Web-based CBT noninferior for OCD in children and adolescents

Reuters Health - 11/05/2021 - Children and adolescents with obsessive-compulsive disorder may respond just as well to cognitive behavioral therapy (CBT) delivered online as they would to similar treatment in person, a new clinical trial suggests.

The noninferiority trial included 152 youth aged 8 to 17 years who were seen at two specialist mental health clinics in Sweden for treatment of obsessive-compulsive disorder (OCD). Youth were randomized to receive 16 weeks of internet-delivered CBT (n=74) with an option for non-responders to switch to in-person treatment after three months, or to 16 weeks of in-person CBT (n=78) with an option for non-responders to get additional sessions after three months.

The primary endpoint was improvement in OCD symptoms at six months measured with the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS), a 10-item scale with each item rated from 0 for no symptoms to 4 for extreme symptoms, and a total score range of 0-40 points. Researchers set a predefined non-inferiority margin of 4 points on the CY-BOCS.

Mean CY-BOCS scores dropped from 23.9 pretreatment to 11.6 at six months for the web-based CBT group, and from 23.0 to 10.6 for the in-person CBT group. The 0.91-point difference in scores at six months did not exceed the non-inferiority margin.

"This is the first study to demonstrate that an online intervention can be provided in a stepped care fashion for children and adolescents with OCD without impairing treatment efficacy," said senior study author Dr. Eva Serlachius of the Karolinska Institute in Stockholm.

"By first offering the online intervention, it was possible to reduce the number of patients who needed face-to-face therapy," Dr. Serlachius said by email.

At three months, 34 participants (46%) in the internet CBT group were non-responders and offered in-person therapy, the study team reports in JAMA.

There were also 23 participants (30%) in the in-person CBT group who were non-responders at three months and offered additional in-person sessions.

Approximately half of participants in both groups experienced adverse events, most often increased symptoms of anxiety or depression. Two serious adverse events were reported, both of which were determined to be unrelated to treatment: one case of inpatient care for anorexia and one case of self-harm.

One limitation of the study is that it was conducted in Sweden, where there are few specialty OCD clinics, the study team notes. Results may therefore not be generalizable to other places, particularly where access to in-person OCD care may be more widely available, they point out.

Even so, the results suggest that internet-delivered care is safe and effective when offered with therapist support, and that this delivery mode may be sufficient for many patients, said Dr. John Torous, director of digital psychiatry at Beth Israel Deaconess Medical Center and Harvard Medical School in Boston, who wrote an editorial accompanying the study.

"But this study also shows that it will not be effective for all, so offering internet-delivered care in a stepped model where there is the option for more traditional care when needed appears the most effective and safe option," Dr. Touros said by email. "Offering online-only today would leave some youth without access to the effective care they need."

SOURCE: https://bit.ly/3w0jqZ6 and https://bit.ly/3oa2Bba JAMA, online May 11, 2021.

By Lisa Rapaport



Posted on 11 May 202124 May 2021