Disorders - Obsessive Compulsive Disorder
Wong, S. F., Krause, S., Marishel, D., Grisham, J. R.
Previous research has linked certain psychological disorders, including obsessive-
compulsive disorder (OCD), to the experience of disgust and how it is interpreted/appraised. Therefore, the present study examined whether targeting
primary and secondary disgust appraisals (i.e., cognitive reappraisal) in individuals with moderate to high OCD-relevant contamination fears can
effectively reduce disgust. Fifty-two participants were randomly assigned to one of three conditions; two of which involved reading a brief script
modifying either a primary disgust appraisal (i.e., likelihood of a feared outcome) or a secondary disgust appraisal (i.e., the individual's ability
to cope), and a third control condition with no reappraisal script. Following this experimental manipulation of disgust appraisal, participants
completed two contamination-relevant behavioural approach tasks which involved 1) increasing proximity to, and eventually touching, a dead cockroach,
and 2) drinking apple juice from an unused urine sample collection container. Results indicated that the interventions successfully modified their
intended appraisal targets. Furthermore, on the second behavioural approach task, the secondary reappraisal condition demonstrated significantly less
disgust-related avoidance relative to the control condition and reported significantly less disgust relative to the primary reappraisal condition.
Our results incrementally add to the existing literature that emphasises the potential advantages of modifying disgust appraisals and specifically
secondary disgust appraisals when treating disgust-based psychological disorders.
, 78 : 102346
- Year: 2021
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions
Wolters, L. H., Hagen, A., Beek, V. O. D., Dol, P., de-Haan, E., Salemink, E.
Background: Cognitive behavioral therapy (CBT) is the treatment of choice for
pediatric obsessive-compulsive disorder (OCD), but not all patients profit sufficiently. Long waitlists and wide variations in improvement rates ask
for new interventions. We examined the effectiveness of a Cognitive Bias Modification-Interpretation (CBM-I) training that was offered during the
waiting period for CBT. We tested 1) whether the CBM-I training is an effective intervention during a waitlist period for CBT, and 2) whether
augmenting CBT with CBM-I improves treatment effect. Method(s): Participants (74 children with OCD, 8-18 years) were randomly assigned to either a
CBM-I training or a waitlist, both followed by CBT. Result(s): indicated that compared to the waitlist, the CBM-I training was effective in reducing
OCD severity, with a medium effect size. Patients in the CBM-I training condition started subsequent CBT with less severe OCD, and this advantage was
maintained during CBT. However, the CBM-I training did not result in a faster decline of symptoms during subsequent CBT. Conclusion(s): These
findings indicate that CBM-I training could be an easy to implement, helpful intervention during a waitlist period. However, replications in larger
samples and comparisons to active control conditions are needed. Copyright © 2021 The Author(s)
Journal
of Obsessive-Compulsive and Related Disorders, 29 (no
pagination) :
- Year: 2021
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Attention/cognitive bias
modification, Technology, interventions delivered using technology (e.g. online, SMS), Other service delivery and improvement
interventions
Reid, J. E., Laws, K. R., Drummond, L., Vismara, M., Grancini, B., Mpavaenda, D., Fineberg, N.
A.
Background: Cognitive behavioural therapy (CBT),
incorporating exposure and response prevention (ERP) is widely recognised as the psychological treatment of choice for obsessive-compulsive disorder
(OCD). Uncertainty remains however about the magnitude of the effect of CBT with ERP and the impact of moderating factors in patients with OCD.
