Internet-based cognitive behavioral therapy in children and adolescents with obsessive-compulsive disorder: A randomized controlled trial

Effectiveness of videoconference-delivered psychotherapy for children, adolescents, and their parents: A meta-analysis of randomized controlled trials

IntroductionOver the last years, videoconference-delivered psychotherapy (VCP) has been more commonly used in clinical practice. This meta-analysis is the first to evaluate the effectiveness of VCP for children and adolescents with a mental disorder and their parents.MethodsA systematic literature search was performed to identify randomized controlled trials (RCTs) that compared the effectiveness of VCP for youths with a mental disorder to a control condition. Twelve studies were included. Two reviewers independently extracted data and rated study quality.ResultsEffect size estimates for measures of children's symptoms of mental disorders were large for comparison between VCP and waitlist (posttreatment: Hedges's g = -1.26, k = 5) and negligible for comparisons between VCP and in-person treatment (posttreatment: g = 0.00, k = 6; follow-up: g = -0.05, k = 3). Similarly, effect size estimates for measures of children's functional impairments were large for comparison between VCP and waitlist (posttreatment: g = -1.10, k = 3) and negligible for comparisons between VCP and in-person treatment (posttreatment: g = -0.23, k = 3; follow-up: g = 0.04, k = 2). VCP more effectively reduced symptoms in children with an internalizing disorder (g = -0.88, k = 5) compared to externalizing disorders (g = 0.25, k = 2) or tic disorders (g = -0.08, k = 3).DiscussionThe results provide preliminary evidence that VCP is an effective treatment for youths with a mental disorder and their parents. VCP was equally effective as in-person treatment in reducing children's symptoms and functional impairments. Limitations include the limited number of RCTs and incomplete reporting of methodological features.

Evaluating the effectiveness of a collaborative care digital mental health intervention on obsessive-compulsive symptoms in adolescents: A retrospective study

Objective

Obsessive-compulsive (OC) symptoms, characterized by distressing and repetitive thoughts and behaviors, frequently onset during adolescence for individuals with obsessive-compulsive disorder or anxiety disorders. Digital mental health interventions (DMHIs) offer a promising platform to deliver mental health treatment, which may address OC symptoms. The purpose of this retrospective study was to determine the effects of a DMHI, Bend Health, on various domains of OC symptoms, including contamination, responsibility (for harm), unwanted thoughts, and symmetry, in adolescents.

Methods

OC symptoms were assessed at baseline (before beginning care) and monthly in adolescents engaged in different care programs involving coaching and/or therapy with the DMHI. Retrospective analyses were used to identify characteristics associated with OC symptoms (N = 2151) and to characterize treatment responsiveness of adolescents with elevated OC symptoms (n = 553).

Results

Adolescents with elevated OC symptoms (32.2%; n = 693 of 2151) were more likely than those with non-elevated OC symptoms to be female (p < .001), to have comorbid symptoms (e.g. anxiety and depression; p < .001), and participate in therapy (p < .001). Further, their caregivers had higher rates of sleep problems and burnout (p < .05). OC symptoms improved for 87.7% (n = 485 of 532) of adolescents during care with the DMHI, and 46.6% (n = 249 of 534) reported clinically substantive improvement. Scores decreased significantly over months in care (t1187 = -8.06, p < .001). Improvements were also identified for OC symptom dimensions (contamination, responsibility (for harm), unwanted thoughts, and symmetry).

Conclusions

Our results deliver compelling preliminary evidence that participation in coaching and therapy with a DMHI may mitigate a variety of OC symptoms for adolescents. Improvements were observed across different OC symptom types, demonstrating the broad applicability of the DMHI to address various presentations and complexities of OC symptoms.

Acceptance of a sensor-based online psychotherapy for adolescents with obsessive-compulsive disorder (SSTeP-KiZ)

Background and aim

E-mental health interventions with use of cognitive behavioral therapy methods and therapist contact via video have been well established in their effectiveness for various mental illnesses. With the help of sensors worn on the body, relevant contextual information can be made visible. In the SSTeP-KiZ study, the feasibility of a multimodal sensor system was tested, which was used in video-based psychotherapy for adolescents with obsessive-compulsive disorder during therapy sessions in the home environment. The present study investigated the acceptance and satisfaction of participating patients and families with the novel sensor-based therapy approach.

Material and methods

A mixed study design with focus groups was used. In a quantitative longitudinal study, personality characteristics of the study participants and families of the SSTeP-KiZ study were collected. Following the main study, a total of five focus group interviews were conducted with patients, parents, therapists to determine satisfaction and acceptance of the sensor technology. The study was part of the main SSTeP-KiZ study registered by ClinicalTrails.gov (NCT05291611) and used the COREQ-Checklist.

