13 Mar The Efficacy of Exposure with Response Prevention in Treating Pediatric Obsessive-Compulsive Disorder
The World Health Organization (WHO) reports that Obsessive Compulsive Disorder (OCD) is one of the ten most disabling disorders. The prevalence of the onset of OCD in childhood is relatively high, with 1 to 3% of children experiencing this disorder. Untreated, research links child-onset OCD with significant functional impairment and increased risk of other psychiatric disorders in adulthood. These findings urge psychologists and other child health professionals to rapidly employ the most efficacious treatment interventions to support positive outcomes.
Pediatric Obsessive-Compulsive Disorder (POCD) has a low prevalence of being clinically recognized. The delay of diagnosis, presence of comorbid psychiatric conditions, and delays in treatment have an adverse effect on clinical outcomes. Research in 2001 in the American Journal of Psychiatry identified that, on average, an OCD diagnosis is delayed by three years after the initial onset of symptoms. These delays in treatment may be associated with poorer outcomes.
Treatment, however, is effective in promoting the remission of POCD symptoms. A study done in 2009 and reported in the Pediatrics journal reported that approximately one-half of children with OCD experience remission of related symptoms with appropriate treatment. The researchers found that 44% of children with OCD were not experiencing significant symptoms at the follow-up evaluation in early adulthood.
The “gold standard” in treating POCD is a combination of psychopharmacology and a form of cognitive behavioral therapy (CBT) known as Exposure with Response Prevention (ERP). While the first line of treatment for pediatric patients is CBT, a class of anti-depressant medication known as selective serotonin reuptake inhibitors or SSRIs, which can reduce the symptoms of anxiety a child is experiencing. Reducing these symptoms can help the child be more responsive to therapy.
Based on the premise that OCD is maintained and exacerbated because compulsive and avoidance behaviors relieve anxiety, ERP disrupts this cycle. Numerous clinical trials support the efficacy of ERP for the treatment of OCD. The Journal of Behavioral Therapy and Experimental Psychiatry reported a study conducted in 2008 that found statistically and clinically significant improvement in symptoms of OCD in youth who underwent ERP compared with the control group. Subjects were noted to maintain progress in symptom management at follow-up an average of 14 weeks later.
In a 2021 article, the American Psychiatric Association reported additional benefits of using ERP, including how the intervention helps youth avoid psychotropic medications and subsequent side effects. While the use of SSRI drugs is recommended in the treatment of OCD in childhood, the least restrictive approach initially is desirable. Additionally, individuals treated with ERP show lower incidences of relapse. ERP assists patients in identifying and ranking the severity of stimuli that provoke obsessions, then exposure to these while preventing compulsions, and cognitive restructuring offers the development of lifelong skills.
Implications for continued research into ERP use in treating POCD include expanded research on family-focused CBT and ERP. The family’s accommodation and emotional response to a patient’s symptoms may interfere with therapy and perpetuate the disorder. The frequency and number of ERP sessions for optimal outcomes also require additional research.
Evidence-based and timely treatment interventions for mental illness in youth remain a priority. The identified increase in OCD prevalence post-COVID elevates the professional need to employ effective treatment modalities.