Acceptability, feasibility, and efficacy of Internet cognitive behavioral therapy (iCBT) for pediatric obsessive-compulsive disorder: a systematic review

Abstract

BackgroundObsessive-compulsive disorder (OCD) is a chronic mental health disorder characterized by recurring obsessions and compulsions affecting 1–3% of children and adolescents. Current treatment options are limited by accessibility, availability, and quality of care. New technologies provide opportunities to address at least some of these challenges. This paper aims to investigate the acceptability, feasibility, and efficacy of traditional cognitive behavioral therapy with Internet cognitive behavioral therapy (iCBT) for pediatric OCD according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.MethodWe searched EMBASE, Medline, PsycINFO, CENTRAL, LILACS, CINAHL, and Scopus. Results include articles from 1987 to March 2018. Main inclusion criteria were patients aged 4–18, primary diagnosis of OCD, and iCBT.ResultsOf the 2323 unique articles identified during the initial search, six studies with a total of 96 participants met our inclusion criteria: three randomized controlled trials, one single-case multiple-baseline design, one open-label trial, and one case series. Four studies reported a significant decrease in OCD severity on the Children’s Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) following iCBT, one study reported significant decrease in CY-BOCS scores for iCBT relative to waitlist, and the case series reported (some) symptom reduction in all participants. Six studies reported high rates of feasibility, and five studies reported good acceptability of iCBT.ConclusionAt present, evidence regarding acceptability, feasibility, and efficacy of iCBT for pediatric OCD is limited. Results are promising but need to be confirmed and refined in further research.Systematic review registrationPROSPERO CRD4201808587

Feasibility, Acceptability, and Effectiveness of Enhanced Cognitive Behavioral Therapy (eCBT) for Children and Adolescents With Obsessive-Compulsive Disorder: Protocol for an Open Trial and Therapeutic Intervention

“…Several types of technology-based CBT (tCBT) programs for OCD have been developed and implemented, including online bibliotherapy, online self-help therapy, therapist-supported computerized CBT, smartphone apps, traditional CBT delivered via telephone or videoconferencing, and combinations of these forms [ 22 , 24 - 27 ]. Preliminary evidence shows that these programs yield positive effects overall.…”

“…Moreover, tCBT was found to be superior to control conditions (waitlist and active controls, d =0.82), and no difference was found in efficacy between tCBT and traditional therapist-delivered CBT [ 25 ]. Results from a recent systematic review on tCBT for pediatric OCD (N=96) indicated that tCBT can be a feasible and acceptable treatment for youth with OCD [ 24 ].…”

Acceptability and feasibility of enhanced cognitive behavioral therapy (eCBT) for children and adolescents with obsessive–compulsive disorder

“…Farrell et al [ 37 ] reported a 49% CY-BOCS score reduction after 3 face-to-face CBT sessions, followed by maintenance sessions via webcam. Other studies applying various degrees of Internet technology to deliver CBT to children with OCD reported somewhat lower reductions of CY-BOCS scores after treatment [ 18 ].…”

“…A recent systematic review concluded that Internet-based CBT (iCBT) programs for pediatric OCD are feasible, acceptable, and possibly effective. However, the systematic review was based on six studies (N = 96), and the authors called for more studies on iCBT for pediatric OCD before reaching firmer conclusions [ 18 ].…”

The efficacy of exposure and response prevention for Obsessive-Compulsive Disorder and Tourette Syndrome: A meta-analysis

“…Many patients with OCD have no access to ERP [40], and possible barriers include clinician-related factors, aspects of the phenomenology of OCD, willingness to experience unpleasant sensations during ERP, nancial barriers, and geographical factors [41,42]. Several options of accessing the online CBT have been developed in order to make it easier to access this treatment [43,44], but further research is needed to extend the reach of ERP online. Furthermore, more research is needed regarding the long-term e cacy of ERP, as longer treatment durations may yield reduced OCD symptoms.…”