Therapist-Guided, Internet-Delivered Cognitive-Behavioral Therapy for Adolescents With Obsessive-Compulsive Disorder: A Randomized Controlled Trial

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• 作者：Fabian Lenhard ; MSc^a ; ^{fabian.lenhard@ki.se} ; Erik Andersson ; PhD^b ; David Mataix-Cols ; PhD^a ; Christian Rü ; ck ; PhD^a ; Sarah Vigerland ; PhD^a ; Jens H&ouml ; gstr&ouml ; m ; PhD^a ; Maria Hillborg ; MSc^c ; Gustaf Brander ; MSc^d ; Mari Ljungstr&ouml ; m ; MSc^c ; Brjá ; nn Ljó ; tsson ; PhD^e ; Eva Serlachius ; PhD^a
• 关键词：obsessive-compulsive disorder ; cognitive-behavioral therapy ; internet
• 刊名：Journal of the American Academy of Child & Adolescent Psychiatry
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：56
• 期：1
• 页码：10-19.e2
• 全文大小：787 K
• 卷排序：56

文摘

Cognitive-behavioral therapy (CBT) is the first-line treatment for young people with obsessive-compulsive disorder (OCD), but most patients do not have access to this treatment. Thus, innovative ways to increase the accessibility of CBT are needed. The objective of this trial was to evaluate the efficacy of therapist-guided internet-based CBT (ICBT) for adolescents with OCD.MethodSixty-seven adolescents (12–17 years old) with OCD were randomly assigned to a 12-week clinician- and parent-supported ICBT program (BiP OCD) or a waitlist condition. The primary outcome was the Children Yale-Brown Obsessive Compulsive Scale (CY-BOCS) administered by blinded assessors before and after the intervention. All patients were followed up 3 months after the intervention.ResultsIn intention-to-treat analyses, BiP OCD was superior to waitlist on the CY-BOCS (time-by-group interaction, B = −4.53, z = −3.74, p < .001; Cohen's d = 0.69; 95% CI 0.19–1.18) and on most secondary outcome measurements. Patients randomized to BiP OCD also showed further improvement from post-treatment to 3-month follow-up, with a within-group pretreatment to follow-up effect size (Cohen's d) equal to 1.68 (95% CI 1.00–2.36). Patient satisfaction with BiP OCD was high. There were no relevant adverse events. Average clinician support time was 17.5 minutes per patient per week.ConclusionTherapist-guided ICBT is a promising low-intensity intervention for adolescents with OCD and has the potential to increase access to CBT. It might be particularly useful in a stepped-care approach, in which a large proportion of patients with moderately severe OCD could first be offered ICBT, thus freeing limited resources for more complex cases.Clinical trial registration information—Internet-Delivered CBT for Adolescents With OCD: A Randomized Controlled Study (BiPOCD); http://clinicaltrials.gov; NCT02191631.