Elsevier

Clinical Psychology Review

Volume 43, February 2016, Pages 103-113
Clinical Psychology Review

Remote cognitive–behavior therapy for obsessive–compulsive symptoms: A meta-analysis

https://doi.org/10.1016/j.cpr.2015.10.001Get rights and content

Highlights

  • This study synthesizes the findings on remote treatment for obsessive–compulsive symptoms using a meta-analytic approach.

  • Eighteen controlled and uncontrolled studies were included in the meta-analysis.

  • Remote treatment for OCD produces a large effect size.

  • Remote treatment for OCD is significantly more effective than control.

  • Outcomes from remote treatment do not differ from face-to-face treatment.

Abstract

Obsessive–compulsive disorder (OCD) is a chronic mental health condition that results in a significant societal burden. Remote treatments do not require the patient to attend traditional face-to-face treatment services and can be used as a way to overcome barriers to accessing face-to-face treatment. The aim of the current study was to synthesize the current literature on remote treatment for OCD using a meta-analytic approach. Relevant articles were identified through an electronic database search and the references of previously completed reviews on the topic of remote treatment for OCD were also reviewed. Eighteen studies (n = 823; mean age = 31.20 (SD = 10.36); 56.2% female) were included in the meta-analysis. Within-group findings indicate that remote treatment for OCD produces a decrease in symptoms of a large magnitude (g = 1.17; 95% CI: 0.91–1.43). Between-group findings indicate that remote treatment for OCD is more effective than control (g = 1.06; 95% CI: 0.68–1.45) and outcomes are not meaningfully different from face-to-face treatment (g =  0.21; 95% CI: − 0.43–0.02). Those methodologies that are low intensity produce a decrease in symptoms of a large magnitude (g = 1.36, 95% CI: 1.00–1.72), as do higher intensity treatments (g = 1.64, 95% CI: 1.33–1.95). These findings have important implications for the development of stepped-care treatments, which may be able to be delivered in a purely remote fashion.

Section snippets

Measurement of obsessive–compulsive symptoms

The Yale–Brown Obsessive–Compulsive Scale (Y-BOCS) (Goodman et al., 1989) is a 10-item measure of the severity of obsessive–compulsive symptoms regardless of symptom presentation and is the gold-standard outcome measure in the OCD literature. The Y-BOCS is usually completed as a clinician-administered measure, however a self-report version of the scale is also available, and responses on the self-report Y-BOCS correlate highly with those on the clinician-administered scale (r = .76) (Steketee,

Cognitive–behavioral treatment for obsessive–compulsive disorder

Cognitive–behavioral models of OCD are largely based on the body of research that demonstrates that intrusive thoughts are a universal phenomenon which becomes problematic only when individuals misinterpret those intrusions as threatening (Rachman & de Silva, 1978). These cognitive–behavioral models hypothesize that symptoms of OCD are maintained by cognitive biases, engagement in compulsive behaviors, and avoidance of triggers (Rachman, 1997, Salkovskis, 1985, Salkovskis, 1999). Best practice

Barriers to accessing evidence-based treatment

Despite the availability of effective psychological treatments for OCD many individuals do not access traditional face-to-face evidence-based treatments. Results from epidemiological studies indicate that approximately 60% of individuals with OCD remain untreated (Kohn, Saxena, Levav, & Saraceno, 2004). Other research indicates that when individuals with OCD do access treatment they are often not provided with an evidence-based treatment or do not receive a sufficient dose of ERP (Stobie,

Remote treatment for obsessive–compulsive disorder

Remote treatments are those that can be delivered without the therapist physically being in the same room as the client, and can thus improve access to evidence-based care. Remote treatments differ along multiple continua including whether they use technology to deliver remote treatments in synchronous, or real time (high intensity remote interventions) or whether they involve brief and often asynchronous contact with a therapist (low intensity remote interventions). These interventions are

