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Completed

NCT Number: NCT03263546

Internet-delivered CBT for Paediatric OCD

The purpose of this study is to investigate if therapist-guided internet-delivered cognitive behavioral therapy (ICBT) in a stepped-care approach is an effective and cost-effective treatment in reducing OCD symptoms for children and adolescents compared to gold standard treatment (face-to-face CBT).

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Key information

Conditions

Obsessive-Compulsive Disorder Anxiety Disorders Mental Disorders

Age range

7 year–17 year

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

BUP Specialmottagning, Gothenburg, Sweden

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About this study

A randomized controlled non-inferiority trial comparing therapist-guided internet-delivered cognitive behavioral therapy (ICBT) in a stepped care model with face-to-face CBT for children and adolescents with obsessive-compulsive disorder (OCD).

Participants will be randomized to either stepped care ICBT or to gold standard face-to-face CBT. One group (stepped care) will be first offered ICBT for 16 weeks. Non-responders at the 3-month follow-up will receive additional face-to-face CBT. The other group (gold standard treatment) will be randomized directly to receive face-to-face CBT for 16 weeks. Non-responders will, as in the other group, receive additional face-to-face treatment after the 3-month follow-up. The primary endpoint will be at 6-month follow-up. Long-term effects are also investigated (1 year, 2 years and 5 years after treatment completion).

The primary objective is to evaluate whether ICBT in a stepped care approach will be non-inferior to gold standard treatment (face-to-face CBT) in reducing OCD symptoms, depression, impairment, sleep problems, health and functioning. The secondary objective is to a) carry out a full health economic evaluation and b) investigate if self-referred and referred participants differ regarding outcome in the two treatment groups.

The hypotheses are:

  • An ICBT stepped care approach will be non-inferior to gold standard treatment (face-to-face CBT) in reducing OCD symptoms.
  • The stepped care approach will be associated with lower costs, such as reduced therapist and administration times, service utilization, minimized work and school absence for families etc., compared to gold standard treatment.
  • Self-referred patients will benefit significantly better than referred patients regarding outcome in the ICBT group, but there will not be any difference in the face-to-face CBT group.

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Primary DSM-5 diagnosis of OCD
  • Total score of ≥16 on the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS)
  • Age between 7 and 17 years
  • Ability to read and write Swedish and with access to a computer and use of internet.
  • Participants on psychotropic medication must had been on a stable dose for the last 6 weeks prior to baseline assessment. If the child is on medication for OCD, they will be requested to stay on stable doses for the duration of the trial.

Exclusion criteria

  • Organic brain disorders, global learning disabilities, autism spectrum disorder, psychosis, bipolar disorder and severe eating disorder.
  • Suicidal ideation
  • Not able to understand the basics of the ICBT self-help material, patient being housebound or in need of intensive- or in-patient treatment.
  • Having completed a course of CBT for OCD within the last 12 months (defined as at least 5 sessions CBT including exposure and response prevention).
  • Children with ongoing psychological treatment for OCD or another anxiety disorder will not be included in the study.

Treatment and study plan

Internet-delivered cognitive behavioral therapy (iCBT)

Behavioral

Participants will receive internet-delivered CBT with therapist support for 16 weeks. The treatment consists of 14 online chapters with interactive features as videos and illustrations. The treatment has the main focus on exposure with ritual prevention. The children and parents have regular contact with a personal assigned therapist via written text messages in the platform.

Participants that are classified as non-responders at 3 months follow-up will receive face-to-face CBT of up to 12 sessions over 12 weeks.

Cognitive Behavioral Therapy (CBT)

Behavioral

Participants in the gold standard group will receive 14 individual face-to-face CBT sessions over 16 weeks. The treatment is based on current evidence based recommendations for OCD, and focuses on exposure with ritual prevention.

Participants that are classified as non-responders at 3 months follow-up will receive additional face-to-face CBT of up to 12 sessions over 12 weeks.

Primary outcomes

  1. Children's Yale Brown Obsessive-Compulsive Scale (CY-BOCS)

    Time frame: week 0, week 16, at 3 and 6 months follow-up, at 1, 2 and 5 years follow-up.

    Change in OCD symptom severity from baseline to week 16 and 3 and 6 months after treatment has ended, and at 1, 2 and 5 years follow-up. Primary endpoint is 6 months follow-up.

Secondary outcomes

  1. Clinical global impression severity (CGI-S)

    Time frame: week 0, week 16, at 3 and 6 months follow-up, at 1, 2 and 5 years follow-up

    Change in global severity from baseline to week 16 and 3 and 6 months after treatment has ended, and at 1, 2 and 5 years follow-up.

  2. Clinical global impression improvement (CGI-I)

    Time frame: week 16, at 3 and 6 months follow-up, at 1, 2 and 5 years follow-up

    Change in global improvement from week 16 to 3 and 6 months after treatment has ended, and at 1, 2 and 5 years follow-up.

