Geïntegreerde, cognitieve gedragstherapeutische gezins- en relatietherapie voor volwassenen met OCD: een meta-analyse
Tóm tắt
Achtergrond: Het gezin betrekken bij een behandeling voor obsessieve compulsieve stoornis (OCD) is weliswaar heel gebruikelijk bij kinderen, maar volwassenen patiënten worden meestal individueel behandeld. Toch bestaat er overtuigend bewijs dat gezinsleden de OCD-symptomen kunnen verergeren, en dat is een goede reden om gezinsleden te betrekken bij de behandeling van OCD bij volwassenen. In deze meta-analyse hebben we onderzocht of een gezinsbehandeling effectief is voor OCD bij een volwassen populatie, en of er moderatoren zijn voor de behandeluitkomst. Methode: In deze meta-analyse zijn vijftien studies beoordeeld (16 onafhankelijke steekproeven). Resultaten: Gebleken is dat de gezinsbehandeling voor OCD bij volwassenen de OCD-symptomen, depressie, angst en functiebeperkingen bij patiënten vermindert. Ook meldden patiënt en gezin een verbetering van de algemene relatietevredenheid, tegenwerken, accommoderen en de geestelijke gezondheid. Met name de vorm van de individuele behandeling en de aandacht voor accommoderen door het gezin hadden een gunstig effect op de depressie van de patiënt. Gezinsleden meldden meer verbeteringen in de relatie dan patiënten. Een lager aantal behandelsessies voor de patiënt was gerelateerd aan meer verbetering in het tegenwerken. Dit gold ook voor het vrouwelijke geslacht. Een lager aantal sessies voor gezinsleden was gerelateerd aan een grotere verbetering voor de geestelijke gezondheid van de gezinsleden. FIT overtrof de controlegroep met individuele ERP in de afname van symptomen van OCD en depressie, accommoderen en verbetering van het functioneren. Beperkingen: Beperkingen van deze review zijn onder andere de relatief kleine steekproefgrootte, de rekkelijke insluitingscriteria van de studies en de subjectiviteit van een aantal moderatorcategorieën. Conclusies: het integreren van het gezin in de behandeling lijkt effectief voor OCD bij volwassenen, voor de gerelateerde symptomen en voor relatiefactoren. Er is voorlopig bewijs dat het betrekken van het gezin bij de behandeling tot betere uitkomsten leidt dan individuele behandeling. In dit artikel worden ook klinische aanbevelingen besproken.
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