Search procedure

Relevant articles were identified through electronic databases (Scopus, Medline and PsycINFO) through to December 4th 2014. The search terms used in the electronic database search included ‘obsessive compulsive or OCD’ AND ‘internet or telephone or videoconferenc* or bibliotherapy or computeri* or DVD or CD or distance or remote or self-help’ AND ‘trial or RCT or randomi*ed’. The references of previously completed reviews on the topic of remote treatment for OCD (Herbst et al., 2012, Lovell and

Results

Fig. 1 outlines the study selection process. The search yielded 256 articles. The abstracts were reviewed and 209 were excluded, resulting in 47 studies. These 47 studies were reviewed in full against the inclusion and exclusion criteria and 29 were excluded, resulting in 18 included studies in the meta-analysis. Study eligibility was determined by the author using a comprehensive coding sheet.

Discussion

The aim of this study was to extend the existing reviews of remote treatment for OCD and to provide an evaluation of the efficacy of remote treatment for OCD using a meta-analytic approach. Because of the small amount of research conducted in this area to date both controlled and uncontrolled studies were included the analysis. Overall, the results of this meta-analysis indicate that remote treatment for OCD is an efficacious and promising treatment delivery with large within-group effect sizes

Role of funding sources

This was an unfunded study and no funding sources have been omitted.

Contributors

This is a single author manuscript and I confirm that there are no other persons who satisfied the criteria for authorship that are not listed. The author conducted literature searches, collected and analyzed the data, and wrote the manuscript.

Conflict of interest

There are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome.

Acknowledgments

None.

References (97)

  • S. Nordin et al.

    Expanding the limits of bibliotherapy for panic disorder: Randomized trial of self-help without support but with a clear deadline

    Behavior Therapy

    (2010)
  • B.O. Olatunji et al.

    Cognitive–behavioral therapy for obsessive–compulsive disorder: A meta-analysis of treatment outcome and moderators

    Journal of Psychiatric Research

    (2013)
  • S. Rachman

    A cognitive theory of obsessions

    Behaviour Research and Therapy

    (1997)
  • S. Rachman et al.

    Abnormal and normal obsessions

    Behaviour Research and Therapy

    (1978)
  • S. Rachman et al.

    The treatment of chronic obsessive–compulsive neurosis

    Behaviour Research and Therapy

    (1971)
  • A.I. Rosa-Alcázar et al.

    Psychological treatment of obsessive–compulsive disorder: A meta-analysis

    Clinical Psychology Review

    (2008)
  • P.M. Salkovskis

    Obsessional–compulsive problems: A cognitive–behavioural analysis

    Behaviour Research and Therapy

    (1985)
  • P.M. Salkovskis

    Understanding and treating obsessive–compulsive disorder

    Behaviour Research and Therapy

    (1999)
  • J. Sánchez-Meca et al.

    Differential efficacy of cognitive–behavioral therapy and pharmacological treatments for pediatric obsessive–compulsive disorder: A meta-analysis

    Journal of Anxiety Disorders

    (2014)
  • G. Steketee et al.

    The Yale–Brown obsessive compulsive scale: Interview versus self-report

    Behaviour Research and Therapy

    (1996)
  • E.A. *Storch et al.

    Preliminary investigation of web-camera delivered cognitive–behavioral therapy for youth with obsessive–compulsive disorder

    Psychiatry Research

    (2011)
  • D.F. Tolin et al.

    Stepped care for obsessive–compulsive disorder: A pilot study

    Cognitive and Behavioral Practice

    (2005)
  • D.F. *Tolin et al.

    A randomized controlled trial of self-directed versus therapist-directed cognitive–behavioral therapy for obsessive–compulsive disorder patients with prior medication trials

    Behavior Therapy

    (2007)
  • P. Van Oppen et al.

    Cognitive therapy and exposure in vivo in the treatment of obsessive compulsive disorder

    Behaviour Research and Therapy

    (1995)
  • P.A. *Vogel et al.

