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

  • E. Andersson (a1), J. Enander (a1) (a2), P. Andrén (a2), E. Hedman (a3), B. Ljótsson (a4), T. Hursti (a2), J. Bergström (a1) (a5), V. Kaldo (a1), N. Lindefors (a1), G. Andersson (a1) (a6) and C. Rück (a1)...
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.

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Copyright
The online version of this article is published within an Open Access environment subject to the conditions of the Creative Commons Attribution-NonCommercial-ShareAlike licence . The written permission of Cambridge University Press must be obtained for commercial re-use.
Corresponding author
*Address for correspondence: Mr E. Andersson, M 46, Karolinska University Hospital, Huddinge, SE-141 86 Stockholm, Sweden. (Email: erik.m.andersson@ki.se)
References
Hide All
Abramowitz, J, Tolin, D, Diefenbach, G (2005). Measuring change in OCD: sensitivity of the Obsessive Compulsive Inventory – Revised. Journal of Psychopathology and Behavioral Assessment 27, 317324.
Abramowitz, JS (2006). The psychological treatment of obsessive-compulsive disorder. Canadian Journal of Psychiatry 51, 407416.
Abramowitz, JS (2009). Getting over OCD: a 10-step Workbook for Taking Back Your Life. Guilford Press: New York.
Andersson, E, Ljotsson, B, Hedman, E, Kaldo, V, Paxling, B, Andersson, G, Lindefors, N, Rück, C (2011). Internet-based cognitive behavior therapy for obsessive compulsive disorder: a pilot study. BioMed Central Psychiatry 11, 125.
Andersson, G (2009). Using the Internet to provide cognitive behaviour therapy. Behavior Research and Therapy 47, 175180.
Andersson, G, Bergstrom, J, Buhrman, M, Carlbring, P, Hollandare, F, Kaldo, V, Nilsson-Ihrfelt, E, Paxling, B, Strom, L, Waara, J (2008). Development of a new approach to guided self-help via the internet: the Swedish Experience. Journal of Technology in Human Services 26, 161181.
APA (2000). Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). American Psychiatric Association: Washington, DC.
Baer, L, Blais, MA (2010). Handbook of Clinical Rating Scales and Assessment in Psychiatry and Mental Health. Humana Press: New York.
Bergstrom, J, Andersson, G, Ljotsson, B, Rück, C, Andreewitch, S, Karlsson, A, Carlbring, P, Andersson, E, Lindefors, N (2010). Internet- versus group-administered cognitive behaviour therapy for panic disorder in a psychiatric setting: a randomised trial. BioMed Central Psychiatry 10, 54.
Berman, AH, Bergman, H, Palmstierna, T, Schlyter, F (2005). Evaluation of the Drug Use Disorders Identification Test (DUDIT) in criminal justice and detoxification settings and in a Swedish population sample. European Addiction Research 11, 2231.
Blanco, C, Olfson, M, Stein, DJ, Simpson, HB, Gameroff, MJ, Narrow, WH (2006). Treatment of obsessive-compulsive disorder by U.S. psychiatrists. Journal of Clinical Psychiatry 67, 946951.
First, MB, Gibbon, M, Spitzer, RL, Williams, JBW, Benjamin, LS (1999). Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) (Swedish Version). Pilgrim Press.: Danderyd.
Foa, EB, Huppert, JD, Leiberg, S, Langner, R, Kichic, R, Hajcak, G, Salkovskis, PM (2002). The Obsessive-Compulsive Inventory: development and validation of a short version. Psychological Assessment 14, 485496.
Gava, I, Barbui, C, Aguglia, E, Carlino, D, Churchill, R, De Vanna, M, McGuire, HF (2007). Psychological treatments versus treatment as usual for obsessive compulsive disorder (OCD). Cochrane Database of Systematic Reviews. Issue No. 18. Art. No. CD005333.
