Acceptability and Feasibility of Internet-Based Cognitive-Behavioral Therapy for Obsessive-Compulsive Disorder in...

This study describes the implementation of an Internet-based cognitive-behavior therapy program (ICBT) developed in Sweden for individuals seeking OCD treatment in Sao Paulo, Brazil. After translating and adapting the treatment manual (OCD-NET), we conducted an open-label trial including 35 adults with OCD. The ICBT treatment was conducted in 10 modules and was based on Exposure and Response Prevention (EPR). The RE-AIM implementation science framework was used to evaluate Reach, Effectiveness, Adoption, Implementation, and Maintenance. Our primary outcome was the reduction of the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) total score. The study enrolled 35 participants, with 30 completing all of the ICBT protocol (85.7%). OCD severity decreased significantly over time, with 60% of participants showing a treatment response, and 30% were in remission at the 6-month follow-up. At posttreatment, 54.5% of the participants (95% CI, 37.8-70.4) were classified as treatment responders, and 27.3% (95% CI, 14.8-44.7) were in remission. At the 6-month follow-up, 60% (95% CI, 41.9-75.7) were responders, and 30% (95% CI, 16.4-48.3) were in remission. Depressive symptoms measured by PHQ-9 (SE = 1.68, [95% CI 15.2 to 21.9], p < .001) also improved. Our results provide preliminary evidence that ICBT is effective and feasible to be implemented in an upper-middle-income country. Further research investigating the acceptability and feasibility of ICBT in marginalized populations living in underserved areas is necessary.