Research paperA randomized controlled study of brief family-based intervention in obsessive compulsive disorder

- A brief family based intervention (BFBI) as an adjunct to SRIs was effective in treating OCD.
- Illness severity, family accommodation and expressed emotion declined significantly over time with the BFBI.
- Treatment with BFBI predicted greater response and higher baseline illness severity predicted poorer response.
- Briefer format of the intervention has important implications for resource constrained countries.

BackgroundCognitive behaviour therapy (CBT) for Obsessive Compulsive Disorder (OCD) is therapist-intensive and prolonged making it less accessible to patients, particularly in resource-constrained situations. We examined the efficacy of a brief psychotherapeutic intervention as an adjunct to serotonin reuptake inhibitors (SRIs) in OCD.MethodWe randomized 64 adult OCD patients stabilized on SRIs to either the 6-session brief family-based intervention (BFBI; n = 30) that included psychoeducation, exposure and response prevention and family intervention or to a control arm of relaxation exercises (RE). Assessments were conducted at baseline and at 1- and 3- months post-intervention. Primary outcome measure was response to treatment defined as ≥ 35% reduction in the Yale-Brown Obsessive Compulsive Scale total score relative to baseline score plus a Clinical Global Impression- Improvement rating of very much improved or much improved. Family accommodation and expressed emotions were also assessed.ResultsAt 3- month follow-up, the BFBI group responded better than the RE group (53% vs. 12%, p < 0.001). Illness severity, family accommodation and expressed emotion declined significantly over time in the BFBI group compared to the RE group. The BFBI (OR = 13.17, p < 0.001) and baseline illness severity (OR = 0.746, p < 0.011) predicted treatment response.LimitationsSample size was small and follow-up duration was short. Control group had less time with the therapist although number of sessions was identical in both the groups.ConclusionBriefer intervention is effective in treating OCD. Briefer and inclusive format of intervention has important implications for clinical practice in resource-constrained circumstances.