Method(s): This systematic review and meta-analysis assessed randomised-controlled trials of CBT with ERP in patients of all ages with OCD. The study
was preregistered in PROSPERO (CRD42019122311). The primary outcome was end-of-trial OCD symptom scores. The moderating effects of patient-related
and study-related factors including type of control intervention and risk of bias were examined. Additional exploratory analyses assessed the effects
of treatment fidelity and impact of researcher allegiance. Result(s): Thirty-six studies were included, involving 2020 patients (537
children/adolescents and 1483 adults) with 1005 assigned to CBT with ERP and 1015 to control conditions. When compared against all control
conditions, a large pooled effect size (ES) emerged in favour of CBT with ERP (g = 0.74: 95% CI = 0.51 to 0.97 k = 36), which appeared to diminish
with increasing age. While CBT with ERP was more effective than psychological placebo (g = 1.13 95% CI 0.71 to 1.55, k = 10), it was no more
effective than other active forms of psychological therapy (g = -0.05: 95% CI -0.27 to 0.16, k = 8). Similarly, whereas CBT with ERP was
significantly superior when compared to all forms of pharmacological treatment (g = 0.36: 95% CI 0.7 to 0.64, k = 7), the effect became marginal when
compared with adequate dosages of pharmacotherapy for OCD (g = 0.32: 95% CI -0.00 to 0.64, k = 6).A minority of studies (k = 8) were deemed to be at
low risk of bias. Moreover, three quarters of studies (k = 28) demonstrated suspected researcher allegiance and these studies reported a large ES (g
= 0.95: 95% CI 0.69 to 1.2), while those without suspected researcher allegiance (k = 8) indicated that CBT with ERP was not efficacious (g = 0.02:
95% CI -0.29 to 0.33). Conclusion(s): A large effect size was found for CBT with ERP in reducing the symptoms of OCD, but depends upon the choice of
comparator control. This meta-analysis also highlights concerns about the methodological rigor and reporting of published studies of CBT with ERP in
OCD. In particular, efficacy was strongly linked to researcher allegiance and this requires further future investigation. Copyright © 2021
Comprehensive
Psychiatry, 106 (no pagination) :
- Year: 2021
- Problem: Obsessive Compulsive Disorder
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Exposure therapy, Exposure
and response prevention
Raines, A. M., Koscinski, B., Mathes, B. M., Portero, A. K., Allan, N. P., Schmidt, N. B.
OBJECTIVES: Despite the existence of several
first-line treatments for obsessive-compulsive disorder (OCD), many patients fail to experience symptom reduction and/or do not complete treatment.
As a result, the field has increasingly moved towards identifying and treating malleable underlying risk factors that may in turn improve treatment
efficacy. One salient underlying risk factor, anxiety sensitivity (AS) cognitive concerns, has been found to be uniquely associated with obsessive-
compulsive (OC) symptom dimensions. However, no studies have yet examined whether reductions in AS cognitive concerns will lead to subsequent
reductions in OC symptoms. METHOD(S): The current study attempted to fill this gap by recruiting individuals reporting elevations on both AS
cognitive concerns and at least one OC symptom dimension. Participants were randomly assigned to receive either a one-session AS cognitive concerns
intervention (n = 35) or a single health information control session (n = 37). AS cognitive concerns were assessed at post-intervention and one-month
follow-up. RESULT(S): The active intervention produced significantly greater reductions in AS cognitive concerns post-intervention than the control
intervention. However, this effect was no longer significant at one-month follow-up. Further, while there was not an effect of treatment condition on
OC symptoms at one-month follow-up, changes in AS cognitive concerns from baseline to post-intervention mediated changes in OC symptoms at one-month
follow-up. CONCLUSION(S): Findings support previous research attesting to the malleable nature of AS. Extending this research, findings provide
initial support for the efficacy of AS interventions among individuals with elevated OC symptoms. PRACTITIONER POINTS: Clinicians should consider
assessing anxiety sensitivity (AS) among patients with obsessive-compulsive disorder. If elevated, clinicians should consider targeting AS as an
adjunct to treatment as usual. Copyright © 2021 The British Psychological Society.
The British journal of clinical
psychology., 04 :
- Year: 2021
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Other Psychological Interventions, Technology, interventions delivered using technology (e.g. online, SMS)
Orsolini, L., Pompili, S., Salvi, V., Volpe, U.
Background and Objectives: The Internet
is widely used and disseminated amongst youngsters and many web-based applications may serve to improve mental health care access, particularly in
remote and distant sites or in settings where there is a shortage of mental health practitioners. However, in recent years, specific digital
psychiatry interventions have been developed and implemented for special populations such as children and adolescents. Material(s) and Method(s):
Hereby, we describe the current state-of-the-art in the field of TMH application for young mental health, focusing on recent studies concerning
anxiety, obsessive-compulsive disorder and affective disorders. Result(s): After screening and selection process, a total of 56 studies focusing on
TMH applied to youth depression (n = 29), to only youth anxiety (n = 12) or mixed youth anxiety/depression (n = 7) and youth OCD (n = 8) were
selected and retrieved. Conclusion(s): Telemental Health (TMH; i.e., the use of telecommunications and information technology to provide access to
mental health assessment, diagnosis, intervention, consultation, supervision across distance) may offer an effective and efficacious tool to overcome
many of the barriers encountering in the delivery of young mental health care.
