Thompson-Hollands Johanna, Abramovitch Amitai, Tompson Martha C, Barlow David H
Boston University.
Massachusetts General Hospital, Harvard Medical School.
Behav Ther. 2015 Mar;46(2):218-29. doi: 10.1016/j.beth.2014.11.001. Epub 2014 Nov 11.
Accommodation consists of changes in family members' behavior to prevent or reduce patients' obsessive-compulsive disorder (OCD) rituals or distress. High levels of family accommodation are associated with more severe symptoms and functional impairment in patients, and may also interfere with exposure-based treatment. The purpose of this study was to develop and test an intervention to reduce accommodation in the family members of adult OCD patients. Patients (N=18, mean age=35.44, 33% male, 94% Caucasian) received a course of standard individual exposure and ritual prevention (ERP) for OCD. Family members (N=18, mean age=41.72, 56% male, 94% Caucasian) were randomized to either receive or not receive the adjunctive intervention, consisting of two sessions of psychoeducation and skills training in reducing accommodation. Results revealed that the intervention successfully reduced scores on the clinician-rated Family Accommodation Scale (Week 8: d=1.05). Patients whose family members received the intervention showed greater reductions in Yale-Brown Obsessive-Compulsive Scale scores across treatment than patients whose family members had not (Week 8: d=1.27), and hierarchical regression analyses revealed that change in family accommodation from baseline accounted for a significant amount of variance in later OCD symptoms (β=.45, p=.02). Results from this preliminary study suggest that adjunctive intervention produces more rapid treatment response compared with traditional ERP alone. Accommodation is a potentially important target for improving treatment in OCD and other diagnostic groups where accommodation is likely to occur.
家庭适应指家庭成员行为的改变，以预防或减少患者的强迫症（OCD）仪式行为或痛苦。高水平的家庭适应与患者更严重的症状和功能损害相关，还可能干扰基于暴露的治疗。本研究的目的是开发并测试一种干预措施，以减少成年强迫症患者家庭成员的适应行为。患者（N = 18，平均年龄 = 35.44岁，33%为男性，94%为白种人）接受了一个疗程的强迫症标准个体暴露与仪式预防（ERP）治疗。家庭成员（N = 18，平均年龄 = 41.72岁，56%为男性，94%为白种人）被随机分为接受或不接受辅助干预组，辅助干预包括两节关于减少适应行为的心理教育和技能培训课程。结果显示，该干预成功降低了临床医生评定的家庭适应量表得分（第8周：d = 1.05）。与家庭成员未接受干预的患者相比，家庭成员接受干预的患者在整个治疗过程中耶鲁-布朗强迫症量表得分的降低幅度更大（第8周：d = 1.27），分层回归分析显示，从基线开始的家庭适应变化在后期强迫症症状的变异中占了很大比例（β = 0.45，p = 0.02）。这项初步研究的结果表明，与单独的传统ERP相比，辅助干预能产生更快的治疗反应。适应行为可能是改善强迫症及其他可能出现适应行为的诊断组治疗效果的一个重要潜在靶点。
