Online Exposure Therapy for Obsessive-Compulsive Disorder

Overseen By Amelia Dev, MS

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of Miami

Must not be taking: Psychotropic medications

Disqualifiers: Severe mental illness, Hoarding, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 1 Jurisdiction This treatment is already approved in other countries

Compensation: Varies

Number of Visits: Unknown

Duration: 12 months

50 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

The trial does not require you to stop taking your current medications, but you must have been on a stable dose of any psychotropic medication for at least 4 weeks and not have started any new psychotropic medication in the last 12 weeks.

What data supports the effectiveness of the treatment OCD-NET, Online Exposure Therapy for OCD, OCD-NET Bibliotherapy with Coaching?

Research shows that internet-based cognitive behavioral therapy (CBT) with exposure and response prevention (ERP) can be effective for treating obsessive-compulsive disorder (OCD). Studies found that online CBT programs led to significant improvements in OCD symptoms, with many participants completing the treatment and finding it acceptable. ^{1 2 3 4 5}

Is online exposure therapy for OCD safe for humans?

Research suggests that exposure-based cognitive-behavioral therapy (CBT), including online versions, does not lead to negative effects like dropping out of treatment or dissatisfaction compared to other treatments. This indicates that it is generally safe for humans. ^{3 6 7 8 9}

How is the OCD-NET treatment different from other treatments for OCD?

OCD-NET is unique because it offers online exposure therapy, which allows patients to receive cognitive behavioral therapy with exposure and response prevention (ERP) over the internet, overcoming barriers like geographical location and access to trained therapists. ^{1 3 10 11 12}

What is the purpose of this trial?

The overarching goal of this protocol is to investigate mechanisms that influence symptom outcomes of exposure and response prevention (ERP) therapy for OCD. Mechanisms may include affective processes, learning factors, cognitive factors, or other constructs that could influence treatment outcomes. The study team will conduct this research within the context of an effective online treatment for OCD called OCD-NET. OCD-NET is bibliotherapy with coaching and its content is reflective of standard care for OCD.

Research Team

Kiara Timpano, PhD

Principal Investigator

University of Miami

Amelia Dev, MS

Principal Investigator

University of Miami

Eligibility Criteria

This trial is for individuals with Obsessive-Compulsive Disorder (OCD) or Compulsive Personality Disorder who are interested in an online therapy program. Specific eligibility criteria details were not provided, so it's best to contact the study team for more information.

Inclusion Criteria

English-speaking

Able to provide consent

Located within the United States

Exclusion Criteria

Participants currently located outside of the United States

Prisoners

Participants with hoarding as the primary OCD symptom

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive the OCD-NET intervention, which includes bibliotherapy with coaching, for up to 12 months

12 months

Follow-up

Participants are monitored for safety and effectiveness after treatment

4 weeks

Treatment Details

Interventions

• OCD-NET

Trial Overview The study tests OCD-NET, an online bibliotherapy with coaching that reflects standard care for OCD. It aims to understand how different factors like emotions, learning, and cognition can affect treatment outcomes.

Participant Groups

Group I: OCD-NET Group Experimental Treatment 1 Intervention

Participants will receive the OCD-NET intervention for up to 12 months.

Who Is Running the Clinical Trial?

University of Miami

Lead Sponsor

Trials

976

Recruited

423,000+

Findings from Research

A study involving 34 volunteers with OCD showed that Internet-based writing therapy significantly improved OCD symptoms, with large effect sizes (Cohen's d = 0.82 for Y-BOCS SR and d = 0.87 for OCI-R) compared to a waiting-list control group.

The positive effects of the therapy were maintained at a 6-month follow-up, and 90% of participants who completed the program reported feeling improved and would recommend it to others, indicating high satisfaction and potential efficacy of this treatment approach.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

No talking, just writing! Efficacy of an Internet-based cognitive behavioral therapy with exposure and response prevention in obsessive compulsive disorder. Herbst, N., Voderholzer, U., Thiel, N., et al.[2022]

A study involving 151 individuals with obsessive-compulsive disorder (OCD) found that both unguided internet-based cognitive-behavioral therapy (iCBT) formats significantly reduced OCD severity over 16 weeks.

