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We investigated benefits and harms of family-based CBT with exposure and response prevention (FCBT) versus family-based psychoeducation and relaxation training (FPRT) in pediatric OCD. This single-center RCT was investigator-initiated, independently funded, including participants with OCD aged 8\u201317 years with a Children\u2019s Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) entry score\u2009\u2265\u200916. We randomized participants 1:1 to 14 sessions of FCBT versus FPRT. Allocation was masked to assessors and statisticians. The primary outcome was CY-BOCS end-of-treatment-score (week-16) analyzed by intention-to-treat. Adverse events were reported by the Negative Effects Questionnaire (NEQ-20). One-hundred-and-thirty participants were randomized, 52.3% females; mean age 13.3 (SD\u2009=\u20092.9) years; mean CY-BOCS total score 25.8 (SD\u2009=\u20094.9);\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200964 to FCBT versus\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200966 to FPRT. Sixteen participants dropped out (four from FCBT, 12 from FPRT). The mean CY-BOCS total score at end-of-treatment was significantly lower for FCBT (15.9, SD\u2009=\u20098.7) versus FPRT (19.9, SD\u2009=\u20098.1), estimate \u2212\u20093.89, 95%CI [\u20136.83, \u2212\u20090.96),\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.01, effect size\u2009=\u20090.47, 95% CI [0.09, 0.85]. This difference was below our predefined minimal clinically important difference of four points. The average weekly NEQ frequency score showed no significant group differences. FCBT was associated with significantly larger symptom reduction than FPRT, but with a modest effect. FCBT and FPRT appeared comparably tolerable. A rigorous methodology enabled the counteraction of several biases. Limitations included missing self-reported data and inability of masking participants and treatment providers.\n                  <\/jats:p>","DOI":"10.1007\/s00787-025-02797-4","type":"journal-article","created":{"date-parts":[[2025,7,31]],"date-time":"2025-07-31T09:05:28Z","timestamp":1753952728000},"page":"3955-3971","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Family-based cognitive behavioral therapy versus family-based psychoeducation and relaxation training for obsessive-compulsive disorder in children and adolescents: a randomized clinical trial (TECTO)"],"prefix":"10.1007","volume":"34","author":[{"given":"Anne Katrine","family":"Pagsberg","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole Nadine","family":"L\u00f8nfeldt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine Lykke","family":"Thoustrup","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicoline L\u00f8cke Jepsen","family":"Korsbjerg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Camilla Funch","family":"Uhre","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sofie Heidenheim","family":"Christensen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valdemar Funch","family":"Uhre","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna-Rosa Cecilie","family":"Mora-Jensen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melanie","family":"Ritter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linea","family":"Pretzmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helga Kristensen","family":"Ingstrup","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Birgitte Borgbjerg","family":"Moltke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gitte Sommer","family":"Harboe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emilie Daml\u00f8v","family":"Thorsen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Line Katrine Harder","family":"Clemmensen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane","family":"Lindschou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janus","family":"Engstr\u00f8m","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Gluud","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hartwig Roman","family":"Siebner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Per Hove","family":"Thomsen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katja","family":"Hybel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Verhulst","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Baare","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pia","family":"Jeppesen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jens Richardt M\u00f8llegaard","family":"Jepsen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Signe","family":"Vangkilde","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus Harboe","family":"Olsen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie","family":"Hagstr\u00f8m","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kerstin Jessica","family":"Plessen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,7,31]]},"reference":[{"key":"2797_CR1","doi-asserted-by":"publisher","first-page":"491","DOI":"10.1016\/S0140-6736(09)60240-3","volume":"374","author":"JS Abramowitz","year":"2009","unstructured":"Abramowitz JS, Taylor S, McKay D (2009) Obsessive-compulsive disorder. 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Funding bodies have not been involved in any part of the design, conduct, analysis, interpretation, and reporting of this trial. The Steering Committee had the overall responsibility for the planning, conducting, and reporting of the trial. Decisions relevant for day-to-day management were handled by the Executive Committee.The following authors declare no known competing interests: AKP, NNL, CLT, NLJ, CU, SHC, VU, ACM, MR, LP, HKI, GSH, EDT, LKHC, JE, CG, PHT, KH, FV, WB, PJ, JRMJ, SV, MHO, JH, KJP. Hartwig R. Siebner has received honoraria as speaker from Sanofi Genzyme, Denmark and Novartis, Denmark, as consultant from Sanofi Genzyme, Denmark, and Lundbeck AS, Denmark, and as editor-in-chief (Neuroimage Clinical) and senior editor (NeuroImage) from Elsevier Publishers, Amsterdam, The Netherlands. He has received royalties as book editor from Springer Publishers, Stuttgart, Germany, Gyldendal Publishers, Copenhagen, Denmark, and Oxford University Press, Oxford, UK.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}