Augmenting cognitive-behavioral therapy with parent management training to reduce coercive and disruptive behavior in pediatric obsessive-compulsive disorder

Coercive and disruptive behaviors are common among youth with obsessive-compulsive disorder (OCD) and are thought to contribute to impairment and interfere with the effectiveness of cognitive-behavioral therapy (CBT). Parent management training (PMT) is the most empirically supported intervention for disruptive behavior problems in youth; however, no group-based PMT intervention has been adapted to address OCD-related disruptive behaviors. This study investigated the efficacy of a novel, group-based adjunctive PMT intervention among a non-randomized sample of youth receiving family-based group CBT for pediatric OCD. Linear mixed models were used to estimate treatment effects across several OCD-related and parenting outcomes at post-treatment and 1-month follow-up. Treatment response for 37 families who received the augmented program (CBT+PMT; Mage = 13.90) was compared to that of 80 families who previously received only CBT (CBT-Only; Mage = 13.93) using propensity scores and inverse probability of treatment weighting. Multiple regression models were conducted using pre-treatment characteristics and quality of participation to predict post-treatment outcomes for CBT+PMT. Families who received CBT+PMT showed significant improvements in all OCD-related outcomes and parents' tolerance of their children's distress at post-treatment and follow-up. Treatment response on OCD-related outcomes did not significantly differ between groups. Youths' higher age significantly predicted greater symptom severity at post-treatment, and more severe symptoms at pre-treatment significantly predicted lower parental involvement in youth's lives at post-treatment. Results suggest that CBT+PMT is an effective treatment for pediatric OCD across multiple indicators; however, CBT+PMT may not provide incremental benefits beyond CBT-Only, at least as presently delivered/examined. Future research is needed to determine the most effective and feasible ways to incorporate key PMT components into CBT-based interventions.