University of Virginia.
Johns Hopkins University School of Medicine and University of California, Los Angeles.
Behav Ther. 2024 Mar;55(2):306-319. doi: 10.1016/j.beth.2023.07.005. Epub 2023 Jul 18.
The current study investigates a novel digital tool designed to address barriers to out-of-session homework adherence in exposure with response prevention (ERP) for child obsessive-compulsive disorder (OCD). The OC-Go platform allows clinicians to create and push tailored interactive protocol- or symptom-specific assignments to patients on their mobile devices, providing in-the-moment step-by-step directions, encouragement, accountability, and a sense of therapeutic presence for patients during out-of-office exposures. The platform also facilitates objective measurement of homework and allows providers to support one another through a shared and searchable crowdsourced library with hundreds of assignable exposures and psychoeducation activities for specific OCD symptoms. The current study tested the usability and feasibility of the OC-Go platform with ERP stakeholders (OCD therapists, patients, and parents; N = 172) using the System Usability Scale (SUS). The study also tested the efficacy of OC-Go for augmenting homework adherence and clinical response using a randomized controlled, crossover design in a sample of 28 treatment-seeking youth with OCD. Participants randomized to standard ERP exhibited a homework adherence rate of 68.4% (95% CI [65.6, 71.0]), those randomized to ERP with OC-Go exhibited a greater adherence rate of 83.3% (95% CI [80.8, 85.6], p < .001). Both groups experienced large declines in Children's Yale-Brown Obsessive-Compulsive Scale-rated OCD (d = 1.31, p < .001), though participants randomized to begin ERP with OC-Go exhibited clinically significant greater improvement (p = .05), translating into an additional augmented treatment response at the Week 6 primary end point (d = 0.36) and the Week 12 treatment end point (d = 0.72). Stakeholders rated OC-Go in the 90th percentile for usability on the SUS, indicative of a highly usable and easy-to-learn technology. Initial evidence supports OC-Go as a feasible and effective adjunct to improve out-of-office exposure measurement, adherence, and treatment response in ERP for child OCD.
本研究调查了一种新的数字工具，旨在解决暴露反应预防（ERP）治疗儿童强迫症（OCD）中课外作业依从性的障碍。OC-Go 平台允许临床医生在患者的移动设备上创建和推送量身定制的互动协议或症状特异性作业，为患者提供即时的逐步指导、鼓励、问责制和治疗存在感，以帮助患者在课外暴露时完成作业。该平台还便于对作业进行客观测量，并通过一个共享的、可搜索的众包库为提供者提供支持，该库中有数百种可分配的暴露和特定 OCD 症状的心理教育活动。本研究使用系统可用性量表（SUS）对 OC-Go 平台的可用性和可行性进行了测试，参与者包括 ERP 利益相关者（OCD 治疗师、患者和家长；N=172）。研究还采用随机对照、交叉设计，在 28 名寻求治疗的 OCD 青少年样本中测试了 OC-Go 增强作业依从性和临床反应的效果。随机分配到标准 ERP 的参与者表现出 68.4%（95%CI[65.6，71.0]）的作业依从率，随机分配到 OC-Go 加 ERP 的参与者表现出更高的 83.3%（95%CI[80.8，85.6]，p<.001）。两组儿童耶鲁布朗强迫症量表（CY-BOCS）评定的 OCD 均有较大程度的下降（d=1.31，p<.001），但随机分配先接受 OC-Go 加 ERP 的参与者表现出更大的临床显著改善（p=.05），这转化为第 6 周主要终点（d=0.36）和第 12 周治疗终点（d=0.72）的额外增强治疗反应。利益相关者在 SUS 上对 OC-Go 的评价为第 90 个百分位，表明这是一种非常可用和易于学习的技术。初步证据支持 OC-Go 作为一种可行且有效的辅助手段，可提高 ERP 治疗儿童 OCD 时的课外暴露测量、依从性和治疗反应。