Results

The participants in the focus groups indicated a high level of satisfaction with the therapy method and would recommend the treatment to friends 100% of the time. One factor to be modified appears to be the personal contact design, particularly at the beginning of the therapy. Personality characteristics such as affinity for technology or acceptance of technology were not dependent on the patient's age or gender.

Discussion

The present results indicate that the sensor-based video therapy approach was accepted by patients and families and that the sensor system was experienced as practicable and supportive. To improve the use of sensor technology in psychotherapy further and to adapt the sensor system optimally to the needs of patients, further research involving users in the sense of participatory research is necessary.

Clinical trial registration

[www.ClinicalTrials.gov], identifier [NCT05291611]. The qualitative study is part of the SSTeP-KiZ main study.

Feasibility, satisfaction, and goal attainment in routine telemedicine consultation in child and adolescent psychiatry and psychotherapy

Telehealth services were rapidly adopted during the COVID-19 pandemic, but evidence regarding the effectiveness and feasibility of telehealth services in child and adolescent mental healthcare is sparse. This study aims to investigate feasibility, satisfaction, and goal attainment in video-delivered consultations in routine care child and adolescent psychiatry and psychotherapy. A total of 1046 patients from four university child and adolescent outpatient psychiatric clinics and one university outpatient unit for child and adolescent psychotherapy were screened for study participation. We examined a) the percentage of patients considered eligible for video-delivered consultation, b) clinicians', parents' and patients' satisfaction with video consultation, c) clinicians' ratings of goal attainment in video consultation, and d) factors associated with satisfaction and goal attainment. 59% of the screening sample (n = 621) fulfilled eligibility criteria and were considered eligible for video consultation. A total of 267 patients consented to participate in the study and received a video consultation. Clinicians reported high levels of satisfaction with video consultation and high levels of goal attainment in video consultations, especially for patients scheduled for initial patient assessments. Parents and patients were also highly satisfied with the video consultations, especially if patients had less severe emotional and behavioral problems. The present findings suggest that video consultations are a feasible and well-accepted alternative to in-person consultations in child and adolescent mental health care, especially for children with less severe symptoms and for children in early phases of assessment and treatment. Limitations include the lack of a control group. The study was registered at the German Clinical Trials Registry (DRKS00023525).

Cognitive behavioral therapy for pediatric obsessive-compulsive disorder delivered via internet videoconferencing: a manualized sensor-assisted feasibility approach

BACKGROUND

Between 1 and 4% of children and adolescents suffer from obsessive-compulsive disorder (OCD) worldwide, but the majority of these young people do not have access to cognitive behavioral therapy (CBT) as a first-line treatment. CBT delivered via online videoconferencing (vCBT) offers a new way to provide young people with therapy, especially in the home environment where symptoms usually occur.

METHODS

In this study, we investigated the feasibility of a newly revised vCBT manual, symptom change during treatment, and effects on family life and social functioning. 20 patients with OCD, aged 12-18 years, were treated during 14 weekly sessions while using a multimodal sensor system that assessed their physiological and behavioral responses during therapy. Treatment was delivered in real time via an online videoconferencing platform. Measurements of feasibility, acceptance, and implementation were evaluated descriptively, and clinical measures were assessed with t tests.

RESULTS

The primary results showed that patients and parents perceived the manual-based vCBT as feasible and easy to understand. According to the therapists' ratings, all treatment modules and the content could be carried out in accordance with the manual. As a secondary outcome, OCD symptoms improved significantly during treatment (p <.001, d = 1.87), revealed by an average decrease of more than half in the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) score. As the psychotherapy could be implemented directly in the patients' home environment, low barriers to participation were reported, and the majority of participants reported improvements in family life after treatment.

CONCLUSIONS

In summary, the results of this feasibility study indicated a successful application of manual-based psychotherapy delivered via videoconferencing for pediatric OCD supported by a sensor system. This method should be further investigated in future randomized controlled trials with larger patient samples.

CLINICAL TRIAL REGISTRATION

[ www.

CLINICALTRIALS

gov ], identifier [NCT05291611], first submission: 2021-12-10.

Satisfaction with videoconference-delivered CBT provided as part of a blended treatment approach for children and adolescents with mental disorders and their families during the COVID-19 pandemic: A follow-up survey among caregivers and therapists

INTRODUCTION

Psychotherapy delivered via videoconferencing (teletherapy) was a well-accepted treatment option for children and adolescents during the early phases of the COVID-19 pandemic. Information on the long-term satisfaction with teletherapy in routine clinical practice is missing.

