Efficacy of Technology-delivered Cognitive Behavioural Therapy for OCD Versus Control Conditions, and in Comparison with Therapist-Administered CBT: Meta-Analysis of Randomized Controlled Trials

• Published in: Cognitive behaviour therapy 2015, Vol.44 (3), p.190-211
• Main Authors: Dèttore, Davide, Pozza, Andrea, Andersson, Gerhard
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Bibliotherapy - statistics & numerical data; Child; cognitive behavioural therapy; Cognitive therapy; Cognitive Therapy - statistics & numerical data; Depression - complications; Depression - therapy; Female; Humans; Male; Mental depression; Mental health care; meta-analysis; Obsessive compulsive disorder; Obsessive-Compulsive Disorder - complications; Obsessive-Compulsive Disorder - therapy; Randomized Controlled Trials as Topic; Systematic review; technology-delivered cognitive-behavioural therapy; Therapy, Computer-Assisted - statistics & numerical data; treatment outcome; Young Adult
• ISSN: 1650-6073; 1651-2316; 1651-2316
• DOI: 10.1080/16506073.2015.1005660

Cognitive behavioural therapy (CBT) is a well-established treatment for obsessive-compulsive disorder (OCD). However, few patients receive CBT, due to factors such as geographic limitations, perceived stigmatization, and lack of CBT services. Technology-delivered cognitive behavioural therapy (T-CBT) could be an effective strategy to improve patients' access to CBT. To date, a meta-analysis on the effectiveness of T-CBT for OCD has not been conducted. This study used meta-analytic techniques to summarize evidence on the efficacy of T-CBT for OCD versus control conditions and therapist-administered CBT. A meta-analysis according to Prisma guidelines was conducted on randomized controlled trials (RCTs) of T-CBT for OCD. Treatment was classified as T-CBT if evidence-based CBT active ingredients for OCD were included (psychoeducation, ERP, and cognitive restructuring), delivered through health technologies (e.g. self-help books, leaflets, and other forms of bibliotherapy) or remote communication technologies (e.g. the Internet, web-cameras, telephones, telephone-interactive voice response systems, and CD-ROMS). Studies using validated outcomes for OCD or depression were included. Eight trials were included (N = 420). Two trials were classified as at high risk of bias. T-CBT seemed to be superior to control conditions on OCD symptom outcomes at post-treatment (d = 0.82, 99% CI = 0.55-1.08, p = 0.001), but not on comorbid depression (d = 0.33, 99% CI = − 0.01-0.67, p = 0.020). Difference in the efficacy on OCD symptoms between T-CBT and therapist-administered CBT was not significant, despite a trend favouring therapist-administered CBT emerged (d = 0.45, 95% CI = 0.03-0.87, p = 0.033). Directions for research are discussed. Further RCTs are warranted to examine the efficacy of T-CBT for OCD.