Unguided Internet‐based cognitive‐behavioral therapy for obsessive‐compulsive disorder: A randomized controlled trial

Abstract

Background: Many individuals with obsessive-compulsive disorder (OCD) do not receive professional treatment due to various idiosyncratic barriers. Internet-based cognitive-behavioral therapy (iCBT) is increasingly used to narrow treatment gaps, but the efficacy of such interventions without guidance of therapists has not been well studied. This study evaluated the efficacy of an unguided iCBT that includes third-wave approaches for the treatment of OCD symptoms. Methods: A total of 128 individuals with self-reported OCD symptoms were randomly allocated to either an intervention group (unguided iCBT) or to a care-asusual (CAU) control group following an anonymous baseline assessment via an online survey. Eight weeks after inclusion, a reassessment was carried out online. The Yale-Brown Obsessive-Compulsive Scale served as the primary outcome parameter for detecting symptom changes in the per-protocol sample with at least 60 minutes utilization. Results: The iCBT group showed a significantly stronger reduction of OCD symptoms with a medium effect size (η² p = 0.06) compared with the control condition. This effect was moderated by the general frequency of Internet usage (η² p = 0.08); the more time per day users spent online, the less they benefited from the intervention. Secondary outcomes revealed (1) a medium effect size on self-esteem (η² p = 0.06); (2) no statistically significant effects on quality of life, depression symptoms, impulsivity, or social insecurity; and (3) good acceptability of the intervention. Conclusions: The current study provides evidence that unguided iCBT for OCD may be a viable option for individuals who experience treatment barriers. As non-compliance remains a challenge, this topic needs further research.

When a nightmare comes true: Change in obsessive-compulsive disorder over the first months of the COVID-19 pandemic

“…This involves professional support, which was less available during the first months of the pandemic, further increasing the distress of people in need of help. If standard treatment is not available, online interventions should be considered (e.g., Schröder et al, 2020 ). Without treatment, the OC beliefs of some patients concerning how contamination occurs (e.g., touching contaminated surfaces) were not only consolidated but potentially amplified (e.g., to contamination through aerosols), which may have maintained symptom severity in people with C-OCD.…”

Low intensity technology-delivered cognitive behavioral therapy for obsessive-compulsive disorder: a meta-analysis

“…Primary OCD diagnosis was assessed by the Structured Clinical Interview (SCID) or the short version Mini-International Neuropsychiatric Interview (MINI) for DSM-IV and DSM-IV-TR ( k = 7), self-report measures ( k = 2), diagnosed prior by a mental health specialist ( k = 5), self-report measures and diagnosed by a mental health specialist ( k = 1) or a certain cut-off score of Y-BOCS and DOCS ( k = 2). As mentioned above, two studies (i.e., [ 29 , 30 ]) included a sample with a self-reported OCD diagnosis and two studies included a sample with a Y-BOCS score of at least 8 and with a DOCS subscale score of at least 7(i.e., [ 61 , 63 ]). However, these studies were included as OCD measures indicated average scores above the cut-off-score (Y-BOCS: 8–23, indicating a mild to moderate OCD, see Goodman et al, 1989; DOCS: > 15, see [ 64 ]).…”

“…Three studies were at high risk of bias for the selection bias [ 56 , 61 , 62 ]. Risk of bias for the attrition bias was high in three studies as an ITT analysis was not conducted [ 28 , 60 , 63 ]. Additionally, there was a high risk of bias owing to incomplete outcome data reporting for five studies: missing means and standard deviations [ 56 , 68 ], incomplete ITT results report [ 27 , 30 ] and missing report of the amount of sample [ 29 ].…”

“…As there were many recent randomized controlled trials, providing an updated meta-analysis was highly recommended [ 75 ]. Therefore, one strength of the present article is the inclusion of seven recently published RCTs [ 27 , 29 , 53 , 55 , 61 , 63 , 68 ]. The present article is one of the first articles in this line of research to include only RCTs as well as a sample comprising only adults.…”

Unguided Computer-Assisted Self-Help Interventions Without Human Contact in Patients With Obsessive-Compulsive Disorder: Systematic Review and Meta-analysis

“…Participants were recruited in European countries in 3 studies [27][28][29], in North America in 2 studies [26,30], and cross-continental in 1 study [31], but recruitment method was unclear in the other studies because it was done through the internet [32][33][34][35][36]. Diagnosis was based on DSM-IV-TR in 2 studies [27,28], DSM-IV in 1 study [26], health professional diagnosis using unclear diagnostic criteria in 5 studies [32][33][34]36,37], and the OCD symptom scale in 3 studies [29,30,38]. The proportion of women ranged from 42% to 83%.…”