METHODS

Caregivers (parents) and psychotherapists of n  =  228 patients (4-20 years) treated in a university outpatient clinic completed a follow-up survey on satisfaction with videoconference-delivered cognitive-behavioral treatment (CBT). The follow-up survey (T2) was conducted about 1 year after initial assessment of treatment satisfaction in 2020 (T1).

RESULTS

At follow up, therapists reported that 79% of families had received teletherapy as part of a blended treatment approach including in-person and videoconference delivery of CBT. Wilcoxon tests revealed that satisfaction with teletherapy was stable over time. In addition, parent ratings of the impact of teletherapy on treatment satisfaction and the therapeutic relationship did not change over time. Therapists' ratings of the impact of teletherapy on the therapeutic relationship with the caregiver were more negative at T2 compared to T1. Satisfaction with teletherapy was higher for patients with less pandemic-related stress, less externalizing behavior problems, and older age (all r < .35).

CONCLUSION

The high level of satisfaction with teletherapy for children and adolescents treated in routine clinical practice reported in 2020 was maintained after social distancing regulations were eased in 2021. Teletherapy provided as part of a blended treatment approach is a well-accepted method of treatment delivery for youths with mental health problems. The study was registered in the German Clinical Trials Register (DRKS00028639).

Effect of Internet-Based Cognitive Behavioral Therapy on Psychological Distress and Quality of Life Among Breast Cancer Survivors: A Meta-Analysis of Randomized Controlled Trials

OBJECTIVES

This meta-analysis was to critically evaluate the effectiveness of Internet-based Cognitive Behavioral Therapy (ICBT) on psychological distress and quality of life in breast cancer survivors.

METHODS

A search was conducted across eleven databases (PubMed, Web of Science, Embase, Cochrane Library, Scopus, ProQuest, CINAHL, CBM, CNKI, VIP and Wanfang) to identify relevant randomized controlled trials (RCTs) published from databases inception to September 2023. Two reviewers independently conducted study screening, data extraction, and quality assessment of the included studies. Review Manager 5.4 and Stata 18.0 were utilized for analysis.

RESULTS

Ten studies with 1409 patients were included. Meta-analysis indicated that ICBT alleviated anxiety [SMD = -0.34, 95% CI (-0.64, -0.04), p = 0.03] and depression [SMD = -0.43, 95% CI (-0.76, -0.09), p = 0.01] in breast cancer patients. Therapist-guided ICBT outperformed self-guided ICBT, with interventions lasting ≤ 9 weeks better than > 9 weeks, and module quantity didn't affect the results. Additionally, ICBT significantly improved quality of life [SMD = 0.37, 95% CI (0.21, 0.52), p < 0.001], yet didn't reduce fatigue [SMD = -0.13, 95% CI (-0.59, 0.34), p = 0.60], insomnia [MD = -2.24, 95% CI (-5.77, 1.28), p = 0.21], or fear of progression [SMD = -0.10, 95% CI (-0.31, 0.11), p = 0.34].

CONCLUSIONS

ICBT, especially therapist-guided and lasting for ≤ 9 weeks, can effectively relieve anxiety and depression, as well as enhance breast cancer patients' quality of life. Nevertheless, it fails to improve fatigue, insomnia, or fear of progression. High-quality, large-sample studies must be conducted in the future for further validation.

Lessons learned from a multimodal sensor-based eHealth approach for treating pediatric obsessive-compulsive disorder

Introduction

The present study investigates the feasibility and usability of a sensor-based eHealth treatment in psychotherapy for pediatric obsessive-compulsive disorder (OCD), and explores the promises and pitfalls of this novel approach. With eHealth interventions, therapy can be delivered in a patient's home environment, leading to a more ecologically valid symptom assessment and access to experts even in rural areas. Furthermore, sensors can help indicate a patient's emotional and physical state during treatment. Finally, using sensors during exposure with response prevention (E/RP) can help individualize therapy and prevent avoidance behavior.

Methods

In this study, we developed and subsequently evaluated a multimodal sensor-based eHealth intervention during 14 video sessions of cognitive-behavioral therapy (CBT) in 20 patients with OCD aged 12-18. During E/RP, we recorded eye movements and gaze direction via eye trackers, and an ECG chest strap captured heart rate (HR) to identify stress responses. Additionally, motion sensors detected approach and avoidance behavior.

