Department of Psychology, University of Graz, Graz, Austria.
Clin Psychol Psychother. 2024 May-Jun;31(3):e2989. doi: 10.1002/cpp.2989.
Obsessive-compulsive disorder (OCD) is a common mental health condition characterized by distressing, intrusive thoughts (obsessions) and repetitive behaviours (compulsions) aimed at reducing anxiety. Internet-based cognitive behavioural therapy (ICBT) has emerged as an effective treatment modality for various mental health disorders. This meta-analysis evaluates the efficacy of guided self-help ICBT (GSH ICBT) and unguided self-help ICBT (SH ICBT) against active and passive control conditions in adults with OCD. A comprehensive systematic literature search yielded 12 randomized controlled trials (RCTs) comprising 15 comparison arms (N = 1416) that met the inclusion criteria. Results indicate that GSH ICBT significantly reduced OCD symptomatology posttreatment compared to active controls (g = 0.378, k = 9), with no significant effects maintained at follow-up (g = 0.153, k = 4). GSH ICBT was also found to be as effective as active CBT interventions in reducing comorbid anxiety and depression symptoms posttreatment (g = 0.278, k = 6) and at follow-up (g = 0.124, k = 4). However, improvements in quality of life were not significant posttreatment (g = 0.115, k = 4) nor at follow-up (g = 0.179, k = 3). Combined GSH and SH ICBT demonstrated large effects on reducing OCD symptoms (g = 0.754, k = 6), medium effects on comorbid symptoms (g = 0.547, k = 6) and small effects on quality of life (g = 0.227, k = 2) when compared to inactive controls. No significant differences were found between GSH and SH ICBT in all measured outcomes posttreatment (OCD: g = 0.098, k = 3; AD: g = 0.070, k = 3; QoL: g = -0.030, k = 1) and at follow-up (OCD: g = 0.265, k = 2; AD: g = 0.084, k = 2; QoL: g = 0.00, k = 1). Sample size was identified as a significant moderator of treatment effects. This paper further explores clinical significance, treatment adherence, therapist time investment and moderator influences of the ICBT. The limitations of the study and recommendations for future research are thoroughly discussed.
强迫症（OCD）是一种常见的心理健康障碍，其特征为令人痛苦、侵入性的想法（强迫症）和重复行为（强迫症），旨在减轻焦虑。基于互联网的认知行为疗法（ICBT）已成为治疗各种心理健康障碍的有效方法。本荟萃分析评估了指导自助 ICBT（GSH ICBT）和自助 ICBT（SH ICBT）与活跃和被动对照条件相比，在治疗强迫症成人中的疗效。全面的系统文献检索产生了 12 项符合纳入标准的随机对照试验（RCT），共 15 个比较组（N=1416）。结果表明，与积极对照相比，GSH ICBT 在治疗后显著降低了强迫症症状（g=0.378，k=9），但在随访时没有持续的显著效果（g=0.153，k=4）。GSH ICBT 也被发现与积极的 CBT 干预一样有效，可降低治疗后共病焦虑和抑郁症状（g=0.278，k=6）和随访时的症状（g=0.124，k=4）。然而，治疗后生活质量的改善并不显著（g=0.115，k=4），随访时也不显著（g=0.179，k=3）。与非活动对照相比，联合 GSH 和 SH ICBT 对降低强迫症症状有较大影响（g=0.754，k=6），对共病症状有中等影响（g=0.547，k=6），对生活质量有较小影响（g=0.227，k=2）。在治疗后（OCD：g=0.098，k=3；AD：g=0.070，k=3；QoL：g=-0.030，k=1）和随访时（OCD：g=0.265，k=2；AD：g=0.084，k=2；QoL：g=0.00，k=1），GSH 和 SH ICBT 在所有测量结果上均未发现显著差异。在治疗效果方面，样本量被确定为一个重要的调节因素。本文进一步探讨了 ICBT 的临床意义、治疗依从性、治疗师时间投入和调节因素的影响。彻底讨论了研究的局限性和对未来研究的建议。
