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Long-term efficacy of Internet-based cognitive behavior therapy for obsessive–compulsive disorder with or without booster: a randomized controlled trial

Published online by Cambridge University Press:  14 March 2014

E. Andersson ,
S. Steneby ,
K. Karlsson ,
B. Ljótsson ,
E. Hedman ,
J. Enander ,
V. Kaldo ,
G. Andersson ,
N. Lindefors  and
C. Rück
E. Andersson*
Affiliation:
Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden
S. Steneby
Affiliation:
Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden
K. Karlsson
Affiliation:
Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden
B. Ljótsson
Affiliation:
Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
E. Hedman
Affiliation:
Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden Osher Center for Integrative Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
J. Enander
Affiliation:
Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden
V. Kaldo
Affiliation:
Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden
G. Andersson
Affiliation:
Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden Department of Behavioral Sciences and Learning, Swedish Institute for Disability Research, Linköping University, Linköping, Sweden
N. Lindefors
Affiliation:
Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden
C. Rück
Affiliation:
Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden
*
*Address for correspondence: E. Andersson, M.Sc., M 46, Karolinska University Hospital, Huddinge, SE-141 86 Stockholm, Sweden. (Email: [email protected])
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Abstract

Background

As relapse after completed cognitive behavior therapy (CBT) for obsessive–compulsive disorder (OCD) is common, many treatment protocols include booster programs to improve the long-term effects. However, the effects of booster programs are not well studied. In this study, we investigated the long-term efficacy of Internet-based CBT (ICBT) with therapist support for OCD with or without an Internet-based booster program.

Method

A total of 101 participants were included in the long-term follow-up analysis of ICBT. Of these, 93 were randomized to a booster program or no booster program. Outcome assessments were collected at 4, 7, 12 and 24 months after receiving ICBT.

Results

The entire sample had sustained long-term effects from pre-treatment to all follow-up assessments, with large within-group effect sizes (Cohen's d = 1.58–2.09). The booster group had a significant mean reduction in OCD symptoms compared to the control condition from booster baseline (4 months) to 7 months, but not at 12 or 24 months. Participants in the booster group improved significantly in terms of general functioning at 7, 12 and 24 months, and had fewer relapses. Kaplan–Meier analysis also indicated a significantly slower relapse rate in the booster group.

Conclusions

The results suggest that ICBT has sustained long-term effects and that adding an Internet-based booster program can further improve long-term outcome and prevent relapse for some OCD patients.

Keywords

Cognitive behavior therapyboosterInternetlong-term outcomeobsessive–compulsive disorderrelapse prevention
Type
Original Articles
Information
Psychological Medicine , Volume 44 , Issue 13 , October 2014 , pp. 2877 - 2887
Copyright
Copyright © Cambridge University Press 2014 

