title: Efficacy of technology-delivered cognitive behavioural therapy for OCD versus control conditions, and in comparison with therapist-administered CBT: meta-analysis of randomized controlled trials.
abstract: Cognitive behavioural therapy (CBT) is a well-established treatment for obsessive-compulsive disorder (OCD). However, few patients receive CBT, due to factors such as geographic limitations, perceived stigmatization, and lack of CBT services. Technology-delivered cognitive behavioural therapy (T-CBT) could be an effective strategy to improve patients' access to CBT. To date, a meta-analysis on the effectiveness of T-CBT for OCD has not been conducted. This study used meta-analytic techniques to summarize evidence on the efficacy of T-CBT for OCD versus control conditions and therapist-administered CBT. A meta-analysis according to Prisma guidelines was conducted on randomized controlled trials (RCTs) of T-CBT for OCD. Treatment was classified as T-CBT if evidence-based CBT active ingredients for OCD were included (psychoeducation, ERP, and cognitive restructuring), delivered through health technologies (e.g. self-help books, leaflets, and other forms of bibliotherapy) or remote communication technologies (e.g. the Internet, web-cameras, telephones, telephone-interactive voice response systems, and CD-ROMS). Studies using validated outcomes for OCD or depression were included. Eight trials were included (N = 420). Two trials were classified as at high risk of bias. T-CBT seemed to be superior to control conditions on OCD symptom outcomes at post-treatment (d = 0.82, 99% CI = 0.55-1.08, p = 0.001), but not on comorbid depression (d = 0.33, 99% CI = - 0.01-0.67, p = 0.020). Difference in the efficacy on OCD symptoms between T-CBT and therapist-administered CBT was not significant, despite a trend favouring therapist-administered CBT emerged (d = 0.45, 95% CI = 0.03-0.87, p = 0.033). Directions for research are discussed. Further RCTs are warranted to examine the efficacy of T-CBT for OCD.
authors.affiliation: a Department of Health Sciences , University of Florence , Via di San Salvi 12, building 26, 50135 Florence , Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Dèttore
authors.forename: Andrea
authors.initials: A
authors.lastname: Pozza
authors.forename: Gerhard
authors.initials: G
authors.lastname: Andersson
mesh_terms: D000293:Adolescent; D000328:Adult; D001638:Bibliotherapy / Q000706:statistics & numerical data; D002648:Child; D015928:Cognitive Behavioral Therapy / Q000706:statistics & numerical data; D003863:Depression / Q000150:complications / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D009771:Obsessive-Compulsive Disorder / Q000150:complications / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic; D013813:Therapy, Computer-Assisted / Q000706:statistics & numerical data; D055815:Young Adult
keywords: cognitive behavioural therapy; meta-analysis; obsessive-compulsive disorder; technology-delivered cognitive-behavioural therapy; treatment outcome