Initial evaluation of a therapist‐supported online cognitive therapy self‐help for patients with taboo obsessions

• Published in: British journal of clinical psychology Vol. 61; no. 4; pp. 964 - 982
• Main Authors: Olofsdotter Lauri, Klara, Aspvall, Kristina, Bagøien Hustad, Ingvill, Malmqvist, Karin, Serlachius, Eva, Mataix‐Cols, David, Rück, Christian, Ivanov, Volen, Andersson, Erik
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.11.2022; John Wiley and Sons Inc
• Subjects: Clinical research; Clinical trials; Cognitive Behavioral Therapy - methods; Cognitive change; Cognitive models; Cognitive therapy; Feasibility; Humans; Internet; internet‐delivered treatment; Intervention; Medicin och hälsovetenskap; Obsessive Behavior; Obsessive compulsive disorder; Obsessive-Compulsive Disorder - psychology; Obsessive-Compulsive Disorder - therapy; Self help; Severity; Taboo; taboo obsessions; Taboos; Treatment Outcome; taboo obsessions; internet-delivered treatment; obsessive-compulsive disorder; cognitive therapy
• ISSN: 0144-6657; 2044-8260
• DOI: 10.1111/bjc.12369

Objectives The current study evaluated the feasibility of an internet‐delivered cognitive therapy (I‐CT) in a self‐help format with minimal therapist support for patients with obsessive–compulsive disorder (OCD) with primary taboo obsessions. Specifically, the aims were to investigate (1) whether participants were able to grasp and apply the internet‐delivered cognitive framework to their own situation; (2) whether they had clinically meaningful reductions of OCD symptom severity; and (3) whether reduced negative appraisals (hypothesized mechanism of change in CT) preceded reductions in OCD symptom severity. Method Nineteen OCD patients with primary taboo obsessions, recruited from an OCD clinic or self‐referrals, received the I‐CT intervention for 10 weeks. I‐CT did not contain any systematic exposure or response prevention. Results Adherence and engagement with the intervention was high. Most participants (n = 13, 68%) understood and successfully applied the cognitive model to their own situation. Within‐group analyses showed large reductions in OCD symptom severity at post‐treatment (bootstrapped within group d = 1.67 [95% CI; 0.67 to 2.66]) measured with the Yale–Brown Obsessive–Compulsive Scale. The gains were maintained at the 6‐month follow‐up. Post‐hoc analyses revealed that the large reductions in OCD symptom severity were driven by the participants who understood the cognitive model. Reductions in negative appraisals predicted subsequent reductions in OCD symptom severity during treatment. Conclusion It is possible to adapt a purely cognitive intervention to a digital guided self‐help format and to achieve both cognitive change and meaningful symptom reduction. The results require confirmation in a randomized clinical trial.