Effectiveness of Internet-based cognitive-behavioural therapy for obsessive-compulsive disorder (OCD-NET) and body dysmorphic disorder (BDD-NET) in the Swedish public health system using the RE-AIM implementation framework

Abstract

Objectives: Therapist-guided internet cognitive behaviour therapy (ICBT) is an efficacious treatment for obsessive-compulsive disorder (OCD) and body dysmorphic disorder (BDD), but it is unclear if the results obtained in controlled trials can be reproduced in clinical settings. We evaluated the implementation of ICBT for OCD (OCD-NET) and BDD (BDD-NET) in the Swedish public health system.Methods: Consecutive referrals to an outpatient psychiatric clinic, with a primary diagnosis of OCD or BDD, were included in the study. Four hundred and thirty-four participants started OCD-NET and 163 started BDD-NET. The primary outcome measures were the Yale Brown Obsessive Compulsive Scale (Y-BOCS) and the Y-BOCS for BDD (BDD-YBOCS), respectively. Participants were assessed before treatment, weekly during treatment, and after treatment. The study used the RE-AIM implementation framework, and the elements of reach, effectiveness, adoption, and implementation for the evaluation.Results: Analysis of the ITT OCD-NET sample (n=434) showed a significant decrease in OCD symptoms from pre-treatment to post-treatment (mean reduction= -8.77 [95% CI -9.48 to -8.05] p < .001, d=1.94 [95% CI 1.75 to 2.13]). Forty-nine percent (95% CI 43% to 56%) of the participants in OCD-NET were classified as treatment responders and 21% (95% CI 16% to 27%) were in remission. Participants in BDD-NET (n=163) also showed a significant decrease in BDD symptoms from pre-post treatment (mean reduction= -11.37 [95% CI -12.9 to -9.87] p < .001, d=2.07 [95% CI 1.74 to 2.4]) and 69% (95% CI 58% to 79%) of the participants were classified as treatment responders and 48% (95% CI 38% to 58%) were in remission. Eighty-seven percent of the participants in OCD-NET and 78% in BDD-NET were treatment completers and a large proportion of participants in both treatment groups reported a high treatment satisfaction at post treatment (OCD-NET=87%, BDD-NET=79%). The most reported negative effects attributed to the treatments were transient experiences of more unpleasant feelings (52%) and more anxiety (50%). The implementation also influenced treatment delivery and dramatically decreased the mean number of patients waiting to receive face-to-face treatment options at the clinic.Conclusions: OCD-NET and BDD-NET are effective, acceptable, and safe treatments which are suitable for implementation in the Swedish public health system.

Cite this work

No public copy is stored for this record, so only the metadata is cited.

Stored only when both papers are in the corpus — 32 citations exist upstream.

Papers that cite the same references — the relational fallback while embeddings are still backfilling.