Goodman, WK, Price, LH, Rasmussen, SA, Mazure, C, Fleischmann, RL, Hill, CL, Heninger, GR, Charney, DS (1989). The Yale-Brown Obsessive Compulsive Scale. I. Development, use, and reliability. Archives of General Psychiatry 46, 10061011.
Goodwin, R, Koenen, KC, Hellman, F, Guardino, M, Struening, E (2002). Helpseeking and access to mental health treatment for obsessive-compulsive disorder. Acta Psychiatrica Scandinavica 106, 143149.
Greist, JH, Marks, IM, Baer, L, Kobak, KA, Wenzel, KW, Hirsch, MJ, Mantle, JM, Clary, CM (2002). Behavior therapy for obsessive-compulsive disorder guided by a computer or by a clinician compared with relaxation as a control. Journal of Clinical Psychiatry 63, 138145.
Guy, W (ed.) (1976). Clinical Global Impressions. US Department of Health and Human Services: Rockville, MD.
Hedman, E, Andersson, G, Andersson, E, Ljotsson, B, Rück, C, Asmundson, GJ, Lindefors, N (2011 a). Internet-based cognitive-behavioural therapy for severe health anxiety: randomised controlled trial. British Journal of Psychiatry 198, 230236.
Hedman, E, Andersson, G, Ljotsson, B, Andersson, E, Rück, C, Mortberg, E, Lindefors, N (2011 b). Internet-based cognitive behavior therapy vs. cognitive behavioral group therapy for social anxiety disorder: a randomized controlled non-inferiority trial. PLoS One 6, e18001.
Hofmann, SG, Smits, JA (2008). Cognitive-behavioral therapy for adult anxiety disorders: a meta-analysis of randomized placebo-controlled trials. Journal of Clinical Psychiatry 69, 621632.
Hunot, V, Churchill, R, Silva de Lima, M, Teixeira, V (2007). Psychological therapies for generalised anxiety disorder. Cochrane Database of Systematic Reviews. Issue No. 24. Art. No. CD001848.
Jacobson, NS, Truax, P (1991). Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology 59, 1219.
Kenwright, M, Marks, I, Graham, C, Franses, A, Mataix-Cols, D (2005). Brief scheduled phone support from a clinician to enhance computer-aided self-help for obsessive-compulsive disorder: randomized controlled trial. Journal of Clinical Psychology 61, 14991508.
Kessler, RC, Chiu, WT, Demler, O, Merikangas, KR, Walters, EE (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry 62, 617627.
Litz, BT, Engel, CC, Bryant, RA, Papa, A (2007). A randomized, controlled proof-of-concept trial of an Internet-based, therapist-assisted self-management treatment for posttraumatic stress disorder. American Journal of Psychiatry 164, 16761683.
Mataix-Cols, D, Cameron, R, Gega, L, Kenwright, M, Marks, IM (2006). Effect of referral source on outcome with cognitive-behavior therapy self-help. Comprehensive Psychiatry 47, 241245.
Mataix-Cols, D, Marks, IM (2006). Self-help with minimal therapist contact for obsessive-compulsive disorder: a review. European Psychiatry 21, 7580.
Mataix-Cols, D, Rauch, SL, Baer, L, Eisen, JL, Shera, DM, Goodman, WK, Rasmussen, SA, Jenike, MA (2002). Symptom stability in adult obsessive-compulsive disorder: data from a naturalistic two-year follow-up study. American Journal of Psychiatry 159, 263268.
McLean, PD, Whittal, ML, Thordarson, DS, Taylor, S, Sochting, I, Koch, WJ, Paterson, R, Anderson, KW (2001). Cognitive versus behavior therapy in the group treatment of obsessive-compulsive disorder. Journal of Consulting and Clinical Psychology 69, 205214.
Moritz, S, Jelinek, L, Hauschildt, M, Naber, D (2010). How to treat the untreated: effectiveness of a self-help metacognitive training program (myMCT) for obsessive-compulsive disorder. Dialogues in Clinical Neuroscience 12, 209220.
