Temporal precedence of the change in obsessive-compulsive symptoms and change in depressive symptoms during exposure and response prevention for pediatric obsessive-compulsive disorders

Jafar Bakhshaie; Daniel A Geller; Sabine Wilhelm; Joseph F McGuire; Brent J Small; Sandra L Cepeda; Sophie C Schneider; Tanya K Murphy; Rachel Porth; Eric A Storch

doi:10.1016/j.brat.2020.103697

Temporal precedence of the change in obsessive-compulsive symptoms and change in depressive symptoms during exposure and response prevention for pediatric obsessive-compulsive disorders

Behav Res Ther. 2020 Oct:133:103697. doi: 10.1016/j.brat.2020.103697. Epub 2020 Jul 28.

Authors

Affiliations

¹ Menninger Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd, Suite 400, Houston, TX, 77030, USA. Electronic address: jbakhshaie@mgh.harvard.edu.
² Massachusetts General Hospital, 185 Cambridge Street, Suite 2000, Boston, MA, 02114, USA; Harvard University Medical School, 25 Shattuck St, Boston, MA, 02115, USA.
³ Division of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD, 21205, USA.
⁴ School of Aging Studies, University of South Florida, 13301 Bruce B Downs Blvd, Tampa, FL, 33620, USA.
⁵ Menninger Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd, Suite 400, Houston, TX, 77030, USA.
⁶ Department of Pediatrics, University of South Florida, 2 Tampa General Cir, Tampa, FL, 33606, USA; Department of Psychiatry & Behavioral Neurosciences, University of South Florida, 3515 E Fletcher Ave, Tampa, FL, 33613, USA; Johns Hopkins Medicine All Children's Hospital, 501 6th Ave S, St. Petersburg, FL, 33701, USA.
⁷ Massachusetts General Hospital, 185 Cambridge Street, Suite 2000, Boston, MA, 02114, USA.

Abstract

The current study examined the temporal precedence of change in obsessive-compulsive symptoms and change in depressive symptoms during the course of an Exposure and Response Prevention (ERP) for pediatric OCD. Participants included 142 children and adolescents (7-17 years; mean age = 12.39, SD = 2.92; 51.40% female; 60.40% Non-Hispanic White) with a primary or co-primary diagnosis of OCD who received ERP in a two-site randomized controlled trial on d-cycloserine augmentation of CBT for pediatric OCD. Participants completed clinician-administered assessments of OC symptoms (Children's Yale-Brown Obsessive Compulsive Scale) and depressive symptoms (Children's Depression Rating Scale-Revised) from baseline to post-treatment follow-up. Lagged mediational analyses did not yield evidence in support of a mediating role for the change in OC symptoms in the effect of ERP on the change in depressive symptoms. In contrast, change in depressive symptoms mediated the effect of ERP treatment on the subsequent change in OC symptoms (95% confidence interval for indirect effect = -0.04 to -0.001), though the effect size was small. Controlling for the prior levels of the depressive symptoms this indirect effect became non-significant. Theoretical and clinical implications of the findings for the youth with OCD and comorbid depression are discussed.

Keywords: Depression; Exposure and response prevention; Longitudinal mediation; Mechanisms of change; Obsessive-compulsive disorder; Pediatrics.

Abstract

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