Expectations and Outcomes in Cognitive Behavioral Therapy for Pediatric OCD

Background<br/>Obsessive-compulsive disorder (OCD) in childhood often leads to significant functional impairment and reduced quality of life. Cognitive behavioral therapy (CBT) is the recommended first-line treatment, yet treatment outcomes vary considerably. Treatment expectations and compliance are thought to play a central role in determining outcomes, but evidence among children and adolescents remains limited.<br/><br/>Method<br/>This study was part of NordLOTS and included 269 children and adolescents (aged 7–17) with a DSM-IV diagnosis of OCD. All participants received 14-week manualized CBT. Treatment expectations were assessed early in treatment by patients, parents, and therapists, while compliance was rated by therapists during treatment. Treatment outcome was measured using the Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS), with a score ≤15 defined as treatment response.<br/><br/>Results<br/>Patients reporting high treatment expectations at baseline presented with milder OCD symptoms and fewer externalizing problems compared to those with lower expectations. Similarly, higher therapist-rated expectations were associated with lower parent-reported externalizing symptoms. In contrast, parental expectations showed no significant association with symptom severity or treatment response. Across treatment, both patient and therapist high expectations predicted greater symptom reduction, while low expectations were linked to poorer outcomes. Higher expectations were also correlated with greater compliance, particularly among patients.<br/><br/>Conclusion<br/>Findings indicate that patient and therapist treatment expectations are important predictors of treatment success in CBT for pediatric OCD. Actively fostering realistic yet positive expectations through psychoeducation and early engagement may enhance treatment outcomes, while the role of parental expectations warrants further study.<br/>