No Talking, Just Writing! Efficacy of an Internet-Based Cognitive Behavioral Therapy with Exposure and Response Prevention in Obsessive Compulsive Disorder

Abstract

Background: Many patients with obsessive-compulsive disorder (OCD) do not receive first-line treatment according to the current guidelines (cognitive behavioral therapy with exposure and response prevention, CBT with ERP) due to barriers to treatment. Internet-based therapy is designed to overcome these barriers. The present study evaluates the efficacy of an Internet-based writing therapy with therapeutic interaction based on the concept of CBT with ERP for patients with OCD. Methods: Thirty-four volunteers with OCD according to DSM-IV-criteria were included in the trial and randomized according to a waiting-list control design with follow-up measures at 8 weeks and 6 months. The intervention consisted of 14 sessions, either starting directly after randomization or with an 8-week delay. Main outcome measure was the change in the severity of OCD symptoms (Yale-Brown Obsessive Compulsive Scale Self-Rating, Y-BOCS SR, and Obsessive-Compulsive Inventory-Revised, OCI-R). Results: Obsessive-compulsive symptoms were significantly improved in the treatment group compared to the waiting-list control group with large effect sizes of Cohen's d = 0.82 (Y-BOCS SR) and d = 0.87 (OCI-R), using an intention-to-treat analysis. This effect remained stable at 6-month follow-up. Only 4 participants (12%) dropped out prematurely from the study. Of the 30 completers, 90% rated their condition as improved and would recommend the program to their friends. Conclusions: Internet-based writing therapy led to a significant improvement of obsessive-compulsive symptoms. Even though replications with larger sample sizes are needed, the results support the notion that Internet-based approaches have the potential for improving the treatment situation for patients with OCD.

A pilot randomized controlled trial of videoconference-assisted treatment for obsessive-compulsive disorder

“…The primary outcome measure showed a within group effect size of 2.83 at post-treatment and 1.9 at follow-up. In comparison internet-based ERP has found effect sizes ranging from .82 (Herbst et al, 2014) to 1.55 (Anderson et al, 2012) when using the same outcome measure as in our study. However, our secondary outcome measures (VOCI and BDI) did not show significant differences among the treatment groups.…”

Effectiveness of a Web-Based Cognitive Behavioural Intervention for Subthreshold Depression: Pragmatic Randomised Controlled Trial

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Working Alliance in Internet-Based Cognitive-Behavioral Therapy for Obsessive-Compulsive Disorder

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