Addressing Interpersonal Contexts in Obsessive-Compulsive Disorder

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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.