Internet-based cognitive behaviour therapy for obsessive–compulsive disorder: a randomized controlled trial

Abstract

BackgroundCognitive behaviour therapy (CBT) is an effective treatment for obsessive–compulsive disorder (OCD) but access to CBT is limited. Internet-based CBT (ICBT) with therapist support is potentially a more accessible treatment. There are no randomized controlled trials testing ICBT for OCD. The aim of this study was to investigate the efficacy of ICBT for OCD in a randomized controlled trial.MethodParticipants (n=101) diagnosed with OCD were randomized to either 10 weeks of ICBT or to an attention control condition, consisting of online supportive therapy. The primary outcome measure was the Yale–Brown Obsessive Compulsive Scale (YBOCS) administered by blinded assessors.ResultsBoth treatments lead to significant improvements in OCD symptoms, but ICBT resulted in larger improvements than the control condition on the YBOCS, with a significant between-group effect size (Cohen's d) of 1.12 (95% CI 0.69–1.53) at post-treatment. The proportion of participants showing clinically significant improvement was 60% (95% CI 46–72) in the ICBT group compared to 6% (95% CI 1–17) in the control condition. The results were sustained at follow-up.ConclusionsICBT is an efficacious treatment for OCD that could substantially increase access to CBT for OCD patients. Replication studies are warranted.

Therapist-Assisted Internet-Based Cognitive-Behavioral Therapy Versus Progressive Relaxation in Obsessive-Compulsive Disorder: Randomized Controlled Trial (Preprint)

“…Andersson et al [32] reported a mean therapist contact time of 2.15 hours for iCBT, although this was significantly higher than for their control condition (0.28 hours). However, the between groups difference remained significant after therapist contact was statistically controlled.…”

“…Additionally, there was a large between-group effect size (Cohen's d = 1.12) on the YBOCS in favor of the iCBT condition. Finally, only 6% participants in the control condition met criteria for clinically significant change, compared with 60% of those receiving iCBT [32]. Similar results were demonstrated by Wootton, Dear, Johnston, Terides, and Titov [34], who found that 8-week courses of therapist guided iCBT and therapist guided bibliotherapy (bCBT) were both effective compared to a waitlist control condition (betweengroup effect sizes of Cohen's d = 1.57 and 1.40, respectively).…”

“…Olatunji, Davis, Powers, and Smits [9] assert that CBT is effective regardless of gender, baseline severity or symptom subtype, comorbidities or treatment length. However, there are mixed results from face-to-face and remote treatment studies predicting outcomes from baseline severity [10][11][12]. While other psychological treatments have been applied to OCD, inclusive of progressive relaxation [13][14][15][16] and Acceptance and Commitment Therapy [17], these interventions still lack an extensive evidence-base for their efficacy.…”

“…The author concluded that both low and high intensity remote treatments for OCD lead to large magnitude improvements in OCD symptoms, are more effective than control conditions and not meaningfully different in efficacy from face-to-face treatment. In the largest RCT to date, Andersson et al [32] randomly allocated 101 participants to ten weeks of therapist-guided iCBT or 10-weeks of online supportive therapy. The iCBT condition was associated with a significant reduction in OCD symptoms (Cohen's d = 1.55) as measured by the clinician-administered Yale-Brown Obsessive Compulsive Scale (YBOCS; [33]), compared to a medium within-group effect size (Cohen's d = 0.47) for the supportive therapy control.…”

Transdiagnostic internet treatment for anxiety and depression = Tratamiento transdiagnóstico por internet de la ansiedad y la depresión

“…For example, more than 10 randomised controlled trials (RCTs) have reported the clinical benefi ts of iPT for clinical and subclinical depression Perini, Titov, & Andrews, 2009;Ruwaard et al, 2009;Titov, Andrews, Davies, et al, 2010), social phobia (Andersson et al, 2006;Berger, Hohl, & Caspar, 2009;Botella et al, 2010;Carlbring et al, 2007;, and panic disorder Klein et al, 2009;Wims, Titov, Andrews, & Choi, 2010). Encouraging evidence has also been found from a smaller but rapidly growing number of RCTs or open trials evaluating iPT for generalised anxiety disorder Robinson et al, 2010;, obsessive compulsive disorder Andersson et al, 2012;Wootton et al, 2011), and post-traumatic stress disorder (Klein et al, 2010;Spence et al, 2011).…”