. CBT alone or CBT with concurrent SSRI therapy are considered the first-line treatment. Nevertheless, relatively few mental health professionals are adequately trained in CBT for OCD. For example, in a national survey of 79 clinicians treating pediatric OCD in Norway, less than 33% of clinicians reported using exposure/response prevention (or similar techniques) despite rating CBT as a favorable approach to treatment. Limited access to professionals proficient in CBT may result in the prescription of pharmacotherapy alone or pharmacotherapy with other concurrent psychotherapies (that are not demonstrated as efficacious). Clearly, improving the referral network to experts trained in CBT for OCD is necessary to provide efficacious treatment, associated with reduced rates of relapse. Intensive CBT may extend resources to families without access to trained professionals in their area, given the potential for effective therapy in a succinct time period. Accordingly, in addition to the controlled trial evaluating CBT, pharmacotherapy, and combined treatment, initial investigations of intensive CBT for pediatric patients appear necessary. Additionally, intervention studies for children with significant comorbid psychopathology should be pursued.

Cognitive-Behavioral Therapy for Obsessive-Compulsive Disorder: Review of Treatment Techniques

Obsessive-compulsive disorder (OCD) is a chronic, impairing condition with an estimated lifetime prevalence in adults of 2.5%. Controlled treatment trials have demonstrated that cognitive-behavioral therapy (CBT) is an effective intervention for OCD. However, many individuals diagnosed with OCD do not receive appropriate, empirically validated interventions, perhaps due to limited knowledge of CBT among mental health practitioners. This article provides a review of CBT for OCD. Issues related to treatment delivery and assessment are presented and highlighted by an individual example.1. Attendance at a 10-week class designed to teach behavioral management strategies to people with schizophrenia was effective in reducing some of the negative characteristics of auditory hallucinations for 12 months and in reducing anxiety for 9 months after completion of the class. 2. The sustained improvement experienced by class participants was characterized by their voices being less frequent and more mumbled and the participants feeling more in control, less distractible, and less anxious. 3. Participants recommended that other mental health consumers take similar classes to learn how to better manage their voices. 4. Monthly support groups may help participants maintain gains lost during the follow-up period.

Evidence-Based Treatment of Pediatric Obsessive-Compulsive Disorder

Obsessive-compulsive disorder (OCD) is marked by incessant distressing thoughts or images (obsessions) and/or overt or covert behaviors (or mental rituals) aimed to reduce anxiety (compulsions). The disorder affects 1-2% of children and adults, with up to 80% of adults reporting symptom onset prior to the age of 18 years. Without appropriate intervention, symptoms tend to run a chronic course from childhood into adulthood. Obsessive-compulsive disorder contributes to considerable impairment across multiple domains of functioning, and as a result calls for effective and efficient treatment. To date, both psychological and pharmacological interventions have shown efficacy for pediatric OCD although there are associated advantages and disadvantages that must be considered in treatment planning. The intent of this review is to discuss the current state of literature regarding treatment for pediatric OCD, highlight efficient and cost-effective means of reducing impairment, and conclude with directions for future study.