While adherence was similar in both fixed and free-choice module orders, the fixed order (iCBTfixed) showed greater improvements in OCD severity and quality of life, suggesting that a structured approach may enhance treatment outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Improving adherence to unguided Internet-based therapy for obsessive-compulsive disorder: A randomized controlled trial. Jelinek, L., Schröder, J., Bücker, L., et al.[2023]

In a study involving 11 patients with obsessive-compulsive disorder (OCD), 64% showed a positive response to home-based exposure and response prevention therapy after 24 sessions.

Of those treated, 36% experienced lasting improvements in their OCD symptoms, suggesting that this approach can be effective in real-world settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Home-based behavior therapy for obsessive-compulsive disorder: a case series with data. Rosqvist, J., Egan, D., Manzo, P., et al.[2019]

The Internet-administered cognitive behavioral therapy (CBT) program for OCD showed significant improvement in symptoms, with effect sizes of 1.28 and 0.60 on key measures after 8 weeks, indicating strong efficacy.

Eighty-one percent of participants completed the program, and they found the treatment highly acceptable, despite limited therapist contact averaging only 86 minutes over the entire duration.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

An Internet administered treatment program for obsessive-compulsive disorder: a feasibility study. Wootton, BM., Titov, N., Dear, BF., et al.[2018]

Self-help approaches, particularly fully interactive computer-aided self-help programs based on exposure and ritual prevention (ERP), have shown efficacy in treating OCD, supported by a large multicenter randomized controlled trial and smaller studies.

There is a lack of randomized controlled trials for bibliotherapy and self-help groups, but brief therapist-supported ERP via phone has demonstrated effectiveness, suggesting that accessible self-treatment options could significantly benefit patients who are currently untreated or inadequately treated.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Self-help with minimal therapist contact for obsessive-compulsive disorder: a review. Mataix-Cols, D., Marks, IM.[2022]

Exposure-based cognitive-behavioral therapy (CBT) for pediatric obsessive-compulsive disorder (OCD) does not lead to negative outcomes such as treatment attrition, poor therapeutic relationships, or low treatment satisfaction when compared to nonexposure-based treatments.

These findings support expert recommendations for using exposure-based CBT in treating pediatric OCD, helping to alleviate clinician concerns about potential adverse effects on patients and their families.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Editorial Perspective: Exposures in cognitive behavior therapy for pediatric obsessive-compulsive disorder: addressing common clinician concerns. McGuire, JF., Wu, MS., Choy, C., et al.[2019]

This study will analyze adverse events in psychotherapy for youth with OCD by including at least 128 participants aged 8-17, comparing family-based cognitive behavioral therapy (FCBT) and family-based psychoeducation and relaxation training (FPRT).

The mixed methods approach will combine quantitative assessments of adverse events with qualitative interviews to better understand their nature and causes, aiming to improve the safety and effectiveness of psychotherapy for OCD.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Adverse events in cognitive behavioral therapy and relaxation training for children and adolescents with obsessive-compulsive disorder: A mixed methods study and analysis plan for the TECTO trial. Pretzmann, L., Christensen, SH., Bryde Christensen, A., et al.[2023]

A randomized controlled trial with 67 participants showed that technician-administered internet-based cognitive behavior therapy (iCBT) significantly reduced symptoms of obsessive-compulsive disorder (OCD) and maladaptive beliefs compared to treatment as usual, with large effect sizes (greater than 0.78).

At a 3-month follow-up, 54% of those who completed the iCBT no longer met the diagnostic criteria for OCD, indicating that the treatment's benefits were maintained over time.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Internet cognitive behavioural treatment for obsessive compulsive disorder: A randomised controlled trial. Mahoney, AE., Mackenzie, A., Williams, AD., et al.[2018]

A pilot study involving 15 adults with OCD demonstrated that videoconference-mediated exposure and ritual prevention (ERP) significantly improved OCD symptoms, indicating its potential as an effective treatment alternative.

