Internet-based psychotherapy in children with obsessive-compulsive disorder (OCD): protocol of a randomized
Annette Conzelmann1,2, Karsten Hollmann3, Anna Haigis3
1Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Psychiatry and Psychotherapy, Osianderstr. 14-16, 72076, Tübingen, Germany. annette.conzelmann@med.uni-tuebingen.de.
Insights
Internet-based cognitive behavioral therapy (iCBT) offers a new way to treat childhood obsessive-compulsive disorder (OCD). This study evaluates an iCBT approach using teleconferences, online materials, and apps to deliver effective home-based treatment.
Area of Science:
- Child and Adolescent Psychiatry
- Behavioral Therapy
- Digital Health
Background:
- Childhood obsessive-compulsive disorder (OCD) imposes a significant burden on patients and families.
- Limited availability of in-person therapists for home-based treatment hinders effective OCD management.
- Existing internet-based cognitive behavioral therapy (iCBT) studies for pediatric OCD are scarce and often limited in scope.
Purpose of the Study:
- To develop and evaluate a novel internet-based cognitive behavioral therapy (iCBT) approach for children with OCD.
- To adapt successful elements of traditional face-to-face CBT for an online format, including teleconferences, digital materials, and mobile applications.
- To assess the feasibility and effectiveness of this iCBT intervention in a pediatric OCD population.
Main Methods:
- A pilot feasibility study informed the development of the iCBT program, comprising 14 teleconference sessions for children and parents.
- An integrated app was utilized for daily and weekly symptom tracking, alongside wearable wristbands to collect heart rate and activity data.
- A randomized controlled trial (RCT) design with a waiting list control group will assess treatment outcomes at multiple time points (baseline, 16, 32, and 48 weeks post-randomization).
Main Results:
- The pilot study successfully guided the development of the iCBT approach.
- The ongoing RCT aims to recruit 60 children (30 per group) to account for potential dropouts.
- Outcome evaluations are planned at baseline, end of treatment, and two follow-up points to measure long-term effectiveness.
Conclusions:
- The developed iCBT approach, mirroring traditional therapy components, is poised for effectiveness investigation.
- This novel iCBT intervention has the potential to enhance treatment accessibility and adherence for pediatric OCD.
- Successful implementation could lead to wider distribution within healthcare systems, improving care for children with OCD.
Background:
Obsessive-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.
Methods:
With 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).
Discussion:
Based 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 Registration:
ClinicalTrials.gov NCT05037344 . Registered May 2019, last release August 13th, 2021.
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