Internet-based cognitive behaviour therapy for obsessive-compulsive disorder: a randomized controlled trial

E Andersson, J Enander, P Andrén, E Hedman, B Ljótsson, T Hursti, J Bergström, V Kaldo, N Lindefors, G Andersson, C Rück, E Andersson, J Enander, P Andrén, E Hedman, B Ljótsson, T Hursti, J Bergström, V Kaldo, N Lindefors, G Andersson, C Rück

Abstract

Background: Cognitive behaviour therapy (CBT) is an effective treatment for obsessive-compulsive disorder (OCD) but access to CBT is limited. Internet-based CBT (ICBT) with therapist support is potentially a more accessible treatment. There are no randomized controlled trials testing ICBT for OCD. The aim of this study was to investigate the efficacy of ICBT for OCD in a randomized controlled trial.

Method: Participants (n=101) diagnosed with OCD were randomized to either 10 weeks of ICBT or to an attention control condition, consisting of online supportive therapy. The primary outcome measure was the Yale-Brown Obsessive Compulsive Scale (YBOCS) administered by blinded assessors.

Results: Both treatments lead to significant improvements in OCD symptoms, but ICBT resulted in larger improvements than the control condition on the YBOCS, with a significant between-group effect size (Cohen's d) of 1.12 (95% CI 0.69-1.53) at post-treatment. The proportion of participants showing clinically significant improvement was 60% (95% CI 46-72) in the ICBT group compared to 6% (95% CI 1-17) in the control condition. The results were sustained at follow-up.

Conclusions: ICBT is an efficacious treatment for OCD that could substantially increase access to CBT for OCD patients. Replication studies are warranted.

Figures

Fig. 1
Fig. 1
Participant flow and reasons for dropout throughout the trial. CBT, Cognitive behavioural therapy; OCD, obsessive–compulsive disorder; SSRI, selective serotonin reuptake inhibitor; YBOCS, Yale–Brown Obsessive Compulsive Scale.
Fig. 2
Fig. 2
Weekly Obsessive Compulsive Inventory – Revised (OCI-R) total score ratings with 95% confidence intervals. ICBT, Internet-based cognitive behaviour therapy; W, week.

