Initial evaluation of a therapist-supported online cognitive therapy self-help for patients with taboo obsessions

Efficacy and mediators of online cognitive therapy for taboo obsessions in adults with obsessive-compulsive disorder: Randomized controlled trial

Taboo obsessions are ego-dystonic, recurrent, and intrusive thoughts involving aggressive, sexual and/or religious themes, which are common in individuals with obsessive-compulsive disorder (OCD). These symptoms are often challenging to treat with traditional, exposure-based approaches. Our research group has developed and successfully piloted an Internet-delivered intervention based on the cognitive framework of taboo obsessions (I-CT). The current randomized controlled trial evaluated the efficacy of I-CT compared to Internet-delivered general psychological support in reducing OCD symptom severity and associated impairments. A secondary aim was to investigate if the treatment effect was mediated by a reduction in negative appraisals, the proposed mechanism of change in cognitive therapy. Sixty-eight participants with a diagnosis of OCD and primary taboo obsessions were randomized to either I-CT or general psychological support for 8 weeks. The primary outcome was change on the clinician-rated Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), administered by masked assessors at pre- and post-treatment. Participants in both groups had a significant reduction of OCD symptom severity but those randomized to I-CT had significantly better outcomes (between group bootstrapped d = 0.69, [95% CI, 0.22-1.17]). The proportion of participants classed as responders and remitters was also higher in the I-CT group (odds ratio 2.33 and 1.77 respectively), though not significantly. A large portion of the treatment effect (55%) was mediated by change in negative appraisals. I-CT could be a promising treatment approach for individuals with taboo obsessions who do not wish, or are unable, to engage in, or do not respond to, exposure-based treatment for OCD.

Predictors of outcome in self-guided internet-delivered cognitive-behavior therapy for obsessive-compulsive disorder: A preliminary investigation

Internet-delivered cognitive-behavioral therapy (ICBT) is an effective treatment for obsessive-compulsive disorder (OCD). ICBT can be delivered in a self-guided or clinician-guided format. While a literature is emerging on the predictors of response to clinician-guided ICBT, there is a lack of research examining the predictors of response to self-guided ICBT. The aim of the present study was to examine predictors of outcome in a large sample of participants with OCD who commenced a self-guided ICBT intervention. One hundred and fifty-seven participants (Mage = 34.82; SD = 10.49; 78% female) were included in the study. Regression analyses were conducted to determine clinical and demographic predictors of (1) posttreatment symptom severity and (2) a clinically meaningful treatment response for both the intention-to-treat (ITT) and completer samples. The regression models significantly predicted posttreatment outcome for both the ITT (F(8, 148) = 15.844, p < .001) and completer sample (F(8, 101) = 5.929, p < .001), explaining 46% and 34% of the variance respectively. Higher baseline OCD severity, younger age, experiencing higher contamination or symmetry symptoms, and a history of past treatment were all found to be significantly associated with higher posttreatment severity in the ITT sample. In the completer sample only higher baseline OCD severity and severity of harm-related obsessions and checking compulsions was significantly associated with higher posttreatment severity. When predicting treatment response the regression models for both the ITT and completer sample were nonsignificant.

Acceptability of internet-delivered cognitive behavioural therapy for adults with symptoms of obsessive-compulsive disorder: A meta-analysis

OBJECTIVES

Obsessive-compulsive disorder (OCD) is a chronic mental health disorder. Internet-delivered cognitive behaviour therapy (ICBT) is demonstrated to be effective for OCD; however little is known about the acceptability of the treatment. Therefore the aim of this study was to examine the acceptability of ICBT for adults with OCD symptoms using a meta-analytic approach.

METHOD

Seventeen studies (N = 1661; Mage range = 28-41 years; 58%-93% female) were included in this analysis.

RESULTS

The random effects pooled estimates indicated that 16.3% (95% CI: 9.8%-25.7%) of participants did not commence the treatment once they were enrolled in the study, 27.6% (95% CI: 19.0%-38.2%) did not complete the treatment, and 27.0% (95% CI: 18.2%-38.0%) did not complete the post-treatment questionnaires of the study. The mean score on the Client Satisfaction Questionnaire ranged from 22.4 to 26.5. Overall, pooled estimates indicated that 81.6% (95% CI: 76.1%-86.0%) of participants were satisfied with the ICBT intervention and 84.7% (95% CI: 72.8%-92.0%) indicated that they would recommend the treatment to a friend. Some of the acceptability moderator analyses indicated that self-guided ICBT interventions had lower levels of acceptability compared with clinician-guided interventions. However, given low power, these results should be considered preliminary.

CONCLUSIONS

This study has important implications in the dissemination of ICBT for OCD.

An online self-guided cognitive intervention for unwanted intrusive thoughts about harming infants in new parents: initial randomised controlled trial with mediation analysis

Approximately one-fifth of new parents struggle with unwanted intrusive thoughts (UITs) about intentionally harming their child. This study evaluated the initial efficacy, feasibility and acceptability of a novel online self-guided cognitive intervention for new parents with distressing UITs. Self-recruited parents (N = 43, 93% female, age 23-43 years) of children 0-3 years reporting daily distressing and impairing UITs were randomized to the 8-week self-guided online cognitive intervention or to waiting-list. The primary outcome was change on the Parental Thoughts and Behaviour Checklist (PTBC) from baseline to week 8 (post-intervention). The PTBC and negative appraisals (mediator) were assessed at baseline, weekly, post-intervention and at the 1-month follow-up. Results showed that the intervention led to statistically significant reductions in distress and impairment associated with UITs at post-intervention (controlled between-group d = 0.99, 95% CI 0.56 to 1.43), which were maintained at the 1-month follow-up (controlled between-group d = 0.90, 95% CI 0.41 to 1.39). The intervention was deemed to be feasible and acceptable by the participants. Change in negative appraisals mediated reductions in UITs but the model was sensitive to mediator-outcome confounders. We conclude that this novel online self-guided cognitive intervention can potentially reduce the distress and impairment associated with UITs in new parents. Large-scale trials are warranted.Abbreviations: UITs: Unwanted Intrusive Thoughts PTBC: Parental Thoughts and Behaviour Checklist.