Acceptability, feasibility, and effectiveness of Internet-based cognitive behaviour therapy for obsessive-compulsive disorder (OCD-NET): Naturalistic pilot trial during the COVID-19 pandemic in a psychiatric outpatient department in Germany (Preprint)
Authors: Kohls Elisabeth , Baldofski Sabrina , Scholl Julia , Flygare Oskar , Lundström Lina , Beyrich-Kolbus Ursula , Steinbrecher Marc , Rück Christian , Rummel-Kluge Christine 
Published: May 2024

UNSTRUCTURED

Background: Cognitive behavior therapy (CBT) for obsessive-compulsive disorder (OCD) is the gold-standard treatment for OCD. However, access to CBT and specialized treatments is often limited. This pilot study describes the implementation of a guided Internet-based CBT program (ICBT) for individuals seeking treatment for OCD in a psychiatric outpatient department in Leipzig, Germany during the COVID-19 pandemic. The aim of the study was to investigate the acceptability, feasibility, and effectiveness of the ICBT program for OCD.
Methods: In an open, naturalistic pilot trial, N = 57 patients with OCD received a 10-week ICBT program (called “OCD-NET”) consisting of 10 different modules of psychoeducation, cognitive restructuring, exposure with response prevention and overall therapist support and guidance via the program. The primary outcome was OCD symptoms at the end of treatment, assessed with the self-report Obsessive Compulsive Inventory – Revised (OCI-R). Secondary outcomes were self-rated measures of depressive symptoms, quality of life, self-efficacy, and psychological distress. Further, treatment credibility, working alliance, and satisfaction were assessed.
Results: Mixed effect models showed a significant reduction in OCD symptoms (OCI-R) with large within-group effect sizes in both intention to treat (ITT) and completer analyses. In ITT analyses, the OCI-R decreased from 26.10 at baseline to 20.67 at post-treatment (mean reduction −5.43 points). On average, participants completed 6.30 (SD = 3.21) modules, and n = 19 (33.9%) participants completed all 10 modules of the program. Overall, n = 45 (78.9%) were treatment completers (minimum 4 modules completed), n = 11 (19.3%) were non-completers, and n = 1 (1.8%) was a dropout. At post-treatment, n = 17 (29.8%) participants showed a treatment response on the OCI-R (≥ 40% reduction). The treatment also resulted in statistically significant improvements in depressive symptoms and self-efficacy. Satisfaction with the program was high, with a majority of participants indicating that they would recommend it to others (n = 56, 98.2%) and that it provided the support they needed (n = 49, 86.0%).
Conclusions: ICBT with therapist guidance reduces OCD symptoms and depressive symptoms meaningfully in real world settings. The OCD-NET program is overall highly acceptable and seem to fit patients’ needs in routine care, even under pandemic constraints. Results also indicate that this ICBT program fits to be blended into routine psychiatric outpatient treatments. However, future research may wish to investigate how upscaling and sustainable implementation could be reached effectively.
Trial Registration: German Clinical Trials register: DRKS00021706