Obsessive-Compulsive Disorder (OCD) in children and adolescents is associated with poor education and deterioration in general health later in life. Access to specialized treatment is often limited. According to a study by the Psychiatry Research Center of the Karolinska Institutet in Sweden and the Stockholm region, cognitive behavioral therapy (CBT) provided over the Internet can be as effective as conventional CBT. The study, published in the journal JAMA, can help make treatment for OCD more accessible.
Obsessive-Compulsive Disorder (OCD) is a potentially serious mental disorder that normally begins in childhood.
Symptoms include intrusive thoughts that trigger anxiety (obsessions) and associated repetitive behaviors (compulsions), which are distressing and time consuming.
Early diagnosis and treatment are essential to minimize the long-term medical and socio-economic consequences of the disorder, including the risk of suicide.
The psychological treatment of OCD requires highly trained therapists and access to this type of skill is currently limited to a handful of specialist centers across Sweden.
Previous research has shown that while CBT helps the majority of young people who receive it, it can take several years between the onset of symptoms and receiving treatment.
Researchers at the Karolinska Institute spent three years evaluating whether low-intensity Internet-delivered CBT for children and adolescents with OCD can be used in a staged care model to improve access to treatment without compromising its effectiveness.
The two-center study was carried out in collaboration with child and adolescent mental health services in the Stockholm and Vastra Gotaland regions and included 152 participants aged between eight and 17 years old.
Participants were randomly assigned to one of two groups. One group received therapist-guided digital CBT first, and the other (control) received standard CBT in weekly in-person sessions with a therapist.
Each group received treatment for a period of 16 weeks, supported by their therapists and parents.
The researchers then followed the participants three months after treatment to assess the therapeutic effect on OCD symptoms, daily function, and depressive symptoms.
After the 3-month follow-up, participants in both groups deemed to need additional support received up to 12 additional sessions of conventional CBT until the 6-month follow-up.
The results showed that digital step-by-step CBT reduced participants’ symptoms of OCD as much as conventional CBT. About 70 percent of participants in both groups were treatment responders at the 6-month follow-up.
“The benefit of the phased-in care approach is that it makes it easier for us to reach more children and adolescents with OCD who need help,” says Kristina Aspvall, lead author study, psychologist and researcher at the Center for Psychiatry Research. is part of the clinical neuroscience department of the Karolinska Institutet.
Importantly, the phased-care group required fewer resources: therapists spent an average of 9 hours per participant in the staggered treatment group and 14 hours per participant in the control group.
“The study demonstrates the potential of technology to improve access to evidence-based therapy for young people with OCD,” says lead researcher Eva Serlachius, associate professor at the Center for Research in Psychiatry at Karolinska Institutet. “By offering a low-intensity digital intervention as the first step in treatment, clinics can save valuable resources and spend their limited time treating more patients or focusing on more complex cases.
Internet CBT for OCD is currently being implemented in regular care through the Stockholm Region Child and Adolescent Mental Health Services (BUP Internetbehandling), which also collaborates with other health authorities in Sweden. The treatment was developed by researchers from the Karolinska Institutet and the Stockholm region.
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