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Internet-based cognitive behaviour therapy for obsessive–compulsive disorder: a randomized controlled trial
Open accessAbstract
Background: Cognitive behaviour therapy (CBT) is an effective treatment for obsessive–compulsive disorder (OCD) but access to CBT is limited. Internet-based CBT (ICBT) with therapist support is potentially a more accessible treatment. There are no randomized controlled trials testing ICBT for OCD. The aim of this study was to investigate the efficacy of ICBT for OCD in a randomized controlled trial. Method: Participants (n=101) diagnosed with OCD were randomized to either 10 weeks of ICBT or to an attention control condition, consisting of online supportive therapy. The primary outcome measure was the Yale–Brown Obsessive Compulsive Scale (YBOCS) administered by blinded assessors. Results: Both treatments lead to significant improvements in OCD symptoms, but ICBT resulted in larger improvements than the control condition on the YBOCS, with a significant between-group effect size (Cohen's d) of 1.12 (95% CI 0.69–1.53) at post-treatment. The proportion of participants showing clinically significant improvement was 60% (95% CI 46–72) in the ICBT group compared to 6% (95% CI 1–17) in the control condition. The results were sustained at follow-up. Conclusions: ICBT is an efficacious treatment for OCD that could substantially increase access to CBT for OCD patients. Replication studies are warranted.
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“The iCBT condition was associated with a significant reduction in OCD symptoms (d = 1.55) as measured by the Yale Brown Obsessive Compulsive Scale (YBOCS; [44]), compared to a medium within-group effect size (d = 0.47) for the Control Group.”
From Study protocol for a randomised controlled trial of internet-based cognitive-behavioural therapy for obsessive-compulsive disorder (2014) · cites this paper as [43]
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“Different studies found that internet-based delivery of exposure with response prevention leads to a clinical significant decrease in symptoms [11–13].”
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“in-person treatment protocols for other psychiatric disorders have previously been translated to therapist-guided digital formats and successfully been evaluated in several trials (Carlbring et al., 2005; Andersson et al., 2012)”
From Internet-delivered acceptance-based behavior therapy for trichotillomania and skin-picking disorder in a psychiatric setting: A feasibility trial (2022) · cites this paper as Andersson et al., 2012
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“Additionally, there was a large between between-group effect size (d = 1.12) on the YBOCS, and only 6% participants in the control condition met criteria for clinically significant change, compared with 60% in iCBT.”
From Study protocol for a randomised controlled trial of internet-based cognitive-behavioural therapy for obsessive-compulsive disorder (2014) · cites this paper as [43]
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“Although therapist contact in the control group was significantly lower than iCBT (129 minutes versus 17 minutes for iCBT and control, respectively), the between groups difference remained significant after therapist contact was statistically controlled.”
From Study protocol for a randomised controlled trial of internet-based cognitive-behavioural therapy for obsessive-compulsive disorder (2014) · cites this paper as [43]
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“The results of iCBT were maintained at 4-month follow up.”
From Study protocol for a randomised controlled trial of internet-based cognitive-behavioural therapy for obsessive-compulsive disorder (2014) · cites this paper as [43]
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“Nevertheless the specific effect of iCBT is unclear, as the control condition did not provide intervention elements that were experienced as similar to the active treatment (e.g., online self-help information, downloadable audio files, worksheets and homework).”
From Study protocol for a randomised controlled trial of internet-based cognitive-behavioural therapy for obsessive-compulsive disorder (2014) · cites this paper as [43]
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Metadata
- Authors
- Andersson, E., Enander, J., Andrén, P., Hedman, E., Ljótsson, B., Hursti, T., Bergström, J., Kaldo, V., Lindefors, N., Andersson, G., & Rück, C.
- Affiliations
- Karolinska Institutet (SE)
- Uppsala University (SE)
- Stockholm University (SE)
- Linköping University (SE)
- Corresponding author
- Andersson, E.
- ORCID
- Venue
- Psychological Medicine
- Publisher
- Cambridge University Press (CUP)
- Published
- 2012-02-21
- Volume
- 42
- Issue
- 10
- Pages
- 2193-2203
- ISSN
- 0033-2917 (ISSN-L)
- 1469-8978
- PMC
- PMC3435873
- OpenAlex
- W2099538769
- Cited by
- 274
- References
- 55
- Citations by year
- 2026: 10 · 2025: 12 · 2024: 21 · 2023: 29 · 2022: 21 · 2021: 22 · 2020: 18 · 2019: 9 · 2018: 15 · 2017: 26 · 2016: 19 · 2015: 24 · 2014: 28 · 2013: 14 · 2012: 6
- FWCI
- 32.27
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc-sa
- www.cambridge.org/core/terms (unspecified)
- Locations
- Psychological Medicine (publishedVersion, cc-by-nc-sa)
- PubMed Central (publishedVersion, cc-by-nc-sa)
- PubMed (publishedVersion)
- Funders
- Karolinska Institutet
- Stockholms Läns Landsting
- Vetenskapsrådet
- Svenska Läkaresällskapet
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- internet-based cognitive behavioral therapy, obsessive-compulsive disorder, therapist support, treatment efficacy, access to mental health care, Yale-Brown Obsessive Compulsive Scale, symptom remission
- MeSH terms
- Adolescent, Adult, Aged, Female, Follow-Up Studies, Humans, Male, Middle Aged, Obsessive-Compulsive Disorder, Psychiatric Status Rating Scales, Sweden, Therapy, Computer-Assisted, Observer Variation, Cognitive Behavioral Therapy, Treatment Outcome, Internet, Young Adult
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