Internet-based cognitive behavior therapy for obsessive compulsive disorder: A pilot study

BMC Psychiatry

Christian Rück¹  Nils Lindefors¹  Gerhard Andersson²  Björn Paxling²  Viktor Kaldo¹  Erik Hedman¹  Brjánn Ljótsson¹  Erik Andersson¹ 

[1] Department of Clinical Neuroscience, Division of psychiatry, Karolinska Institutet, Stockholm, Sweden;Department of Behavioural Sciences and Learning, Swedish Institute for Disability Research, Linköping University, Linköping, Sweden

关键词: obsessive compulsive disorder;    Internet;    Cognitive behavior therapy;   

Others  :  1124511
DOI  :  10.1186/1471-244X-11-125

 received in 2011-05-31, accepted in 2011-08-03,  发布年份 2011

【 摘 要 】

Background

Cognitive behavior therapy (CBT) is widely regarded as an effective treatment for obsessive compulsive disorder (OCD), but access to CBT therapists is limited. Internet-based CBT (ICBT) with therapist support is a way to increase access to CBT but has not been developed or tested for OCD. The aim of this study was to evaluate ICBT for OCD.

Method

An open trial where patients (N = 23) received a 15-week ICBT program with therapist support consisting of psychoeducation, cognitive restructuring and exposure with response prevention. The primary outcome was the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), which was assessed by a psychiatrist before and immediately after treatment. Secondary outcomes were self-rated measures of OCD symptoms, depressive symptoms, general functioning, anxiety and quality of life. All assessments were made at baseline and post-treatment.

Results

All participants completed the primary outcome measure at all assessment points. There were reductions in OCD symptoms with a large within-group effect size (Cohen's d = 1.56). At post-treatment, 61% of participants had a clinically significant improvement and 43% no longer fulfilled the diagnostic criteria of OCD. The treatment also resulted in statistically significant improvements in self-rated OCD symptoms, general functioning and depression.

Conclusions

ICBT with therapist support reduces OCD symptoms, depressive symptoms and improves general functioning. Randomized trials are needed to confirm the effectiveness of this new treatment format.

Trial Registration

ClinicalTrials.gov: NCT01348529

【 授权许可】

   
2011 Andersson et al; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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【 参考文献 】

