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Preliminary Predictors of Within-Session Adherence to Exposure and Response Prevention in Pediatric Obsessive-Compulsive Disorder

机译：患儿强迫症会话中坚持接触和预防反应的初步预测指标

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Background: Cognitive-behavioral therapy with exposure and response prevention (ERP) is an effective treatment for pediatric OCD; however, up to 30 % of children are treatment non-responders and as many as 40 % are partial responders. Although poor treatment adherence has been linked to attenuated response in adults with OCD, little research has examined treatment adherence in pediatric OCD. Objective: This study aimed to identify predictors of within-session treatment adherence in pediatric OCD. Method: Independent raters coded 20 audiotaped psychotherapy sessions to assess for in-session adherence to ERP across three separate constructs: willingness to engage in exposure, response prevention, and within-session habituation. A number of baseline predictors were examined in relation to overall in-session adherence, including obsessive-compulsive symptom severity, family accommodation, and externalizing behavior. Results: Higher levels of family accommodation and obsessive-compulsive symptom severity, but not externalizing behavior, were directly linked to poor in-session adherence, and the child's willingness to participate in exposure drove these relationships. Mediational analyses suggested that obsessive-compulsive symptom severity mediated the relationship between family accommodation and in-session adherence to ERP. Conclusions: Findings are preliminary but suggest that targeting family accommodation could increase compliance with exposure tasks, thus improving treatment outcome.
机译：背景：认知行为疗法与接触和预防反应（ERP）是一种有效的治疗小儿强迫症的方法。但是，多达30％的儿童是治疗无反应者，多达40％是部分反应者。尽管不良的治疗依从性与成人强迫症患者反应减弱有关，但很少有研究检查小儿强迫症的治疗依从性。目的：本研究旨在确定小儿强迫症中会期治疗依从性的预测因子。方法：独立评估者编码了20个录音心理治疗会议，以评估三个独立结构在会中对ERP的依从性：参与接触的意愿，预防反应和会内习惯。检查了与整个疗程坚持情况有关的许多基线预测因素，包括强迫症症状严重程度，家庭适应和外在行为。结果：较高的家庭住宿水平和强迫症状症状的严重性，而不是外在的行为，与不良的会期依从性直接相关，并且孩子参与暴露的意愿驱动了这些关系。中介分析表明，强迫症症状的严重程度介导了家庭适应与会期坚持ERP的关系。结论：研究结果是初步的，但表明针对家庭住宿可以增加对暴露任务的依从性，从而改善治疗效果。

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