TY - JOUR AU - Feusner, D. Jamie AU - Farrell, R. Nicholas AU - Nunez, Mia AU - Lume, Nicholas AU - MacDonald, W. Catherine AU - McGrath, B. Patrick AU - Trusky, Larry AU - Smith, Stephen AU - Rhode, Andreas PY - 2025/1/27 TI - Effectiveness of Video Teletherapy in Treating Obsessive-Compulsive Disorder in Children and Adolescents With Exposure and Response Prevention: Retrospective Longitudinal Observational Study JO - J Med Internet Res SP - e66715 VL - 27 KW - digital behavioral health KW - youth KW - cognitive-behavioral therapy KW - exposure and response prevention KW - CBT KW - ERP KW - OCD KW - psychiatry KW - clinical trial KW - psychology KW - video therapy KW - teletherapy KW - e-therapy KW - e-counseling KW - cyber-counseling KW - adolescents KW - adolescence KW - obsessive-compulsive disorder KW - retrospective study KW - longitudinal study KW - observational study KW - ERP therapy N2 - Background: An effective primary treatment for obsessive-compulsive disorder (OCD) in children and adolescents as well as adults is exposure and response prevention (ERP), a form of intervention in the context of cognitive-behavioral therapy. Despite strong evidence supporting the efficacy and effectiveness of ERP from studies in research and real-world settings, its clinical use remains limited. This underuse is often attributed to access barriers such as the scarcity of properly trained therapists, geographical constraints, and costs. Some of these barriers may be addressed with virtual behavioral health, providing ERP for OCD through video teletherapy and supplemented by app-based therapeutic tools and messaging support between sessions. Studies of teletherapy ERP in adults with OCD have shown benefits in research and real-world settings in both small and large samples. However, studies of teletherapy ERP in children and adolescents thus far have been in small samples and limited to research rather than real-world settings. Objective: This study reports on the real-world effectiveness of teletherapy ERP for OCD in the largest sample (N=2173) of child and adolescent patients to date. Methods: Children and adolescents with OCD were treated with live, face-to-face video teletherapy sessions, with parent or caregiver involvement, using ERP. Assessments were conducted at baseline, after 7-11 weeks, and after 13-17 weeks. Additionally, longitudinal assessments of OCD symptoms were performed at weeks 18-30, 31-42, and 43-54. We analyzed longitudinal outcomes of OCD symptoms, depression, anxiety, and stress using linear mixed models. Results: Treatment resulted in a median 38.46% (IQR 12.50%-64.00%) decrease in OCD symptoms at 13-17 weeks, and 53.4% of youth met full response criteria at this point. Improvements were observed in all categories of starting symptom severity: mild (median 40.3%, IQR 8.5%-79.8%), moderate (median 38.4%, IQR 13.3%-63.6%), and severe (median 34.1%, IQR 6.6%-58.5%). In addition, there were significant reductions in the severity of depression, anxiety, and stress symptoms. The median amount of therapist involvement was 13 (IQR 10.0-16.0) appointments and 11.5 (IQR 9.0-15.0) hours. Further, symptom improvements were maintained or improved upon in the longitudinal assessment periods of weeks 18-30, 31-42, and 43-54. Conclusions: These results show that remote ERP treatment, assisted by technology, can effectively improve both core OCD and related depression, anxiety, and stress symptoms in children and adolescents with OCD in a real-world setting. Notable outcomes were achieved in a relatively small amount of therapist time, demonstrating its efficiency. Demonstrating the usefulness of a delivery format that overcomes several traditional barriers to treatment, these findings have implications for widespread dissemination of accessible, evidence-based care for children and adolescents with OCD. UR - https://www.jmir.org/2025/1/e66715 UR - http://dx.doi.org/10.2196/66715 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/66715 ER - TY - JOUR AU - Lee Yoon Li, Madeline AU - Lee Si Min, Stephanie AU - Sündermann, Oliver PY - 2024/12/16 TI - Efficacy of the mHealth App Intellect in Improving Subclinical Obsessive-Compulsive Disorder in University Students: Randomized Controlled Trial With a 4-Week Follow-Up JO - JMIR Mhealth Uhealth SP - e63316 VL - 12 KW - mobile health app KW - self-guided interventions KW - obsessive-compulsive disorder KW - cognitive behavioral therapy KW - maladaptive perfectionism KW - randomized controlled trial KW - behavioral KW - efficacy KW - mHealth app KW - university students KW - Singapore KW - symptoms N2 - Background: Obsessive-compulsive disorder (OCD) is the third most prevalent mental health disorder in Singapore, with a high degree of burden and large treatment gaps. Self-guided programs on mobile apps are accessible and affordable interventions, with the potential to address subclinical OCD before symptoms escalate. Objective: This randomized controlled trial aimed to examine the efficacy of a self-guided OCD program on the mobile health (mHealth) app Intellect in improving subclinical OCD and maladaptive perfectionism (MP) as a potential moderator of this predicted relationship. Methods: University students (N=225) were randomly assigned to an 8-day, self-guided app program on OCD (intervention group) or cooperation (active control). Self-reported measures were obtained at baseline, after the program, and at a 4-week follow-up. The primary outcome measure was OCD symptom severity (Obsessive Compulsive Inventory?Revised [OCI-R]). Baseline MP was assessed as a potential moderator. Depression, anxiety, and stress (Depression Anxiety and Stress Scales-21) were controlled for during statistical analyses. Results: The final sample included 192 participants. The intervention group reported significantly lower OCI-R scores compared with the active control group after the intervention (partial eta-squared [?p2]=0.031; P=.02) and at 4-week follow-up (?p2=0.021; P=.044). A significant, weak positive correlation was found between MP and OCI-R levels at baseline (r=0.28; P<.001). MP was not found to moderate the relationship between condition and OCI-R scores at postintervention (P=.70) and at 4-week follow-up (P=.88). Conclusions: This study provides evidence that the self-guided OCD program on the Intellect app is effective in reducing subclinical OCD among university students in Singapore. Future studies should include longer follow-up durations and study MP as a moderator in a broader spectrum of OCD symptom severity. Trial Registration: ClinicalTrials.gov NCT06202677; https://clinicaltrials.gov/study/NCT06202677 UR - https://mhealth.jmir.org/2024/1/e63316 UR - http://dx.doi.org/10.2196/63316 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63316 ER - TY - JOUR AU - Golden, Ashleigh AU - Aboujaoude, Elias PY - 2024/10/18 TI - Describing the Framework for AI Tool Assessment in Mental Health and Applying It to a Generative AI Obsessive-Compulsive Disorder Platform: Tutorial JO - JMIR Form Res SP - e62963 VL - 8 KW - artificial intelligence KW - ChatGPT KW - generative artificial intelligence KW - generative AI KW - large language model KW - chatbots KW - machine learning KW - digital health KW - telemedicine KW - psychotherapy KW - obsessive-compulsive disorder UR - https://formative.jmir.org/2024/1/e62963 UR - http://dx.doi.org/10.2196/62963 UR - http://www.ncbi.nlm.nih.gov/pubmed/39423001 ID - info:doi/10.2196/62963 ER - TY - JOUR AU - Kerry, Camrie AU - Mann, Prabhdeep AU - Babaei, Nazanin AU - Katz, Joel AU - Pirbaglou, Meysam AU - Ritvo, Paul PY - 2024/6/12 TI - Web-Based Therapist-Guided Mindfulness-Based Cognitive Behavioral Therapy for Body Dysmorphic Disorder: Pilot Randomized Controlled Trial JO - JMIR Ment Health SP - e55283 VL - 11 KW - body dysmorphic disorder KW - BDD KW - dysmorphophobia KW - obsessive-compulsive and related disorders KW - OCD KW - internet-delivered cognitive behavior therapy KW - iCBT KW - cognitive behavior therapy KW - mindfulness-based cognitive therapy KW - mindfulness KW - eMental health KW - randomized controlled trial N2 - Background: Internet-based cognitive behavioral therapy (CBT) and stand-alone mindfulness meditation interventions are gaining empirical support for a wide variety of mental health conditions. In this study, we test the efficacy of web-based therapist-guided mindfulness-based cognitive behavioral therapy (CBT-M) for body dysmorphic disorder (BDD), a psychiatric disorder characterized by preoccupations with perceived defects in appearance. Objective: This study aims to determine whether CBT-M for BDD delivered on the web is feasible and acceptable and whether mindfulness meditation adds to CBT treatment effects for BDD. Methods: In this 8-week, 2-arm, parallel pilot randomized controlled trial, n=28 adults (aged between 18 and 55 years) were randomly allocated to an experimental group (web-based therapist-guided CBT-M) or a control group (web-based therapist-guided CBT). Study retention, accrual, and intervention adherence were assessed, along with self-report measures for BDD, depression, anxiety, and pain intensity taken at baseline and postintervention. Results: This study was feasible to implement and deemed acceptable by participants. After 8 weeks, significant improvements were found on all outcome measures for both treatment groups, and large between-group effect sizes favoring CBT-M were found for BDD symptom severity (d=?0.96), depression (d=?1.06), pain severity (d=?1.12), and pain interference (d=?1.28). However, linear mixed models demonstrated no significant differences between the groups over 8 weeks. Conclusions: The