Helpful and hindering factors in group-based cognitive-behavioral therapy for adolescents with obsessive-compulsive disorder: a qualitative study

Background: Obsessive-compulsive disorder (OCD) is a debilitating condition in which an individual experiences intense obsessions and extensive compulsions. The disorder is often associated with feelings of shame. Cognitive-behavioral therapy (CBT) including exposure and response prevention is the recommended first-line treatment for youth with OCD. A group-based CBT (GCBT) format offers potential benefits such as peer support and shared experiences. However, optimizing treatment outcomes requires the identification of key factors that clinicians must consider when offering GCBT. The aim of the current study was to qualitatively explore helpful and hindering factors in GCBT through the eyes of Danish adolescents with OCD. Methods: Eleven adolescents aged 14 to 19 were interviewed individually using a semi structured interview guide after a 13-sessions GCBT course in a Danish public hospital setting. Five separate treatment groups were represented. The transcribed interviews were analyzed using thematic analysis. Results: Helpful and hindering factors influencing experienced therapy effectiveness were identified within the following themes: 1) Normalization and alienation, 2) Independence and support, and 3) Need for personalized treatment. Conclusions: GCBT shows promise for adolescents with OCD, offering potential helpful factors such as peer identification and support, training independency doing homework exercises, and being supported by parents. Risk factors that may be hindering for the adolescents include symptom contagion among members in the group, fear of standing out (e.g. due to taboo obsessions), and lack of personalized treatment. Clinicians should be trained to optimize group dynamics, reinforcing helpful factors and minimizing potential obstacles.