Reduction of subjective distress in CBT for childhood OCD: Nature of change, predictors, and relation to treatment outcome

•We examine changes in subjective distress throughout CBT for childhood OCD.•On average during CBT children and parents both report decreases in child distress.•Baseline OCD severity and impairment predict degree of change in child distress.•Decreases in several child distress measures are predictive of better CBT outcomes.•Findings indicate both strengths and limitations of this clinical assessment tool.

Little research has investigated changes in subjective distress during cognitive-behavioral therapy (CBT) for anxiety disorders in youth. In the current study, 40 youth diagnosed with primary obsessive-compulsive disorder (OCD; M age = 11.9 years, 60% male, 80% Caucasian) and 36 parent informants completed separate weekly ratings of child distress for each OC symptom during a 12-session course of CBT. Between-session changes in distress were calculated at the start of, on average throughout, and at the end of treatment. On average throughout treatment, child- and parent-reported decreases in child distress were significant. Baseline OCD severity, functional impairment, and internalizing symptoms predicted degree of change in child distress. Additionally, greater decreases in child distress were predictive of more improved clinical outcomes. Findings advance our understanding of the strengths and limitations of this clinical tool. Future studies should examine youth distress change between and within CBT sessions across both subjective and psychophysiological levels of analysis.