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

Abstract

Background Although the evidence base of cognitive behavioral therapy (CBT) for pediatric obsessive-compulsive disorder (OCD) has been broadly established, the treatment is hampered by limited access, poor compliance, and nonresponse. New technologies offer the opportunity to improve the accessibility, user friendliness, and effectiveness of traditional office-based CBT. By employing an integrated and age-appropriate technologically enhanced treatment package, we aim to execute a more focused and attractive application of CBT principles to increase the treatment effect for pediatric OCD. Objective The aim of this open study is to explore the acceptability, feasibility, and effectiveness of a newly developed enhanced CBT (eCBT) package for pediatric OCD. Methods This study is an open trial using a historical control design conducted at the outpatient clinic of the Department of Child and Adolescent Psychiatry at St. Olavs University Hospital (Trondheim) or at BUP Klinikk (Aalesund). Participants are 30 children (age 7-17 years) with a primary Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 diagnosis of OCD, and their parents. All participants receive eCBT. eCBT consists of the usual evidence-based CBT for pediatric OCD in an “enhanced” format. Enhancements include videoconferencing sessions (supervision and guided exposure exercises at home) in addition to face-to-face sessions; an app system of interconnected apps for the child, the parents, and the therapist; psychoeducative videos; and frequent online self-assessments with direct feedback to patients and the therapist. Primary outcome measures are the Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS) (effectiveness), the Client Satisfaction Questionnaire-8 (acceptability), and treatment drop out (feasibility). Assessments are conducted pretreatment, posttreatment, and at 3- and 6-month follow-ups. A 12-month follow-up assessment is envisioned. The treatment outcome (CY-BOCS) will be compared to traditional face-to-face CBT (data collected in the Nordic Long-term OCD Treatment Study). Results Ethical approval has been obtained (2016/716/REK nord). Inclusion started on September 04, 2017. Data collection is ongoing. Conclusions This study is the first step in testing the acceptability, feasibility, and preliminary effectiveness of eCBT. In case of positive results, future steps include improving the eCBT treatment package based on feedback from service users, examining cost-effectiveness in a randomized controlled trial, and making the package available to clinicians and other service providers treating OCD in children and adolescents. Trial Registration ISRCTN, ISRCTN37530113; registered on January 31, 2020 (retrospectively registered); https://www.isrctn.com/ISRCTN37530113. International Registered Report Identifier (IRRID) DERR1-10.2196/24057

A Systematic Review on TeleMental Health in Youth Mental Health: Focus on Anxiety, Depression and Obsessive-Compulsive Disorder

“…Overall, most of studies here retrieved demonstrated the superiority of TMH interventions over the placebo or a comparable efficacy of TMH intervention to face-to-face modality with regards to studies on youth anxiety [ 29 , 30 , 31 , 32 , 33 , 34 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 ] depression [ 9 , 21 , 38 , 46 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 83 , 84 , 85 , 86 ] or OCD [ 70 , 71 , 73 , 74 , 75 , 76 , 77 , 87 ]. Computer-assisted...…”

“…Thirdly, few studies own a large sample size, mainly being carried out on small sample sizes, with mixed samples (i.e., anxious and depressive individuals, some including both parents/caregivers and patients). Finally, some studies are only pilot study or evaluated the feasibility and acceptability of computer-assisted or internet-based CBT or TMH interventions, without reporting completed findings [ 29 , 46 , 69 , 77 ].Therefore, further studies should include longer term follow-up (in order to assess the effectiveness in naturalistic settings); larger sample sizes to examine mediators and moderators of outcomes following TMH interventions in youngsters affected with anxiety disorders, major depressive disorder or OCD; provide complementary parent self-report measures (in order to compare and integrate findings coming from self-report assessments provided by young people) and clinician-based assessments during each TMH session. Moreover, further studies should investigate and define specific standardized, age- and young-tailored Internet-delivered protocols address to youth anxiety disorders (i.e., social anxiety, generalized anxiety disorder, separation anxiety disorder, phobias, etc.…”

“…A pilot study evaluated an Internet-delivered family-based CBT intervention on a sample of early-onset OCD young people, by reporting an OCD symptomatology improvement and global severity improvements from pre- to -post-treatment [ 71 ]. An open label study explored the acceptability, feasibility and effectiveness of a newly developed enhanced CBT (eCBT) to children and adolescents [ 77 ]. The eCBT includes VC sessions, such as supervision and guided exposure exercises at home in addition to face-to-face sessions), an interconnected app designed for children, their parents and the therapists and an online assessment with direct feedback to patients and the therapist.…”

“…The study was applied to 30 children (aged 7–17) with a primary diagnosis of OCD according to the DSM-5 criteria and their parents. The findings are still ongoing [ 77 ]. Overall, among 8 papers here retrieved, 2 were short-term, 4 medium-term, 1 with a long-term follow-up while only one is still ongoing not providing preliminary results but only a research protocol.…”

“…Therefore, a comparison of these studies is limiting being represented by not homogeneous interventions online delivered for OCD. However, all seven studies reporting preliminary findings showed a significant improvement in OCD symptomatology, which persisted over time [ 70 , 75 , 77 ], a superiority over placebo [ 70 ] and a comparable efficacy compared to face-to-face interventions [ 76 ], particularly among those studies in which the sample was randomly assigned to the intervention or WLC/face-to-face modality.…”