Internet-based psychotherapy in children with obsessive-compulsive disorder (OCD): protocol of a randomized controlled trial

Abstract

Background Obsessive-compulsive disorder (OCD) in children can lead to a huge burden on the concerned patients and their family members. While successful state-of-the art cognitive behavioral interventions exist, there is still a lack of available experts for treatment at home, where most symptoms manifest. Internet-based cognitive behavioral therapy (iCBT) could overcome these restrictions; however, studies about iCBT in children with OCD are rare and mostly target computerized self-help resources and only email contact with the therapist. Therefore, we intended to build up and to evaluate an iCBT approach for children with OCD, replacing successful elements of traditional in-office face-to-face CBT, with face-to-face teleconferences, online materials, and apps. Methods With the help of a pilot feasibility study, we developed the iCBT consisting of 14 teleconference sessions with the child and parents. The sessions are supported by an app assessing daily and weekly symptoms and treatment course completed by children and parents. Additionally, we obtain heart rate and activity scores from the child via wristbands during several days and exposure sessions. Using a waiting list randomized control trial design, we aim to treat and analyze 20 children with OCD immediately after a diagnostic session whereas the control group of another set of 20 OCD patients will be treated after waiting period of 16 weeks. We will recruit 30 patients in each group to take account for potential dropouts. Outcomes for the treatment group are evaluated before randomization (baseline, t0), 16 weeks (end of treatment, t1), 32 weeks (follow-up 1, t2), and 48 weeks after randomization (follow-up 2, t3). For the waiting list group, outcomes are measured before the first randomization (baseline), at 16 weeks (waiting list period), 32 weeks (end of treatment), 48 weeks after the first randomization (follow-up I), and 64 weeks after the first randomization (follow-up II). Discussion Based on our experience of feasibility during the pilot study, we were able to develop the iCBT approach and the current study will investigate treatment effectiveness. Building up an iCBT approach, resembling traditional in-office face-to-face therapy, may ensure the achievement of well-known therapy effect factors, the acceptance in both patients and clinicians, and the wide distribution within the health system. Trial registration ClinicalTrials.govNCT05037344. Registered May 2019, last release August 13th, 2021.

Integrative Art-therapeutic Correction of Psychosomatic Disorders in Children with Undifferentiated Connective Tissue Dysplasia

“…The ancient Greeks believed that art is a refuge for people in misfortune. As a result of creative activities, a person overcomes doubts about his ability to freely express their fears [24,25]. Firstly, integrative art therapy helps to establish closer contact with the patient and gain access to his experiences, secondly, it is fairytale therapy that creates an atmosphere of positive mood for the child, thirdly, this technique can transform a person's feelings and give a way out to destructive tendencies [8,13,22].…”

Suicidal Risk in People with Obsessive Compulsive Disorder

“…Apabila derajat keluhan adalah berat, kombinasi dengan SSRI dan CBT/ERP direkomendasikan (Conzelmann et al, 2022). Secara keseluruhan, panduan NICE merekomendasikan pengobatan kombinasi untuk keluhan OCD yang berat, apabila tanpa respon yang memadai terhadap pengobatan, maka dilakukan terapi dengan SSRI saja (dalam 12 minggu) atau CBT (termasuk ERP) sendiri (lebih dari 10 jam terapis per pasien).…”

“…Selama Exposure with response prevention (ERP), pasien dihadapkan dengan pikiran yang menjadi penyebab terjadinya gangguan pada mereka dan situasi sebelumnya. Pasien dapat belajar untuk menghentikan pengulangan mereka diikuti oleh penurunan alami dalam kesusahan dan pengalaman belajar yang mengganggu pikiran bahwa tidak berbahaya melalui terapi ini (Conzelmann et al, 2022). Sayangnya, ketersediaannya terbatas terapis cukup terlatih dalam prosedur CBT khusus ini untuk OCD.…”

“…Sayangnya, ketersediaannya terbatas terapis cukup terlatih dalam prosedur CBT khusus ini untuk OCD. Selain itu, ERP hampir tidak digunakan selama CBT karena kepraktisan dalam terapi sehari-hari, dan asumsi negatif dari terapis (Conzelmann et al, 2022). Selain itu, salah satu kendala utama adalah fakta bahwa akses ke pengobatan yang tepat khususnya, sulit bagi anak-anak dan remaja di pedesaan daerah karena lebih sedikit psikoterapis yang tersedia secara lokal.…”

“…Selain itu, salah satu kendala utama adalah fakta bahwa akses ke pengobatan yang tepat khususnya, sulit bagi anak-anak dan remaja di pedesaan daerah karena lebih sedikit psikoterapis yang tersedia secara lokal. Oleh karena itu, terlalu sedikit anak dengan OCD yang mendapatkan bantuan secara benar (Conzelmann et al, 2022).…”