Medicina, 57(8) :
- Year: 2021
- Problem: Anxiety Disorders (any), Obsessive Compulsive Disorder, Depressive Disorders
- Type: Systematic reviews
-
Stage: Universal prevention, At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Technology, interventions delivered using technology (e.g. online, SMS)
Norman, L. J., Mannella, K. A., Yang, H., Angstadt, M., Abelson, J. L., Himle, J. A., Fitzgerald, K. D., Taylor, S. F.
Objective: The authors sought to examine whether brain activity is associated with treatment response to cognitive-behavioral therapy (CBT)
in adolescents and adults with obsessive-compulsive disorder (OCD), and whether any associations are treatment specific relative to an active control
psychotherapy (stress management therapy; SMT). Method(s): Eighty-seven patients with OCD (age range 12-45 years; 57 female, 39 medicated) were
randomly assigned to receive 12 weeks of CBT or SMT. Prior to treatment, functional MRI scans were conducted in patients performing an incentive
flanker task, which probes brain activation to both cognitive control and reward processing. Voxelwise linear mixed-effects models examined whether
baseline brain activation was differentially associated with change in scores on the Yale-Brown Obsessive Compulsive Scale (standard or Children's
version) over the course of CBT or SMT treatment. Result(s): Within the CBT group, a better treatment response was significantly associated with
greater pretreatment activation within the right temporal lobe and rostral anterior cingulate cortex during cognitive control and within the
ventromedial prefrontal, orbitofrontal, lateral prefrontal, and amygdala regions during reward processing. In contrast, reduced pretreatment
activation within a largely overlapping set of regions was significantly associated with a better treatment response to SMT. Conclusion(s): The study
findings demonstrate that associations between brain activation and treatment response were treatment specific to CBT relative to a control
psychotherapy and that these associations were stable from adolescence to mature adulthood. Such treatment-specific associations are important for
the development of biomarkers to personalize treatment in OCD. Copyright © 2021 American Psychiatric Association. All rights reserved.
American Journal of Psychiatry, 178(1) : 39-
47
- Year: 2021
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Other Psychological Interventions
Hawley, L. L., Rector, N. A., Richter, M.
A.
The current study examined the association of OCD symptoms and OCD belief domains, for individuals engaged in Technology
Supported Mindfulness training (TSM) using an EEG-based biofeedback device (called \"Muse\") that permits individuals to engage in home based
mindfulness meditation practices. In this randomized controlled study, treatment-seeking participants with a principal DSM-5 diagnosis of OCD (N =
71) were randomly assigned to eight weeks of: 1) a meditation program involving daily use of the \"Muse\" device, or 2) wait list control. At weeks
1, 4, and 8, participants completed self-report measures of OCD symptoms (YBOCS: Yale-Brown Obsessive Compulsive Scale) and OCD beliefs (OBQ; OCCWG,
2005). Latent Difference Score (LDS) models indicated that there was no significant longitudinal relationship between OBQ \"Responsibility/Threat\"
(OBQ R/T) scores and OCD symptoms. The analysis of OBQ \"Perfectionism/Certainty\" (OBQ P/C) and OCD symptoms demonstrated a significant reciprocal
relationship between these two variables, in which OCD symptoms predicted subsequent increases in OBQ P/C and vice versa. The analysis of OBQ
\"Importance/Control of Thoughts\" (OBQ I/C) and OCD symptoms demonstrated a significant reciprocal relationship between these two variables, in
which OCD symptoms predicted subsequent increases in OBQ I/C and vice versa. The analysis of OBQ domains and EEG derived attentional changes
demonstrated a significant association between OBQ P/C and Alpha band frequencies. These results clarify the association of OBQ belief domains, OCD
symptom change and EEG derived indicators of attention during TSM. Copyright © 2021 Elsevier Ltd
, 81 (no
pagination) :
- Year: 2021
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Service Delivery & Improvement, Psychological Interventions
(any), Mindfulness based
therapy, Meditation, Technology, interventions delivered using technology (e.g. online, SMS)
Hansmeier, J., Haberkamp, A., Glombiewski, J.