results suggest that mindfulness meditation may add to beneficial web-based CBT treatment effects for BDD. An adequately powered randomized control trial of web-based CBT-M is warranted. Trial Registration: ClinicalTrials.gov NCT05402475, http://clinicaltrials.gov/ct2/show/NCT05402475 UR - https://mental.jmir.org/2024/1/e55283 UR - http://dx.doi.org/10.2196/55283 UR - http://www.ncbi.nlm.nih.gov/pubmed/38865704 ID - info:doi/10.2196/55283 ER - TY - JOUR AU - Chaves, Antonio AU - Arnáez, Sandra AU - García-Soriano, Gemma PY - 2024/3/29 TI - The Effectiveness of a Cell Phone eHealth App in Changing Knowledge, Stigmatizing Attitudes, and Intention to Seek Help Associated With Obsessive-Compulsive Disorder: Pilot Questionnaire Study JO - JMIR Mhealth Uhealth SP - e48027 VL - 12 KW - obsessive-compulsive disorder KW - OCD KW - mental health literacy KW - stigma KW - app KW - help-seeking intention KW - seek help KW - mobile phone N2 - Background: Obsessive-compulsive disorder (OCD) is a disabling disorder associated with high interference in people?s lives. However, patients with OCD either do not seek help or delay seeking help. Research suggests that this could be explained by poor mental health literacy about the disorder and the associated stigma. Objective: This study aims to evaluate the feasibility, acceptability, and preliminary effectiveness of a mental health mobile app, esTOCma, developed to improve knowledge about OCD and its treatment, increase help-seeking intention, and reduce stigmatizing attitudes and social distance associated with OCD. Methods: We used preintervention, postintervention, and 3-month follow-up assessments in this single-arm pilot intervention. Overall, 90 participants were recruited from the community using the snowball sampling method. We used esTOCma to defeat the ?stigma monster? over the course of 10 missions. The participants completed the sociodemographic information and Obsessive-Compulsive Inventory?Revised at preassessment and an acceptability questionnaire at postassessment. All other measures were completed at the preassessment, postassessment, and 3-month follow-up (ie, the Spanish Mental Illness Stigma Attribution Questionnaire?27, the General Help-Seeking Questionnaire, the Social Distance Scale, and the Mental Health Literacy Questionnaire). Results: Of the 90 participants from the community that were assessed for eligibility, 86% (n=78) were allocated to intervention. Of these 78 participants, 79% (n=62) completed the game and answered the postintervention assessment (completer group). Overall, 69% (43/62) of the participants also completed the 3-month follow-up assessment. The participants completing the study were older (P=.003) and had a higher baseline knowledge of OCD (P=.05). The participants took an average of 13.64 (SD 10.50) days to complete the intervention, including the pre- and postassessments. The participants spent an average of 4.56 (SD 3.33) days completing the 10 missions included in the app. Each mission took a mean of between 2 (SD 3.01) and 9.35 (SD 3.06) minutes. The app was rated as useful or very useful by the vast majority of participants 90% (56/62). Moreover, 90% (56/62) of the participants reported that they had learned or learned a lot, and 98% (61/62) of the participants reported that they would recommend the app to a friend. Repeated measures ANOVA (43/62, 69%) showed that after the intervention participants showed an increased knowledge of mental health and intention to seek help as well as fewer stigmatizing attitudes and less social distance. Conclusions: Preliminary data show that esTOCma is a feasible and acceptable app, and after completing its 10 missions, there is an increase in the understanding of OCD and help-seeking intention along with a decrease in the social stigma and social distance associated with OCD that lasts for at least 3 months. The results support the potential of technology-based interventions to increase the intention to seek help and reduce the stigma associated with OCD. A larger, community-controlled study is also recommended. UR - https://mhealth.jmir.org/2024/1/e48027 UR - http://dx.doi.org/10.2196/48027 UR - http://www.ncbi.nlm.nih.gov/pubmed/38551629 ID - info:doi/10.2196/48027 ER - TY - JOUR AU - Voderholzer, Ulrich AU - Meule, Adrian AU - Koch, Stefan AU - Pfeuffer, Simone AU - Netter, Anna-Lena AU - Lehr, Dirk AU - Zisler, Maria Eva PY - 2024/3/13 TI - Effectiveness of One Videoconference-Based Exposure and Response Prevention Session at Home in Adjunction to Inpatient Treatment in Persons With Obsessive-Compulsive Disorder: Nonrandomized Study JO - JMIR Ment Health SP - e52790 VL - 11 KW - obsessive-compulsive disorder KW - videoconference-based treatment KW - therapy KW - exposure KW - response prevention KW - OCD KW - prevention KW - inpatient KW - video KW - videoconference KW - therapist KW - therapists KW - mood KW - positive mood KW - environment KW - clinical setting N2 - Background: Therapist-guided exposure and response prevention (ERP) for the treatment of obsessive-compulsive disorder (OCD) is frequently conducted within clinical settings but rarely at places where patients are usually confronted with OCD symptom-provoking situations in daily life (eg, at home). Objective: This study aimed to investigate patients? views on 1 ERP session at home via videoconference and its impact on treatment outcome. Methods: A total of 64 inpatients with OCD received 1 session of therapist-guided videoconference-based ERP at home in adjunction to a multimodal inpatient treatment between 2015 and 2020. Results: Compared with 64 age- and sex-matched controls who received a multimodal inpatient treatment without 1 session of videoconference-based ERP at home, patients who received 1 session of videoconference-based ERP in adjunction to a multimodal inpatient treatment showed stronger reductions in OCD symptom severity from admission to discharge. Before the videoconference-based ERP session, patients reported high rationale credibility and treatment expectancy. After the videoconference-based ERP session, patients reported medium-to-high positive mood as well as depth and smoothness of the session, and they perceived the working alliance as high. Conclusions: Results highlight the importance of administering therapist-guided ERP sessions in patients? natural environment to enhance treatment response in OCD. Videoconference-based ERP as add-on to treatment as usual is, therefore, a promising approach to facilitate the application of ERP in patients? natural environment and foster the generalization of ERP conducted in clinical settings. UR - https://mental.jmir.org/2024/1/e52790 UR - http://dx.doi.org/10.2196/52790 UR - http://www.ncbi.nlm.nih.gov/pubmed/38477970 ID - info:doi/10.2196/52790 ER - TY - JOUR AU - Olesen, Vinther Kristoffer AU - Lønfeldt, Nadine Nicole AU - Das, Sneha AU - Pagsberg, Katrine Anne AU - Clemmensen, Harder Line Katrine PY - 2023/11/14 TI - Predicting Obsessive-Compulsive Disorder Events in Children and Adolescents in the Wild Using a Wearable Biosensor (Wrist Angel): Protocol for the Analysis Plan of a Nonrandomized Pilot Study JO - JMIR Res Protoc SP - e48571 VL - 12 KW - machine learning KW - obsessive-compulsive disorder KW - children KW - teens KW - adolescents KW - OCD KW - AI KW - artificial intelligence KW - mental health KW - Empatica E4 KW - prediction KW - physiological signal KW - mental health care KW - wearable KW - monitoring KW - obsessive compulsive disorder N2 - Background: Physiological signals such as heart rate and electrodermal activity can provide insight into an individual?s mental state, which are invaluable information for mental health care. Using recordings of physiological signals from wearable devices in the wild can facilitate objective monitoring of symptom severity and evaluation of treatment progress. Objective: We designed a study to evaluate the feasibility of predicting obsessive-compulsive disorder (OCD) events from physiological signals recorded using wrist-worn devices in the wild. Here, we present an analysis plan for the study to document our a priori hypotheses and increase the robustness of the findings of our planned study. Methods: In total, 18 children and adolescents aged between 8 and 16 years were included in this study. Nine outpatients with an OCD diagnosis were recruited from a child and adolescent mental health center. Nine youths without a psychiatric diagnosis were recruited from the catchment area. Patients completed a clinical interview to assess OCD severity, types of OCD, and number of OCD symptoms in the clinic. Participants wore a biosensor on their wrist for up to 8 weeks in their everyday lives. Patients were asked to press an event tag button on the biosensor when they were stressed by OCD symptoms. Participants without a psychiatric diagnosis were asked to press this button whenever they felt really scared. Before and after the 8-week observation period, participants wore the biosensor under controlled conditions of rest and stress in the clinic. Features are extracted from 4 different physiological signals within sliding windows to predict the distress event logged by participants during data collection. We will test the prediction models within participants across time and multiple participants. Model selection and estimation using 2-layer cross-validation are outlined for both scenarios. Results: Participants were included between December 2021 and December 2022. Participants included 10 female and 8 male participants with an even sex distribution between groups. Patients were aged between 10 and 16 years, and adolescents without a