References

    1. Abramowitz J, Tolin D, Diefenbach G. Measuring change in OCD: sensitivity of the Obsessive Compulsive Inventory – Revised. Journal of Psychopathology and Behavioral Assessment. 2005;27:317–324.
    1. Abramowitz JS. The psychological treatment of obsessive-compulsive disorder. Canadian Journal of Psychiatry. 2006;51:407–416.
    1. Abramowitz JS. Getting over OCD: a 10-step Workbook for Taking Back Your Life. Guilford Press; New York: 2009.
    1. Andersson E, Ljotsson B, Hedman E, Kaldo V, Paxling B, Andersson G, Lindefors N, Rück C. Internet-based cognitive behavior therapy for obsessive compulsive disorder: a pilot study. BioMed Central Psychiatry. 2011;11:125.
    1. Andersson G. Using the Internet to provide cognitive behaviour therapy. Behavior Research and Therapy. 2009;47:175–180.
    1. Andersson G, Bergstrom J, Buhrman M, Carlbring P, Hollandare F, Kaldo V, Nilsson-Ihrfelt E, Paxling B, Strom L, Waara J. Development of a new approach to guided self-help via the internet: the Swedish Experience. Journal of Technology in Human Services. 2008;26:161–181.
    1. APA. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) American Psychiatric Association; Washington, DC: 2000.
    1. Baer L, Blais MA. Handbook of Clinical Rating Scales and Assessment in Psychiatry and Mental Health. Humana Press; New York: 2010.
    1. Bergstrom J, Andersson G, Ljotsson B, Rück C, Andreewitch S, Karlsson A, Carlbring P, Andersson E, Lindefors N. Internet- versus group-administered cognitive behaviour therapy for panic disorder in a psychiatric setting: a randomised trial. BioMed Central Psychiatry. 2010;10:54.
    1. Berman AH, Bergman H, Palmstierna T, Schlyter F. Evaluation of the Drug Use Disorders Identification Test (DUDIT) in criminal justice and detoxification settings and in a Swedish population sample. European Addiction Research. 2005;11:22–31.
    1. Blanco C, Olfson M, Stein DJ, Simpson HB, Gameroff MJ, Narrow WH. Treatment of obsessive-compulsive disorder by U.S. psychiatrists. Journal of Clinical Psychiatry. 2006;67:946–951.
    1. First MB, Gibbon M, Spitzer RL, Williams JBW, Benjamin LS. Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) (Swedish Version) Pilgrim Press.; Danderyd: 1999.
    1. Foa EB, Huppert JD, Leiberg S, Langner R, Kichic R, Hajcak G, Salkovskis PM. The Obsessive-Compulsive Inventory: development and validation of a short version. Psychological Assessment. 2002;14:485–496.
    1. Gava I, Barbui C, Aguglia E, Carlino D, Churchill R, De Vanna M, McGuire HF. Psychological treatments versus treatment as usual for obsessive compulsive disorder (OCD) Cochrane Database of Systematic Reviews 2007 . Issue No. 18. Art. No. CD005333.
    1. Goodman WK, Price LH, Rasmussen SA, Mazure C, Fleischmann RL, Hill CL, Heninger GR, Charney DS. The Yale-Brown Obsessive Compulsive Scale. I. Development, use, and reliability. Archives of General Psychiatry. 1989;46:1006–1011.
    1. Goodwin R, Koenen KC, Hellman F, Guardino M, Struening E. Helpseeking and access to mental health treatment for obsessive-compulsive disorder. Acta Psychiatrica Scandinavica. 2002;106:143–149.
    1. Greist JH, Marks IM, Baer L, Kobak KA, Wenzel KW, Hirsch MJ, Mantle JM, Clary CM. Behavior therapy for obsessive-compulsive disorder guided by a computer or by a clinician compared with relaxation as a control. Journal of Clinical Psychiatry. 2002;63:138–145.
    1. Guy W. Clinical Global Impressions. US Department of Health and Human Services; Rockville, MD: 1976.
    1. Hedman E Andersson G Andersson E Ljotsson B Rück C Asmundson GJ Lindefors N 2011aInternet-based cognitive-behavioural therapy for severe health anxiety: randomised controlled trial British Journal of Psychiatry 198230–236.
    1. Hedman E Andersson G Ljotsson B Andersson E Rück C Mortberg E Lindefors N 2011bInternet-based cognitive behavior therapy vs. cognitive behavioral group therapy for social anxiety disorder: a randomized controlled non-inferiority trial PLoS One 6e18001.
    1. Hofmann SG, Smits JA. Cognitive-behavioral therapy for adult anxiety disorders: a meta-analysis of randomized placebo-controlled trials. Journal of Clinical Psychiatry. 2008;69:621–632.
    1. Hunot V, Churchill R, Silva de Lima M, Teixeira V. Psychological therapies for generalised anxiety disorder. Cochrane Database of Systematic Reviews 2007 . Issue No. 24. Art. No. CD001848.
    1. Jacobson NS, Truax P. Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology. 1991;59:12–19.
    1. Kenwright M, Marks I, Graham C, Franses A, Mataix-Cols D. Brief scheduled phone support from a clinician to enhance computer-aided self-help for obsessive-compulsive disorder: randomized controlled trial. Journal of Clinical Psychology. 2005;61:1499–1508.
    1. Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry. 2005;62:617–627.
