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Table 1 tCBT programs for pediatric OCD

From: How can technology enhance cognitive behavioral therapy: the case of pediatric obsessive compulsive disorder

Authors

Type of intervention

Age group

Content intervention

Duration of intervention

Study design

Study outcome

Aimed contribution to current treatment

Rees et al. (2015) [59]

CBT self-help program no therapist contact

Adolescents 12–18 years

A website offered self-guided treatment including interactive elements, personalized feedback, and a reminder system. The treatment contains E/RP (main component), cognitive restructuring, coping with stress, and family accommodation. The program consists of eight modules with separate content for adolescents and for parents.

8 weeks

Open trial

Under study

Increasing treatment availability and accessibility, and improving cost-effectivity (stepped care model)

Lenhard et al. (2014; 2017) [60, 61]

Web-based CBT reduced therapist contact

Adolescents 12–17 years

The program (12 chapters for adolescents and 5 for parents) contains educative texts, interactive elements, animations, films and exercises, addressing psychoeducation, E/RP, cognitive elements, relapse prevention, family accommodation and parental coping strategies. Participants can have regular contact with a therapist through e-mails, phone calls and standardized forms.

The treatment is supported by a smartphone app offering the possibility to add and edit exposure tasks and set reminders for ERP.

12 weeks

RCT

N = 67

Results of the RCT showed a moderate effect size (CYBOCS effect size d = 0.69) for the web-based CBT compared to a waiting list. Average therapist time was 17.5 min per week per participant. Almost half of the adolescents reported that they were satisfied with the treatment, 50% were satisfied most of the time but would have liked face-to-face contact with a therapist occasionally, and 4% would have preferred face-to-face treatment.

Increasing treatment availability, accessibility, and improving cost-effectivity

Whiteside et al. (2014) [34]

CBT smartphone application reduced therapist contact

Children and adolescents (not further specified)

App that can be used both as stand-alone CBT intervention with minimal therapist contact in cases of milder symptoms, and as adjunct to face-to-face CBT in cases of more severe OCD combined with geographical barriers. The app contains 3 modules: assessment, psychoeducation, and treatment. The treatment module guides patients through the E/RP. Patients can track their progress over time.

Not reported

Case examples

N = 2

Results indicate that both applications of the app can be effective. The app appeared to encourage treatment adherence and to facilitate exposure exercises between sessions. Detailed information via the app about exposure exercises at home was helpful for treatment management.

Increasing treatment availability and accessibility, and improving cost-effectivity

Farrell et al. (2016) [36]

Video conferencing sessions after brief, intensive CBT full therapist contact

Adolescents 11–16 years

The treatment package consisted of a face-to-face psychoeducation session and two intensive CBT sessions (three hours per session) with exposure as the main component, followed by three therapist-guided video conferencing sessions aimed at continuation of the exposure exercises and relapse prevention.

6 weeks

A multiple baseline controlled study

N = 10

Results showed an overall reduction in OCD severity after treatment, and gains were maintained during a six months follow-up period. Eight of ten children were considered reliable improved

Increasing treatment accessibility, efficiency, and improving cost-effectivity

Storch et al. (2011) [50]

CBT delivered via video conferencing (w-CBT) full therapist contact

Children and adolescents 7–16 years

Therapist-guided, web-camera delivered CBT (14 sessions) based on the protocol used in POTS (2004), including psychoeducation, cognitive therapy, E/RP, and relapse prevention. Parents were instructed to coach E/RP exercises out of the therapist’s view.

At least one parent attended the sessions with the child.

12 weeks

Preliminary RCT, w-CBT versus 4 weeks waitlist

N = 31

w-CBT was found to be effective, and superior to the waiting list control. Average reduction in OCD severity (CYBOCS) was 56% for the w-CBT arm (pre- to post-treatment d = 1.09). Despite a slight significant increase of OC symptom severity, gains were generally maintained in a naturalistic 3-month follow-up for w-CBT.

Increasing treatment accessibility

Comer et al. (2014) [49]

CBT delivered via video conferencing full therapist contact

Young children (4–8 years)

Internet-delivered family-based CBT based on the protocol of Freeman & Garcia (2009), including externalizing OCD, E/RP, contingency management, parental accommodation, and relapse prevention. Parents are trained as coaches for their children and play a key role throughout the treatment.

The program consists of 12 therapist-guided sessions with child and parents, and contains interactive elements and computer games.

14 weeks

Case series

N = 5

All children completed the full treatment course. Effect size for within-subjects CY-BOCS changes was large (d = 2.54), although results showed individual differences in treatment effect; 60% no longer met diagnostic criteria for OCD at post-treatment.

All mothers characterized the quality of services as excellent.

Increasing treatment accessibility

Turner et al. (2009; 2014) [53, 54]

Telephone delivered CBT (t-CBT) full therapist contact

Adolescents 11–18 years

Up to 14 weekly telephone CBT sessions. t-CBT consisting of psychoeducation, E/RP, cognitive interventions, and relapse prevention. Parents were involved (10 min parental discussion at the end of each treatment session).

Within 17 weeks

RCT, t-CBT compared to face-to-face CBT.

N = 72

Results indicated that telephone delivered CBT was equally effective as face-to-face CBT until 6-month follow-up. Non-inferiority could not be established at 12-month follow-up. After t-CBT, 88% of the participants fulfilled the criterion for responder (≥ 35% CYBOCS reduction), and 59% for remission (CYBOCS ≤12). Participants reported to be satisfied with both interventions.

Increasing treatment accessibility

  1. Note. E/RP Exposure with response prevention, RCT Randomized controlled trial