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Therapist-assisted internet-based cognitive behavioral therapy versus progressive relaxation in obsessive-compulsive disorder: randomized controlled trial

Kyrios, Michael, Ahern, Claire, Fassnacht, Daniel B., Nedeljkovic, Maja, Moulding, Richard and Meyer, Denny 2018, Therapist-assisted internet-based cognitive behavioral therapy versus progressive relaxation in obsessive-compulsive disorder: randomized controlled trial, Jounal of medical internet research, vol. 20, no. 8, doi: 10.2196/jmir.9566.

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Title Therapist-assisted internet-based cognitive behavioral therapy versus progressive relaxation in obsessive-compulsive disorder: randomized controlled trial
Author(s) Kyrios, Michael
Ahern, Claire
Fassnacht, Daniel B.
Nedeljkovic, Maja
Moulding, RichardORCID iD for Moulding, Richard orcid.org/0000-0001-7779-3166
Meyer, Denny
Journal name Jounal of medical internet research
Volume number 20
Issue number 8
Article ID e242
Total pages 18
Publisher JMIR Publications
Place of publication Toronto, Ont.
Publication date 2018-08-08
ISSN 1438-8871
Keyword(s) CBT
cognitive behavioral therapy
mental health
obsessive-compulsive disorder
online intervention
Science & Technology
Life Sciences & Biomedicine
Health Care Sciences & Services
Medical Informatics
QUALITY-OF-LIFE
MENTAL-HEALTH
RESPONSE PREVENTION
SERVICE UTILIZATION
CLINICAL-TRIAL
PRIMARY-CARE
METAANALYSIS
SCALE
EXPOSURE
EFFICACY
Summary BACKGROUND: Obsessive-compulsive disorder (OCD) is a highly disabling psychological disorder with a chronic course if left untreated. Cognitive behavioral therapy (CBT) has been shown to be an effective treatment, but access to face-to-face CBT is not always possible. Internet-based CBT (iCBT) has become an increasingly viable option. However, no study has compared iCBT to an analogous control condition using a randomized controlled trial (RCT).

OBJECTIVE: A 2-armed RCT was used to compare a therapist-assisted 12-module iCBT to an analogous active attention control condition (therapist-assisted internet-based standard progressive relaxation training, iPRT) in adult OCD. This paper reports pre-post findings for OCD symptom severity.

METHOD: In total, 179 participants (117 females, 65.7%) were randomized (stratified by gender) into iCBT or iPRT. The iCBT intervention included psychoeducation, mood and behavioral management, exposure and response prevention (ERP), cognitive therapy, and relapse prevention; the iPRT intervention included psychoeducation and relaxation techniques as a way of managing OCD-related anxiety but did not incorporate ERP or other CBT elements. Both treatments included audiovisual content, case stories, demonstrations of techniques, downloadable audio content and worksheets, and expert commentary. All participants received 1 weekly email, with a maximum 15-minute preparation time per client from a remote therapist trained in e-therapy. Emails aimed to monitor progress, provide support and encouragement, and assist in individualizing the treatment. Participants were assessed for baseline and posttreatment OCD severity with the telephone-administered clinician-rated Yale-Brown Obsessive-Compulsive Scale and other measures by assessors who were blinded to treatment allocation.

RESULTS: No pretreatment differences were found between the 2 conditions. Intention-to-treat analysis revealed significant pre-post improvements in OCD symptom severity for both conditions (P<.001). However, relative to iPRT, iCBT showed significantly greater symptom severity improvement (P=.001); Cohen d for iCBT was 1.05 (95% CI 0.72-1.37), whereas for iPRT it was 0.48 (95% CI 0.22-0.73). The iCBT condition was superior in regard to reliable improvement (25/51, 49% vs 16/55, 29%; P=.04) and clinically significant pre-post-treatment changes (17/51, 33% vs 6/55, 11%; P=.005). Those undertaking iCBT post completion of iPRT showed further significant symptom amelioration (P<.001), although the sequential treatment was no more efficacious than iCBT alone (P=.63).

CONCLUSION: This study is the first to compare a therapist-assisted iCBT program for OCD to an analogous active attention control condition using iPRT. Our findings demonstrate the large magnitude effect of iCBT for OCD; interestingly, iPRT was also moderately efficacious, albeit significantly less so than the iCBT intervention. The findings are compared to previous internet-based and face-to-face CBT treatment programs for OCD. Future directions for technology-enhanced programs for the treatment of OCD are outlined.
Language eng
DOI 10.2196/jmir.9566
Field of Research 08 Information And Computing Sciences
11 Medical And Health Sciences
17 Psychology And Cognitive Sciences
HERDC Research category C1 Refereed article in a scholarly journal
Copyright notice ©2018, Michael Kyrios, Claire Ahern, Daniel B Fassnacht, Maja Nedeljkovic, Richard Moulding, Denny Meyer
Free to Read? Yes
Use Rights Creative Commons Attribution licence
Persistent URL http://hdl.handle.net/10536/DRO/DU:30112730

Document type: Journal Article
Collections: School of Psychology
Open Access Collection
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Every reasonable effort has been made to ensure that permission has been obtained for items included in DRO. If you believe that your rights have been infringed by this repository, please contact drosupport@deakin.edu.au.