• [1]Abramowitz JS: Understanding and treating obsessive-compulsive disorder: A cognitive-behavioral approach. NJ: Lawrence Erlbaum; 2006.
• [2]Jacobi F, et al.: Estimating the prevalence of mental and somatic disorders in the community: aims and methods of the German National Health Interview and Examination Survey. Int J Methods Psychiatr Res 2002, 11(1):1-18.
• [3]Fullana MA, et al.: Obsessive-compulsive symptom dimensions in the general population: Results from an epidemiological study in six European countries. J Affect Disord 2009.
• [4]Abramowitz J, Houts A: Concepts and controversies in obsessive-compulsive disorder. New York: Springer; 2005.
• [5]Foa EB: Cognitive behavioral therapy of obsessive-compulsive disorder. Dialogues Clin Neurosci 2010, 12(2):199-207.
• [6]Larsson BPM, Kaldo V, Broberg AG: Similarities and differences between practitioners of psychotherapy in Sweden: A comparison of attitudes between psychodynamic, cognitive, cognitive-behavioral, and integrative therapists. Journal of Psychotherapy Integration 2009, 19(1):34-66.
• [7]Goisman RM, et al.: Utilization of behavioral methods in a multicenter anxiety disorders study. J Clin Psychiatry 1993, 54(6):213-8.
• [8]Mataix-Cols D, Marks IM: Self-help with minimal therapist contact for obsessive-compulsive disorder: a review. Eur Psychiatry 2006, 21(2):75-80.
• [9]Cuijpers P, et al.: Is guided self-help as effective as face-to-face psychotherapy for depression and anxiety disorders? A systematic review and meta-analysis of comparative outcome studies. Psychological Medicine 2010, 40(12):1943-1957.
• [10]Cuijpers P, et al.: Self-guided psychological treatment for depressive symptoms: a meta-analysis. PLoS One 6(6):e21274.
• [11]Fritzler BK, Hecker JE, Losee MC: Self-directed treatment with minimal therapist contact: preliminary findings for obsessive-compulsive disorder. Behav Res Ther 1997, 35(7):627-31.
• [12]Lovella K, et al.: A pilot study of a self-help manual with minimal therapist contact in the treatment of obsessive-compulsive disorder. Clinical Effectiveness in Nursing 2004, 8(2):122-127.
• [13]Tolin DF, et al.: A randomized controlled trial of self-directed versus therapist-directed cognitive-behavioral therapy for obsessive-compulsive disorder patients with prior medication trials. Behav Ther 2007, 38(2):179-91.
• [14]Moritz S, et al.: How to treat the untreated: effectiveness of a self-help metacognitive training program (myMCT) for obsessive-compulsive disorder. Dialogues Clin Neurosci 2010, 12(2):209-20.
• [15]Clark A, et al.: A pilot study of computer-aided vicarious exposure for obsessive-compulsive disorder. Aust N Z J Psychiatry 1998, 32(2):268-75.
• [16]Marks IM, et al.: Home self-assessment of obsessive-compulsive disorder. Use of a manual and a computer-conducted telephone interview: two UK-US studies. Br J Psychiatry 1998, 172:406-12.
• [17]Bachofen M, et al.: Home self-assessment and self-treatment of obsessive-compulsive disorder using a manual and a computer-conducted telephone interview: replication of a UK-US study. J Clin Psychiatry 1999, 60(8):545-9.
• [18]Greist JH, et al.: Self-treatment for obsessive compulsive disorder using a manual and a computerized telephone interview: a U.S.-U.K. study. MD Comput 1998, 15(3):149-57.
• [19]Greist JH, et al.: Behavior therapy for obsessive-compulsive disorder guided by a computer or by a clinician compared with relaxation as a control. J Clin Psychiatry 2002, 63(2):138-45.
• [20]Kenwright M, et al.: Brief scheduled phone support from a clinician to enhance computer-aided self-help for obsessive-compulsive disorder: randomized controlled trial. J Clin Psychol 2005, 61(12):1499-508.
• [21]Palmqvist B, Carlbring P, Andersson G: Internet-delivered treatments with or without therapist input: does the therapist factor have implications for efficacy and cost? Expert Rev Pharmacoecon Outcomes Res 2007, 7(3):291-7.
• [22]Andersson G: Using the Internet to provide cognitive behaviour therapy. Behav Res Ther 2009, 47(3):175-80.
• [23]Hedman E, et al.: Internet-Based Cognitive Behavior Therapy vs. Cognitive Behavioral Group Therapy for Social Anxiety Disorder: A Randomized Controlled Non-inferiority Trial. PLoS One 2011, 6(3):e18001.
• [24]Ljotsson B, et al.: Internet-delivered exposure and mindfulness based therapy for irritable bowel syndrome--a randomized controlled trial. Behav Res Ther 2010, 48(6):531-9.
• [25]Hedman E, et al.: Internet-based cognitive-behavioural therapy for severe health anxiety: randomised controlled trial. Br J Psychiatry 2011, 198(3):230-6.
• [26]Griffiths F, et al.: Why are health care interventions delivered over the internet? A systematic review of the published literature. J Med Internet Res 2006, 8(2):e10.
• [27]American Psychiatric Association: Diagnostic and statistical manual of mental disorders: DSM-IV-TR. Volume xxxvii. 4th edition. Washington, DC: American Psychiatric Association; 2000::943.
• [28]First MB, et al.: Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) (Swedish Version). Danderyd: Pilgrim Press; 1999.
• [29]Sheehan DV, et al.: 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. J Clin Psychiatry 1998, 59(Suppl 20):22-33.
• [30]Goodman WK, et al.: The Yale-Brown Obsessive Compulsive Scale. I. Development, use, and reliability. Arch Gen Psychiatry 1989, 46(11):1006-11.
• [31]Steketee G, Frost RO: Compulsive hoarding and acquiring: therapist guide. Volume vii. New York; Oxford: Oxford University Press; 2007::226.
• [32]Mataix-Cols D, et al.: Hoarding disorder: a new diagnosis for DSM-V? Depress Anxiety 2010, 27(6):556-72.