psychiatric diagnosis were between the ages of 8 and 16 years. Most patients had moderate to moderate to severe OCD, except for 1 patient with mild OCD. Conclusions: The strength of the planned study is the investigation of predictions of OCD events in the wild. Major challenges of the study are the inherent noise of in-the-wild data and the lack of contextual knowledge associated with the recorded signals. This preregistered analysis plan discusses in detail how we plan to address these challenges and may help reduce interpretation bias of the upcoming results. If the obtained results from this study are promising, we will be closer to automated detection of OCD events outside of clinical experiments. This is an important tool for the assessment and treatment of OCD in youth. Trial Registration: ClinicalTrials.gov NCT05064527; https://clinicaltrials.gov/study/NCT05064527 International Registered Report Identifier (IRRID): DERR1-10.2196/48571 UR - https://www.researchprotocols.org/2023/1/e48571 UR - http://dx.doi.org/10.2196/48571 UR - http://www.ncbi.nlm.nih.gov/pubmed/37962931 ID - info:doi/10.2196/48571 ER - TY - JOUR AU - Karpov, Boris AU - Lipsanen, Olavi Jari AU - Ritola, Ville AU - Rosenström, Tom AU - Saarni, Suoma AU - Pihlaja, Satu AU - Stenberg, Jan-Henry AU - Laizane, Paula AU - Joffe, Grigori PY - 2023/8/17 TI - The Overall Anxiety Severity and Impairment Scale as an Outcome Measure in Internet-Delivered Cognitive Behavioral Therapy for Anxiety Disorders: Observational Study JO - J Med Internet Res SP - e45362 VL - 25 KW - Overall Anxiety Severity and Impairment Scale KW - OASIS KW - internet-delivered cognitive behavioral therapy KW - iCBT KW - anxiety KW - social anxiety disorder KW - panic disorder KW - obsessive-compulsive disorder KW - OCD N2 - Background: Internet-delivered cognitive behavioral therapy (iCBT) is effective in the treatment of anxiety disorders. iCBT clinical trials use relatively long and time-consuming disorder-specific rather than transdiagnostic anxiety measurements. Overall Anxiety Severity and Impairment Scale (OASIS) is a brief self-report scale that could offer a universal, easy-to-use anxiety measurement option in disorder-specific and transdiagnostic iCBT programs. Objective: We aimed to investigate relationships between OASIS and disorder-specific instruments in iCBT. We expected these relationships to be positive. Methods: We investigated patients in original nationwide iCBT programs for generalized anxiety disorder (GAD), obsessive-compulsive disorder, panic disorder, and social anxiety disorder, which were administered by Helsinki University Hospital, Finland. In each program, anxiety symptoms were measured using both disorder-specific scales (the 7-item Generalized Anxiety Disorder scale, Penn State Worry Questionnaire, revised Obsessive-Compulsive Inventory, Panic Disorder Severity Scale, and Social Phobia Inventory) and by OASIS. A general linear model for repeated measures (mixed models) and interaction analysis were used for investigating the changes and relationships in the mean scores of OASIS and disorder-specific scales from the first session to the last one. Results: The main effect of linear mixed models indicated a distinct positive association between OASIS and disorder-specific scale scores. Interaction analysis demonstrated relatively stable associations between OASIS and the revised Obsessive-Compulsive Inventory (F822.9=0.09; 95% CI 0.090-0.277; P=.32), and OASIS and the Panic Disorder Severity Scale (F596.6=?0.02; 95% CI ?0.108 to ?0.065; P=.63) from first the session to the last one, while the 7-item Generalized Anxiety Disorder scale (F4345.8=?0.06; 95% CI ?0.109 to ?0.017; P=.007), Penn State Worry Questionnaire (F4270.8=?0.52; 95% CI ?0.620 to ?0.437; P<.001), and Social Phobia Inventory (F862.1=?0.39; 95% CI ?0.596 to ?0.187; P<.001) interrelated with OASIS more strongly at the last session than at the first one. Conclusions: OASIS demonstrates clear and relatively stable associations with disorder-specific symptom measures. Thus, OASIS might serve as an outcome measurement instrument for disorder-specific and plausibly transdiagnostic iCBT programs for anxiety disorders in regular clinical practice. UR - https://www.jmir.org/2023/1/e45362 UR - http://dx.doi.org/10.2196/45362 UR - http://www.ncbi.nlm.nih.gov/pubmed/37590055 ID - info:doi/10.2196/45362 ER - TY - JOUR AU - Lønfeldt, Nadine Nicole AU - Clemmensen, Harder Line Katrine AU - Pagsberg, Katrine Anne PY - 2023/7/24 TI - A Wearable Artificial Intelligence Feedback Tool (Wrist Angel) for Treatment and Research of Obsessive Compulsive Disorder: Protocol for a Nonrandomized Pilot Study JO - JMIR Res Protoc SP - e45123 VL - 12 KW - machine learning KW - signal processing KW - wearable biosensor KW - obsessive compulsive disorder KW - oxytocin KW - children KW - adolescents KW - family accommodation KW - psychiatric symptoms KW - clinical practice KW - automatic assessment tool KW - psychotherapy KW - mental health N2 - Background: Obsessive compulsive disorder (OCD) in youth is characterized by behaviors, emotions, physiological reactions, and family interaction patterns. An essential component of therapy involves increasing awareness of the links among thoughts, emotions, behaviors, bodily sensations, and family interactions. An automatic assessment tool using physiological signals from a wearable biosensor may enable continuous symptom monitoring inside and outside of the clinic and support cognitive behavioral therapy for OCD. Objective: The primary aim of this study is to evaluate the feasibility and acceptability of using a wearable biosensor to monitor OCD symptoms. The secondary aim is to explore the feasibility of developing clinical and research tools that can detect and predict OCD-relevant internal states and interpersonal processes with the use of speech and behavioral signals. Methods: Eligibility criteria for the study include children and adolescents between 8 and 17 years of age diagnosed with OCD, controls with no psychiatric diagnoses, and one parent of the participating youths. Youths and parents wear biosensors on their wrists that measure pulse, electrodermal activity, skin temperature, and acceleration. Patients and their parents mark OCD episodes, while control youths and their parents mark youth fear episodes. Continuous, in-the-wild data collection will last for 8 weeks. Controlled experiments designed to link physiological, speech, behavioral, and biochemical signals to mental states are performed at baseline and after 8 weeks. Interpersonal interactions in the experiments are filmed and coded for behavior. The films are also processed with computer vision and for speech signals. Participants complete clinical interviews and questionnaires at baseline, and at weeks 4, 7, and 8. Feasibility criteria were set for recruitment, retention, biosensor functionality and acceptability, adherence to wearing the biosensor, and safety related to the biosensor. As a first step in learning the associations between signals and OCD-related parameters, we will use paired t tests and mixed effects models with repeated measures to assess associations between oxytocin, individual biosignal features, and outcomes such as stress-rest and case-control comparisons. Results: The first participant was enrolled on December 3, 2021, and recruitment closed on December 31, 2022. Nine patient dyads and nine control dyads were recruited. Sixteen participating dyads completed follow-up assessments. Conclusions: The results of this study will provide preliminary evidence for the extent to which a wearable biosensor that collects physiological signals can be used to monitor OCD severity and events in youths. If we find the study to be feasible, further studies will be conducted to integrate biosensor signals output into machine learning algorithms that can provide patients, parents, and therapists with actionable insights into OCD symptoms and treatment progress. Future definitive studies will be tasked with testing the accuracy of machine learning models to detect and predict OCD episodes and classify clinical severity. Trial Registration: ClinicalTrials.gov NCT05064527; https://clinicaltrials.gov/ct2/show/NCT05064527 International Registered Report Identifier (IRRID): DERR1-10.2196/45123 UR - https://www.researchprotocols.org/2023/1/e45123 UR - http://dx.doi.org/10.2196/45123 UR - http://www.ncbi.nlm.nih.gov/pubmed/37486738 ID - info:doi/10.2196/45123 ER - TY - JOUR AU - Frank, C. Adam AU - Li, Ruibei AU - Peterson, S. Bradley AU - Narayanan, S. Shrikanth PY - 2023/7/18 TI - Wearable and Mobile Technologies for the Evaluation and Treatment of Obsessive-Compulsive Disorder: Scoping Review JO - JMIR Ment Health SP - e45572 VL - 10 KW - wearable KW - smartphone KW - obsessive-compulsive disorder KW - OCD KW - digital KW - phenotype KW - biomarker KW - mobile phone N2 - Background: Smartphones and wearable biosensors can continuously and passively measure aspects of behavior and physiology while also collecting data that require user input. These devices can potentially be used to monitor symptom burden; estimate diagnosis and risk for relapse; predict treatment response; and deliver digital interventions in patients with obsessive-compulsive disorder (OCD), a prevalent and disabling psychiatric condition that often follows a chronic and fluctuating course and may uniquely benefit from these technologies. Objective: Given the speed at which mobile and wearable technologies are being developed and implemented in clinical settings, a continual reappraisal of this field is needed. In this scoping review, we map the literature on