    1. Litz BT, Engel CC, Bryant RA, Papa A. A randomized, controlled proof-of-concept trial of an Internet-based, therapist-assisted self-management treatment for posttraumatic stress disorder. American Journal of Psychiatry. 2007;164:1676–1683.
    1. Mataix-Cols D, Cameron R, Gega L, Kenwright M, Marks IM. Effect of referral source on outcome with cognitive-behavior therapy self-help. Comprehensive Psychiatry. 2006;47:241–245.
    1. Mataix-Cols D, Marks IM. Self-help with minimal therapist contact for obsessive-compulsive disorder: a review. European Psychiatry. 2006;21:75–80.
    1. Mataix-Cols D, Rauch SL, Baer L, Eisen JL, Shera DM, Goodman WK, Rasmussen SA, Jenike MA. Symptom stability in adult obsessive-compulsive disorder: data from a naturalistic two-year follow-up study. American Journal of Psychiatry. 2002;159:263–268.
    1. McLean PD, Whittal ML, Thordarson DS, Taylor S, Sochting I, Koch WJ, Paterson R, Anderson KW. Cognitive versus behavior therapy in the group treatment of obsessive-compulsive disorder. Journal of Consulting and Clinical Psychology. 2001;69:205–214.
    1. Moritz S, Jelinek L, Hauschildt M, Naber D. How to treat the untreated: effectiveness of a self-help metacognitive training program (myMCT) for obsessive-compulsive disorder. Dialogues in Clinical Neuroscience. 2010;12:209–220.
    1. Rosenfeld R, Dar R, Anderson D, Kobak K, Greist JH. A computer-administered version of the Yale-Brown Obsessive-Compulsive Scale. Psychological Assessment. 1992;4:329–332.
    1. Saunders JB, Aasland OG, Babor TF, de la Fuente JR, Grant M. Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption. Addiction. 1993;88:791–804.
    1. Shapiro DA, Cavanagh K, Lomas H. Geographic inequity in the availability of cognitive behavioural therapy in England and Wales. Behavioural and Cognitive Psychotherapy. 2003;31:185–192.
    1. Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, Hergueta T, Baker R, Dunbar GC. The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry. 1998;59:22–33. (Suppl. 20),
    1. Simpson HB, Foa EB, Liebowitz MR, Ledley DR, Huppert JD, Cahill S, Vermes D, Schmidt AB, Hembree E, Franklin M, Campeas R, Hahn CG, Petkova E. A randomized, controlled trial of cognitive-behavioral therapy for augmenting pharmacotherapy in obsessive-compulsive disorder. American Journal of Psychiatry. 2008;165:621–630.
    1. Simpson HB, Huppert JD, Petkova E, Foa EB, Liebowitz MR. Response versus remission in obsessive-compulsive disorder. Journal of Clinical Psychiatry. 2006;67:269–276.
    1. Skoog G, Skoog I. A 40-year follow-up of patients with obsessive-compulsive disorder. Archives of General Psychiatry. 1999;56:121–127.
    1. Storch EA, Merlo LJ, Lehmkuhl H, Geffken GR, Jacob M, Ricketts E, Murphy TK, Goodman WK. Cognitive-behavioral therapy for obsessive-compulsive disorder: a non-randomized comparison of intensive and weekly approaches. Journal of Anxiety Disorders. 2008;22:1146–1158.
    1. Svanborg P, Åsberg M. A new self-rating scale for depression and anxiety states based on the Comprehensive Psychopathological Rating Scale. Acta Psychiatrica Scandinavica. 1994;89:21–28.
    1. Tolin DF, Hannan S, Maltby N, Diefenbach GJ, Worhunsky P, Brady RE. A randomized controlled trial of self-directed versus therapist-directed cognitive-behavioral therapy for obsessive-compulsive disorder patients with prior medication trials. Behavior Therapy. 2007;38:179–191.
    1. Torres AR, Prince MJ, Bebbington PE, Bhugra DK, Brugha TS, Farrell M, Jenkins R, Lewis G, Meltzer H, Singleton N. Treatment seeking by individuals with obsessive-compulsive disorder from the british psychiatric morbidity survey of 2000. Psychiatric Services. 2007;58:977–982.
    1. Tumur I, Kaltenthaler E, Ferriter M, Beverley C, Parry G. Computerised cognitive behaviour therapy for obsessive-compulsive disorder: a systematic review. Psychotherapy and Psychosomatics. 2007;76:196–202.
    1. van Oppen P, de Haan E, van Balkom AJ, Spinhoven P, Hoogduin K, van Dyck R. Cognitive therapy and exposure in vivo in the treatment of obsessive compulsive disorder. Behavior Research and Therapy. 1995;33:379–390.
    1. Ward E, King M, Lloyd M, Bower P, Sibbald B, Farrelly S, Gabbay M, Tarrier N, Addington-Hall J. Randomised controlled trial of non-directive counselling, cognitive-behaviour therapy, and usual general practitioner care for patients with depression. I: clinical effectiveness. British Medical Journal. 2000;321:1383–1388.
    1. Weissman MM, Bland RC, Canino GJ, Greenwald S, Hwu HG, Lee CK, Newman SC, Oakley-Browne MA, Rubio-Stipec M, Wickramaratne PJ. The cross national epidemiology of obsessive compulsive disorder. The Cross National Collaborative Group. Journal of Clinical Psychiatry. 1994;55:5.
    1. Wootton BM, Titov N, Dear BF, Spence J, Andrews G, Johnston L, Solley K. An Internet administered treatment program for obsessive-compulsive disorder: a feasibility study. Journal of Anxiety Disorders. 2011;25:1102–1107.

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