  3. Children's global assessment scale (C-GAS)

    Time frame: week 0, week 16, at 3 and 6 months follow-up, at 1 year follow-up

    Change in global functioning from baseline to week 16 and 3 and 6 months after treatment has ended, and at 1 year follow-up.

  4. Obsessive-compulsive inventory - child version (OCI-CV)

    Time frame: week 0, week 16, at 3 and 6 months follow-up, at 1 year follow-up, and weekly during treatment

    Change in child-rated OCD symptoms from baseline to week 16 and 3 and 6 months after treatment has ended, at 1 year follow-up, and weekly during treatment.

  5. The Child Health Utility 9D (CHU9D)

    Time frame: week 0, week 16, at 3 and 6 months follow-up, at 1 year follow-up

    Change in general health from baseline to week 16 and 3 and 6 months after treatment has ended, and at 1 year follow-up.

  6. Insomnia Severity Index (ISI)

    Time frame: week 0, week 16, at 3 and 6 months follow-up, at 1 year follow-up

    Change in sleep problems from baseline to week 16 and 3 and 6 months after treatment has ended, and at 1 year follow-up

  7. Children's Obsessional Compulsive Inventory Revised - parent version (ChOCI-R)

    Time frame: week 0, week 16, at 3 and 6 months follow-up, at 1 year follow-up, and weekly during treatment

    Change in parent-rated OCD symptoms from baseline to week 16 and 3 and 6 months after treatment has ended, at 1 year follow-up, and weekly during treatment.

  8. Family accommodation scale for obsessive-compulsive disorder - self-rated version (FAS-SR)

    Time frame: week 0, week 16, at 3 and 6 months follow-up, at 1 year follow-up

    Change in parent-rated family accommodation from baseline to week 16 and 3 and 6 months after treatment has ended, and at 1 year follow-up

  9. Trimbos/iMTA questionnaire for Costs associated with Psychiatric Illness (TiC-P)

    Time frame: week 0, week 16, at 3 and 6 months follow-up, at 1, 2 and 5 years follow-up.

    Change in economic costs from baseline to week 16 and 3 and 6 months after treatment has ended, and at 1, 2 and 5 years follow-up.

  10. Mood and Feeling Questionnaire (MFQ)

    Time frame: week 0, week 16, at 3 and 6 months follow-up, at 1 year follow-up

    Change in child and parent rated depressive symptoms from baseline to week 16 and 3 and 6 months after treatment has ended, and at 1 year follow-up

  11. Education, work and social adjustment scale (EWSAS)

    Time frame: week 0, week 16, at 3 and 6 months follow-up, at 1 year follow-up

    Change in child and parent rated impairment and functioning from baseline to week 16 and 3 and 6 months after treatment has ended, and at 1 year follow-up

Other outcomes

  1. Autism Spectrum Quotient (AQ-10)

    Time frame: week 0

    Measure of autistic symptoms at baseline

  2. Treatment credibility and expectancy scale

    Time frame: week 2

    Child and parent version. Investigate if both conditions have equal credibility in order to rule out placebo.

  3. Working alliance inventory (WAI)

    Time frame: week 2

    Child and parent version. Investigate if both conditions have equal working alliance in order to rule out non-specific factors.

  4. Client Satisfaction Questionnaire (CSQ-8)

    Time frame: week 16 and at 6 months follow-up

    Child and parent version. Investigate if both conditions have equal satisfaction.

  5. Patient EX/RP Adherence Scale (PEAS)

    Time frame: week 1, week 2, week 3, week 4, week 5, week 6, week 7, week 8, week 9, week 10, week 11, week 12, week 13, week 14, week 15, week 16

    Clinician-rated version during face-to-face CBT. Self-rated version during both ICBT and face-to-face CBT. Investigate treatment adherence in both conditions.

  6. internet intervention Patient Adherence Scale (iiPAS)

    Time frame: week 8 and 16

    Investigate treatment adherence in the ICBT condition.

  7. Parental strategy scale

    Time frame: week 1, week 2, week 3, week 4, week 5, week 6, week 7, week 8, week 9, week 10, week 11, week 12, week 13, week 14, week 15, week 16

    Investigate the use of parental strategies weekly during treatment.

Sponsors and collaborators

Lead sponsor

Karolinska Institutet

Other

Collaborators

  • Region Stockholm
  • Vastra Gotaland Region

Registry information

Official study title

Implementation of Internet-delivered Cognitive-behavior Therapy for Paediatric Obsessive-compulsive Disorder in the Clinic: a Randomized Stepped Care Non-inferiority Trial

Important dates

Study start
2017
Primary completion
2020
Study completion
2024
First posted
Aug 28, 2017
Registry last updated
Feb 14, 2025

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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