3 - (SYM 22) Localization and Development of a Family-based Self-help Cognitive Behavioral Therapy Manual for Adolescents with Obsessive-compulsive Disorder in China

Objective:

Obsessive-compulsive disorder (OCD) is a disabling condition affecting over three million Chinese youth. This study aimed to develop and culturally adapt a family-based self-help CBT manual for adolescents with OCD and their parents, and to assess its acceptability, readability, and usability. A randomized controlled trial (NCT06942494) will be conducted in 2025–2027 to further evaluate its effectiveness.

Methods:

The manual was developed in three stages. First, content was drafted based on established CBT protocols for adolescent OCD, integrating narrative and metaphorical elements to enhance engagement. The recovery journey was framed as a “forest adventure,” guiding youth through Exposure and Response Prevention (ERP) practice. Second, two rounds of Delphi consultation were conducted with 30 experts in child and adolescent psychiatry or clinical psychology to assess content validity and cultural adaptation. Third, six adolescents with OCD (Mage = 14.33, SD = 2.50) and their parents evaluated the manual via satisfaction ratings and semi-structured interviews, focusing on acceptability, readability, and usability. The manual was revised based on feedback from all participants.

Results:

The finalized manual, Clearing the Fog, Walking Through the Forest — A Family-Based Self-Help CBT Manual, includes 12 chapters in three modules: psychoeducation, ERP practice, and relapse prevention. Each chapter has two parallel sections—an adolescent version with step-by-step CBT guidance and a parent version offering coaching and support strategies. Expert response rates were 100% and 86.7% for the two rounds, with an authority coefficient of 0.83 and Kendall’s W of 0.214 and 0.307, indicating good coordination and consensus. Experts identified ten key cultural adaptation dimensions, and mean acceptability ratings of this manual ranged from 4.37 to 4.78 (out of 5). Adolescents and parents reported high satisfaction (means = 3.16 and 3.52 out of 4), appreciating the narrative format that framed ERP as “unlocking” sealed lands within a journey—symbolizing mastery over OCD symptoms.



Conclusion:

This study developed and culturally adapted a family-based self-help CBT manual tailored for Chinese adolescents with OCD. Preliminary findings demonstrate high content validity, strong cultural adaptability, and good acceptability among both experts and users. As a low-cost, accessible tool, this manual may complement traditional CBT and expand access to evidence-based interventions in community and school mental health settings.