• [33]Rosenfeld R, et al.: A computer-administered version of the Yale-Brown Obsessive-Compulsive Scale. Psychological Assessment 1992, 4(3):329-332.
• [34]Foa EB, et al.: The Obsessive-Compulsive Inventory: development and validation of a short version. Psychol Assess 2002, 14(4):485-96.
• [35]Svanborg P, Åsberg M: A new self-rating scale for depression and anxiety states based on the Comprehensive Psychopathological Rating Scale. Acta Psychiatr Scand 1994, 89(1):21-8.
• [36]Saunders JB, et al.: Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption. Addiction 1993, 88(6):791-804.
• [37]Berman AH, et al.: Evaluation of the Drug Use Disorders Identification Test (DUDIT) in criminal justice and detoxification settings and in a Swedish population sample. Eur Addict Res 2005, 11(1):22-31.
• [38]Sheehan DV, et al.: 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. J Clin Psychiatry 1998, 59(Suppl 20):22-33. quiz 34-57
• [39]Guy W, ed: Clinical Global Impressions. US Department of Health and Human services: Rockville; 1976.
• [40]Zaider TI, et al.: Evaluation of the clinical global impression scale among individuals with social anxiety disorder. Psychol Med 2003, 33(4):611-22.
• [41]Jones SH, et al.: A brief mental health outcome scale-reliability and validity of the Global Assessment of Functioning (GAF). Br J Psychiatry 1995, 166(5):654-9.
• [42]Baer L, Blais MA: Handbook of clinical rating scales and assessment in psychiatry and mental health. In Current clinical psychiatry. Volume xxi. New York: Humana Press; 2010::320.
• [43]Federici A, et al.: Consistency between self-report and clinician-administered versions of the Yale-Brown Obsessive-Compulsive Scale. J Anxiety Disord 2010, 24(7):729-33.
• [44]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.
• [45]Svanborg P, Asberg M: A comparison between the Beck Depression Inventory (BDI) and the self-rating version of the Montgomery Asberg Depression Rating Scale (MADRS). J Affect Disord 2001, 64(2-3):203-16.
• [46]Hollandare F, Andersson G, Engstrom I: A comparison of psychometric properties between internet and paper versions of two depression instruments (BDI-II and MADRS-S) administered to clinic patients. J Med Internet Res 2010, 12(5):e49.
• [47]Meyer TJ, et al.: Development and validation of the Penn State Worry Questionnaire. Behav Res Ther 1990, 28(6):487-95.
• [48]Zlomke KR: Psychometric properties of internet administered versions of Penn State Worry Questionnaire (PSWQ) and Depression, Anxiety, and Stress Scale (DASS). Computers in Human Behavior 2009, 25(4):841-843.
• [49]EuroQol-Group: EuroQol - a new facility for the measurement of health-related quality of life. Health Policy 1990, 16(3):199-208.
• [50]Rabin R, Charro Fd: EQ-SD: a measure of health status from the EuroQol Group. Annals of Medicine 2001, 33(5):337-343.
• [51]Ravens-Sieberer U, et al.: Feasibility, reliability, and validity of the EQ-5D-Y: results from a multinational study. Quality of Life Research 2010, 19(6):887-897.
• [52]Shervin N, et al.: Comparison of paper and computer-based questionnaire modes for measuring health outcomes in patients undergoing total hip arthroplasty. J Bone Joint Surg Am 93(3):285-93.
• [53]Frisch MB, et al.: Clinical validation of the Quality of Life Inventory. A measure of life satisfaction for use in treatment planning and outcome assessment. Psychological Assessment 1992, 4(1):92-101.
• [54]Carlbring P, et al.: Internet vs. paper and pencil administration of questionnaires commonly used in panic/agoraphobia research. Computers in Human Behavior 2007, 23(3):1421-1434.
• [55]Hedman E, et al.: Internet administration of self-report measures commonly used in research on social anxiety disorder: A psychometric evaluation. Computers in Human Behavior 2010, 26(4):736-740.
• [56]Abramowitz JS: Getting over OCD: a 10-step workbook for taking back your life. In The Guilford self-help workbook series. Volume x. New York: Guilford Press; 2009::307.
• [57]Jacobson NS, Truax P: Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. J Consult Clin Psychol 1991, 59(1):12-9.
• [58]Tolin DF, Abramowitz JS, Diefenbach GJ: Defining response in clinical trials for obsessive-compulsive disorder: a signal detection analysis of the Yale-Brown obsessive compulsive scale. J Clin Psychiatry 2005, 66(12):1549-57.
• [59]Andrews G, et al.: Computer therapy for the anxiety and depressive disorders is effective, acceptable and practical health care: a meta-analysis. PLoS One 2010, 5(10):e13196.
• [60]Oldfield VB, Salkovskis PM, Taylor T: Time-intensive cognitive behaviour therapy for obsessive-compulsive disorder: A case series and matched comparison group. Br J Clin Psychol 2011, 50(1):7-18.
• [61]Andersson G, et al.: Development of a New Approach to Guided Self-Help via the Internet: The Swedish Experience. Journal of Technology in Human Services 2008, 26(2-4):161-181.
• [62]Lindsay M, Crino R, Andrews G: Controlled trial of exposure and response prevention in obsessive-compulsive disorder. Br J Psychiatry 1997, 171:135-9.
• [63]Twohig MP, et al.: A randomized clinical trial of acceptance and commitment therapy versus progressive relaxation training for obsessive-compulsive disorder. J Consult Clin Psychol 2010, 78(5):705-16.
• [64]Foa EB, et al.: Randomized, placebo-controlled trial of exposure and ritual prevention, clomipramine, and their combination in the treatment of obsessive-compulsive disorder. Am J Psychiatry 2005, 162(1):151-61.
• [65]Mataix-Cols D, et al.: Effect of referral source on outcome with cognitive-behavior therapy self-help. Compr Psychiatry 2006, 47(4):241-5.