Telephone Cognitive-Behavioral Therapy for Adolescents With Obsessive-Compulsive Disorder: A Randomized Controlled Non-inferiority Trial

Abstract

ObjectiveMany adolescents with obsessive-compulsive disorder (OCD) do not have access to evidence-based treatment. A randomized controlled non-inferiority trial was conducted in a specialist OCD clinic to evaluate the effectiveness of telephone cognitive-behavioral therapy (TCBT) for adolescents with OCD compared to standard clinic-based, face-to-face CBT.MethodSeventy-two adolescents, aged 11 through 18 years with primary OCD, and their parents were randomized to receive specialist TCBT or CBT. The intervention provided differed only in the method of treatment delivery. All participants received up to 14 sessions of CBT, incorporating exposure with response prevention (E/RP), provided by experienced therapists. The primary outcome measure was the Children’s Yale–Brown Obsessive-Compulsive Scale (CY-BOCS). Blind assessor ratings were obtained at midtreatment, posttreatment, 3-month, 6-month, and 12-month follow-up.ResultsIntent-to-treat analyses indicated that TCBT was not inferior to face-to-face CBT at posttreatment, 3-month, and 6-month follow-up. At 12-month follow-up, there were no significant between-group differences on the CY-BOCS, but the confidence intervals exceeded the non-inferiority threshold. All secondary measures confirmed non-inferiority at all assessment points. Improvements made during treatment were maintained through to 12-month follow-up. Participants in each condition reported high levels of satisfaction with the intervention received.ConclusionTCBT is an effective treatment and is not inferior to standard clinic-based CBT, at least in the midterm. This approach provides a means of making a specialized treatment more accessible to many adolescents with OCD. Clinical trial registration information–Evaluation of telephone-administered cognitive-behaviour therapy (CBT) for young people with obsessive-compulsive disorder (OCD); http://www.controlled-trials.com; ISRCTN27070832.

Obsessive–compulsive disorder in children and adolescents

“…49 In recent years, research has begun to focus on developing evidence-based methods for increasing the availability of, and access to, CBT. Novel approaches that have shown promise include CBT delivered via telephone 50 or web-camera 51 and internet CBT with minimal therapist input. 52 While further validation is required, these methods have the potential to transform service delivery for this population.…”

The role of digital communication in patient–clinician communication for NHS providers of specialist clinical services for young people [the Long-term conditions Young people Networked Communication (LYNC) study]: a mixed-methods study

“…Further details: students screening positive for depression in a web-based screening tool were invited to take part in telepsychiatric consultation 311 Turner et al 309 compared telephone CBT to face-to-face CBT. They found no significant clinical difference between the two groups following treatment after assessing the groups with a number of clinical scales, indicating the non-inferiority of telephone CBT compared with face to face.…”

“…Turner, 2014, UK 309 Clinical outcome: no significant difference, tCBT non-inferior to CBT. Clinician-rated global functioning -no significant difference…”

Evidence-Based Treatments in Treatment-Naïve and Treatment-Resistant Pediatric Obsessive-Compulsive Disorder

“…At least one uncontrolled feasibility study also exists [98]. A non-inferiority RCT comparing telephone-delivered CBT with standard in-office CBT showed that CBT could be effectively delivered over the telephone [99].…”