the use of wearable devices and smartphone-based devices or apps in the assessment, monitoring, or treatment of OCD. Methods: In July 2022 and April 2023, we conducted an initial search and an updated search, respectively, of multiple databases, including PubMed, Embase, APA PsycINFO, and Web of Science, with no restriction on publication period, using the following search strategy: (?OCD? OR ?obsessive? OR ?obsessive-compulsive?) AND (?smartphone? OR ?phone? OR ?wearable? OR ?sensing? OR ?biofeedback? OR ?neurofeedback? OR ?neuro feedback? OR ?digital? OR ?phenotyping? OR ?mobile? OR ?heart rate variability? OR ?actigraphy? OR ?actimetry? OR ?biosignals? OR ?biomarker? OR ?signals? OR ?mobile health?). Results: We analyzed 2748 articles, reviewed the full text of 77 articles, and extracted data from the 25 articles included in this review. We divided our review into the following three parts: studies without digital or mobile intervention and with passive data collection, studies without digital or mobile intervention and with active or mixed data collection, and studies with a digital or mobile intervention. Conclusions: Use of mobile and wearable technologies for OCD has developed primarily in the past 15 years, with an increasing pace of related publications. Passive measures from actigraphy generally match subjective reports. Ecological momentary assessment is well tolerated for the naturalistic assessment of symptoms, may capture novel OCD symptoms, and may also document lower symptom burden than retrospective recall. Digital or mobile treatments are diverse; however, they generally provide some improvement in OCD symptom burden. Finally, ongoing work is needed for a safe and trusted uptake of technology by patients and providers. UR - https://mental.jmir.org/2023/1/e45572 UR - http://dx.doi.org/10.2196/45572 UR - http://www.ncbi.nlm.nih.gov/pubmed/37463010 ID - info:doi/10.2196/45572 ER - TY - JOUR AU - Wu, Yiwen AU - Li, Xin AU - Zhou, Yuxin AU - Gao, Rui AU - Wang, Kaifeng AU - Ye, Huiling AU - Lyu, Na AU - Wang, Chun AU - Zhang, Ning AU - Wang, Zhen AU - Fan, Qing PY - 2023/5/24 TI - Efficacy and Cost-Effectiveness Analysis of Internet-Based Cognitive Behavioral Therapy for Obsessive-Compulsive Disorder: Randomized Controlled Trial JO - J Med Internet Res SP - e41283 VL - 25 KW - obsessive-compulsive disorder KW - cognitive behavioral therapy KW - internet-based cognitive behavioral therapy KW - cost-effectiveness KW - randomized controlled trial N2 - Background: Obsessive-compulsive disorder (OCD) is a common and chronic mental illness with a high rate of disability. Internet-based cognitive behavioral therapy (ICBT) makes online treatment available to patients and has been shown to be effective. However, 3-arm trials on ICBT, face-to-face cognitive behavioral group therapy (CBGT), and only medication are still lacking. Objective: This study is a randomized, controlled, assessor-blinded trial of 3 groups for OCD: ICBT combined with medication, CBGT combined with medication, and conventional medical treatment (ie, treatment as usual [TAU]). The study aims to investigate the efficacy and cost-effectiveness of ICBT related to CBGT and TAU for adults with OCD in China. Methods: In total, 99 patients with OCD were selected and randomly assigned to the ICBT, CBGT, and TAU groups for treatment for 6 weeks. The primary outcomes were the Yale-Brown Obsessive-Compulsive Scale (YBOCS) and the self-rating Florida Obsessive-Compulsive Inventory (FOCI), compared at baseline, during treatment (3 weeks), and after treatment (6 weeks), to analyze efficacy. The secondary outcome was the EuroQol Visual Analogue Scale (EQ-VAS) scores of the EuroQol 5D Questionnaire (EQ-5D). The cost questionnaires were recorded to analyze cost-effectiveness. Results: Repeated-measures ANOVA was used for data analysis, and the final effective sample size was 93 (ICBT: n=32, 34.4%; CBGT: n=28, 30.1%; TAU: n=33, 35.5%). After 6-week treatment, the YBOCS scores of the 3 groups significantly decreased (P<.001), and there were no significant differences among groups. The FOCI score of the ICBT (P=.001) and CBGT (P=.035) groups was significantly lower than that of the TAU group after treatment. The total cost of the CBGT group (renminbi [RMB] 6678.45, 95% CI 4460.88-8896.01 [US $1010.36, 95% CI 678.87-1345.84]) was significantly higher than that of the ICBT group (RMB 3308.81, 95% CI 2476.89-4140.73[US $500.58, 95% CI 374.72-626.43], P<.001) and the TAU group (RMB 2259.61, 95% CI 2074.16-2445.05 [US $341.85, 95% CI 313.79-369.90], P<.001) after treatment. The ICBT group spent RMB 303.19 (US $45.97) less than the CBGT group and RMB 11.57 (US $1.75) less than the TAU group for each unit reduction in the YBOCS score. Conclusions: Therapist-guided ICBT combined with medication is as effective as face-to-face CBGT combined with medication for OCD. ICBT combined with medication is more cost-effective than CBGT combined with medication and conventional medical treatment. It is expected to become an efficacious and economic alternative for adults with OCD when face-to-face CBGT is not available. Trial Registration: Chinese Clinical Trial Registry ChiCTR1900023840; https://www.chictr.org.cn/showproj.html?proj=39294 UR - https://www.jmir.org/2023/1/e41283 UR - http://dx.doi.org/10.2196/41283 UR - http://www.ncbi.nlm.nih.gov/pubmed/37223977 ID - info:doi/10.2196/41283 ER - TY - JOUR AU - Maraone, Annalisa AU - Trebbastoni, Alessandro AU - Di Vita, Antonella AU - D'Antonio, Fabrizia AU - De Lena, Carlo AU - Pasquini, Massimo PY - 2023/5/11 TI - Memantine for Refractory Obsessive-Compulsive Disorder: Protocol for a Pragmatic, Double-blind, Randomized, Parallel-Group, Placebo-Controlled, Monocenter Trial JO - JMIR Res Protoc SP - e39223 VL - 12 KW - obsessive-compulsive disorder KW - refractory patients KW - antiglutamatergic agents KW - glutamate KW - augmentation medication KW - memantine KW - double blind KW - parallel group KW - placebo KW - OCD KW - psychiatric KW - distress KW - symptoms KW - neuropsychiatric KW - disability KW - overactivity KW - drug KW - treatment KW - Alzheimer KW - cognitive KW - titration KW - medication KW - mental health KW - psychiatric disorder N2 - Background: Obsessive-compulsive disorder (OCD) is a psychiatric syndrome characterized by unwanted and repetitive thoughts and repeated ritualistic compulsions for decreasing distress. Symptoms can cause severe distress and functional impairment. OCD affects 2% to 3% of the population and is ranked within the 10 leading neuropsychiatric causes of disability. Cortico-striatal-thalamo-cortical circuitry dysfunction has been implicated in OCD, including altered brain activation and connectivity. Complex glutamatergic signaling dysregulation within cortico-striatal circuitry has been proposed in OCD. Data obtained by several studies indicate reduced glutamatergic concentrations in the anterior cingulate cortex, combined with overactive glutamatergic signaling in the striatum and orbitofrontal cortex. A growing number of randomized controlled trials have assessed the utility of different glutamate-modulating drugs as augmentation medications or monotherapies for OCD, including refractory OCD. However, there are relevant variations among studies in terms of patients? treatment resistance, comorbidity, age, and gender. At present, 4 randomized controlled trials are available on the efficacy of memantine as an augmentation medication for refractory OCD. Objective: Our study?s main purpose is to conduct a double-blind, randomized, parallel-group, placebo-controlled, monocenter trial to assess the efficacy and safety of memantine as an augmentative agent to a selective serotonin reuptake inhibitor in the treatment of moderate to severe OCD. The study?s second aim is to evaluate the effect of memantine on cognitive functions in patients with OCD. The third aim is to investigate if responses to memantine are modulated by variables such as gender, symptom subtypes, and the duration of untreated illness. Methods: Investigators intend to conduct a double-blind, randomized, parallel-group, placebo-controlled, monocenter trial to assess the efficacy and safety of memantine as an augmentative agent to a selective serotonin reuptake inhibitor in the treatment of patients affected by severe refractory OCD. Participants will be rated via the Yale-Brown Obsessive Compulsive Scale at baseline and at 2, 4, 6, 8, 10, and 12 months. During the screening period and T4 and T6 follow-up visits, all participants will undergo an extensive neuropsychological evaluation. The 52-week study duration will consist of 4 distinct periods, including memantine titration and follow-up periods. Results: Recruitment has not yet started. The study will be conducted from June 2023 to December 2024. Results are expected to be available in January 2025. Throughout the slow-titration period, we will observe the minimum effective dose of memantine, and the follow-up procedure will detail its residual efficacy after drug withdrawal. Conclusions: The innovation of this research proposal is not limited to the evaluation of the efficacy and safety of memantine as an augmentation medication for OCD. We will also test if memantine acts as a pure antiobsessive medication or if memantine?s ability to improve concentration and attention mimics an antiobsessive effect. Trial Registration: ClinicalTrials.gov NCT05015595; https://clinicaltrials.gov/ct2/show/NCT05015595 International Registered Report Identifier (IRRID): PRR1-10.2196/39223 UR - https://www.researchprotocols.org/2023/1/e39223 UR - http://dx.doi.org/10.2196/39223 UR - http://www.ncbi.nlm.nih.gov/pubmed/37166948 