Aspvall Kristina, Lenhard Fabian, Melin Karin, Krebs Georgina, Norlin Lisa, Näsström Kristina, Jassi Amita, Turner Cynthia, Knoetze Elizabeth, Serlachius Eva, Andersson Erik, Mataix-Cols David
Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Sweden.
Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Internet Interv. 2020 Jan 27;20:100308. doi: 10.1016/j.invent.2020.100308. eCollection 2020 Apr.
Obsessive-compulsive disorder (OCD) can be successfully treated with cognitive behaviour therapy (CBT). However, as few patients have access to CBT, there is a strong push to develop and evaluate scalable and cost-effective internet-delivered interventions. BIP OCD is a therapist-guided online CBT intervention for pediatric OCD that has shown promise in trials conducted at a single site in Stockholm, Sweden. In this study, we evaluated if BIP OCD is an acceptable, feasible, and effective treatment in other countries and clinical contexts. Thirty-one patients were recruited at three different sites; a specialist OCD clinic in Gothenburg (Sweden), a specialist OCD clinic in London (United Kingdom), and a university-based clinic in Brisbane (Australia). Acceptability and feasibility measures included treatment adherence and feedback from therapists. Clinician assessments were conducted at baseline, post-treatment, and 3-month follow-up. The average module completion for the participants was 8.1/12 (SD = 3.2) and the majority of patients completed the BIP OCD treatment (100% in Gothenburg, and 55.6% in both London and Brisbane). Pooling data from the three sites, the within-group effect sizes from baseline to post-treatment on the Children's Yale-Brown Obsessive-Compulsive Scale were in the expected range (bootstrapped Cohen's = 1.78; 95% CI 1.18-2.39), with an additional symptom reduction to the 3-month follow-up (bootstrapped Cohen's = 0.27; 95% CI 0.02-0.51). Participating therapists identified both advantages and difficulties supporting patients in this digital format. The results of this study suggest that the treatment effects obtained in the original BIP OCD trials can be generalized to other clinical contexts nationally and internationally. Lessons learned provide important information for successful implementation of BIP OCD in regular healthcare contexts.
强迫症（OCD）可通过认知行为疗法（CBT）成功治疗。然而，由于很少有患者能够接受CBT治疗，因此大力推动开发和评估可扩展且具有成本效益的互联网干预措施。BIP OCD是一种由治疗师指导的针对儿童强迫症的在线CBT干预措施，在瑞典斯德哥尔摩的一个单一地点进行的试验中已显示出前景。在本研究中，我们评估了BIP OCD在其他国家和临床环境中是否为可接受、可行且有效的治疗方法。在三个不同地点招募了31名患者；分别是瑞典哥德堡的一家专业强迫症诊所、英国伦敦的一家专业强迫症诊所和澳大利亚布里斯班的一家大学诊所。可接受性和可行性指标包括治疗依从性和治疗师的反馈。在基线、治疗后和3个月随访时进行临床评估。参与者的平均模块完成数为8.1/12（标准差 = 3.2），大多数患者完成了BIP OCD治疗（哥德堡为100%，伦敦和布里斯班均为55.6%）。汇总来自三个地点的数据，从基线到治疗后，儿童耶鲁-布朗强迫症量表的组内效应大小在预期范围内（自抽样Cohen's = 1.78；95%置信区间1.18 - 2.39），到3个月随访时症状进一步减轻（自抽样Cohen's = 0.27；95%置信区间0.02 - 0.51）。参与的治疗师指出了以这种数字形式支持患者的优点和困难。本研究结果表明，最初BIP OCD试验中获得的治疗效果可以推广到国内和国际的其他临床环境。所吸取的经验教训为在常规医疗环境中成功实施BIP OCD提供了重要信息。