At the 3-month follow-up, 30% of participants no longer met the criteria for OCD, and 80% reported substantial improvement, suggesting that remote ERP can be a viable option for increasing access to effective mental health care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

An open trial of videoconference-mediated exposure and ritual prevention for obsessive-compulsive disorder. Goetter, EM., Herbert, JD., Forman, EM., et al.[2018]

A 15-week internet-based cognitive behavior therapy (ICBT) program with therapist support significantly reduced OCD symptoms in 23 participants, showing a large effect size (Cohen's d = 1.56).

At the end of treatment, 61% of participants experienced clinically significant improvement, and 43% no longer met the criteria for OCD, indicating that ICBT can effectively enhance mental health and functioning.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Internet-based cognitive behavior therapy for obsessive compulsive disorder: a pilot study. Andersson, E., Ljótsson, B., Hedman, E., et al.[2021]

In a study involving six outpatients with OCD, 15 sessions of teleconference and phone-based exposure therapy led to significant improvements, with four out of six patients no longer meeting the diagnostic criteria for OCD after treatment.

Patients found the teletherapy format acceptable and reported a strong therapeutic alliance, suggesting that this method could enhance access to effective OCD treatment for those unable to attend in-person sessions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Videoconference- and cell phone-based cognitive-behavioral therapy of obsessive-compulsive disorder: a case series. Vogel, PA., Launes, G., Moen, EM., et al.[2018]

A large study involving 3552 adults with OCD showed that a digital treatment using video teletherapy and exposure and response prevention (ERP) led to a significant 43.4% reduction in obsessive-compulsive symptoms, demonstrating its efficacy as a treatment option.

The treatment not only reduced OCD symptoms but also improved quality of life by 22.7%, and it was achieved in less than half the therapist time compared to traditional in-person therapy, making it a more accessible and efficient option for patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Online Video Teletherapy Treatment of Obsessive-Compulsive Disorder Using Exposure and Response Prevention: Clinical Outcomes From a Retrospective Longitudinal Observational Study. Feusner, JD., Farrell, NR., Kreyling, J., et al.[2022]

References

1. Switzerland pubmed.ncbi.nlm.nih.gov

No talking, just writing! Efficacy of an Internet-based cognitive behavioral therapy with exposure and response prevention in obsessive compulsive disorder. [2022]

2. Netherlands pubmed.ncbi.nlm.nih.gov

Improving adherence to unguided Internet-based therapy for obsessive-compulsive disorder: A randomized controlled trial. [2023]

3. Netherlands pubmed.ncbi.nlm.nih.gov

Home-based behavior therapy for obsessive-compulsive disorder: a case series with data. [2019]

4. Netherlands pubmed.ncbi.nlm.nih.gov

An Internet administered treatment program for obsessive-compulsive disorder: a feasibility study. [2018]

5. England pubmed.ncbi.nlm.nih.gov

Self-help with minimal therapist contact for obsessive-compulsive disorder: a review. [2022]

6. England pubmed.ncbi.nlm.nih.gov

Editorial Perspective: Exposures in cognitive behavior therapy for pediatric obsessive-compulsive disorder: addressing common clinician concerns. [2019]

7. Netherlands pubmed.ncbi.nlm.nih.gov

Adverse events in cognitive behavioral therapy and relaxation training for children and adolescents with obsessive-compulsive disorder: A mixed methods study and analysis plan for the TECTO trial. [2023]

8. England pubmed.ncbi.nlm.nih.gov

Internet cognitive behavioural treatment for obsessive compulsive disorder: A randomised controlled trial. [2018]

9. Netherlands pubmed.ncbi.nlm.nih.gov

An open trial of videoconference-mediated exposure and ritual prevention for obsessive-compulsive disorder. [2018]

10. England pubmed.ncbi.nlm.nih.gov

Internet-based cognitive behavior therapy for obsessive compulsive disorder: a pilot study. [2021]

11. Netherlands pubmed.ncbi.nlm.nih.gov

Videoconference- and cell phone-based cognitive-behavioral therapy of obsessive-compulsive disorder: a case series. [2018]

12. Canada pubmed.ncbi.nlm.nih.gov

Online Video Teletherapy Treatment of Obsessive-Compulsive Disorder Using Exposure and Response Prevention: Clinical Outcomes From a Retrospective Longitudinal Observational Study. [2022]