Department of Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
Department of Psychotherapy and Psychiatry, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
Depress Anxiety. 2020 Dec;37(12):1208-1220. doi: 10.1002/da.23105. Epub 2020 Nov 10.
Many individuals with obsessive-compulsive disorder (OCD) do not receive professional treatment due to various idiosyncratic barriers. Internet-based cognitive-behavioral therapy (iCBT) is increasingly used to narrow treatment gaps, but the efficacy of such interventions without guidance of therapists has not been well studied. This study evaluated the efficacy of an unguided iCBT that includes third-wave approaches for the treatment of OCD symptoms.
A total of 128 individuals with self-reported OCD symptoms were randomly allocated to either an intervention group (unguided iCBT) or to a care-as-usual (CAU) control group following an anonymous baseline assessment via an online survey. Eight weeks after inclusion, a reassessment was carried out online. The Yale-Brown Obsessive-Compulsive Scale served as the primary outcome parameter for detecting symptom changes in the per-protocol sample with at least 60 minutes utilization.
The iCBT group showed a significantly stronger reduction of OCD symptoms with a medium effect size (η² = 0.06) compared with the control condition. This effect was moderated by the general frequency of Internet usage (η² = 0.08); the more time per day users spent online, the less they benefited from the intervention. Secondary outcomes revealed (1) a medium effect size on self-esteem (η² = 0.06); (2) no statistically significant effects on quality of life, depression symptoms, impulsivity, or social insecurity; and (3) good acceptability of the intervention.
The current study provides evidence that unguided iCBT for OCD may be a viable option for individuals who experience treatment barriers. As non-compliance remains a challenge, this topic needs further research.
许多强迫症（OCD）患者由于各种特殊障碍而未接受专业治疗。基于互联网的认知行为疗法（iCBT）越来越多地用于缩小治疗差距，但未经治疗师指导的此类干预措施的疗效尚未得到很好的研究。本研究评估了一种无指导的 iCBT 治疗方法，该方法包括用于治疗 OCD 症状的第三波方法。
共有 128 名自我报告有 OCD 症状的个体在通过在线调查进行匿名基线评估后，被随机分配到干预组（无指导的 iCBT）或对照组（常规护理）。纳入 8 周后，在线进行重新评估。耶鲁-布朗强迫症量表（Yale-Brown Obsessive-Compulsive Scale）是检测方案样本中症状变化的主要结果参数，方案样本要求至少使用 60 分钟。
与对照组相比，iCBT 组的 OCD 症状明显减轻，具有中等效果大小（η² = 0.06）。该效果受到互联网使用一般频率的调节（η² = 0.08）；用户每天在线花费的时间越多，他们从干预中获益就越少。次要结果显示：（1）自尊方面有中等效果大小（η² = 0.06）；（2）生活质量、抑郁症状、冲动性或社交不安全感没有统计学上的显著影响；（3）干预措施的可接受性良好。
本研究提供了证据表明，针对 OCD 的无指导 iCBT 可能是那些经历治疗障碍的个体的可行选择。由于不依从仍然是一个挑战，因此这个话题需要进一步研究。