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References

Abramowitz, JS (2006). The psychological treatment of obsessive-compulsive disorder. Canadian Journal of Psychiatry 51, 407–416.CrossRefGoogle ScholarPubMed
Abramowitz, JS (2009). Getting Over OCD: A 10-Step Workbook for Taking Back Your Life. Guilford Press: New York.Google Scholar
Andersson, E, Enander, J, Andren, P, Hedman, E, Ljotsson, B, Hursti, T, Bergstrom, J, Kaldo, V, Lindefors, N, Andersson, G, Ruck, C (2012). Internet-based cognitive behaviour therapy for obsessive-compulsive disorder: a randomized controlled trial. Psychological Medicine 42, 2193–2203.Google Scholar
Andersson, E, Ljotsson, B, Hedman, E, Kaldo, V, Paxling, B, Andersson, G, Lindefors, N, Ruck, C (2011). Internet-based cognitive behavior therapy for obsessive compulsive disorder: a pilot study. BMC Psychiatry 11, 125.CrossRefGoogle ScholarPubMed
Andersson, G (2009). Using the Internet to provide cognitive behaviour therapy. Behaviour Research and Therapy 47, 175–180.CrossRefGoogle ScholarPubMed
APA (2000). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. DSM-IV-TR. American Psychiatric Association: Washington, DC.Google Scholar
Baer, L, Blais, MA (2010). Handbook of Clinical Rating Scales and Assessment in Psychiatry and Mental Health. Humana: New York.Google Scholar
Barlow, DH (2010). Negative effects from psychological treatments: a perspective. American Psychologist 65, 13–20.Google Scholar
Braga, DT, Cordioli, AV, Niederauer, K, Manfro, GG (2005). Cognitive-behavioral group therapy for obsessive-compulsive disorder: a 1-year follow-up. Acta Psychiatrica Scandinavica 112, 180–186.Google Scholar
Coles, ME, Cook, LM, Blake, TR (2007). Assessing obsessive compulsive symptoms and cognitions on the Internet: evidence for the comparability of paper and Internet administration. Behaviour Research and Therapy 45, 2232–2240.Google Scholar
Cummings, P (2009). Methods for estimating adjusted risk ratios. Stata Journal 9, 175–196.CrossRefGoogle Scholar
Espie, CA (1986). The group treatment of obsessive-compulsive ritualisers: behavioural management of identified patterns of relapse. Behavioural and Cognitive Psychotherapy 14, 21–33.Google Scholar
Eyberg, SM, Edwards, D, Boggs, SR, Foote, R (1998). Maintaining the treatment effects of parent training: the role of booster sessions and other maintenance strategies. Clinical Psychology: Science and Practice 5, 544–554.Google Scholar
Eysenck, HJ (1963). Behaviour therapy, extinction and relapse in neurosis. British Journal of Psychiatry 109, 12–18.Google Scholar
Foa, EB, Huppert, JD, Leiberg, S, Langner, R, Kichic, R, Hajcak, G, Salkovskis, PM (2002). The Obsessive-Compulsive Inventory: development and validation of a short version. Psychological Assessment 14, 485–496.Google Scholar
Goodman, WK, Price, LH, Rasmussen, SA, Mazure, C, Fleischmann, RL, Hill, CL, Heninger, GR, Charney, DS (1989). The Yale-Brown Obsessive Compulsive Scale. I. Development, use, and reliability. Archives of General Psychiatry 46, 1006–1011.Google Scholar
Hayes, SC (2004). Acceptance and commitment therapy, relational frame theory, and the third wave of behavioral and cognitive therapies. Behavior Therapy 35, 639–665.Google Scholar
Hedman, E, Ljótsson, B, Rück, C, Furmark, T, Carlbring, P, Lindefors, N, Andersson, G (2010). Internet administration of self-report measures commonly used in research on social anxiety disorder: a psychometric evaluation. Computers in Human Behavior 26, 736–740.Google Scholar
Hennessy, M, Bolan, GA, Hoxworth, T, Iatesta, M, Rhodes, F, Zenilman, JM (1999). Using growth curves to determine the timing of booster sessions. Structural Equation Modeling: A Multidisciplinary Journal 6, 322–342.Google Scholar
Hollandare, F, Andersson, G, Engstrom, I (2010). A comparison of psychometric properties between internet and paper versions of two depression instruments (BDI-II and MADRS-S) administered to clinic patients. Journal of Medical Internet Research 12, e49.CrossRefGoogle ScholarPubMed
Jacobson, NS, Truax, P (1991). Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology 59, 12–19.CrossRefGoogle ScholarPubMed
