Internet-Based Cognitive-Behavioral Therapy May Help Youth With OCD

Internet-based, therapist guided cognitive-behavior therapy (ICBT) appears to be a promising low-intensity intervention for adolescents with obsessive-compulsive disorder (OCD), according to a report in the Journal of the American Academy of Adolescent and Child Psychiatry. The study found that adolescents with OCD who participated in a ICBT program experienced significant symptom improvements after 12 weeks. 

While randomized, controlled trials have demonstrated the efficacy of ICBT in adults with OCD, this study was one of the first to evaluate the effectiveness of therapist-guided ICBT for adolescents with the disorder. 

Researchers at several Swedish institutions randomly assigned 67 adolescents (aged 12 to 17) with OCD to a 12-week clinician- and parent-supported ICBT program or a waitlist condition. (Some of the participants lived more than 200 miles from the clinic, the authors noted.) Using a personal password-secured account, youth and parents in the ICBT group were invited to learn about OCD and the rationale for cognitive-behavioral interventions and perform exposure with response prevention (ERP) exercises and cognitive strategies; the intervention also offered tips on problem solving and relapse prevention.

Youth were assessed at the start of the study, after 12 weeks, and three months after ICBT. The primary outcome was the Children Yale-Brown Obsessive Compulsive Scale (CY-BOCS).

The researchers found that at posttreatment, the group receiving the intervention had significantly lower CY-BOCS total scores compared with the waitlist group. The intervention group also showed further improvement from posttreatment to three-month follow up. Average clinician support time was 17.5 minutes per patient per week. Additionally, 28 of the waitlist patients crossed over to ICBT at 12 weeks and experienced a significant improvement on the CY-BOCS.

“The per-patient clinician time spent supporting the patients was approximately a third to a fourth the time that would have been necessary in standard face-to-face CBT, suggesting that ICBT has great potential to increase the capacity of mental health services to treat more patients with the available resources,” including those who may have limited access to a clinic for in-person treatment, the authors wrote. “ICBT could be a promising first step in a stepped-care model, freeing resources for face-to-face CBT and medication as a second step for non-responders and/or more complex cases.”

For related information, see the Psychiatric News article “Online CBT-I Program May Reduce Depression, Anxiety Symptoms.”

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