Turner Cynthia M, Mataix-Cols David, Lovell Karina, Krebs Georgina, Lang Katie, Byford Sarah, Heyman Isobel
University of Queensland, Brisbane, Australia.
Institute of Psychiatry, Psychology, and Neuroscience, King's College London, and the Karolinska Institutet, Stockholm.
J Am Acad Child Adolesc Psychiatry. 2014 Dec;53(12):1298-1307.e2. doi: 10.1016/j.jaac.2014.09.012. Epub 2014 Sep 30.
Many adolescents with obsessive-compulsive disorder (OCD) do not have access to evidence-based treatment. A randomized controlled non-inferiority trial was conducted in a specialist OCD clinic to evaluate the effectiveness of telephone cognitive-behavioral therapy (TCBT) for adolescents with OCD compared to standard clinic-based, face-to-face CBT.
Seventy-two adolescents, aged 11 through 18 years with primary OCD, and their parents were randomized to receive specialist TCBT or CBT. The intervention provided differed only in the method of treatment delivery. All participants received up to 14 sessions of CBT, incorporating exposure with response prevention (E/RP), provided by experienced therapists. The primary outcome measure was the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS). Blind assessor ratings were obtained at midtreatment, posttreatment, 3-month, 6-month, and 12-month follow-up.
Intent-to-treat analyses indicated that TCBT was not inferior to face-to-face CBT at posttreatment, 3-month, and 6-month follow-up. At 12-month follow-up, there were no significant between-group differences on the CY-BOCS, but the confidence intervals exceeded the non-inferiority threshold. All secondary measures confirmed non-inferiority at all assessment points. Improvements made during treatment were maintained through to 12-month follow-up. Participants in each condition reported high levels of satisfaction with the intervention received.
TCBT is an effective treatment and is not inferior to standard clinic-based CBT, at least in the midterm. This approach provides a means of making a specialized treatment more accessible to many adolescents with OCD. Clinical trial registration information-Evaluation of telephone-administered cognitive-behaviour therapy (CBT) for young people with obsessive-compulsive disorder (OCD); http://www.controlled-trials.com; ISRCTN27070832.
许多患有强迫症（OCD）的青少年无法获得循证治疗。在一家专业的强迫症诊所进行了一项随机对照非劣效性试验，以评估电话认知行为疗法（TCBT）相较于基于门诊的标准面对面认知行为疗法（CBT）对患有强迫症的青少年的有效性。
72名年龄在11至18岁的原发性强迫症青少年及其父母被随机分配接受专业的TCBT或CBT。提供的干预措施仅在治疗方式上有所不同。所有参与者均接受了由经验丰富的治疗师提供的多达14节包含暴露与反应阻止（E/RP）的CBT课程。主要结局指标是儿童耶鲁-布朗强迫症量表（CY-BOCS）。在治疗中期、治疗后、3个月、6个月和12个月随访时获得盲法评估者评分。
意向性分析表明，在治疗后、3个月和6个月随访时，TCBT并不劣于面对面CBT。在12个月随访时，CY-BOCS的组间差异无统计学意义，但置信区间超过了非劣效性阈值。所有次要指标均证实了在所有评估点的非劣效性。治疗期间取得的改善一直维持到12个月随访。每种治疗条件下的参与者对所接受的干预措施均表示高度满意。
TCBT是一种有效的治疗方法，至少在中期并不劣于基于门诊的标准CBT。这种方法为许多患有强迫症的青少年提供了一种更容易获得专业治疗的途径。临床试验注册信息 - 电话认知行为疗法（CBT）对患有强迫症（OCD）的年轻人的评估；http://www.controlled-trials.com；ISRCTN27070832 。
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