Center for Psychiatry Research, Karolinska Institutet, Stockholm, and Stockholm Health Care Services, Stockholm County Council, Sweden.
Division of Psychology, Karolinska Institutet.
J Am Acad Child Adolesc Psychiatry. 2017 Jan;56(1):10-19.e2. doi: 10.1016/j.jaac.2016.09.515. Epub 2016 Oct 25.
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.
Sixty-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.
In 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.
Therapist-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.
认知行为疗法（CBT）是治疗青少年强迫症（OCD）的首选方法，但大多数患者无法获得这种治疗。因此，需要创新的方法来增加 CBT 的可及性。本试验旨在评估治疗师指导的基于互联网的认知行为疗法（ICBT）治疗青少年 OCD 的疗效。
67 名（12-17 岁）青少年 OCD 患者被随机分配至 12 周的临床医生和家长支持的 ICBT （BiP OCD）或候补组。主要结局指标是由盲法评估者在干预前后使用儿童耶鲁-布朗强迫症量表（CY-BOCS）评估。所有患者在干预后 3 个月进行随访。
在意向治疗分析中，BiP OCD 在 CY-BOCS 上优于候补组（时间-组交互作用，B =-4.53，z =-3.74，p<.001；Cohen's d =0.69；95%CI 0.19-1.18）和大多数次要结局测量指标。随机分配至 BiP OCD 的患者在治疗后至 3 个月随访期间也表现出进一步的改善，组内从治疗前到随访的效应大小（Cohen's d）等于 1.68（95%CI 1.00-2.36）。患者对 BiP OCD 的满意度较高。无相关不良事件。平均每周每位患者的治疗师支持时间为 17.5 分钟。
治疗师指导的 ICBT 是一种有前途的针对青少年 OCD 的低强度干预措施，有可能增加 CBT 的可及性。在阶梯式治疗方法中，它可能特别有用，对于中度严重 OCD 的大多数患者，首先可以提供 ICBT，从而为更复杂的病例释放有限的资源。临床试验注册信息-互联网治疗青少年 OCD：一项随机对照研究（BiPOCD）；http://clinicaltrials.gov；NCT02191631。