A., Exner, C.
Behavior therapy of obsessive-compulsive disorder (OCD) aims to reduce avoidance, rituals, and discomfort in OCD-relevant
situations. The Behavioral Avoidance Test (BAT) measures these behavior-related outcomes in individually challenging OCD-related situations. The
association of the BAT with OCD severity measures and its relevance for treatment outcome is, however, still unclear. The current study investigates
with a retrospective analysis of a subsample of a pilot study, (1) if reactions on the BAT are related to OCD severity measures in an OCD sample (n =
28), (2) if treatment with two variants of cognitive-behavior therapy (exposure and response prevention vs. metacognitive therapy) changes the BAT
scores and (3) if these changes as well as pretreatment BAT avoidance are relevant for OCD treatment outcome as measured by the Yale-Brown Obsessive
Compulsive Scale (Y-BOCS). Participants rated avoidance, ritual, and discomfort in three individually challenging OCD-related situations before and
after therapy. For one of these situations, BAT dimensions were rated by the therapist and an independent rater in addition to the patients'
ratings. Correlational analyses found significant correlations between BAT discomfort and OCD severity measures like the Y-BOCS. A repeated measures
ANOVA with pre- and posttest scores showed that all three BAT dimensions significantly decreased during both treatments. Hierarchical regression
analyses (controlling for Y-BOCS pretest scores) revealed that changes in BAT discomfort as well as pretreatment BAT avoidance scores predicted the
Y-BOCS posttest score. These findings suggest that the BAT is a distinct measure of behavior-related outcomes partly being relevant for OCD treatment
outcome. Copyright © 2021 Hansmeier, Haberkamp, Glombiewski and Exner.
Frontiers in Psychiatry, 12 (no
pagination) :
- Year: 2021
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Exposure therapy, Exposure
and response prevention
Grover,
S., Nguyen, J. A., Viswanathan, V., Reinhart, R. M. G.
Nearly one
billion people worldwide suffer from obsessive-compulsive behaviors1,2, yet our mechanistic understanding of these behaviors is
incomplete, and effective therapeutics are unavailable. An emerging perspective characterizes obsessive-compulsive behaviors as maladaptive habit
learning3,4, which may be associated with abnormal beta-gamma neurophysiology of the orbitofrontal-striatal circuitry during reward
processing5,6. We target the orbitofrontal cortex with alternating current, personalized to the intrinsic beta-gamma frequency of the
reward network, and show rapid, reversible, frequency-specific modulation of reward- but not punishment-guided choice behavior and learning, driven
by increased exploration in the setting of an actor-critic architecture. Next, we demonstrate that chronic application of the procedure over 5 days
robustly attenuates obsessive-compulsive behavior in a non-clinical population for 3 months, with the largest benefits for individuals with more
severe symptoms. Finally, we show that convergent mechanisms underlie modulation of reward learning and reduction of obsessive-compulsive symptoms.
The results contribute to neurophysiological theories of reward, learning and obsessive-compulsive behavior, suggest a unifying functional role of
rhythms in the beta-gamma range, and set the groundwork for the development of personalized circuit-based therapeutics for related disorders.
Copyright © 2021, The Author(s), under exclusive licence to Springer Nature America, Inc.
Nature Medicine, 27(2) : 232-
238
- Year: 2021
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: Universal prevention, At risk (indicated or selected prevention)
-
Treatment and intervention: Biological Interventions
(any), Other biological interventions
Gosmann, N. P., De-Abreu-Costa, M., De-Barros-Jaeger, M., Motta, L. S., Frozi, J., Spanemberg, L., Manfro, G. G., Cuijpers, P., Pine, D. S., Salum, G. A.
