Addressing Interpersonal Contexts in Obsessive-Compulsive Disorder

描述(由申请人提供)：这项研究的具体目标是检查人际强迫症(OCD)，并评估如何修改这些过程以改善患者的治疗结果，同时提供宝贵的家庭治疗管理培训。调查员将为家庭设计和实施简短的家庭干预，目的是减少家庭成员对患者强迫症症状的适应。干预将在两个90分钟的会议期间进行，将包括关于强迫症和焦虑的心理教育，以及针对住宿请求的适当反应的建模和角色扮演。研究中一半的家庭成员将随机接受干预，另一半将随机进入无干预条件。在整个研究过程中，将在5个时间点采取家庭住宿措施，包括在患者完成治疗后1个月的随访。研究人员还将评估家庭成员的抑郁和焦虑程度，以及家庭成员对患者的批评或拒绝态度。这项研究将探讨：1)与不干预相比，参与干预是否与家庭住宿的变化更大相关；2)家庭成员参与干预是否与患者症状的更大缓解相关；3)患者的治疗结果是否受到家庭住宿水平的变化的影响；4)家庭功能和住宿之间的关系的性质以及干预对家庭功能衡量标准的影响；以及5)在后续评估中，住宿和患者症状的改善是否保持不变。这项研究的更广泛的目的是开始确定有效的家庭干预的具体参数，包括治疗目标和适当的治疗时间。鉴于越来越多的人认识到焦虑和情绪障碍之间重要的潜在相似性(Barlow，2002；Brown，2007；Brown&Barlow，2009)，这种对家庭干预有效组成部分的深入理解可能会对一系列不同的诊断产生重大影响。在美国，焦虑和情绪障碍的终生患病率估计分别占总人口的29%和21%(Kessler等人，2005年)，而针对患者更广泛的人际环境的经验性干预措施有可能提高我们目前治疗的成功率，降低辍学率和复发率。 公共卫生相关性：鉴于越来越多的人认识到焦虑和情绪障碍之间重要的潜在相似性(Barlow，2002；Brown，2007；Brown&Barlow，2009)，这种对家庭干预有效组成部分的深入理解可能会对一系列不同的诊断产生重大影响。在美国，焦虑和情绪障碍的终生患病率估计分别占总人口的29%和21%(Kessler等人，2005年)，而针对患者更广泛的人际环境的经验性干预措施有可能提高我们目前治疗的成功率，降低辍学率和复发率。

DESCRIPTION (provided by applicant): The specific goals of the research study proposed for this fellowship are to examine interpersonal obsessive-compulsive disorder (OCD) and to assess how these processes can be modified in order to improve patients' treatment outcomes, while simultaneously providing invaluable training in the administration of a family treatment. The investigator will design and implement a brief family intervention for families with the aim of reducing family members' accommodation of patients' OCD symptoms. The intervention will take place during two 90-minute sessions and will encompass psychoeducation regarding OCD and anxiety, as well as modeling and role-play of appropriate responses to requests for accommodation. Half of the family members in the study will be randomized to receive the intervention, and half will be randomized to the no-intervention condition. Measures of family accommodation will be taken at 5 timepoints throughout the study, including a 1-month follow-up after patients have completed treatment. The investigator will also assess levels of depression and anxiety in family members, as well as family members' critical or rejecting attitudes toward the patient. The study will examine: 1) whether participation in the intervention is associated with greater change in family accommodation compared to a no-intervention condition, 2) whether family members' participation in the intervention is associated with greater symptom reductions in patients, 3) whether patients' treatment outcomes are mediated by changes in the level family accommodation, 4) the nature of the relationship between family functioning and accommodation and the effect of the intervention on measures of family functioning, and 5) whether improvements in accommodation and patients' symptoms are maintained at follow-up assessment. The broader aim of this study is to begin determining specific parameters for an effective family intervention, including targets for treatment and appropriate treatment length. In light of the growing acknowledgement of important underlying similarities across anxiety and mood disorders (Barlow, 2002; Brown, 2007; Brown & Barlow, 2009), this deeper understanding of the effective components of family interventions is likely to have significant implications across a range of different diagnoses. The lifetime prevalence of anxiety and mood disorders in America are estimated to be 29% and 21% of the population, respectively (Kessler et al., 2005), and empirically-supported interventions which address patients' broader interpersonal contexts have the potential to bolster the success rates of our current treatments, reducing dropout and relapse rates. PUBLIC HEALTH RELEVANCE: In light of the growing acknowledgement of important underlying similarities across anxiety and mood disorders (Barlow, 2002; Brown, 2007; Brown & Barlow, 2009), this deeper understanding of the effective components of family interventions is likely to have significant implications across a range of different diagnoses. The lifetime prevalence of anxiety and mood disorders in America are estimated to be 29% and 21% of the population, respectively (Kessler et al., 2005), and empirically-supported interventions which address patients' broader interpersonal contexts have the potential to bolster the success rates of our current treatments, reducing dropout and relapse rates.