Internet-based cognitive behavioral therapy in children and adolescents with obsessive-compulsive disorder: A randomized controlled trial

Abstract

ObjectivesObsessive-compulsive disorder (OCD) in childhood and adolescence often leads to significant impairment in various areas of life and has a high risk of becoming chronic. Cognitive behavioral therapy (CBT) is the recommended first-line treatment, but it is too rarely implemented in accordance with guidelines and is often not available close to the patient’s home. Importantly, internet-based CBT could help to reduce this gap in care. Having previously successfully demonstrated the feasibility of an internet-based CBT approach, we aimed to assess its effectiveness in a waiting list controlled randomized trial.MethodsChildren and adolescents aged 6–18 years with a principal diagnosis of OCD received 14 sessions of therapist-delivered CBT via videoconference distributed over 16 weeks. After inclusion, participants were randomly assigned to either the treatment or waiting list group. Participants in the treatment group began treatment immediately after baseline diagnostics, and participants in the waiting list group began treatment after a 16-week waiting period. The primary outcome was a pre-post comparison of OCD symptoms as measured with the Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS). Additionally, remission was an important outcome measure. Follow-up assessments were conducted for all measures 16 and 32 weeks after completion of treatment.ResultsA total of 60 children and adolescents were included into the analyses. Over the course of the treatment, OCD symptoms according to the CY-BOCS significantly decreased in the treatment group compared to the waiting-list control group. Cohen’s d between groups was 1.63. After the patients in the waiting list group also received the treatment, the OCD symptoms decreased significantly in this group as well. This improvement of symptoms increased over the course of the follow-up assessments. Remission rate peaked at the 32-week follow-up, with 68% in the treatment group and 79% in the waiting list group. Importantly, patient satisfaction with treatment was high to very high.ConclusionIn our study, OCD symptoms decreased significantly and remission rate was high after internet-based CBT. Those effects were comparable to those found in studies of face-to-face treatment. Although further evidence is needed, these are early indications that our approach may be a viable way to provide access to adequate treatment for children and adolescents affected by OCD.Clinical trial registration[www.ClinicalTrials.gov], identifier [NCT05037344].

Efficacy and acceptability of cognitive‐behavioral therapy and serotonin reuptake inhibitors for pediatric obsessive‐compulsive disorder: a network meta‐analysis

“…We identified 30 unique studies that met PICO criteria. These studies comprised 35 comparisons and 2,057 children and adolescents with OCD randomized to one of eight conditions: in‐person CBT (20 comparisons; Asbahr et al., 2005; Aspvall et al., 2021; Barrett, Healy‐Farrell, & March, 2004; Bolton et al., 2011; Bolton & Perrin, 2008; de Haan, Hoogduin, Buitelaar, & Keijsers, 1998; Fatori et al., 2018; Freeman et al., 2008, 2014; Himle et al., 2003; Lewin et al., 2014; O'Neill et al., 2017; Piacentini et al., 2011; POTS, 2004; Russman Block et al., 2023; Storch et al., 2013; Williams et al., 2010), SRIs (14 comparisons; DeVeaugh‐Geiss et al., 1992; Geller et al., 2001, 2004; Liebowitz et al., 2002; March et al., 1998; March, Johnston, Jefferson, Kobak, & Greist, 1990; POTS, 2004; Riddle et al., 1992, 2001), in‐person CBT + SRIs (five comparisons; POTS, 2004; Storch et al., 2013) CBT delivered via webcam/telephone (four comparisons; Comer et al., 2017; Hollmann et al., 2022; Storch et al., 2011; Turner et al., 2014), ICBT (two comparisons; Aspvall et al., 2021; Lenhard et al., 2017), pill placebo (nine comparisons; DeVeaugh‐Geiss et al., 1992; Geller et al., 2001, 2004; Liebowitz et al., 2002; March et al., 1990, 1998; POTS, 2004; Riddle et al., 1992, 2001), relaxation training (five comparisons; Freeman et al., 2008, 2014; Himle et al., 2003; Piacentini et al., 2011; Russman Block et al., 2023), and waitlist (eight comparisons; Barrett et al., 2004; Bolton et al., …”

“…The necessary information from eligible studies was extracted by author MC and cross‐checked by author JMD and then rechecked again by MC. When relevant data were not identified, study authors were contacted, resulting in the inclusion of four studies (Geller et al., 2001, 2004; Hollmann et al., 2022; O'Neill et al., 2017). For one study (Himle, Van Etten‐Lee, Fischer, & Muroff, 2003), information was retrieved from an earlier meta‐analysis (Watson & Rees, 2008).…”

“…Second, the introduction of new technologies has meant that CBT is now available in different delivery formats. Therapist‐administered CBT has been adapted to be delivered via telephone (Turner et al., 2014) or webcam (Hollmann et al., 2022; Storch et al., 2011), where a therapist provides the full CBT protocol but where most contact takes place remotely. In contrast, Internet‐delivered CBT (ICBT; Aspvall et al., 2021; Lenhard et al., 2017) is a form of therapist‐guided self‐help that includes the same active ingredients as CBT (e.g.…”