Abstract
Cognitive behavioral therapy (CBT) is the first choice of treatment of obsessive–compulsive disorder (OCD) in children and adolescents. However, there is often a lack of access to appropriate treatment close to the home of the patients. An internet-based CBT via videoconferencing could facilitate access to state-of-the-art treatment even in remote areas. The aim of this study was to investigate feasibility and acceptability of this telemedical approach. A total of nine children received 14 sessions of CBT. The first session took place face-to-face, the remaining 13 sessions via videoconference. OCD symptoms were recorded with a smartphone app and therapy materials were made accessible in a data cloud. We assessed diagnostic data before and after treatment and obtained measures to feasibility, treatment satisfaction and acceptability. Outcomes showed high acceptance and satisfaction on the part of patients with online treatment (89%) and that face-to-face therapy was not preferred over an internet-based approach (67%). The majority of patients and their parents classified the quality of treatment as high. They emphasized the usefulness of exposures with response prevention (E/RP) in triggering situations at home. The app itself was rated as easy to operate and useful. In addition to feasibility, a significant decrease in obsessive–compulsive symptoms was also achieved. Internet-based CBT for pediatric OCD is feasible and well received by the patients and their parents. Furthermore, obsessive–compulsive symptomatology decreased in all patients. The results of this study are encouraging and suggest the significance of further research regarding this technology-supported approach, with a specific focus on efficacy.Trial registration number: Clinical trials AZ53-5400.1-004/44.
Highlights
Obsessive–compulsive disorder (OCD) is a frequent psychiatric disease of children and adolescents with a prevalence of 0.5–3% (Heyman et al 2003; Zohar et al 1992; Canals et al 2012)
cognitive behavioral therapy (CBT) for children and adolescents with OCD should be centrally based on exposures with response prevention (E/RP) leading to habituation towards OCD triggering situations and stimuli (Walitza et al 2021; McGuire et al 2015; RosaAlcázar et al 2015)
Inclusion criteria were (1) a primary diagnosis of OCD as defined by the DSM-5 (APA 2013); (2) age between 7 and 17 years; (3) a total score of at least 16 on the Children’s Yale-Brown Obsessive–Compulsive Scale (CY-BOCS; Scahill et al 1997); (4) ability to read and write in German for the participant and one parent; (5) family home equipped with an internet broadband connection, computer, HD webcam and speaker; (6) being medication-free or on a stable dose for a period of 6 weeks or more; and (7)
Summary
Obsessive–compulsive disorder (OCD) is a frequent psychiatric disease of children and adolescents with a prevalence of 0.5–3% (Heyman et al 2003; Zohar et al 1992; Canals et al 2012). There is a high risk of chronification and development of further mental health problems in adulthood (Wewetzer et al 2001; Peterson et al 2001), accompanied by reduced socioeconomic status and Extended author information available on the last page of the article social integration (Thomsen 2000; Piacentini et al 2003). CBT for children and adolescents with OCD should be centrally based on exposures with response prevention (E/RP) leading to habituation towards OCD triggering situations and stimuli (Walitza et al 2021; McGuire et al 2015; RosaAlcázar et al 2015). Another argument in favor of such an approach is provided by the inhibitory learning theory (Craske et al 2014). This assumes that the original association between the response-provoking stimulus and the unconditioned stimulus is inhibited by a newly learned,
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