Background Anxiety, obsessive-compulsive, and stress-related disorders frequently co-occur, and patients often
present symptoms of several domains. Treatment involves the use of selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine
reuptake inhibitors (SNRIs), but data on comparative efficacy and acceptability are lacking. We aimed to compare the efficacy of SSRIs, SNRIs, and
placebo in multiple symptom domains:in patients with these diagnoses over the lifespan through a 3-level network meta-analysis. Methods and findings
We searched for published and unpublished randomized controlled trials that aimed to assess the efficacy of SSRIs or SNRIs in participants (adults
and children) with diagnosis of any anxiety, obsessive-compulsive, or stress-related disorder in MEDLINE, PsycINFO, Embase, and Cochrane Library from
inception to 23 April 2015, with an update on 11 November 2020. We supplemented electronic database searches with manual searches for published and
unpublished randomized controlled trials registered in publicly accessible clinical trial registries and pharmaceutical companies' databases. No
restriction was made regarding comorbidities with any other mental disorder, participants' age and sex, blinding of participants and researchers,
date of publication, or study language. The primary outcome was the aggregate measure of internalizing symptoms of these disorders. Secondary
outcomes included specific symptom domains and treatment discontinuation rate. We estimated standardized mean differences (SMDs) with 3-level network
meta-analysis with random slopes by study for medication and assessment instrument. Risk of bias appraisal was performed using the Cochrane
Collaboration's risk of bias tool. This study was registered in PROSPERO (CRD42017069090). We analyzed 469 outcome measures from 135 studies (n =
30,245). Medication (SSRI or SNRI) was: More effective than placebo for the aggregate measure of internalizing symptoms (SMD -0.56, 95% CI -0.62 to
-0.51, p < 0.001), for all symptom domains, and in patients from all diagnostic categories. We also found significant results when restricting to the
most used assessment instrument for each diagnosis; nevertheless, this restriction led to exclusion of 72.71% of outcome measures. Pairwise
comparisons revealed only small differences between medications in efficacy and acceptability. Limitations include the moderate heterogeneity found
in most outcomes and the moderate risk of bias identified in most of the trials. Conclusions In this study, we observed that SSRIs and SNRIs were
effective for multiple symptom domains, and in patients from all included diagnostic categories. We found minimal differences between medications
concerning efficacy and acceptability. This 3-level network meta-analysis contributes robust evidence to the ongoing discussion about the true
benefit of antidepressants, with a significantly larger quantity of data and higher statistical power than previous studies. The 3-level approach
allowed us to properly assess the efficacy of these medications on internalizing psychopathology, avoiding potential biases related to the exclusion
of information due to distinct assessment instruments, and to explore the multilevel structure of transdiagnostic efficacy. Copyright © 2021 Public
Library of Science. All rights reserved.
PLoS
Medicine, 18(6) :
- Year: 2021
- Problem: Anxiety Disorders (any), Obsessive Compulsive Disorder, Post Traumatic Stress Disorder
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs), Serotonin-norepinephrine reuptake inhibitors
(SNRIs), Antidepressants
(any)
Correll, C. U., Cortese, S., Croatto, G., Monaco, F., Krinitski, D., Arrondo, G., Ostinelli, E., Zangani, C., Fornaro, M., Estrade, A., Fusar-Poli, P., Carvalho, A. F., Solmi, M.
