Research roundup: Effective technology-enhanced treatments for pediatric obsessive-compulsive disorder

Rates of obsessive-compulsive disorder (OCD) symptoms in individuals have worsened since the COVID-19 pandemic began. Recent studies show that OCD symptoms increasingly manifested in both previously treated and newly diagnosed children and adolescents with OCD.¹

In this installment of “Research Roundup,” we explore research on treating pediatric OCD remotely using a stepped care approach (offering a less intensive intervention before offering a more intensive intervention),  introducing skills via the internet to counter OCD behaviors/urges, and providing a family-based intervention via videoconferencing.

Note: In addition to reviewing the research summaries, psychologists are encouraged to explore the literature more completely to determine what may be useful to them in practice, particularly as it relates to patients’ values, preferences, and culture.

Lenhard, F., Andersson, E., Mataix-Cols, D., Rück, C., Vigerland, S., Högström, J., Hillborg, M., Brander, G., Ljungström, M., Ljótsson, B., & Serlachius, E. (2017). Therapist-guided, internet-delivered cognitive-behavioral therapy for adolescents with obsessive-compulsive disorder: a randomized controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry, 56(1), 10–19.

Using technology to deliver behavioral health interventions may make treatment for pediatric OCD more accessible. In-person cognitive behavioral therapy (CBT) sessions require a block of time for therapy plus transit to and from the session, which can be time consuming and challenging for some patients. This study tested the efficacy of a 12-week internet cognitive-behavioral therapy (ICBT) program for adolescents with OCD, with asynchronous email and occasional phone contact with a therapist.

Sixty-seven Swedish adolescents (aged 12–17) and their parents were randomly assigned to either the ICBT program or a waitlist control group. Both groups completed therapist interviews as well as self-report ratings that assessed adolescent OCD and anxiety. The ICBT program consists of 12 chapters of online reading and video materials that educate adolescents on the symptoms and causes of OCD (psychoeducation) and guide them in facing their fear and anxiety toward an object or situation without engaging in the compulsive behavior. A review of what the adolescent learned throughout the program and how to cope with OCD was then provided at the end. The adolescent had access to a therapist via a chat room or telephone and therapists averaged 18 minutes of overall time per patient, per week. Parents also completed a version of the online program (consisting of five chapters of online reading and video materials) that teaches parents how to encourage and support their children in facing their fears without resorting to compulsive behaviors.

Adolescents who were randomly assigned to the ICBT program had better treatment outcomes than their waitlist counterparts. Those who were assigned to the waitlist control had the option to then receive ICBT at the conclusion of the study. Study authors also found that adolescents from the waitlist control group improved their OCD symptoms after switching over to the program at the end of the experiment. The positive effects of the treatment continued three months after the study and 74% of the adolescents did not seek additional, outside treatment, further demonstrating that internet-delivered CBT works well. Adolescents reported that they were satisfied with the program, although half wished they were able to occasionally meet their therapist in person and 4% would have elected in-person treatment. The latter finding indicates the importance of tailoring treatments to fit the patients’ needs, values, and preferences.

Wolters, L. H., Hagen, A., op de Beek, V., Dol, P., de Haan, E., and Salemink, E. (2021). Effectiveness of an online interpretation training as a pre-treatment for cognitive behavioral therapy for obsessive-compulsive disorder in youth: A randomized controlled trial. Journal of Obsessive-Compulsive and Related Disorders, 29, Article 100636.

More children and adolescents are using mental health services during the pandemic, which has led to younger patients sometimes waiting several weeks to receive treatment for OCD. This study examined whether there was improvement and reduction in OCD symptom severity in youth who received an online pretreatment training followed by 16 weekly sessions of cognitive behavioral therapy. The training program consisted of 12 online sessions, each lasting around 15 minutes, that trained children and adolescents to identify and modify unhelpful thinking patterns that influence the development of compulsive safety behaviors. The authors hypothesized that there would be significant improvement in youth’s OCD symptoms in the group that received the pretreatment training, and that this improvement would extend throughout the CBT treatment.

Seventy-nine Dutch children and adolescents (aged 8–17) were randomly assigned to receive either pretreatment training or be placed on a waitlist before entering CBT treatment. Youth assigned to the online pretreatment training were presented with 24 anxiety-provoking situations and completed a sentence that consisted of a solution to the situation as quickly as possible. Children and adolescents were then asked whether the solution to the feared situation was correct. Both the pretreatment training and waitlist groups received 16 weekly sessions of CBT and were assessed on their OCD symptoms as well as depression and anxiety symptoms.

Youth who were assigned to complete the pretreatment training showed significant reduction in severity of their OCD symptoms. This group also reported high satisfaction in the training scenarios, suggesting that an online pretreatment training may be useful for reducing OCD symptoms in youth as they wait to receive treatment, particularly when psychologists are not as available.

Comer, J. S., Furr, J. M., Kerns, C. E., Miguel, E., Coxe, S., Elkins, R. M., Carpenter, A. L., Cornacchio, D., Cooper-Vince, C. E., DeSerisy, M., Chou, T., Sanchez, A. L., Khanna, M., Franklin, M. E., Garcia, A. M., and Freeman, J. B. (2017). Internet-delivered, family-based treatment for early-onset OCD: A pilot randomized trial. Journal of Consulting and Clinical Psychology, 85(2), 178–186.

Young patients and families are currently facing obstacles in receiving effective treatment for OCD due to the location of specialty clinics and lack of mental health personnel. The authors examined whether there would be a significant difference in OCD symptoms in children who received family-based cognitive-behavioral therapy (FB-CBT) over videoconferencing versus in-person. FB-CBT is a 14-week program that teaches young children about OCD, where it comes from, and effective skills to face their feared object or situation without resorting to compulsive safety behaviors. Parents also complete modules on the signs and symptoms of OCD in children and how to effectively model the strategies the children are taught in the program. The web-based program uses the same material as in-person sessions would, except children are learning how to face their fears head-on through an interactive game and use the drawing feature in Google Documents for paper and marker tasks.

Twenty-two children (aged 4–8) with OCD were randomly assigned to receive FB-CBT either through videoconferencing or in-person. Those assigned to receive the web-based intervention were offered complimentary video/internet equipment if needed. Children and their parents completed assessments that measured the child’s OCD symptoms, treatment satisfaction, and quality of the therapeutic relationship at baseline, posttreatment, and six months after treatment.

There was no significant difference in treatment outcomes between the internet-delivered program and in-person format, meaning the videoconferencing FB-CBT may be just as effective. Parents of children with OCD in the videoconferencing group also reported high satisfaction in the quality of the therapeutic relationship and the content of the program. Delivering treatment for families via videoconferencing could provide more flexibility and the opportunity to directly or indirectly engage other family members.

Given that many psychologists have pivoted to telehealth during the global pandemic, understanding the effectiveness of interventions delivered via technology is critical to making recommendations for patients and utilizing resources accordingly. All three studies indicate that treatments for pediatric OCD can be effectively delivered remotely and lead to positive outcomes, just as in-person treatments. Psychologists and other clinicians may be able to recommend stepped care approaches as one way to maximize the limited number of experts available in the treatment of OCD. Integrating technology options into treatment planning can increase access to effective treatments while also balancing the patient’s preferences for care.