Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden.
Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.
Br J Clin Psychol. 2022 Nov;61(4):964-982. doi: 10.1111/bjc.12369. Epub 2022 Apr 16.
The current study evaluated the feasibility of an internet-delivered cognitive therapy (I-CT) in a self-help format with minimal therapist support for patients with obsessive-compulsive disorder (OCD) with primary taboo obsessions. Specifically, the aims were to investigate (1) whether participants were able to grasp and apply the internet-delivered cognitive framework to their own situation; (2) whether they had clinically meaningful reductions of OCD symptom severity; and (3) whether reduced negative appraisals (hypothesized mechanism of change in CT) preceded reductions in OCD symptom severity.
Nineteen OCD patients with primary taboo obsessions, recruited from an OCD clinic or self-referrals, received the I-CT intervention for 10 weeks. I-CT did not contain any systematic exposure or response prevention.
Adherence and engagement with the intervention was high. Most participants (n = 13, 68%) understood and successfully applied the cognitive model to their own situation. Within-group analyses showed large reductions in OCD symptom severity at post-treatment (bootstrapped within group d = 1.67 [95% CI; 0.67 to 2.66]) measured with the Yale-Brown Obsessive-Compulsive Scale. The gains were maintained at the 6-month follow-up. Post-hoc analyses revealed that the large reductions in OCD symptom severity were driven by the participants who understood the cognitive model. Reductions in negative appraisals predicted subsequent reductions in OCD symptom severity during treatment.
It is possible to adapt a purely cognitive intervention to a digital guided self-help format and to achieve both cognitive change and meaningful symptom reduction. The results require confirmation in a randomized clinical trial.
本研究评估了一种互联网认知疗法（I-CT）在自我帮助模式下的可行性，该模式仅提供最低限度的治疗师支持，适用于存在主要禁忌强迫观念的强迫症（OCD）患者。具体而言，目的是调查：（1）参与者是否能够理解并将互联网提供的认知框架应用于自身情况；（2）他们是否具有临床意义的 OCD 症状严重程度降低；以及（3）负面评估的减少（CT 假设的变化机制）是否先于 OCD 症状严重程度的降低。
19 名患有主要禁忌强迫观念的 OCD 患者，从 OCD 诊所或自我推荐中招募，接受为期 10 周的 I-CT 干预。I-CT 不包含任何系统的暴露或反应预防。
对干预的依从性和参与度很高。大多数参与者（n=13，68%）理解并成功地将认知模型应用于自身情况。组内分析显示，在治疗后 OCD 症状严重程度有很大的降低（Bootstrapped within group d=1.67[95%CI；0.67 至 2.66]），用耶鲁-布朗强迫症量表（Yale-Brown Obsessive-Compulsive Scale）测量。在 6 个月的随访中，这些改善得到了维持。事后分析表明，OCD 症状严重程度的大幅降低是由理解认知模型的参与者驱动的。负面评估的减少预测了治疗期间 OCD 症状严重程度的后续降低。
可以将纯粹的认知干预适应为数字引导的自助格式，并实现认知改变和有意义的症状减轻。结果需要在随机临床试验中得到确认。