ID - info:doi/10.2196/39223 ER - TY - JOUR AU - Feusner, D. Jamie AU - Farrell, R. Nicholas AU - Kreyling, Jeremy AU - McGrath, B. Patrick AU - Rhode, Andreas AU - Faneuff, Ted AU - Lonsway, Stephanie AU - Mohideen, Reza AU - Jurich, E. John AU - Trusky, Larry AU - Smith, M. Stephen PY - 2022/5/19 TI - Online Video Teletherapy Treatment of Obsessive-Compulsive Disorder Using Exposure and Response Prevention: Clinical Outcomes From a Retrospective Longitudinal Observational Study JO - J Med Internet Res SP - e36431 VL - 24 IS - 5 KW - digital behavioral health KW - cognitive-behavioral therapy KW - CBT KW - exposure and ritual prevention KW - ERP KW - EX/RP KW - digital health KW - telehealth KW - cognitive therapy KW - obsessive compulsive disorder KW - OCD KW - clinical outcomes KW - teletherapy KW - remote therapy KW - telemedicine KW - obsessive compulsive KW - symptom KW - comorbid symptom KW - comorbidity KW - comorbidities KW - video therapy KW - virtual therapy KW - clinical outcome KW - patient outcome KW - online therapy KW - mobile health KW - mHealth KW - app based KW - health app KW - technology assisted KW - messaging N2 - Background: Exposure and response prevention, a type of cognitive-behavioral therapy, is an effective first-line treatment for obsessive-compulsive disorder (OCD). Despite extensive evidence of the efficacy of exposure and response prevention (ERP) from clinical studies and in real-world samples, it is still underused as a treatment. This is likely due to the limits to access to care that include the availability of adequately trained therapists, as well as geographical location, time, and cost barriers. To address these, NOCD created a digital behavioral health treatment for OCD using ERP delivered via video teletherapy and with technology-assisted elements including app-based therapy tools and between-session therapist messaging. Objective: We examined treatment outcomes in a large naturalistic sample of 3552 adults with a primary OCD diagnosis who received NOCD treatment. Methods: The treatment model consisted of twice-weekly, live, face-to-face video teletherapy ERP for 3 weeks, followed by 6 weeks of once-weekly brief video teletherapy check-ins for 30 minutes. Assessments were conducted at baseline, at midpoint after completion of 3 weeks of twice-weekly sessions, and at the end of 6 weeks of brief check-ins (endpoint). Longitudinal assessments were also obtained at 3, 6, 9, and 12 months after endpoint. Results: Treatment resulted in clinically and statistically significant improvements, with a 43.4% mean reduction in obsessive-compulsive symptoms (g=1.0; 95% CI 0.93 to 1.03) and a 62.9% response rate. Treatment also resulted in a 44.2% mean reduction in depression, a 47.8% mean reduction in anxiety, and a 37.3% mean reduction in stress symptoms. Quality of life improved by a mean of 22.7%. Reduction in OCD symptoms and response rates were similar for those with mild, moderate, or severe symptoms. The mean duration of treatment was 11.5 (SD 4.0) weeks, and the mean total therapist time was 10.6 (SD 1.1) hours. Improvements were maintained at 3, 6, 9, and 12 months. Conclusions: In this sample, representing the largest reported treated cohort of patients with OCD to date, video teletherapy treatment demonstrated effectiveness in reducing obsessive-compulsive and comorbid symptoms and improved quality of life. Further, it achieved meaningful results in less than half the total therapist time compared with standard once-weekly outpatient treatment, an efficiency that represents substantial monetary and time savings. The effect size was large and similar to studies of in-person ERP. This technology-assisted remote treatment is readily accessible for patients, offering an advancement in the field in the dissemination of effective evidence-based care for OCD. UR - https://www.jmir.org/2022/5/e36431 UR - http://dx.doi.org/10.2196/36431 UR - http://www.ncbi.nlm.nih.gov/pubmed/35587365 ID - info:doi/10.2196/36431 ER - TY - JOUR AU - Imai, Hissei AU - Tajika, Aran AU - Narita, Hisashi AU - Yoshinaga, Naoki AU - Kimura, Kenichi AU - Nakamura, Hideki AU - Takeshima, Nozomi AU - Hayasaka, Yu AU - Ogawa, Yusuke AU - Furukawa, Toshi PY - 2022/4/21 TI - Unguided Computer-Assisted Self-Help Interventions Without Human Contact in Patients With Obsessive-Compulsive Disorder: Systematic Review and Meta-analysis JO - J Med Internet Res SP - e35940 VL - 24 IS - 4 KW - randomized controlled trial KW - RCT KW - information technology KW - psychotherapy KW - treatment adherence KW - anxiety disorder KW - anxiety KW - OCD KW - obsessive-compulsive disorder KW - systematic review KW - meta-analysis KW - mental health KW - computer-assisted KW - therapy KW - efficacy KW - acceptability KW - eHealth KW - mental illness N2 - Background: Computer-assisted treatment may reduce therapist contact and costs and promote client participation. This meta-analysis examined the efficacy and acceptability of an unguided computer-assisted therapy in patients with obsessive-compulsive disorder (OCD) compared with a waiting list or attention placebo. Objective: This study aimed to evaluate the effectiveness and adherence of computer-assisted self-help treatment without human contact in patients with OCD using a systematic review and meta-analysis approach. Methods: Randomized controlled trials with participants primarily diagnosed with OCD by health professionals with clinically significant OCD symptoms as measured with validated scales were included. The interventions included self-help treatment through the internet, computers, and smartphones. We excluded interventions that used human contact. We conducted a search on PubMed, Cochrane Central Register of Controlled Trials, EMBASE, World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov, as well as the reference lists of the included studies. The risk of bias was evaluated using version 2 of the Cochrane risk-of-bias tool for randomized trials. We calculated the standardized mean differences for continuous outcomes and risk ratios for dichotomous outcomes. The primary outcomes were short-term improvement of OCD symptoms measured by validated scales and dropout for any reason. Results: We included 11 randomized controlled trials with a total of 983 participants. The results indicated that unguided computer-assisted self-help therapy was significantly more effective than a waiting list or psychological placebo (standard mean difference ?0.47, 95% CI ?0.73 to ?0.22). Unguided computer-assisted self-help therapy had more dropouts for any reason than waiting list or psychological placebo (risk ratio 1.98, 95% CI 1.21 to 3.23). However, the quality of evidence was very low because of the risk of bias and inconsistent results among the included studies. The subgroup analysis showed that exposure response and prevention and an intervention duration of more than 4 weeks strengthen the efficacy without worsening acceptability. Only a few studies have examined the interaction between participants and systems, and no study has used gamification. Most researchers only used text-based interventions, and no study has used a mobile device. The overall risk of bias of the included studies was high and the heterogeneity of results was moderate to considerable. Conclusions: Unguided computer-assisted self-help therapy for OCD is effective compared with waiting lists or psychological placebo. An exposure response and prevention component and intervention duration of more than 4 weeks may strengthen the efficacy without worsening the acceptability of the therapy. Trial Registration: PROSPERO (International Prospective Register of Systematic Reviews) CRD42021264644; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=264644 UR - https://www.jmir.org/2022/4/e35940 UR - http://dx.doi.org/10.2196/35940 UR - http://www.ncbi.nlm.nih.gov/pubmed/35451993 ID - info:doi/10.2196/35940 ER - TY - JOUR AU - van Loenen, Inge AU - Scholten, Willemijn AU - Muntingh, Anna AU - Smit, Johannes AU - Batelaan, Neeltje PY - 2022/2/10 TI - The Effectiveness of Virtual Reality Exposure?Based Cognitive Behavioral Therapy for Severe Anxiety Disorders, Obsessive-Compulsive Disorder, and Posttraumatic Stress Disorder: Meta-analysis JO - J Med Internet Res SP - e26736 VL - 24 IS - 2 KW - anxiety disorders KW - virtual reality KW - virtual reality exposure therapy KW - cognitive behavioral therapy KW - meta-analysis KW - mobile phone N2 - Background: In recent years, virtual reality exposure?based cognitive behavioral therapy (VRE-CBT) has shown good treatment results in (subclinical) anxiety disorders and seems to be a good alternative to exposure in vivo in regular cognitive behavioral therapy (CBT). However, previous meta-analyses on the efficacy of VRE-CBT on anxiety disorders have included studies on specific phobias and subthreshold anxiety; therefore, these results may not be generalizable to patients with more severe and disabling anxiety disorders. Objective: The objective of our study is to determine the efficacy of VRE-CBT on more severe anxiety disorders, excluding specific phobias and subthreshold anxiety disorders. Meta-analyses will be conducted to examine the efficacy of VRE-CBT versus waitlist and regular CBT. Our secondary objectives are to examine whether the efficacy differs according to the type of anxiety disorder, type of recruitment, and type of VRE-CBT (virtual reality exposure either with or without regular CBT). Furthermore, attrition in VRE-CBT and CBT will be compared. Methods: Studies published until August 20, 2020, were retrieved through systematic literature searches in PubMed, PsycINFO, and