Understanding Anxiety and Symptom Impact as Mediators Explaining Cognitive-Behavior Therapy and Pharmacotherapy Response
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Understanding Anxiety and Symptom Impact as Mediators Explaining Cognitive-Behavior Therapy and Pharmacotherapy Response in Childhood Obsessive-Compulsive Disorder Se-Kang Kim 1 & Dean McKay 1 & Wayne K. Goodman 2 & Brent J. Small 3 & Joseph P. McNamara 4 & Tanya K. Murphy 3 & Eric A. Storch 2
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Obsessive-compulsive disorder (OCD) is a debilitating psychiatric condition with an onset typically during childhood. Evidencebased treatments include cognitive-behavioral therapy (CBT) and serotonin reuptake inhibitors. This study evaluates the extent that anxiety and OCD-related impairment may mediate symptom improvement during treatment. Data from a randomized treatment trial comparing CBT with placebo, CBT with standard sertraline dosing, and CBT with slowly titrated sertraline were evaluated to understand the extent to which anxiety and OCD-related impairment were systematically associated with improvement. Using correspondence analysis techniques, results generally supported that anxiety and OCD-related impairment mediated OCD symptom improvement. Anxiety and OCD-related impairment had attenuated effects on symptom improvement in those receiving CBT with slowly titrated sertraline, while both CBT with placebo and CBT with sertraline were comparable in efficacy. In addition to targeting OCD severity, treatment should also focus on anxiety and OCD-related impairment. Keywords Obsessive-compulsive disorder . Cognitive-behavioral therapy . Children . Sertraline . Anxiety . Impairment
Obsessive-Compulsive Disorder (OCD) is a disabling neuropsychiatric condition that affects 1–2% of youth and adults (Markarian et al. 2010). Efficacious treatments include cognitive-behavior therapy (CBT; Franklin et al. 2015) and serotonin-reuptake inhibitor medications (SRI; Ivarsson et al. 2015). Treatment guidelines for treating youth OCD emphasize both CBT and medication. However, it is possible that these interventions target different underlying aspects of the disorder, leading to different pathways to symptom improvement. Accordingly, there could be mediators of treatment outcome, or variables that are differentially affected by different Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10862-020-09824-5) contains supplementary material, which is available to authorized users. * Se-Kang Kim [email protected] 1
Department of Psychology, Fordham University, 226 Dealy Hall, 441 East Fordham Road, Bronx, NY 10458, USA
2
Baylor College of Medicine, Houston, TX, USA
3
University of South Florida, Tampa, FL, USA
4
University of Florida, Gainesville, FL, USA
interventions (see Kazdin 2007) involved in achieving symptom relief. These conceptualizations would suggest that changes in anxiety and functioning would be primary mediators of treatment efficacy (McKay and Tolin 2017). Interestingly, despite these conceptualizations there has been limited systematic suitable mediation-based research examining this relatio
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