Goal

The main focus of the PhD thesis was to examine the feasibility and user acceptance of this new treatment eCBT. How easy would it be to recruit children diagnosed with OCD and their parents to this treatment? And how easy would it be to carry out this treatment with eCBT? Preliminary effect was also measured.

Background

Cognitive behavioral therapy (CBT) with Expousure and Response Prevention (ERP) is used to treat OCD. Internet creates opportunities to enhance traditional CBT conducted in the therapy room, making therapy more accessible, user-friendly and cost-effective for children and adolescents with OCD and other mental disorders.

Our team has developed an enhanced treatment with CBT (eCBT). This package includes the use of weekly videoconferencing sessions, an app to work in between sessions, psychoeducative videos and some face-to-face meetings with the patients and their families. The innovative and developmental phase was completed and the initial clinical work was initiated. The eCBT for OCD treatment package was completed in collaboration between the CAPTRA group (RKBU Midt-Norge, Department of Mental Health, NTNU: Norwegian University of Science and Technology), Child and Adolescent Psychiatric Policies (BUP), St.Olavs Hospital, the International OCD Group, Bouvet (largest IT supplier in central Norway) and Kindergarten Media A / S. Developing this type of technology has a great potential for improved accessibility, especially for patients who have a long way to the treatment site and to increase ease of use because exposure exercises can be carried out in the child's natural environment, where they are most relevant.

Development

The project started in 2017, and the candidate (Psyk. Lucía Babiano-Espinosa) will have Disputas on the 13th of January 2023.

We have published four articles: a systematic review, a project protocol, an article on acceptability and feasibility of eCBT and a final article of effectiveness of eCBT and comparisons with traditional treatment. Finally a doctoral thesis introduction or “Kappa” has also been delivered upon the completion of the work. 

The systematic review showed that very few studies (6 studies) had been published in the acceptability, feasibility and effectiveness of internet CBT for children with OCD. These results pointed out the direction of this PhD project. The project protocol was published, and in this article, we described in detail our plans to implement our eCBT. In article three, we published the results in acceptability and feasibility: the patients reported high acceptability, and all patients completed treatment. We showed that eCBT was feasible, and that there were few barriers to treatment. In the fourth article, we compared our clinical eCBT results (n=25) to those of traditional therapy (n=269). 68% of our eCBT patients responded to treatment, compared to 60% of those who had had traditional therapy. eCBT patients had a 64% of symptom reduction, while in traditional therapy the patients had a 53% of symptom reduction. We can statistically affirm that our treatment is non-inferior to traditional in-office treatment. In addition we discuss that hanks to the use of webcams and the app we can reach to more patients and overcome barriers to treatment, just like we later did when COVID hit in 2020. Our team will publish the results from the cohort of patients who received 100% online eCBT during the times of COVID lockdown once this PhD is completed.

PhD-project’s publications:

Paper 1:

Lucía Babiano-Espinosa, Lidewij H. Wolters, Bernhard Weidle, Vivian op de

Beek, Sindre A. Pedersen, Scott Compton, Norbert Skokauskas.

Acceptability, feasibility, and efficacy of Internet cognitive behavioral therapy

(iCBT) for pediatric obsessive-compulsive disorder: a systematic review.

Syst Rev 8, 284 (2019). 

Paper 2:

Lidewij H. Wolters, Bernhard Weidle, Lucia Babiano-Espinosa, Norbert Skokauskas.

Feasibility, Acceptability, and Effectiveness of Enhanced Cognitive Behavioral

Therapy (eCBT) for Children and Adolescents With Obsessive-Compulsive

Disorder: Protocol for an Open Trial and Therapeutic Intervention.

JMIR Res Protoc 2020;9(12):e24057. 

Paper 3:

Lucía Babiano-Espinosa, Lidewij H. Wolters, Bernhard Weidle, Scott N. Compton,

Stian Lydersen, Norbert Skokauskas.

Acceptability and feasibility of enhanced cognitive behavioral therapy (eCBT) for

children and adolescents with obsessive–compulsive disorder.

Child Adolesc Psychiatry Ment Health 15, 47 (2021). 

Paper 4:

Lucía Babiano-Espinosa, Gudmundur Skarphedinsson, Bernhard Weidle, Lidewij H.

Wolters, Tord Ivarsson, Norbert Skokauskas.

eCBT versus standard individual CBT for pediatric obsessive-compulsive

disorder.

Child Psychiatry Hum Dev (2022). 

Finansiering

Regionalt samarbeidsorgan for utdanning, forskning og innovasjon.

Prosjektvarighet

2017-2022

Samarbeidspartnere

Bernhard Weidle, Lidewij Wolters, Stian Lydersen, Scott Compton, Robert Valderhaug