Internet CBT for OCD in youth: From idea to implementation

Obsessive-Compulsive Disorder (OCD) is a common psychological problem in childhood, with a prevalence of about 2% in the population. OCD usually has dramatic effects on the lives of the affected, and is likely to impair social activities, school or work and family life. OCD in youth has also significant socioeconomic effects and is associated with large societal costs if left untreated (Lenhard et al., 2021).

OCD is a treatable condition for most cases, with cognitive behavior therapy (CBT) as the recommended first-line treatment of choice. Unfortunately, CBT is not broadly available due to treatment barriers such as a shortage of trained therapists, limited healthcare resources and geographical distances to specialized clinics. To overcome those barriers and give better access to effective, evidence-based treatment, internet CBT (ICBT) has been developed. ICBT has the same content than in-person CBT, but is presented via the web, very similar to an online e-learning course.

Our group at Karolinska Institutet started to develop ICBT for OCD in youth in 2013. The project was initiated by prof. Eva Serlachius in collaboration with Prof. David Mataix-Cols, Prof. Christian Rück, Dr. Erik Andersson, Dr. Sarah Vigerland, myself and several others. Together we developed the first version of the new internet CBT treatment and tested it in a first pilot study and a qualitative study. Those studies provided encouraging results regarding the clinical effect of the new treatment and acceptability for patients (Lenhard et al., 2014, 2016).

We then further developed the treatment and tested it in a more rigorous study design, a randomized controlled trial, again showing that the treatment did help to reduce OCD symptoms in youth 13 to 17 years with the condition (Lenhard, Andersson, et al., 2017). My colleague Dr. Kristina Aspvall then adapted the ICBT treatment to children 7 to 12 years (Aspvall et al., 2018). Now with the full age range in place, we tested ICBT against the gold standard in-person CBT treatment in a stepped-care model in an advanced, large scale head-to-head comparison (a so called non-inferiority study). This study showed that ICBT yielded results on-par with in-person CBT (Aspvall et al., 2021).

In addition to the demonstration of the clinical effect, we published two studies showing that ICBT is a cost-effective treatment, meaning that precious healthcare resources could be used in a more efficient way if ICBT would be implemented (Lenhard, Ssegonja, et al., 2017; Sampaio et al., 2019), thus, more patients could receive treatment. We could also demonstrate the long-term maintenance of the clinical results up to one year after completed treatment (Lenhard et al., 2020), and are now working on an adapted version of the treatment for youth with autism and OCD (Wickberg et al., 2022).

In 2020, our ICBT treatment for OCD in youth was implemented in regular care and is now freely available to children and adolescents that seek care at the local child and adolescent mental health service in the Stockholm region.

References

  • Aspvall, K., Andersson, E., Melin, K., Norlin, L., Eriksson, V., Vigerland, S., … Serlachius, E. (2021). Effect of an Internet-Delivered Stepped-Care Program vs In-Person Cognitive Behavioral Therapy on Obsessive-Compulsive Disorder Symptoms in Children and Adolescents: A Randomized Clinical Trial. JAMA – Journal of the American Medical Association, 325(18), 1863–1873. https://doi.org/10.1001/jama.2021.3839
  • Aspvall, K., Andrén, P., Lenhard, F., Andersson, E., Mataix-Cols, D., & Serlachius, E. (2018). Internet-delivered cognitive behavioural therapy for young children with obsessive–compulsive disorder: development and initial evaluation of the BIP OCD Junior programme. BJPsych Open, 4(3), 106–112. https://doi.org/10.1192/bjo.2018.10
  • Lenhard, F., Andersson, E., Mataix-Cols, D., Rück, C., Aspvall, K., & Serlachius, E. (2020). Long-term outcomes of therapist-guided Internet-delivered cognitive behavior therapy for pediatric obsessive-compulsive disorder. Npj Digital Medicine, 3(1), 1–5. https://doi.org/10.1038/s41746-020-00327-x
  • Lenhard, F., Andersson, E., Mataix-Cols, D., Rück, C., Vigerland, S., Högström, J., … Serlachius, E. (2017). Therapist-Guided, Internet-Delivered Cognitive-Behavioral Therapy for Adolescents With Obsessive-Compulsive Disorder: A Randomized Controlled Trial. Journal of the American Academy of Child and Adolescent Psychiatry, 56(1), 10-19.e2. https://doi.org/10.1016/j.jaac.2016.09.515
  • Lenhard, F., Aspvall, K., Andersson, E., Ahlen, J., Serlachius, E., Lavner, M., … Mataix-Cols, D. (2021). The Cost of Obsessive–Compulsive Disorder in Swedish Youth. Child Psychiatry and Human Development, 1–7. https://doi.org/10.1007/S10578-021-01261-Z/TABLES/2
  • Lenhard, F., Ssegonja, R., Andersson, E., Feldman, I., Rück, C., Mataix-Cols, D., & Serlachius, E. (2017). Cost-effectiveness of therapist-guided Internet-delivered Cognitive Behavior Therapy for pediatric Obsessive-Compulsive Disorder : Results from a Randomized Controlled Trial. BMJ Open 2017;7:e015246. doi: 10.1136/bmjopen-2016-015246
  • Lenhard, F., Vigerland, S., Andersson, E., Rück, C., Mataix-Cols, D., Thulin, U., … Serlachius, E. (2014). Internet-delivered cognitive behavior therapy for adolescents with obsessive-compulsive disorder: An open trial. PLoS ONE, 9(6), e100773. https://doi.org/10.1371/journal.pone.0100773
  • Lenhard, F., Vigerland, S., Engberg, H., Hallberg, A., Thermaenius, H., & Serlachius, E. (2016). “On My Own, but Not Alone” – Adolescents’ Experiences of Internet-Delivered Cognitive Behavior Therapy for Obsessive-Compulsive Disorder. Plos One, 11(10), e0164311. https://doi.org/10.1371/journal.pone.0164311
  • Sampaio, F., Bonnert, M., Olén, O., Hedman, E., Lalouni, M., Lenhard, F., … Feldman, I. (2019). Cost-effectiveness of internet-delivered cognitive–behavioural therapy for adolescents with irritable bowel syndrome. BMJ Open, 9(1), e023881. https://doi.org/10.1136/bmjopen-2018-023881
  • Wickberg, F., Lenhard, F., Aspvall, K., Serlachius, E., Andrén, P., Johansson, F., … Mataix-Cols, D. (2022). Feasibility of internet-delivered cognitive-behavior therapy for obsessive-compulsive disorder in youth with autism spectrum disorder: A clinical benchmark study. Internet Interventions, 28, 100520. https://doi.org/10.1016/J.INVENT.2022.100520

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