Telephone Cognitive-Behavioral Therapy for Adolescents With Obsessive-Compulsive Disorder: A Randomized Controlled Non-inferiority Trial - 29/10/14

Doi : 10.1016/j.jaac.2014.09.012

Cynthia M. Turner, PhD ^a,^⁎ , David Mataix-Cols, PhD ^b, Karina Lovell, PhD ^c, Georgina Krebs, DClinPsy ^d, Katie Lang, MPhil ^e, Sarah Byford, PhD ^▪, Isobel Heyman, PhD ^f
^a The University of Queensland, Brisbane, Australia
^b Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, and the Karolinska Institutet, Stockholm
^c School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
^d Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, the OCD and Related Disorders Clinic for Young People, South London, and Maudsley National Health Service (NHS) Foundation Trust, London
^e Institute of Psychiatry, Psychology, and Neuroscience, King’s College London
^f Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, the Great Ormond Street Hospital, London, and the Institute of Child Health, University College London

^∗Correspondence to Cynthia Turner, PhD, Child and Family Psychology Clinic, Parenting and Family Support Centre, Department of Psychology, The University of Queensland, Brisbane QLD 4072, Australia

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Abstract

Objective

Many adolescents with obsessive-compulsive disorder (OCD) do not have access to evidence-based treatment. A randomized controlled non-inferiority trial was conducted in a specialist OCD clinic to evaluate the effectiveness of telephone cognitive-behavioral therapy (TCBT) for adolescents with OCD compared to standard clinic-based, face-to-face CBT.

Method

Seventy-two adolescents, aged 11 through 18 years with primary OCD, and their parents were randomized to receive specialist TCBT or CBT. The intervention provided differed only in the method of treatment delivery. All participants received up to 14 sessions of CBT, incorporating exposure with response prevention (E/RP), provided by experienced therapists. The primary outcome measure was the Children’s Yale–Brown Obsessive-Compulsive Scale (CY-BOCS). Blind assessor ratings were obtained at midtreatment, posttreatment, 3-month, 6-month, and 12-month follow-up.

Results

Intent-to-treat analyses indicated that TCBT was not inferior to face-to-face CBT at posttreatment, 3-month, and 6-month follow-up. At 12-month follow-up, there were no significant between-group differences on the CY-BOCS, but the confidence intervals exceeded the non-inferiority threshold. All secondary measures confirmed non-inferiority at all assessment points. Improvements made during treatment were maintained through to 12-month follow-up. Participants in each condition reported high levels of satisfaction with the intervention received.

Conclusion

TCBT is an effective treatment and is not inferior to standard clinic-based CBT, at least in the midterm. This approach provides a means of making a specialized treatment more accessible to many adolescents with OCD. Clinical trial registration information–Evaluation of telephone-administered cognitive-behavioal therapy (CBT) for young people with obsessive-compulsive disorder (OCD); 27070832.

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Key Words : OCD, psychotherapy, CBT, telehealth

Plan

Method

Recruitment and Inclusion Criteria

Measures

Procedure

Randomization and Assessment Points

Masking Procedures

Monitoring of Treatment Integrity

Treatment

Power Analysis

Results

Participant Characteristics

Attrition

Primary Outcome

Secondary Outcomes

Clinician-Administrated Measure of Global Improvement and Functioning

Treatment Credibility and Expectancy

Satisfaction With Treatment Received

Assessment of Blinding

Discussion

	Supplemental material cited in this article is available online.
	This research was funded by the National Institute for Health Research (NIHR) under its Research for Patients Benefit (RfPB) Programme (grant reference number PB-PG-0107-12333). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health.
	Martin O’Flaherty, BA (Hons), of the University of Queensland, served as the statistical expert for this research.
	Disclosure: Dr. Turner has received grant funding from the NIHR and The Maudsley Charity (UK). Dr. Mataix-Cols has received salary support from the Karolinska Institutet, Sweden. He has received grant funding from the National Institute of Mental Health (UK), the Maudsley Charity (UK), and the Stockholm County Council (Avtal om Läkarutbildning och Forskning [ALF] Project). Dr. Krebs has received salary support from the NIHR Mental Health Biomedical Research Centre at the South London and Maudsley NHS Foundation Trust and Kings College London. She has received grant funding from the NIHR. Ms. Lang has received salary support from the NIHR Mental Health Biomedical Research Centre at the South London and Maudsley NHS Foundation Trust and Kings College London. Drs. Lovell, Byford, and Heyman report no biomedical financial interests or potential conflicts of interest.