Improving adherence to unguided Internet-based therapy for obsessive-compulsive disorder: A randomized controlled...

Area of Science:

• Psychiatry and Behavioral Sciences
• Digital Health
• Clinical Psychology

Background:

• Low adherence to internet-based cognitive-behavioral therapy (iCBT) can limit its effectiveness for obsessive-compulsive disorder (OCD).
• Module autonomy (free choice vs. fixed order) is a potential factor influencing iCBT adherence and outcomes.

Purpose of the Study:

• To investigate if varying module autonomy in unguided iCBT impacts adherence and treatment effects for OCD.
• To compare the efficacy of a fixed module order (iCBTfixed) versus a free-choice module order (iCBTfree+) for OCD.

Main Methods:

• 151 individuals with OCD were randomized to iCBTfixed or iCBTfree+.
• Outcomes assessed at baseline, 8 weeks, and 16 weeks included OCD severity (Y-BOCS), adherence metrics, depression, self-esteem, and satisfaction.
• Intent-to-treat (ITT) and complete case (CC) analyses were performed.

Main Results:

• Both iCBT programs significantly reduced OCD severity.
• Complete case analyses indicated greater improvement in OCD severity and quality of life in the iCBTfixed group compared to iCBTfree+ from baseline to 8 weeks (medium effect sizes).
• No significant differences in adherence (utilization time, modules completed) were observed between the groups.

Conclusions:

• Unguided iCBT is effective for improving OCD symptoms.
• A fixed module order may offer superior treatment effects for OCD compared to a free-choice order, even with comparable adherence.
• Further research is needed to understand the relationship between adherence and outcomes in iCBT for OCD.