Rosenfeld, R, Dar, R, Anderson, D, Kobak, K, Greist, JH (1992). A computer-administered version of the Yale-Brown Obsessive-Compulsive Scale. Psychological Assessment 4, 329332.
Saunders, JB, Aasland, OG, Babor, TF, de la Fuente, JR, Grant, M (1993). Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption. Addiction 88, 791804.
Shapiro, DA, Cavanagh, K, Lomas, H (2003). Geographic inequity in the availability of cognitive behavioural therapy in England and Wales. Behavioural and Cognitive Psychotherapy 31, 185192.
Sheehan, DV, Lecrubier, Y, Sheehan, KH, Amorim, P, Janavs, J, Weiller, E, Hergueta, T, Baker, R, Dunbar, GC (1998). 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 59 (Suppl. 20), 2233.
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 (2008). A randomized, controlled trial of cognitive-behavioral therapy for augmenting pharmacotherapy in obsessive-compulsive disorder. American Journal of Psychiatry 165, 621630.
Simpson, HB, Huppert, JD, Petkova, E, Foa, EB, Liebowitz, MR (2006). Response versus remission in obsessive-compulsive disorder. Journal of Clinical Psychiatry 67, 269276.
Skoog, G, Skoog, I (1999). A 40-year follow-up of patients with obsessive-compulsive disorder. Archives of General Psychiatry 56, 121127.
Storch, EA, Merlo, LJ, Lehmkuhl, H, Geffken, GR, Jacob, M, Ricketts, E, Murphy, TK, Goodman, WK (2008). Cognitive-behavioral therapy for obsessive-compulsive disorder: a non-randomized comparison of intensive and weekly approaches. Journal of Anxiety Disorders 22, 11461158.
Svanborg, P, Åsberg, M (1994). A new self-rating scale for depression and anxiety states based on the Comprehensive Psychopathological Rating Scale. Acta Psychiatrica Scandinavica 89, 2128.
Tolin, DF, Hannan, S, Maltby, N, Diefenbach, GJ, Worhunsky, P, Brady, RE (2007). A randomized controlled trial of self-directed versus therapist-directed cognitive-behavioral therapy for obsessive-compulsive disorder patients with prior medication trials. Behavior Therapy 38, 179191.
Torres, AR, Prince, MJ, Bebbington, PE, Bhugra, DK, Brugha, TS, Farrell, M, Jenkins, R, Lewis, G, Meltzer, H, Singleton, N (2007). Treatment seeking by individuals with obsessive-compulsive disorder from the british psychiatric morbidity survey of 2000. Psychiatric Services 58, 977982.
Tumur, I, Kaltenthaler, E, Ferriter, M, Beverley, C, Parry, G (2007). Computerised cognitive behaviour therapy for obsessive-compulsive disorder: a systematic review. Psychotherapy and Psychosomatics 76, 196202.
van Oppen, P, de Haan, E, van Balkom, AJ, Spinhoven, P, Hoogduin, K, van Dyck, R (1995). Cognitive therapy and exposure in vivo in the treatment of obsessive compulsive disorder. Behavior Research and Therapy 33, 379390.
Ward, E, King, M, Lloyd, M, Bower, P, Sibbald, B, Farrelly, S, Gabbay, M, Tarrier, N, Addington-Hall, J (2000). 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 321, 13831388.
Weissman, MM, Bland, RC, Canino, GJ, Greenwald, S, Hwu, HG, Lee, CK, Newman, SC, Oakley-Browne, MA, Rubio-Stipec, M, Wickramaratne, PJ (1994). The cross national epidemiology of obsessive compulsive disorder. The Cross National Collaborative Group. Journal of Clinical Psychiatry 55 (Suppl.), 5–10.
Wootton, BM, Titov, N, Dear, BF, Spence, J, Andrews, G, Johnston, L, Solley, K (2011). An Internet administered treatment program for obsessive-compulsive disorder: a feasibility study. Journal of Anxiety Disorders 25, 11021107.
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