Internet-delivered cognitive-behaviour therapy (ICBT) for obsessive-compulsive disorder when delivered as routine clinical care: A phase IV clinical trial

Abstract

Cognitive-behaviour therapy (CBT) is an effective treatment for obsessive-compulsive disorder (OCD), but many patients experience difficulty accessing this treatment. Internet-delivered CBT (ICBT) enhances access to CBT for individuals with OCD and has been shown to be efficacious in Phase I, II, and III clinical trials. However, there are fewer studies investigating ICBT for OCD in Phase IV clinical trials, which demonstrate the effectiveness of the intervention when provided as part of routine care. The aim of the present study was to report on the effectiveness of ICBT for OCD, using data from Australia’s MindSpot Clinic, a federally funded treatment service that provides free ICBT to Australian adults with anxiety, depression, and pain conditions. A total of 225 MindSpot users (68 % female; Mage = 34.82; SD = 11.02) were included in the study. Within-group effect sizes at post-treatment on the Yale-Brown Obsessive-Compulsive Scale, indicated medium effect sizes (g = 0.6; 95 % CI: 0.5−0.7), increasing to large effects at three-month follow up (g = 0.9; 95 % CI: 0.8–1.0). Effects on secondary outcome measures including measures of depression, generalized anxiety, and psychological distress ranged from (g = 0.5–0.6) at post-treatment and (g = 0.5–0.7) at three-month follow up. Results from benchmarking analyses indicated that the results from routine care were significantly smaller than those found in a recent clinical trial using the same treatment protocol. The results indicate that ICBT delivered in real world settings is associated with meaningful improvements in OCD symptoms, however future research may wish to examine which patients respond best to this treatment approach and how to enhance outcomes.