Acceptability and feasibility of enhanced cognitive behavioral therapy (eCBT) for children and adolescents with obsessive-compulsive disorder

Lucía Babiano-Espinosa; Lidewij H Wolters; Bernhard Weidle; Scott N Compton; Stian Lydersen; Norbert Skokauskas

doi:10.1186/s13034-021-00400-7

Acceptability and feasibility of enhanced cognitive behavioral therapy (eCBT) for children and adolescents with obsessive-compulsive disorder

Child Adolesc Psychiatry Ment Health. 2021 Sep 4;15(1):47. doi: 10.1186/s13034-021-00400-7.

Authors

Lucía Babiano-Espinosa^{1

2}, Lidewij H Wolters¹, Bernhard Weidle^{1

2}, Scott N Compton³, Stian Lydersen^{1

2}, Norbert Skokauskas^{4

5}

Affiliations

¹ Regional Centre for Child and Youth Mental Health and Child Welfare, Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.
² Department of Child and Adolescent Psychiatry, St. Olav's University Hospital, Trondheim, Norway.
³ Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA.
⁴ Regional Centre for Child and Youth Mental Health and Child Welfare, Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway. norbert.skokauskas@ntnu.no.
⁵ Department of Child and Adolescent Psychiatry, St. Olav's University Hospital, Trondheim, Norway. norbert.skokauskas@ntnu.no.

Abstract

Introduction: Obsessive-compulsive disorder (OCD) is a disabling mental health disorder affecting 1-3% of children and adolescents. Cognitive behavioral therapy (CBT) is recommended as the first-line treatment, but is limited by accessibility, availability, and, in some cases, response to treatment. Enhancement with Internet technologies may mitigate these challenges.

Methods: We developed an enhanced CBT (eCBT) treatment package for children and adolescents with OCD to improve treatment effect as well as user-friendliness. This study aims to explore the feasibility, acceptability, and preliminary effectiveness of the eCBT intervention. The eCBT protocol consists of 10 face-to-face and 12 webcam sessions delivered in 14 weeks. CBT is enhanced by a smartphone application (app) for children and parents to support and monitor treatment, psychoeducative videos, and therapist-guided webcam exposure exercises conducted at home. Assessments were performed at baseline, post-treatment, and at 3- and 6-month follow-up. Primary measures of outcomes were the the Client Satisfaction Questionnaire-8 (CSQ-8) (acceptability), treatment drop-out (feasibility) and the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) (preliminary effectiveness).

Results: This paper describes 25 patients with OCD (aged 8-17 years) treated with eCBT. Results indicated that children and parents were satisfied with eCBT, with CSQ-8 mean scores of 27.58 (SD 0.67) and 29.5 (SD 3.74), respectively (range 8-32). No patients dropped out from treatment. We found a mean of 63.8% symptom reduction on the CY-BOCS from baseline to post-treatment. CY-BOCS scores further decreased during 3-month and 6-month follow-up.

Conclusion: In this explorative study, eCBT for pediatric OCD was a feasible, acceptable intervention demonstrating positive treatment outcomes.

Keywords: Adolescents; Children; Cognitive behavioral therapy (CBT); Enhanced cognitive behavioral therapy (eCBT); Obsessive–compulsive disorder (OCD).