Embase. We calculated the effect sizes (Hedges g) for the difference between the conditions and their 95% CIs for posttest and follow-up measurements in a random effects model. A separate meta-analysis was performed to compare attrition between the VRE-CBT and CBT conditions. Results: A total of 16 trials with 817 participants were included. We identified 10 comparisons between VRE-CBT and a waitlist condition and 13 comparisons between VRE-CBT and a CBT condition. With regard to risk of bias, information on random sequence generation, allocation concealment, and risk of bias for selective outcome reporting was often absent or unclear. The mean effect size of VRE-CBT compared with waitlist (nco=10) was medium and significant, favoring VRE-CBT (Hedges g=?0.490, 95% CI ?0.82 to ?0.16; P=.003). The mean effect size of VRE-CBT compared with CBT (nco=13) was small and nonsignificant, favoring CBT (Hedges g=0.083, 95% CI ?0.13 to 0.30; P=.45). The dropout rates between VRE-CBT and CBT (nco=10) showed no significant difference (odds ratio 0.79, 95% CI 0.49-1.27; P=.32). There were no indications of small study effects or publication bias. Conclusions: The results of our study show that VRE-CBT is more effective than waitlist and as effective as CBT in the treatment of more severe anxiety disorders. Therefore, VRE-CBT may be considered a promising alternative to CBT for patients with more severe anxiety disorders. Higher-quality randomized controlled trials are needed to verify the robustness of these findings. UR - https://www.jmir.org/2022/2/e26736 UR - http://dx.doi.org/10.2196/26736 UR - http://www.ncbi.nlm.nih.gov/pubmed/35142632 ID - info:doi/10.2196/26736 ER - TY - JOUR AU - Matsumoto, Kazuki AU - Hamatani, Sayo AU - Shimizu, Eiji PY - 2021/12/13 TI - Effectiveness of Videoconference-Delivered Cognitive Behavioral Therapy for Adults With Psychiatric Disorders: Systematic and Meta-Analytic Review JO - J Med Internet Res SP - e31293 VL - 23 IS - 12 KW - videoconference-delivered cognitive behavioral therapy KW - depression KW - anxiety KW - psychiatric disorders KW - systematic review KW - meta-analysis KW - digital health KW - mental health KW - cognitive therapy KW - internet-based therapy KW - cognition KW - neurodevelopment KW - communication technology KW - health technology KW - psychological disorders KW - anxiety disorder N2 - Background: Cognitive behavioral therapy (CBT) is the gold standard of psychotherapy for psychiatric disorders. However, the format of delivering CBT in person limits access to the intervention. The advancements in information and communication technology, especially the internet, present an opportunity for cognitive behavioral therapists to service patients or clients in remote areas through videoconferencing. Although many randomized controlled trials of videoconference-delivered cognitive behavioral therapy (VCBT) have already been conducted, the overall estimated effect size of VCBT for psychiatric disorders has not been examined by systematic reviews and meta-analyses. Objective: This study attempts to evaluate the effectiveness of VCBT for psychiatric disorders through a systematic and meta-analytic review. Methods: A systematic review and meta-analysis of studies in which VCBT was directly compared to control groups (such as treatment as usual, attention control, wait-list control, and other minimal supports) was carried out. To identify previous studies that meet our study objective, 2 independent reviewers undertook a systematic search through seven databases: MEDLINE (via PubMed), Web of Science, Science Direct, PsycINFO, CINAHL, LILACS, and SciELO. Other databases (ClinicalTrials.gov and Cochrane Central Resister of Controlled Trials) were also checked. All studies included in the review were assessed using the quality criteria of the Cochrane Collaboration. Statistical analysis was performed by using Cochrane Review Manager (RevMan, version 5.4.0). Standardized mean difference was used in major meta-analyses where a P value of .05 or less was the threshold for statistical significance. A heterogeneity test and the chi-square test were performed to assess the presence and extent of statistical heterogeneity with significance set at P<.10. Funnel plots were visually inspected to assess the risk of bias. Subgroup analyses were conducted for each disorder to estimate intervention effects. Results: The systematic search resulted in 16 studies (total N=1745) that met the criteria for this study and were included in the review. There were 10 studies on depressive symptoms, 3 on chronic pain, 1 on generalized anxiety disorder, 1 on obsessive-compulsive disorder, and 1 on hypochondriasis. The quality and risk of bias was also assessed. Results showed a pooled effect size (Hedge g) post treatment of ?0.49 (95% CI ?0.68 to ?0.29), indicating that VCBT is effective for clients with psychiatric disorders. Study quality did not affect outcomes. Conclusions: While the overall results indicate the effectiveness of VCBT, there are still only a limited number of studies on specific psychiatric and somatic conditions. Therefore, more randomized controlled trials are needed to establish the effectiveness of VCBT for different disorders. Trial Registration: International Prospective Register of Systematic Reviews (PROSPERO) CRD42021224832; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=224832 UR - https://www.jmir.org/2021/12/e31293 UR - http://dx.doi.org/10.2196/31293 UR - http://www.ncbi.nlm.nih.gov/pubmed/34898445 ID - info:doi/10.2196/31293 ER - TY - JOUR AU - Thorarinsdottir, Kristjana AU - Holmes, A. Emily AU - Hardarson, Johann AU - Hedinsdottir, Unnur AU - Kanstrup, Marie AU - Singh, Laura AU - Hauksdottir, Arna AU - Halldorsdottir, Thorhildur AU - Gudmundsdottir, Berglind AU - Valdimarsdottir, Unnur AU - Thordardottir, Bjork Edda AU - Gamble, Beau AU - Bjornsson, Andri PY - 2021/11/4 TI - Reducing Intrusive Memories of Childhood Trauma Using a Visuospatial Intervention: Case Study in Iceland JO - JMIR Form Res SP - e29873 VL - 5 IS - 11 KW - psychological trauma KW - intrusive memories KW - case report KW - visuospatial interference task KW - Tetris gameplay KW - mental imagery KW - mobile phone N2 - Background: Additional interventions are needed for survivors of psychological trauma because of several barriers to and limitations of existing treatment options (eg, need to talk about the trauma in detail). Case studies are an important step in exploring the development of novel interventions, allowing detailed examination of individual responses to treatment over time. Here, we present a case study that aims to test a novel intervention designed to disrupt memory reconsolidation, taking a single-symptom approach by focusing on intrusive memories of a traumatic event. Objective: This study aims to examine a novel brief cognitive intervention to reduce the number of intrusive memories of trauma in an Icelandic setting and to extend previous studies by examining long-term effects for up to 3 months. The intervention was guided by a clinical psychologist and comprised a brief memory reminder, followed by Tetris gameplay with mental rotation, targeting one memory at a time in each session. Methods: This was a single case study in Iceland with a woman in her 50s (drawn from an epidemiological study of trauma) with subthreshold posttraumatic stress disorder and a diagnosis of obsessive-compulsive disorder and social anxiety disorder. The participant had four different intrusive memories from a traumatic event that happened in her childhood. The primary outcome was the change in the number of intrusive memories from baseline to intervention phase and to follow-ups. The number of intrusions was monitored in a daily diary for 4 weeks preintervention, 8 weeks during the intervention, and 1 week at 1-month and 3-month follow-ups. Intrusions were targeted one by one over six intervention sessions, creating four repetitions of an AB design (ie, length of baseline A and intervention phase B varied for each memory). We examined changes in both the total number of intrusions (summed across all four memories) and individually for each memory. In addition, we explored whether having fewer intrusive memories would have an impact on functioning, posttraumatic stress, and depression or anxiety symptoms. Results: The total number of intrusions per week was 12.6 at baseline, 6.1 at the intervention phase (52% reduction from baseline), 3.0 at the 1-month follow-up (76% reduction), and 1.0 at the 3-month follow-up (92% reduction). Reductions in the symptoms of posttraumatic stress and depression were observed postintervention. Sleep, concentration, stress, and functioning improved. The participant considered the gameplay intervention acceptable and helpful in that she found that the memories disappeared while she was playing. Conclusions: This guided brief cognitive intervention reduced the number of intrusive memories over the intervention phase and follow-ups. The brief memory reminder was well tolerated, removing the need to discuss trauma in detail. The next steps require an extension to more cases and exploring remote delivery of the intervention. UR - https://formative.jmir.org/2021/11/e29873 UR - http://dx.doi.org/10.2196/29873 UR - http://www.ncbi.nlm.nih.gov/pubmed/34734830 ID - info:doi/10.2196/29873 ER - TY - JOUR AU - Stephenson, Callum AU - Malakouti, Niloufar AU - Nashed, Y. Joseph AU - Salomons, Tim AU - Cook, J. Douglas AU - Milev, Roumen AU - Alavi, Nazanin PY - 2021/9/14 TI - Using Electronically Delivered Therapy and Brain Imaging to Understand Obsessive-Compulsive Disorder Pathophysiology: Protocol