Effects and Mechanisms of Family-Based Cognitive Behavioral Therapy for Pediatric Obsessive-Compulsive Disorder: A Systematic Review and Meta-Analysis

The purpose of this review is to examine the effectiveness of family-based cognitive-behavioral therapy (FCBT) on pediatric obsessive-compulsive disorder (OCD) and the mechanism of action of family accommodation in this context. Randomized controlled trials of FCBT for pediatric OCD published before May 4, 2024, were retrieved from nine databases. All FCBT studies were compared with control groups (including cognitive-behavioral therapy [CBT] and other treatments). The sequential efficacy of FCBT was also tested in a single-arm design. Additionally, we used a meta-analytic structural equation model to test the efficacy mechanism of FCBT. Using the OCD scale and response and remission status as the criterion, FCBT showed superior immediate effects versus usual treatment/waitlist, while it showed noninferiority when compared with CBT and other subtypes of FCBT. In terms of family accommodation, FCBT demonstrated superior efficacy over CBT as well as usual treatment/waitlist, and exhibited favorable follow-up effects. Meanwhile, the 3- and 6-month follow-up results demonstrated no significant differences in efficacy between FCBT and other treatments. The results from the MASEM analysis revealed that FCBT exerts its effects on pediatric OCD through family accommodation. FCBT has advantages in reducing family accommodation. When designing FCBT protocols, greater emphasis should be placed on intervention modules targeting family accommodation. Due to the limitation of the number of included studies, the estimated efficacy of FCBT compared to other treatments remains highly uncertain. The research questions, method, and planned analysis of this review were registered with PROSPERO: CRD42024539764.