title: Therapist-Guided, Internet-Delivered Cognitive-Behavioral Therapy for Adolescents With Obsessive-Compulsive Disorder: A Randomized Controlled Trial.
abstract: Cognitive-behavioral therapy (CBT) is the first-line treatment for young people with obsessive-compulsive disorder (OCD), but most patients do not have access to this treatment. Thus, innovative ways to increase the accessibility of CBT are needed. The objective of this trial was to evaluate the efficacy of therapist-guided internet-based CBT (ICBT) for adolescents with OCD.
  
  
  
  Sixty-seven adolescents (12-17 years old) with OCD were randomly assigned to a 12-week clinician- and parent-supported ICBT program (BiP OCD) or a waitlist condition. The primary outcome was the Children Yale-Brown Obsessive Compulsive Scale (CY-BOCS) administered by blinded assessors before and after the intervention. All patients were followed up 3 months after the intervention.
  
  
  
  In intention-to-treat analyses, BiP OCD was superior to waitlist on the CY-BOCS (time-by-group interaction, B = -4.53, z = -3.74, p < .001; Cohen's d = 0.69; 95% CI 0.19-1.18) and on most secondary outcome measurements. Patients randomized to BiP OCD also showed further improvement from post-treatment to 3-month follow-up, with a within-group pretreatment to follow-up effect size (Cohen's d) equal to 1.68 (95% CI 1.00-2.36). Patient satisfaction with BiP OCD was high. There were no relevant adverse events. Average clinician support time was 17.5 minutes per patient per week.
  
  
  
  Therapist-guided ICBT is a promising low-intensity intervention for adolescents with OCD and has the potential to increase access to CBT. It might be particularly useful in a stepped-care approach, in which a large proportion of patients with moderately severe OCD could first be offered ICBT, thus freeing limited resources for more complex cases. Clinical trial registration information-Internet-Delivered CBT for Adolescents With OCD: A Randomized Controlled Study (BiPOCD); http://clinicaltrials.gov; NCT02191631.
authors.affiliation: Center for Psychiatry Research, Karolinska Institutet, Stockholm, and Stockholm Health Care Services, Stockholm County Council, Sweden. Electronic address: fabian.lenhard@ki.se.
authors.forename: Fabian
authors.initials: F
authors.lastname: Lenhard
authors.affiliation: Division of Psychology, Karolinska Institutet.
authors.forename: Erik
authors.initials: E
authors.lastname: Andersson
authors.affiliation: Center for Psychiatry Research, Karolinska Institutet, Stockholm, and Stockholm Health Care Services, Stockholm County Council, Sweden.
authors.forename: David
authors.initials: D
authors.lastname: Mataix-Cols
authors.affiliation: Center for Psychiatry Research, Karolinska Institutet, Stockholm, and Stockholm Health Care Services, Stockholm County Council, Sweden.
authors.forename: Christian
authors.initials: C
authors.lastname: Rück
authors.affiliation: Center for Psychiatry Research, Karolinska Institutet, Stockholm, and Stockholm Health Care Services, Stockholm County Council, Sweden.
authors.forename: Sarah
authors.initials: S
authors.lastname: Vigerland
authors.affiliation: Center for Psychiatry Research, Karolinska Institutet, Stockholm, and Stockholm Health Care Services, Stockholm County Council, Sweden.
authors.forename: Jens
authors.initials: J
authors.lastname: Högström
authors.affiliation: Stockholm Health Care Services, Stockholm County Council.
authors.forename: Maria
authors.initials: M
authors.lastname: Hillborg
authors.affiliation: Center for Psychiatry Research, Karolinska Institutet.
authors.forename: Gustaf
authors.initials: G
authors.lastname: Brander
authors.affiliation: Stockholm Health Care Services, Stockholm County Council.
authors.forename: Mari
authors.initials: M
authors.lastname: Ljungström
authors.affiliation: Division of Psychology, Karolinska Institutet.
authors.forename: Brjánn
authors.initials: B
authors.lastname: Ljótsson
authors.affiliation: Center for Psychiatry Research, Karolinska Institutet, Stockholm, and Stockholm Health Care Services, Stockholm County Council, Sweden.
authors.forename: Eva
authors.initials: E
authors.lastname: Serlachius
mesh_terms: D000293:Adolescent; D002648:Child; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020407:Internet; D008297:Male; D009771:Obsessive-Compulsive Disorder / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D016037:Single-Blind Method
keywords: cognitive-behavioral therapy; internet; obsessive-compulsive disorder