Top-tier evidence on the safety/tolerability
of 80 medications in children/adolescents with mental disorders has recently been reviewed in this jour-nal. To guide clinical practice, such data
must be combined with evidence on efficacy and acceptability. Besides medications, psychosocial inter-ventions and brain stimulation techniques are
treatment options for children/adolescents with mental disorders. For this umbrella review, we systematically searched network meta-analyses (NMAs)
and meta-analyses (MAs) of randomized controlled trials (RCTs) evaluating 48 medications, 20 psychosocial interventions, and four brain stimulation
techniques in children/adolescents with 52 different mental disorders or groups of mental disorders, reporting on 20 different efficacy/acceptability
outcomes. Co-primary outcomes were disease-specific symptom reduction and all-cause discontinuation (\"acceptability\"). We included 14 NMAs and 90
MAs, reporting on 15 mental disorders or groups of mental disorders. Overall, 21 medications outperformed placebo regarding the co-primary outcomes,
and three psychosocial interventions did so (while seven outperformed waiting list/no treatment). Based on the meta-analytic evidence, the most
convincing efficacy profile emerged for amphetamines, methylphenidate and, to a smaller extent, behavioral therapy in attention-deficit/hyperactivity
disorder; aripiprazole, risperidone and several psychosocial interventions in autism; risperidone and behavioral interventions in disruptive behavior
disorders; several antipsychotics in schizophrenia spectrum disorders; fluoxetine, the combination of fluoxetine and cognitive behavioral therapy
(CBT), and interpersonal therapy in depression; aripiprazole in mania; fluoxetine and group CBT in anxiety disorders; fluoxetine/selective serotonin
reuptake inhibitors, CBT, and behavioral therapy with exposure and response prevention in obsessive-compulsive disorder; CBT in post-traumatic stress
disorder; imipramine and alarm behavioral intervention in enuresis; behavioral therapy in encopresis; and family therapy in anorexia nervosa. Results
from this umbrella review of interventions for mental disorders in children/adolescents provide evidence-based information for clinical decision
making.Copyright © 2021 World Psychiatric Association
World Psychiatry, 20(2) : 244-
275
- Year: 2021
- Problem: Anxiety Disorders (any), Obsessive Compulsive Disorder, Bipolar Disorders, Depressive Disorders, Anorexia Nervosa, Psychosis Disorders, Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Psychological Interventions
(any)
Aspvall,
K., Andersson, E., Melin, K., Norlin, L., Eriksson, V., Vigerland, S., Jolstedt, M., Silverberg-Morse, M., Wallin, L., Sampaio, F., Feldman, I., Bottai, M., Lenhard, F., Mataix-Cols,
D., Serlachius, E.
Importance: In most countries, young people with obsessive-compulsive disorder have limited access to
specialist cognitive behavioral therapy (CBT), a first-line treatment.\rObjective: To investigate whether internet-delivered CBT implemented in a
stepped-care model is noninferior to in-person CBT for pediatric obsessive-compulsive disorder.\rDesign, Setting and Participants: A randomized
clinical noninferiority trial conducted at 2 specialist child and adolescent mental health clinics in Sweden. Participants included 152 individuals
aged 8 to 17 years with obsessive-compulsive disorder. Enrollment began in October 2017 and ended in May 2019. Follow-up ended in April 2020.
\rInterventions: Participants randomized to the stepped-care group (n = 74) received internet-delivered CBT for 16 weeks. Nonresponders at the 3-
month follow-up were then offered a course of traditional face-to-face treatment. Participants randomized to the control group (n = 78) immediately
received in-person CBT for 16 weeks. Nonresponders at the 3-month follow-up received additional face-to-face treatment.\rMain Outcomes and Measures:
The primary outcome was the masked assessor-rated Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) score at the 6-month follow-up. The
scale includes 10 items rated from 0 (no symptoms) to 4 (extreme symptoms), yielding a total score range of 0 to 40, with higher scores indicating
greater severity. Assessors were masked to treatment allocation at pretreatment, posttreatment, 3-month follow-up, and 6-month follow-up assessments.
The predefined noninferiority margin was 4 points on the CY-BOCS.\rResults: Among the 152 randomized participants (mean age, 13.4 years; 94 [62%]
females), 151 (99%) completed the trial. At the 3-month follow-up, 34 participants (46%) in the stepped-care group and 23 (30%) in the in-person CBT
group were nonresponders. At the 6-month follow-up, the CY-BOCS score was 11.57 points in the stepped-care group vs 10.57 points in the face-to-face
treatment group, corresponding to an estimated mean difference of 0.91 points ([1-sided 97.5% CI, - to 3.28]; P for noninferiority = .02). Increased
anxiety (30%-36%) and depressive symptoms (20%-28%) were the most frequently reported adverse events in both groups. There were 2 unrelated serious
adverse events (1 in each group).\rConclusions and Relevance: Among children and adolescents with obsessive-compulsive disorder, treatment with an
internet-delivered CBT program followed by in-person CBT if necessary compared with in-person CBT alone resulted in a noninferior difference in
symptoms at the 6-month follow-up. Further research is needed to understand the durability and generalizability of these findings.\rTrial
Registration: ClinicalTrials.gov Identifier: NCT03263546.
JAMA, 325(18) : 1863-1873
- Year: 2021
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Technology, interventions delivered using technology (e.g. online, SMS), Other service delivery and improvement
interventions