title: Long-term efficacy of Internet-based cognitive behavior therapy for obsessive-compulsive disorder with or without booster: a randomized controlled trial.
abstract: BACKGROUND
  As relapse after completed cognitive behavior therapy (CBT) for obsessive-compulsive disorder (OCD) is common, many treatment protocols include booster programs to improve the long-term effects. However, the effects of booster programs are not well studied. In this study, we investigated the long-term efficacy of Internet-based CBT (ICBT) with therapist support for OCD with or without an Internet-based booster program.
  
  
  METHODS
  A total of 101 participants were included in the long-term follow-up analysis of ICBT. Of these, 93 were randomized to a booster program or no booster program. Outcome assessments were collected at 4, 7, 12 and 24 months after receiving ICBT.
  
  
  RESULTS
  The entire sample had sustained long-term effects from pre-treatment to all follow-up assessments, with large within-group effect sizes (Cohen's d = 1.58-2.09). The booster group had a significant mean reduction in OCD symptoms compared to the control condition from booster baseline (4 months) to 7 months, but not at 12 or 24 months. Participants in the booster group improved significantly in terms of general functioning at 7, 12 and 24 months, and had fewer relapses. Kaplan-Meier analysis also indicated a significantly slower relapse rate in the booster group.
  
  
  CONCLUSIONS
  The results suggest that ICBT has sustained long-term effects and that adding an Internet-based booster program can further improve long-term outcome and prevent relapse for some OCD patients.
authors: Department of Clinical Neuroscience, Division of Psychiatry,Karolinska Institutet,Stockholm,Sweden.
authors: E
authors: E
authors: Andersson
authors: Department of Clinical Neuroscience, Division of Psychiatry,Karolinska Institutet,Stockholm,Sweden.
authors: S
authors: S
authors: Steneby
authors: Department of Clinical Neuroscience, Division of Psychiatry,Karolinska Institutet,Stockholm,Sweden.
authors: K
authors: K
authors: Karlsson
authors: Department of Clinical Neuroscience, Division of Psychology,Karolinska Institutet,Stockholm,Sweden.
authors: B
authors: B
authors: Ljótsson
authors: Department of Clinical Neuroscience, Division of Psychology,Karolinska Institutet,Stockholm,Sweden.
authors: E
authors: E
authors: Hedman
authors: Department of Clinical Neuroscience, Division of Psychiatry,Karolinska Institutet,Stockholm,Sweden.
authors: J
authors: J
authors: Enander
authors: Department of Clinical Neuroscience, Division of Psychiatry,Karolinska Institutet,Stockholm,Sweden.
authors: V
authors: V
authors: Kaldo
authors: Department of Clinical Neuroscience, Division of Psychiatry,Karolinska Institutet,Stockholm,Sweden.
authors: G
authors: G
authors: Andersson
authors: Department of Clinical Neuroscience, Division of Psychiatry,Karolinska Institutet,Stockholm,Sweden.
authors: N
authors: N
authors: Lindefors
authors: Department of Clinical Neuroscience, Division of Psychiatry,Karolinska Institutet,Stockholm,Sweden.
authors: C
authors: C
authors: Rück
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D009771:Obsessive-Compulsive Disorder / Q000517:prevention & control / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D012008:Recurrence