A meta-analysis of family accommodation and OCD symptom severity
Section snippets
Family accommodation in OCD
Family accommodation can manifest in various forms including modifying family routines, engaging in the patient's compulsions, and facilitating avoidance of OCD triggers (Calvocoressi et al., 1995). For instance, a parent or partner may engage in excessive hand washing rituals to assuage the patient's contamination fears, or excessively reassure the patient that the stove is turned off and the house will not burn down. Although family members often engage in these behaviors in hopes of
Present study
Based on these identified gaps in the literature, the purpose of this meta-analysis was to identify a summary effect of the correlation between family accommodation and OCD symptom severity; considering extant findings, a positive correlation is expected between these variables. Given the importance of moderators, this meta-analysis will also examine potential sample-dependent (e.g., age) and methodological (e.g., family accommodation measure) moderator variables to determine their effects on
Selection of studies
Potential studies for inclusion in the meta-analysis were searched and obtained up to September 20, 2015 and evaluated by two personnel. Studies must have included objective, quantitative measures of both family accommodation and OCD symptom severity; studies solely presenting qualitative descriptions of family accommodation in OCD were excluded (e.g., Lebowitz, Vitulano, & Omer, 2011). Studies investigating family accommodation outside of OCD were discarded. Case report/series with sample
Statistical analyses
All data were analyzed through Comprehensive Meta-Analysis (CMA; Borenstein, Hedges, Higgins, & Rothstein, 2005).
Included studies
An initial search of the literature elicited 326 potential studies for inclusion in the meta-analysis. Fig. 1 outlines the steps and rationale for inclusion and exclusion of studies. Appendix A displays the 41 studies that met full inclusion criteria for the meta-analysis, which resulted in a total sample of 2509 participants. The total sample included in the meta-analysis had a mean age of 20.45 years and was 50% male.
Inter-rater reliability for coding study characteristics
There was excellent agreement for all categorical (κs = 0.95–1.00) and
Sample-dependent moderators
When examining the effect of age, both pediatric (k = 26, r = .44, 95% CI [.37, .51], z = 10.34, p < .001) and adult (k = 15, r = .38, 95% CI [.29, .46], z = 7.92, p < .001) studies exhibited significant moderate effects separately. Although accommodation appeared to be descriptively larger among pediatric OCD studies, there was no statistically significant difference in the relationship between family accommodation and OCD severity by categorical age groups, Q(1)btwn = 1.36, p = .24. When examining mean
Publication bias and sensitivity analyses
Upon visual inspection of the funnel plot (Fig. 3), the studies were generally observed to fall symmetrically around the mean. However, Egger's test for bias was significant (p = .02), suggesting that publication bias may be present. Using Duval and Tweedie's Trim and Fill procedure, one study was imputed to the right of the mean effect, eliciting an unbiased effect size of r = .40, 95% CI [.36, .43]. Using the Rosenthal's Fail-safe N (Rosenthal, 1979), there would need to be 4395 unretrieved
Discussion
This meta-analysis provides support for a medium effect size for the correlation between family accommodation and OCD symptom severity, suggesting that increased symptomology is associated with higher levels of accommodating behaviors. The effect size for this correlation is comparable to the effect size found in Strauss et al. (2015), albeit slightly larger (r = .42 versus r = .35). Although it is unclear which direction of causality is present, the relationship is likely bidirectional. On one
Conclusions
Family accommodation is a salient phenomenon that negatively impacts both the individual with OCD and the family. Because the extant literature has produced mixed findings, the present study sought to identify the strength of the association between family accommodation and OCD severity and to determine whether sample-dependent characteristics or methodological factors influenced the association between family accommodation and OCD symptom severity. Building from the preliminary meta-analysis
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2022, Behavior TherapyCitation Excerpt :With regard to family accommodation, parents of anxious children report that when their child becomes anxious, they do not know how to respond (Calvocoressi et al., 1995; Shafran et al., 1995), so they take actions that temporarily reduce the child's anxious behavior (Storch et al., 2007). This temporary reduction in anxious behavior, through negative reinforcement, also reinforces the parents’ maladaptive behaviors (Wu et al., 2016). At the same time, these accommodations do not help reduce their child's anxiety in the long run (Lebowitz et al., 2015; Lebowitz et al., 2020); thus, a negative cycle is created in which the child's anxiety leads to the use of accommodation and the use of accommodation exacerbates the symptoms of anxiety.