Authors: Karsten Hollmann; Katharina Allgaier; Carolin S. Hohnecker; Heinrich Lautenbacher; Verena Bizu; Matthias Nickola; Gunilla Wewetzer; Christoph Wewetzer; Tord Ivarsson; Norbert Skokauskas; Lidewij H. Wolters; Gudmundur Skarphedinsson; Bernhard Weidle; Else de Haan; Nor Christan Torp; Scott N. Compton; Rosa Calvo; Sara Lera-Miguel; Anna Haigis; Tobias J. Renner; Annette Conzelmann · Research
Can Internet-Based Therapy Help Children With OCD?
A study explores the feasibility and effectiveness of internet-based cognitive behavioral therapy for children with obsessive-compulsive disorder.
Source: Hollmann, K., Allgaier, K., Hohnecker, C. S., Lautenbacher, H., Bizu, V., Nickola, M., Wewetzer, G., Wewetzer, C., Ivarsson, T., Skokauskas, N., Wolters, L. H., Skarphedinsson, G., Weidle, B., de Haan, E., Torp, N. C., Compton, S. N., Calvo, R., Lera-Miguel, S., Haigis, A., ... Conzelmann, A. (2021). Internet-based cognitive behavioral therapy in children and adolescents with obsessive compulsive disorder: a feasibility study. Journal of Neural Transmission, 128, 1445-1459. https://doi.org/10.1007/s00702-021-02409-w
What you need to know
- Internet-based cognitive behavioral therapy (iCBT) for children with obsessive-compulsive disorder (OCD) appears to be feasible and well-accepted by patients and parents.
- The study found significant reductions in OCD symptoms after 14 sessions of iCBT delivered primarily via videoconference.
- Patients and families appreciated being able to do exposure exercises at home with therapist guidance, though some technical issues occurred.
Understanding OCD in Children
Obsessive-compulsive disorder (OCD) is a mental health condition that affects 0.5-3% of children and adolescents. People with OCD experience unwanted, intrusive thoughts (obsessions) and feel compelled to perform repetitive behaviors or mental acts (compulsions) to reduce anxiety. For children with OCD, these symptoms can significantly impact their daily lives, relationships, and academic performance.
Without proper treatment, childhood OCD often continues into adulthood and increases the risk of other mental health problems. This makes early, effective treatment crucial. The gold standard treatment for pediatric OCD is cognitive behavioral therapy (CBT), particularly a technique called exposure and response prevention (ERP).
Challenges in Accessing Treatment
Despite the effectiveness of CBT, many children with OCD do not receive proper treatment. Some key reasons include:
- Lack of access to OCD specialists, especially in rural areas
- Long wait times to see mental health providers
- Difficulty traveling to regular therapy appointments
- Stigma around seeking mental health treatment
To address these barriers, researchers are exploring internet-based approaches to deliver CBT for pediatric OCD. This study aimed to evaluate the feasibility and effectiveness of internet-based CBT (iCBT) for children and adolescents with OCD.
How the Study Worked
The researchers recruited 9 children and adolescents (ages 7-17) diagnosed with OCD. The study used the following approach:
- 14 therapy sessions over several months
- First session conducted in-person, remaining 13 via videoconference
- Based on an established CBT manual for pediatric OCD
- Included exposure exercises guided by the therapist remotely
- Used a smartphone app for patients to track symptoms daily
- Provided therapy materials to families via a secure online cloud
The researchers assessed OCD symptoms before and after treatment. They also gathered feedback from patients, parents, and the therapist on their experience with iCBT.
Key Findings on Feasibility and Acceptance
Overall, the study found that iCBT was feasible to implement and well-accepted by families:
- All 9 participants completed the full treatment
- 89% of patients liked that therapy was conducted via internet
- 67% of patients and parents did not prefer face-to-face therapy over iCBT
- Patients and parents rated the quality of treatment as high
- Families appreciated being able to do exposure exercises at home
- The smartphone app was rated as easy to use and helpful
These results suggest that children and families are open to internet-based therapy for OCD and find it convenient and helpful.
Effectiveness in Reducing OCD Symptoms
In addition to being feasible, the study found iCBT was effective in reducing OCD symptoms:
- Significant decrease in OCD severity as measured by the Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS)
- Average 34% reduction in CY-BOCS scores
- 4 out of 9 patients (44%) were considered treatment responders
- 2 out of 9 patients (22%) achieved remission
- Clinician ratings showed significant improvement in overall functioning
While the sample size was small, these results are encouraging and in line with other studies of technology-based treatments for pediatric OCD.
Benefits of Internet-Based Treatment
The study highlighted several potential advantages of iCBT for pediatric OCD:
Improved Access to Specialists
iCBT allows children to receive treatment from OCD experts regardless of their location. This is especially beneficial for families in rural areas with limited access to mental health providers.
Exposure Exercises in Real-Life Settings
A key component of CBT for OCD is exposure and response prevention (ERP). This involves gradually facing feared situations while resisting the urge to perform compulsions. With iCBT, the therapist can guide patients through exposures in their home environment where OCD symptoms often occur. This may enhance the effectiveness of treatment.
Convenience for Families
Internet-based treatment eliminates travel time and costs associated with in-person therapy. This can make it easier for families to fit treatment into their schedules and may improve adherence.
Reduced Stigma
Some patients and families may feel more comfortable receiving mental health treatment from home rather than going to a clinic. This could help reduce stigma around seeking help.
Challenges and Limitations
While the results are promising, the study also revealed some challenges with iCBT:
Technical Issues
There were occasional problems with the videoconferencing software, particularly when starting sessions. This highlights the need for reliable technology and technical support.
Sample Size
The study only included 9 participants, which limits the generalizability of the findings. Larger studies are needed to confirm the effectiveness of iCBT.
Severity of OCD
The researchers noted that patients with very severe OCD had more difficulty engaging in exposure exercises consistently. iCBT may not be suitable for all patients, particularly those with extreme symptoms.
Need for In-Person Assessment
The initial diagnostic session was still conducted in-person. Fully remote assessment and treatment may present additional challenges.
Conclusions
- Internet-based CBT appears to be a feasible and promising treatment option for children and adolescents with OCD.
- iCBT was well-accepted by patients and parents, with high satisfaction ratings.
- The approach showed effectiveness in reducing OCD symptoms, though larger studies are needed.
- iCBT may help improve access to expert treatment, especially for families in underserved areas.
- Further research should explore optimal ways to combine in-person and internet-based elements in OCD treatment.
While more research is needed, this study suggests that internet-based therapy could play an important role in expanding access to effective treatment for children with OCD. As technology continues to advance, integrating digital tools into mental health care may help more young people get the support they need to overcome OCD and thrive.