for a Pilot Study JO - JMIR Res Protoc SP - e30726 VL - 10 IS - 9 KW - mental health KW - obsessive-compulsive disorder KW - cognitive behavioral therapy KW - exposure ritual prevention KW - electronic KW - functional magnetic resonance imaging KW - eHealth KW - brain imaging N2 - Background: Obsessive-compulsive disorder (OCD) is a debilitating and prevalent anxiety disorder. Although the basal ganglia and frontal cortex are the brain regions that are most commonly hypothesized to be involved in OCD, the exact pathophysiology is unknown. By observing the effects of proven treatments on brain activation levels, the cause of OCD can be better understood. Currently, the gold standard treatment for OCD is cognitive behavioral therapy (CBT) with exposure and response prevention. However, this is often temporally and geographically inaccessible, time consuming, and costly. Fortunately, CBT can be effectively delivered using the internet (electronically delivered CBT [e-CBT]) because of its structured nature, thus addressing these barriers. Objective: The aims of this study are to implement an e-CBT program for OCD and to observe its effects on brain activation levels using functional magnetic resonance imaging (MRI). It is hypothesized that brain activation levels in the basal ganglia and frontal cortex will decrease after treatment. Methods: Individuals with OCD will be offered a 16-week e-CBT program with exposure and response prevention mirroring in-person CBT content and administered through a secure web-based platform. The efficacy of the treatment will be evaluated using clinically validated symptomology questionnaires at baseline, at week 8, and after treatment (week 16). Using functional MRI at baseline and after treatment, brain activation levels will be assessed in the resting state and while exposed to anxiety-inducing images (eg, dirty dishes if cleanliness is an obsession). The effects of treatment on brain activation levels and the correlation between symptom changes and activation levels will be analyzed. Results: The study received initial ethics approval in December 2020, and participant recruitment began in January 2021. Participant recruitment has been conducted through social media advertisements, physical advertisements, and physician referrals. To date, 5 participants have been recruited. Data collection is expected to conclude by January 2022, and data analysis is expected to be completed by February 2022. Conclusions: The findings from this study can further our understanding of the causation of OCD and help develop more effective treatments for this disorder. Trial Registration: ClinicalTrials.gov NCT04630197; https://clinicaltrials.gov/ct2/show/NCT04630197. International Registered Report Identifier (IRRID): PRR1-10.2196/30726 UR - https://www.researchprotocols.org/2021/9/e30726 UR - http://dx.doi.org/10.2196/30726 UR - http://www.ncbi.nlm.nih.gov/pubmed/34348889 ID - info:doi/10.2196/30726 ER - TY - JOUR AU - Feusner, D. Jamie AU - Mohideen, Reza AU - Smith, Stephen AU - Patanam, Ilyas AU - Vaitla, Anil AU - Lam, Christopher AU - Massi, Michelle AU - Leow, Alex PY - 2021/6/21 TI - Semantic Linkages of Obsessions From an International Obsessive-Compulsive Disorder Mobile App Data Set: Big Data Analytics Study JO - J Med Internet Res SP - e25482 VL - 23 IS - 6 KW - OCD KW - natural language processing KW - clinical subtypes KW - semantic KW - word embedding KW - clustering N2 - Background: Obsessive-compulsive disorder (OCD) is characterized by recurrent intrusive thoughts, urges, or images (obsessions) and repetitive physical or mental behaviors (compulsions). Previous factor analytic and clustering studies suggest the presence of three or four subtypes of OCD symptoms. However, these studies have relied on predefined symptom checklists, which are limited in breadth and may be biased toward researchers? previous conceptualizations of OCD. Objective: In this study, we examine a large data set of freely reported obsession symptoms obtained from an OCD mobile app as an alternative to uncovering potential OCD subtypes. From this, we examine data-driven clusters of obsessions based on their latent semantic relationships in the English language using word embeddings. Methods: We extracted free-text entry words describing obsessions in a large sample of users of a mobile app, NOCD. Semantic vector space modeling was applied using the Global Vectors for Word Representation algorithm. A domain-specific extension, Mittens, was also applied to enhance the corpus with OCD-specific words. The resulting representations provided linear substructures of the word vector in a 100-dimensional space. We applied principal component analysis to the 100-dimensional vector representation of the most frequent words, followed by k-means clustering to obtain clusters of related words. Results: We obtained 7001 unique words representing obsessions from 25,369 individuals. Heuristics for determining the optimal number of clusters pointed to a three-cluster solution for grouping subtypes of OCD. The first had themes relating to relationship and just-right; the second had themes relating to doubt and checking; and the third had themes relating to contamination, somatic, physical harm, and sexual harm. All three clusters showed close semantic relationships with each other in the central area of convergence, with themes relating to harm. An equal-sized split-sample analysis across individuals and a split-sample analysis over time both showed overall stable cluster solutions. Words in the third cluster were the most frequently occurring words, followed by words in the first cluster. Conclusions: The clustering of naturally acquired obsessional words resulted in three major groupings of semantic themes, which partially overlapped with predefined checklists from previous studies. Furthermore, the closeness of the overall embedded relationships across clusters and their central convergence on harm suggests that, at least at the level of self-reported obsessional thoughts, most obsessions have close semantic relationships. Harm to self or others may be an underlying organizing theme across many obsessions. Notably, relationship-themed words, not previously included in factor-analytic studies, clustered with just-right words. These novel insights have potential implications for understanding how an apparent multitude of obsessional symptoms are connected by underlying themes. This observation could aid exposure-based treatment approaches and could be used as a conceptual framework for future research. UR - https://www.jmir.org/2021/6/e25482 UR - http://dx.doi.org/10.2196/25482 UR - http://www.ncbi.nlm.nih.gov/pubmed/33892466 ID - info:doi/10.2196/25482 ER - TY - JOUR AU - Kaveladze, Benjamin AU - Chang, Katherine AU - Siev, Jedidiah AU - Schueller, M. Stephen PY - 2021/2/17 TI - Impact of the COVID-19 Pandemic on Online Obsessive-Compulsive Disorder Support Community Members: Survey Study JO - JMIR Ment Health SP - e26715 VL - 8 IS - 2 KW - obsessive-compulsive disorder KW - COVID-19 pandemic KW - online support communities KW - mental health N2 - Background: People with obsessive-compulsive disorder (OCD) have faced unique challenges during the COVID-19 pandemic. Research from the first two months of the pandemic suggests that a small proportion of people with OCD experienced worsening in their OCD symptoms since the pandemic began, whereas the rest experienced either no change or an improvement in their symptoms. However, as society-level factors relating to the pandemic have evolved, the effects of the pandemic on people with OCD have likely changed as well, in complex and population-specific ways. Therefore, this study contributes to a growing body of knowledge on the impact of the COVID-19 pandemic on people and demonstrates how differences across studies might emerge when studying specific populations at specific timepoints. Objective: This study aimed to assess how members of online OCD support communities felt the COVID-19 pandemic had affected their OCD symptoms, around 3 months after the pandemic began. Methods: We recruited participants from online OCD support communities for our brief survey. Participants indicated how much they felt their OCD symptoms had changed since the pandemic began and how much they felt that having OCD was making it harder to deal with the pandemic. Results: We collected survey data from June through August 2020 and received a total of 196 responses, some of which were partial responses. Among the nonmissing data, 65.9% (108/164) of the participants were from the United States and 90.5% (152/168) had been subjected to a stay-at-home order. In all, 92.9% (182/196) of the participants said they experienced worsening of their OCD symptoms since the pandemic began, although the extent to which their symptoms worsened differed across dimensions of OCD; notably, symmetry and completeness symptoms were less likely to have worsened than others. Moreover, 95.5% (171/179) of the participants felt that having OCD made it difficult to deal with the pandemic. Conclusions: Our study of online OCD support community members found a much higher rate of OCD symptom worsening than did other studies on people with OCD conducted during the current COVID-19 pandemic. Factors such as quarantine length, location, overlapping society-level challenges, and differing measurement and sampling choices may help to explain this difference across studies. UR - http://mental.jmir.org/2021/2/e26715/ UR - http://dx.doi.org/10.2196/26715 UR - http://www.ncbi.nlm.nih.gov/pubmed/33595449 ID - info:doi/10.2196/26715 ER - TY - JOUR AU - Hwang, Hyunchan