title: No talking, just writing! Efficacy of an Internet-based cognitive behavioral therapy with exposure and response prevention in obsessive compulsive disorder.
abstract: BACKGROUND
  Many patients with obsessive-compulsive disorder (OCD) do not receive first-line treatment according to the current guidelines (cognitive behavioral therapy with exposure and response prevention, CBT with ERP) due to barriers to treatment. Internet-based therapy is designed to overcome these barriers. The present study evaluates the efficacy of an Internet-based writing therapy with therapeutic interaction based on the concept of CBT with ERP for patients with OCD.
  
  
  METHODS
  Thirty-four volunteers with OCD according to DSM-IV-criteria were included in the trial and randomized according to a waiting-list control design with follow-up measures at 8 weeks and 6 months. The intervention consisted of 14 sessions, either starting directly after randomization or with an 8-week delay. Main outcome measure was the change in the severity of OCD symptoms (Yale-Brown Obsessive Compulsive Scale Self-Rating, Y-BOCS SR, and Obsessive-Compulsive Inventory-Revised, OCI-R).
  
  
  RESULTS
  Obsessive-compulsive symptoms were significantly improved in the treatment group compared to the waiting-list control group with large effect sizes of Cohen's d = 0.82 (Y-BOCS SR) and d = 0.87 (OCI-R), using an intention-to-treat analysis. This effect remained stable at 6-month follow-up. Only 4 participants (12%) dropped out prematurely from the study. Of the 30 completers, 90% rated their condition as improved and would recommend the program to their friends.
  
  
  CONCLUSIONS
  Internet-based writing therapy led to a significant improvement of obsessive-compulsive symptoms. Even though replications with larger sample sizes are needed, the results support the notion that Internet-based approaches have the potential for improving the treatment situation for patients with OCD.
authors.affiliation: Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany.
authors.forename: Nirmal
authors.initials: N
authors.lastname: Herbst
authors.forename: Ulrich
authors.initials: U
authors.lastname: Voderholzer
authors.forename: Nicola
authors.initials: N
authors.lastname: Thiel
authors.forename: Ronja
authors.initials: R
authors.lastname: Schaub
authors.forename: Christine
authors.initials: C
authors.lastname: Knaevelsrud
authors.forename: Silke
authors.initials: S
authors.lastname: Stracke
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Hertenstein
authors.forename: Christoph
authors.initials: C
authors.lastname: Nissen
authors.forename: Anne Katrin
authors.initials: AK
authors.lastname: Külz
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D057194:Intention to Treat Analysis; D020407:Internet; D008297:Male; D008875:Middle Aged; D009771:Obsessive-Compulsive Disorder / Q000523:psychology / Q000628:therapy*; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D017216:Telemedicine / Q000379:methods; D014956:Writing; D055815:Young Adult