Jonsson, H, Hougaard, E, Bennedsen, BE (2011). Randomized comparative study of group versus individual cognitive behavioural therapy for obsessive compulsive disorder. Acta Psychiatrica Scandinavica 123, 387–397.Google Scholar
Lane, P (2008). Handling drop-out in longitudinal clinical trials: a comparison of the LOCF and MMRM approaches. Pharmaceutical Statistics 7, 93–106.Google Scholar
Lazarov, A, Dar, R, Liberman, N, Oded, Y (2012). Obsessive-compulsive tendencies and undermined confidence are related to reliance on proxies for internal states in a false feedback paradigm. Journal of Behavior Therapy and Experimental Psychiatry 43, 556–564.Google Scholar
Lazarov, A, Dar, R, Oded, Y, Liberman, N (2010). Are obsessive-compulsive tendencies related to reliance on external proxies for internal states? Evidence from biofeedback-aided relaxation studies. Behaviour Research and Therapy 48, 516–523.Google Scholar
Mallinckrodt, CH, Clark, WS, David, SR (2001). Accounting for dropout bias using mixed-effects models. Journal of Biopharmaceutical Statistics 11, 9–21.CrossRefGoogle ScholarPubMed
Menzies, R, De Silva, P (2003). Obsessive-Compulsive Disorder: Theory, Research and Treatment. Wiley: New York.Google Scholar
Rachman, S (1983). Obstacles to successful treatment of obsessions. In Failures in Behaviour Therapy (ed. Foa, E. and Emmelkamp, P.), pp. 35–37. Wiley: New York.Google Scholar
Rachman, S, Hodgson, R, Marks, IM (1971). The treatment of chronic obsessive-compulsive neurosis. Behaviour Research and Therapy 9, 237–247.Google Scholar
Rufer, M, Hand, I, Alsleben, H, Braatz, A, Ortmann, J, Katenkamp, B, Fricke, S, Peter, H (2005). Long-term course and outcome of obsessive-compulsive patients after cognitive-behavioral therapy in combination with either fluvoxamine or placebo: a 7-year follow-up of a randomized double-blind trial. European Archives of Psychiatry and Clinical Neurosciences 255, 121–128.Google Scholar
Simpson, HB, Foa, EB, Liebowitz, MR, Ledley, DR, Huppert, JD, Cahill, S, Vermes, D, Schmidt, AB, Hembree, E, Franklin, M, Campeas, R, Hahn, CG, Petkova, E (2008). A randomized, controlled trial of cognitive-behavioral therapy for augmenting pharmacotherapy in obsessive-compulsive disorder. American Journal of Psychiatry 165, 621–630.CrossRefGoogle ScholarPubMed
Simpson, HB, Huppert, JD, Petkova, E, Foa, EB, Liebowitz, MR (2006). Response versus remission in obsessive-compulsive disorder. Journal of Clinical Psychiatry 67, 269–276.CrossRefGoogle ScholarPubMed
Svanborg, P, Åsberg, M (1994). A new self-rating scale for depression and anxiety states based on the Comprehensive Psychopathological Rating Scale. Acta Psychiatrica Scandinavica 89, 21–28.CrossRefGoogle ScholarPubMed
van Oppen, P, van Balkom, AJ, de Haan, E, van Dyck, R (2005). Cognitive therapy and exposure in vivo alone and in combination with fluvoxamine in obsessive-compulsive disorder: a 5-year follow-up. Journal of Clinical Psychiatry 66, 1415–1422.Google Scholar
Verbeke, G, Molenberghs, G (2009). Linear Mixed Models for Longitudinal Data. Springer: New York.Google Scholar
Whisman, MA (1990). The efficacy of booster maintenance sessions in behavior therapy: review and methodological critique. Clinical Psychology Review 10, 155–170.CrossRefGoogle Scholar
Whittal, ML, Robichaud, M, Thordarson, DS, McLean, PD (2008). Group and individual treatment of obsessive-compulsive disorder using cognitive therapy and exposure plus response prevention: a 2-year follow-up of two randomized trials. Journal of Consulting and Clinical Psychology 76, 1003–1014.Google Scholar
Wootton, BM, Dear, BF, Johnston, L, Terides, MD, Titov, N (2013). Remote treatment of obsessive-compulsive disorder: a randomized controlled trial. Journal of Obsessive-Compulsive and Related Disorders 2, 375–384.Google Scholar
Wootton, BM, Titov, N, Dear, BF, Spence, J, Andrews, G, Johnston, L, Solley, K (2011). An Internet administered treatment program for obsessive-compulsive disorder: a feasibility study. Journal of Anxiety Disorders 25, 1102–1107.CrossRefGoogle ScholarPubMed
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