Academic journal article Journal of Cognitive Psychotherapy

A Preliminary Investigation of Acceptance and Commitment Therapy for Adolescent Obsessive-Compulsive Disorder

Academic journal article Journal of Cognitive Psychotherapy

A Preliminary Investigation of Acceptance and Commitment Therapy for Adolescent Obsessive-Compulsive Disorder

Article excerpt

There is growing support for the use of acceptance and commitment therapy (ACT) as a treatment for adults with obsessive-compulsive disorder (OCD), but no research has been published on the use of ACT for adolescent OCD. This preliminary study investigated ACT for youth with OCD using a multiple baseline across participants design. Three adolescents, ages 12 or 13 years, were treated with 8-10 sessions of ACT (without in-session exposure exercises). The primary dependent variable was daily self-monitoring of compulsions. Results showed a 40% mean reduction in self-reported compulsions from pretreatment to posttreatment, with results maintained at 3-month follow-up, for a reduction of 43.8%. Pretreatment to posttreament reductions in Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS) ratings of OCD severity were 50.0%, 12.5%, and 22.0%; pretreatment to follow-up reductions were 54.0%, 12.5%, and 61.0%. Treatment procedures were rated by participants and parents as highly acceptable. Implications and future directions are discussed.

Keywords: acceptance and commitment therapy; adolescents; OCD; treatment

Obsessive-compulsive disorder (OCD) is a debilitating anxiety disorder that affects 2% to 3% of children and adolescents (Rapoport et al., 2000). The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) does not differentiate between adult and childhood OCD (American Psychiatric Association [APA], 2000); however, developmental differences in content of obsessions, topography of compulsions, and level of insight have been reported (Steketee & Barlow, 2002). Childhood-onset OCD is associated with high rates of comorbidity with other psychiatric disorders with lifetime comorbidity rates ranging from 75% to 84% (Geller et al., 1998). In addition, family functioning both contributes to and is affected by childhood OCD (Peris et al., 2012; Piacentini, Bergman, Keller, & McCracken, 2003) and parents and families often participate in the child's compulsions (Peris et al., 2010; Storch et al., 2007). Childhood-onset OCD tends to be a persistent diagnosis (Skoog & Skoog, 1999), lasting into adulthood for 33% to 50% of untreated children and adolescents (Goodman, Rudorfer, & Maser, 2000).

Cognitive behavioral therapy (CBT) that includes exposure and response prevention (ERP) is the recommended first-line treatment, either by itself or in combination with selective serotonin reuptake inhibitor (SSRI) medication (American Academy of Child and Adolescent Psychiatry, 2012; APA, 2007). CBT and combined (CBT1SSRI) treatments have been classified as "probably efficacious" (Franklin et al., 2011). Although CBT is recommended as a first-line treatment, few randomized controlled CBT trials have been conducted with youth, and they have shown moderate levels of symptom remission: 39% of responders in an intent-to-treat sample (Pediatric OCD Treatment Study [POTS] Team, 2004) and 84% of responders in a completer analysis (Barrett, Healy-Farrell, & March, 2004). Storch and colleagues (2007) found intensive family based CBT for pediatric OCD to be more effective (90% of responders) compared to weekly sessions (65%). Open trials have shown 45% to 67% symptom reduction (de Haan, Hoodgum, Buitelaar, Keijsers, 1998; Franklin et al., 1998; March, Mulle, & Herbel, 1994; Piacentini, Bergman, Jacobs, McCracken, & Kretchman, 2002). ERP with youth may be accompanied by the additional challenges of noncompliance to exposure and/or homework, difficulty reporting subjective units of distress scale (SUDS) ratings, family conflict, and/or families that undermine treatment (Peris et al., 2012; Thienemann, Martin, Cregger, Thompson, & Dyer-Friedman, 2001). However, CBT has been found by parents to be an acceptable treatment when compared to medication for treatment of their child's anxiety disorder (Brown, Deacon, Abramowitz, Dammann, & Whiteside, 2007). Because there still appears to be a fair portion of youth who do not respond or respond minimally to CBT (Freeman et al. …

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