Results

The results indicate a promising application of sensor-supported therapy for pediatric OCD, such that the technology was well-accepted by the participants, and the therapeutic relationship was successfully established in the context of internet-based treatment. Patients, their parents, and the therapists all showed high levels of satisfaction with this form of therapy and rated the wearable approach in the home environment as helpful, with fewer OCD symptoms perceived at the end of the treatment.

Discussion

The goal of this study was to gain a better understanding of the psychological and physiological processes that occur in pediatric patients during exposure-based online treatment. In addition, 10 key considerations in preparing and conducting sensor-supported CBT for children and adolescents with OCD are explored at the end of the article. This approach has the potential to overcome limitations in eHealth interventions by allowing the real-time transmission of objective data to therapists, once challenges regarding technical support and hardware and software usability are addressed.

Clinical Trial Registration

www.ClinicalTrials.gov, identifier (NCT05291611).

Online CBT Versus Standard CBT for Pediatric Obsessive-Compulsive Disorder

Obsessive-compulsive disorder (OCD), characterized by recurring obsessions and compulsions, affects 1-3% of the childhood population, often leading to severe impairment and reduced quality of life. Cognitive behavioral therapy (CBT) is well-documented as first choice treatment for pediatric OCD. Traditionally delivered face-to-face CBT has limitations in terms of accessibility, availability, and quality of delivery. Online CBT using video conferencing (online-CBT) at home aims to address some of these barriers. In this pilot study, we aimed to compare acceptability, feasibility and effectiveness of online CBT against face-to-face CBT. Online CBT outcomes of 29 children with OCD were analyzed benchmarked against outcomes of face-to-face CBT (n = 269) from the Nordic Long-term OCD Treatment Study, the largest CBT follow up study in pediatric OCD to date. Acceptability rated by online CBT participants and their parents was very high (Client Satisfaction Questionnaire total scores about 30, range 8-32). Feasibility assessed as dropout rate was comparable to NordLOTS (10.3% versus 9.7%). The online CBT group compared to NordLOTS showed a higher response rate (90% versus 60%; p = .002) and remission rate (81% versus 53%; p = .231). Our results suggest that the trusting therapeutic relationship necessary for demanding exposure-based treatment can be established by online CBT. Online CBT seems to be at least as effective in reducing OCD symptoms than standard CBT. Trial ID: ISRCTN37530113.

Efficacy and acceptability of cognitive-behavioral therapy and serotonin reuptake inhibitors for pediatric obsessive-compulsive disorder: a network meta-analysis

BACKGROUND

Cognitive-behavioral therapy (CBT) and serotonin reuptake inhibitors (SRIs) are recommended treatments for pediatric obsessive-compulsive disorder (OCD), but their relative efficacy and acceptability have not been comprehensively examined. Further, it remains unclear whether the efficacy of in-person CBT is conserved when delivered in other formats, such as over telephone/webcam or as Internet-delivered CBT (ICBT).

METHODS

PubMed, PsycINFO, trial registries, and previous systematic reviews were searched for randomized controlled trials (RCTs) comparing CBT (in-person, webcam/telephone-delivered, or ICBT) or SRIs with control conditions or each other. Network meta-analyses were conducted to examine efficacy (post-treatment Children's Yale-Brown Obsessive Compulsive Scale) and acceptability (treatment discontinuation). Confidence in effect estimates was evaluated with CINeMA (Confidence in Network Meta-Analysis).

RESULTS

Thirty eligible RCTs and 35 contrasts comprising 2,057 youth with OCD were identified. In-person CBT was significantly more efficacious than ICBT, waitlist, relaxation training, and pill placebo (MD range: 3.95-11.10; CINeMA estimate of confidence: moderate) but did not differ significantly from CBT delivered via webcam/telephone (MD: 0.85 [-2.51, 4.21]; moderate), SRIs (MD: 3.07 [-0.07, 6.20]; low), or the combination of in-person CBT and SRIs (MD: -1.20 [-5.29, 2.91]; low). SRIs were significantly more efficacious than pill placebo (MD: 4.59 [2.70, 6.48]; low) and waitlist (MD: 8.03 [4.24, 11.82]; moderate). No significant differences for acceptability emerged, but confidence in estimates was low.

CONCLUSIONS

In-person CBT and SRIs produce clear benefits compared to waitlist and pill placebo and should be integral parts of the clinical management of pediatric OCD, with in-person CBT overall having a stronger evidence base. The combination of in-person CBT and SRIs may be most efficacious, but few studies hinder firm conclusions. The efficacy of CBT appears conserved when delivered via webcam/telephone, while more trials evaluating ICBT are needed.