    A pilot randomized controlled trial of videoconference-assisted treatment for obsessive–compulsive disorder

    Behaviour Research and Therapy

    (2014)
  • A. Winkler et al.

    Treatment of internet addiction: A meta-analysis

    Clinical Psychology Review

    (2013)
  • B.M. *Wootton et al.

    Remote treatment of obsessive–compulsive disorder: A randomized controlled trial

    Journal of Obsessive–Compulsive and Related Disorders

    (2013)
  • B.M. *Wootton et al.

    Self-guided internet administered treatment for obsessive–compulsive disorder: Results from two open trials

    Journal of Obsessive–Compulsive and Related Disorders

    (2014)
  • B.M. Wootton et al.

    Self-guided internet-delivered cognitive behavior therapy (iCBT) for obsessive–compulsive disorder: 12 Month follow-up

    Internet Interventions

    (2015)
  • B.M. *Wootton et al.

    An Internet administered treatment program for obsessive–compulsive disorder: A feasibility study

    Journal of Anxiety Disorders

    (2011)
  • J.S. Abramowitz

    The psychological treatment of obsessive–compulsive disorder

    Canadian Journal of Psychiatry

    (2006)
  • American Psychiatric Association

    Diagnostic and statistical manual of mental disorders

    (2013)
  • E. *Andersson et al.

    Internet-based cognitive behaviour therapy for obsessive–compulsive disorder: A randomized controlled trial

    Psychological Medicine

    (2012)
  • E. *Andersson et al.

    Internet-based cognitive behavior therapy for obsessive compulsive disorder: A pilot study

    BMC Psychiatry

    (2011)
  • Andersson, E., Steneby, S., Karlsson, K., Ljótsson, B., Hedman, E., Enander, J.,... Rück, C. (2014). Long-term efficacy...
  • G. Andersson et al.

    Guided internet-based CBT for common mental disorders

    Journal of Contemporary Psychotherapy

    (2013)
  • G. Andersson et al.

    Guided Internet-based vs. face-to-face cognitive behavior therapy for psychiatric and somatic disorders: A systematic review and meta-analysis

    World Psychiatry

    (2014)
  • G.E. Anholt et al.

    Age of onset in obsessive–compulsive disorder: Admixture analysis with a large sample

    Psychological Medicine

    (2014)
  • G.E. Anholt et al.

    The Yale–Brown obsessive–compulsive scale: Factor structure of a large sample

    Frontiers in Psychiatry

    (2010)
  • Australian Bureau of Statistics

    National survey of mental health and wellbeing: Summary of results (Cat. no. 4326.0)

    (2007)
  • M. *Bachofen et al.

    Home self-assessment and self-treatment of obsessive–compulsive disorder using a manual and a computer-conducted telephone interview: Replication of a U.K.–U.S. study

    Journal of Clinical Psychiatry

    (1999)
  • L. Baer et al.

    Reasons for inadequate utilization of cognitive–behavioral therapy for obsessive–compulsive disorder

    Journal of Clinical Psychiatry

    (2008)
  • P.E. Bee et al.

    Psychotherapy mediated by remote communication technologies: A meta-analytic review

    BMC Psychiatry

    (2008)
  • A. Belloch et al.

    To seek advice or not to seek advice about the problem: The help-seeking dilemma for obsessive–compulsive disorder

    Social Psychiatry and Psychiatric Epidemiology

    (2009)
  • M. Borenstein et al.

    Comprehensive meta-analysis (version 2.2.064)

    (2011)
  • S. Bouchard et al.

    Delivering cognitive–behavior therapy for panic disorder with agoraphobia in videoconference

    Telemedicine Journal and e-Health

    (2004)
  • R. Burton

    The anatomy of melancholoy

    (1989)
  • T.P. Carmody et al.

    Telephone-delivered cognitive–behavioral therapy for pain management among older military veterans: A randomized trial

    Psychological Services

    (2013)
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