Abstract
BackgroundObsessive-compulsive disorder (OCD) in children can lead to a huge burden on the concerned patients and their family members. While successful state-of-the art cognitive behavioral interventions exist, there is still a lack of available experts for treatment at home, where most symptoms manifest. Internet-based cognitive behavioral therapy (iCBT) could overcome these restrictions; however, studies about iCBT in children with OCD are rare and mostly target computerized self-help resources and only email contact with the therapist. Therefore, we intended to build up and to evaluate an iCBT approach for children with OCD, replacing successful elements of traditional in-office face-to-face CBT, with face-to-face teleconferences, online materials, and apps.MethodsWith the help of a pilot feasibility study, we developed the iCBT consisting of 14 teleconference sessions with the child and parents. The sessions are supported by an app assessing daily and weekly symptoms and treatment course completed by children and parents. Additionally, we obtain heart rate and activity scores from the child via wristbands during several days and exposure sessions. Using a waiting list randomized control trial design, we aim to treat and analyze 20 children with OCD immediately after a diagnostic session whereas the control group of another set of 20 OCD patients will be treated after waiting period of 16 weeks. We will recruit 30 patients in each group to take account for potential dropouts. Outcomes for the treatment group are evaluated before randomization (baseline, t0), 16 weeks (end of treatment, t1), 32 weeks (follow-up 1, t2), and 48 weeks after randomization (follow-up 2, t3). For the waiting list group, outcomes are measured before the first randomization (baseline), at 16 weeks (waiting list period), 32 weeks (end of treatment), 48 weeks after the first randomization (follow-up I), and 64 weeks after the first randomization (follow-up II).DiscussionBased on our experience of feasibility during the pilot study, we were able to develop the iCBT approach and the current study will investigate treatment effectiveness. Building up an iCBT approach, resembling traditional in-office face-to-face therapy, may ensure the achievement of well-known therapy effect factors, the acceptance in both patients and clinicians, and the wide distribution within the health system.Trial registrationClinicalTrials.govNCT05037344. Registered May 2019, last release August 13th, 2021.
Highlights
Obsessive-compulsive disorder (OCD) in children can lead to a huge burden on the concerned patients and their family members
During exposures with response prevention (ERP), patients are confronted with their intrusive thoughts and preceding situations; patients learn to stop their repetitive behaviors followed by a natural decline in distress and learning experience that intrusive thoughts are harmless
Due to the Covid-19 pandemic, psychotherapy was only possible via teleconferences which pushed acceptance of psychotherapists and patients forward for this new method more than ever before. Internet-based cognitive behavioral therapy (iCBT) could be especially attractive for pediatric patients as 90–96% of young people aged 12–24 have good internet accessibility and their ability to use new media platforms should be high [11]
Summary
Obsessive-compulsive disorder (OCD) in children can lead to a huge burden on the concerned patients and their family members. Cognitive behavioral therapy (CBT) is a highly effective treatment for OCD in children and adults [2, 3]. OCD patients themselves sometimes refuse psychotherapy due to avoiding behavior, fear of stigmatization, geographical distance to experts and time restrictions, especially in rural areas [8]. ICBT could be especially attractive for pediatric patients as 90–96% of young people aged 12–24 have good internet accessibility and their ability to use new media platforms should be high [11]. It can be costeffective [12]. The inclusion of parents in the therapeutic process is more practical and easier via internet, as compared to traditional face-to-face approaches, as they can be part of the process no matter their location, as long as they have an internet connection
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