Effectiveness of online group cognitive behavioral therapy for adolescents with obsessive-compulsive disorder: a pilot study

OBJECTIVE

To evaluate the effectiveness of online group cognitive behavioral therapy (CBT) based on the CAMALEO TOC manual in the treatment of adolescents with obsessive-compulsive disorder (OCD).

METHODS

This is a quasi-experimental study with a single-group pretest-posttest intervention. Over a 12-week period, 11 adolescents aged 11 to 17 years with OCD participated in weekly online group CBT sessions based on the CAMALEO TOC manual. We used several assessment tools, including the Children's Yale-Brown Obsessive-Compulsive Scale to assess the severity of OCD symptoms, the Family Accommodation Scale for Obsessive-Compulsive Disorder-Interviewer-Rated to measure family accommodation, the Children's Depression Inventory to assess depression symptoms, the Revised Children's Manifest Anxiety Scale to assess anxiety, and the Multidimensional Students' Life Satisfaction Scale to measure satisfaction with life.

RESULTS

OCD symptoms decreased significantly (d = -1.55) after online group CBT, and a strong effect size (d = -1.03) was found for family accommodation. After controlling for variables (e.g., engagement in psychotherapeutic treatment, medication use, or psychiatric comorbidities), no significant differences were found for OCD symptoms and family accommodation scores. In addition, there was insufficient evidence to support the effectiveness of online group CBT in reducing symptoms of depression or anxiety or improving overall quality of life.

CONCLUSION

Our study demonstrates the feasibility of short-term online group CBT as an effective therapeutic approach for adolescents with OCD.

Review: Adverse event monitoring and reporting in studies of pediatric psychosocial interventions: a systematic review

BACKGROUND

Adverse event monitoring in studies of psychotherapy is crucial to clinical decision-making, particularly for weighing of benefits and harms of treatment approaches. In this systematic review, we identified how adverse events are defined, measured, and reported in studies of psychosocial interventions for children with mental disorders.

METHOD

Medline, PsycINFO, Embase, ProQuest Dissertations and Theses Global, and the Cochrane Library were searched from January 2011-January 2023, and Google Scholar from January 2011-February 2023. English language experimental and quasi-experimental studies that evaluated the efficacy or effectiveness of psychosocial interventions for childhood mental disorders were included. Information on the definition, assessment, and report of adverse events was extracted using a checklist based on Good Clinical Practice guidelines.

RESULTS

In this review, 117 studies were included. Studies most commonly involved treating anxiety disorders or obsessive-compulsive disorder (32/117; 27%); 44% of the experimental interventions tested (52/117) were cognitive behavioral therapies. Adverse events were monitored in 36 studies (36/117; 31%) with a protocol used in 19 of these studies to guide monitoring (19/36; 53%). Twenty-seven different events were monitored across the studies with hospitalization the most frequently monitored (3/36; 8%). Event severity was fully assessed in 6 studies (17%) and partially assessed in 12 studies (33%). Only 4/36 studies (11%) included assessing events for cause.

CONCLUSIONS

To date, adverse events have been inconsistently defined, measured and reported in psychosocial intervention studies of childhood mental health disorders. Information on adverse events is an essential knowledge component for understanding the potential impacts and risks of therapeutic interventions.

Things that make you go Hmm: Myths and misconceptions within cognitive-behavioral treatment of obsessive-compulsive disorder

The past four decades have yielded a robust body of evidence supporting the efficacy and effectiveness of cognitive-behavioral therapy (CBT) as a gold-standard treatment for obsessive-compulsive disorder (OCD) across the lifespan. Exposure and response prevention (E/RP) has been identified as a key component of this approach. Despite robust research support for CBT with E/RP, several myths and misconceptions continue to proliferate in both research and practice settings. Such myths and misconceptions are concerning, as they lack empirical basis, may hinder widespread dissemination and implementation of CBT for OCD, and run contrary to the practice of evidence-based psychological medicine. Focusing on the importance of promoting evidence-based practice and generative clinical science, the present review article synthesizes relevant research within the field of treatments for OCD to address the following myths / misconceptions: (a) uncertainty exists concerning the evidence base supporting CBT for OCD, (b) E/RP attrition and dropout rates are unacceptably high due to excessive risk and perceived patient intolerability, and (c) alternative treatments for OCD need to be expeditiously developed due to major limitations of E/RP. Recommendations for future research and clinical dissemination and implementation to further advance a generative clinical science of OCD treatment are discussed.