Unguided Computer-Assisted Self-Help Interventions Without Human Contact in Patients With Obsessive-Compulsive Disorder: Systematic Review and Meta-analysis
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Abstract
Background: Computer-assisted treatment may reduce therapist contact and costs and promote client participation. This meta-analysis examined the efficacy and acceptability of an unguided computer-assisted therapy in patients with obsessive-compulsive disorder (OCD) compared with a waiting list or attention placebo. Objective: This study aimed to evaluate the effectiveness and adherence of computer-assisted self-help treatment without human contact in patients with OCD using a systematic review and meta-analysis approach. Methods: Randomized controlled trials with participants primarily diagnosed with OCD by health professionals with clinically significant OCD symptoms as measured with validated scales were included. The interventions included self-help treatment through the internet, computers, and smartphones. We excluded interventions that used human contact. We conducted a search on PubMed, Cochrane Central Register of Controlled Trials, EMBASE, World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov, as well as the reference lists of the included studies. The risk of bias was evaluated using version 2 of the Cochrane risk-of-bias tool for randomized trials. We calculated the standardized mean differences for continuous outcomes and risk ratios for dichotomous outcomes. The primary outcomes were short-term improvement of OCD symptoms measured by validated scales and dropout for any reason. Results: We included 11 randomized controlled trials with a total of 983 participants. The results indicated that unguided computer-assisted self-help therapy was significantly more effective than a waiting list or psychological placebo (standard mean difference −0.47, 95% CI −0.73 to −0.22). Unguided computer-assisted self-help therapy had more dropouts for any reason than waiting list or psychological placebo (risk ratio 1.98, 95% CI 1.21 to 3.23). However, the quality of evidence was very low because of the risk of bias and inconsistent results among the included studies. The subgroup analysis showed that exposure response and prevention and an intervention duration of more than 4 weeks strengthen the efficacy without worsening acceptability. Only a few studies have examined the interaction between participants and systems, and no study has used gamification. Most researchers only used text-based interventions, and no study has used a mobile device. The overall risk of bias of the included studies was high and the heterogeneity of results was moderate to considerable. Conclusions: Unguided computer-assisted self-help therapy for OCD is effective compared with waiting lists or psychological placebo. An exposure response and prevention component and intervention duration of more than 4 weeks may strengthen the efficacy without worsening the acceptability of the therapy. Trial Registration: PROSPERO (International Prospective Register of Systematic Reviews) CRD42021264644; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=264644
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Dropout rates appear to be greater when the intervention does not involve therapist contact.
“dropout rates appear to be greater when the intervention does not involve therapist contact [21,22].”
From Barriers to and Facilitators of a Blended Cognitive Behavioral Therapy Program for Depression and Anxiety Based on Experiences of University Students: Qualitative Interview Study (2023) · cites this paper as [22]
The Results (Primary Outcomes; page unavailable) report more dropouts with unguided self-help than with waiting-list or psychological-placebo controls (RR 1.98). The paper does not establish that the absence of therapist contact explains the difference, or compare dropout rates directly with otherwise similar therapist-supported interventions. (LLM, conf=0.85)
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Cited by
Sorted by citations
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“In an unguided format, the effectiveness of iCBT, including digital health apps, seems to be limited [19,20], and dropout rates appear to be greater when the intervention does not involve therapist contact [21,22].”
Background
- Authors
- Imai, H., Tajika, A., Narita, H., Yoshinaga, N., Kimura, K., Nakamura, H., Takeshima, N., Hayasaka, Y., Ogawa, Y., & Furukawa, T.
- Affiliations
- Kyoto University (JP)
- Hokkaido University (JP)
- University of Miyazaki (JP)
- Chiba University (JP)
- Corresponding author
- Imai, Hissei
- ORCID
- Venue
- Journal of Medical Internet Research
- Publisher
- JMIR Publications Inc.
- Published
- 2022-04-21
- Volume
- 24
- Issue
- 4
- Pages
- e35940
- ISSN
- 1438-8871 (ISSN-L)
- PMC
- PMC9073609
- OpenAlex
- W4224288593
- Cited by
- 19
- References
- 43
- Citations by year
- 2026: 1 · 2025: 5 · 2024: 8 · 2023: 5
- FWCI
- 0.80
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Journal of Medical Internet Research (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Institutional Repositories DataBase (IRDB) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Kyoto University Research Information Repository (Kyoto University) (submittedVersion, cc-by)
- Funders
- Japan Society for the Promotion of Science (20K16638, 20K23219, 21K15729)
- 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
- obsessive-compulsive disorder, online therapy, exposure and response prevention, medication adherence, dropout, treatment acceptability, waiting list comparison, mobile health intervention, gamification, text-based interventions, intervention duration, risk of bias, low-quality evidence, subgroup analysis, access to mental health care
- MeSH terms
- Humans, Obsessive-Compulsive Disorder, Waiting Lists, Health Behavior, Cognitive Behavioral Therapy, Bias
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