AU - Bae, Sujin AU - Hong, Sun Ji AU - Han, Hyun Doug PY - 2021/1/19 TI - Comparing Effectiveness Between a Mobile App Program and Traditional Cognitive Behavior Therapy in Obsessive-Compulsive Disorder: Evaluation Study JO - JMIR Ment Health SP - e23778 VL - 8 IS - 1 KW - obsessive-compulsive disorder KW - exposure and response prevention KW - cognitive behavior therapy KW - cortico-striato-thalamo-cortical tract KW - functional connectivity KW - prevention KW - cognitive KW - mental illness KW - behavior therapy N2 - Background: This study proposes a digital program for the treatment of mental illness that could increase motivation and improve learning outcomes for patients. Several studies have already applied this method by using an exposure and response prevention?inspired serious game to treat patients with obsessive-compulsive disorder (OCD). Objective: We hypothesized that a mobile cognitive behavior therapy (CBT) program would be as effective in treating OCD as traditional offline CBT. In addition, the treatment efficacy in response to mobile CBT for OCD might be associated with increased brain activity within the cortico-striato-thalamo-cortical (CSTC) tract. Methods: The digital CBT treatment program for OCD, OCfree, consists of 6 education sessions, 10 quests, and 7 casual games. Information was gathered from 27 patients with OCD (15 offline CBT and 12 OCfree CBT). During the 6-week intervention period, changes in clinical symptoms and brain function activity were analyzed. Results: There was no significant difference in the change in OCD symptoms and depressive symptoms between the two groups. However, the OCfree group showed greater improvement in anxiety symptoms compared to the offline CBT group. Both offline CBT and OCfree CBT increased the functional connectivity within the CSTC tract in all patients with OCD. However, CBT using OCfree showed greater changes in brain connectivity within the thalamus and insula, compared to offline CBT. Conclusions: OCfree, an OCD treatment app program, was effective in the treatment of drug-naïve patients with OCD. The treatment effects of OCfree are associated with increased brain connectivity within the CSTC tract. Multisensory stimulation by education, quests, and games in OCfree increases the activity within the thalamus and insula in patients with OCD. UR - http://mental.jmir.org/2021/1/e23778/ UR - http://dx.doi.org/10.2196/23778 UR - http://www.ncbi.nlm.nih.gov/pubmed/33464208 ID - info:doi/10.2196/23778 ER - TY - JOUR AU - Wolters, H. Lidewij AU - Weidle, Bernhard AU - Babiano-Espinosa, Lucía AU - Skokauskas, Norbert PY - 2020/12/18 TI - 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 JO - JMIR Res Protoc SP - e24057 VL - 9 IS - 12 KW - obsessive-compulsive disorder KW - cognitive behavioral therapy KW - e-mental health KW - children KW - adolescents KW - cognitive KW - behavioral KW - pediatric N2 - Background: Although the evidence base of cognitive behavioral therapy (CBT) for pediatric obsessive-compulsive disorder (OCD) has been broadly established, the treatment is hampered by limited access, poor compliance, and nonresponse. New technologies offer the opportunity to improve the accessibility, user friendliness, and effectiveness of traditional office-based CBT. By employing an integrated and age-appropriate technologically enhanced treatment package, we aim to execute a more focused and attractive application of CBT principles to increase the treatment effect for pediatric OCD. Objective: The aim of this open study is to explore the acceptability, feasibility, and effectiveness of a newly developed enhanced CBT (eCBT) package for pediatric OCD. Methods: This study is an open trial using a historical control design conducted at the outpatient clinic of the Department of Child and Adolescent Psychiatry at St. Olavs University Hospital (Trondheim) or at BUP Klinikk (Aalesund). Participants are 30 children (age 7-17 years) with a primary Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 diagnosis of OCD, and their parents. All participants receive eCBT. eCBT consists of the usual evidence-based CBT for pediatric OCD in an ?enhanced? format. Enhancements include videoconferencing sessions (supervision and guided exposure exercises at home) in addition to face-to-face sessions; an app system of interconnected apps for the child, the parents, and the therapist; psychoeducative videos; and frequent online self-assessments with direct feedback to patients and the therapist. Primary outcome measures are the Children?s Yale-Brown Obsessive Compulsive Scale (CY-BOCS) (effectiveness), the Client Satisfaction Questionnaire-8 (acceptability), and treatment drop out (feasibility). Assessments are conducted pretreatment, posttreatment, and at 3- and 6-month follow-ups. A 12-month follow-up assessment is envisioned. The treatment outcome (CY-BOCS) will be compared to traditional face-to-face CBT (data collected in the Nordic Long-term OCD Treatment Study). Results: Ethical approval has been obtained (2016/716/REK nord). Inclusion started on September 04, 2017. Data collection is ongoing. Conclusions: This study is the first step in testing the acceptability, feasibility, and preliminary effectiveness of eCBT. In case of positive results, future steps include improving the eCBT treatment package based on feedback from service users, examining cost-effectiveness in a randomized controlled trial, and making the package available to clinicians and other service providers treating OCD in children and adolescents. Trial Registration: ISRCTN, ISRCTN37530113; registered on January 31, 2020 (retrospectively registered); https://www.isrctn.com/ISRCTN37530113. International Registered Report Identifier (IRRID): DERR1-10.2196/24057 UR - http://www.researchprotocols.org/2020/12/e24057/ UR - http://dx.doi.org/10.2196/24057 UR - http://www.ncbi.nlm.nih.gov/pubmed/33203621 ID - info:doi/10.2196/24057 ER - TY - JOUR AU - Arevian, C. Armen AU - O'Hora, Jennifer AU - Rosser, James AU - Mango, D. Joseph AU - Miklowitz, J. David AU - Wells, B. Kenneth PY - 2020/7/29 TI - Patient and Provider Cocreation of Mobile Texting Apps to Support Behavioral Health: Usability Study JO - JMIR Mhealth Uhealth SP - e12655 VL - 8 IS - 7 KW - mobile health KW - community-based participatory research KW - app development KW - technology platforms KW - personalized medicine KW - behavioral health KW - mobile phone N2 - Background: Mobile technologies hold potential for improving the quality of care and engagement of patients. However, there are considerable challenges in ensuring that technologies are relevant, useful, and engaging. While end users such as patients and providers are increasingly involved in the design of health technologies, there are limited examples of their involvement in directly creating technologies for their personal use. Objective: We aim to evaluate the feasibility and acceptability of patients and providers creating mobile texting apps to support treatment goals. Methods: In an 11-month usability study, we enrolled 4 providers and 28 patients in an intensive outpatient program for obsessive-compulsive disorder. Patients and providers created their own mobile texting apps using a visual app development platform. A subsample of 10 patients and 4 providers completed a usability measure. Results: Participants created a total of 360 unique mobile text messages (1787 total messages sent). There were 4 types of messages identified, including personalized reminders, clinical exposures, interactive prompts, and encouraging/informational messages. A total of 9 out of 10 (90%) patients agreed that the messages were relevant to their recovery, and 8 out of 10 (80%) agreed that the messages were effective at helping complete treatment plans. Conclusions: Enabling patients and providers to cocreate apps for their own use by using a visual application platform is feasible and holds potential for increasing the relevance, sustainability, and effectiveness of digital health technologies. UR - http://mhealth.jmir.org/2020/7/e12655/ UR - http://dx.doi.org/10.2196/12655 UR - http://www.ncbi.nlm.nih.gov/pubmed/32723714 ID - info:doi/10.2196/12655 ER - TY - JOUR AU - Matsumoto, Kazuki AU - Hamatani, Sayo AU - Nagai, Kazue AU - Sutoh, Chihiro AU - Nakagawa, Akiko AU - Shimizu, Eiji PY - 2020/4/23 TI - Long-Term Effectiveness and Cost-Effectiveness of Videoconference-Delivered Cognitive Behavioral Therapy for Obsessive-Compulsive Disorder, Panic Disorder, and Social Anxiety Disorder in Japan: One-Year Follow-Up of a Single-Arm Trial JO - JMIR Ment Health SP - e17157 VL - 7 IS - 4 KW - long-term effectiveness KW - cost-effectiveness KW - videoconference-delivered cognitive behavioral therapy KW - internet-based cognitive behavioral therapy KW - obsessive-compulsive disorder KW - panic disorder KW - social anxiety disorder N2 - Background: Face-to-face individual cognitive behavioral therapy (CBT) and internet-based CBT (ICBT) without videoconferencing are known to have long-term effectiveness for obsessive-compulsive disorder (OCD), panic disorder (PD), and social anxiety disorder (SAD). However, videoconference-delivered CBT (VCBT) has not been investigated regarding its long-term effectiveness and cost-effectiveness. Objective: The purpose of this study was to investigate the long-term effectiveness and cost-effectiveness of VCBT for patients with OCD, PD, or SAD in Japan via a 1-year follow-up to our previous 16-week single-arm study. Methods: Written informed consent was obtained from 25 of 29 eligible patients with OCD, PD, and SAD who had completed VCBT in our clinical trial. Participants were assessed at baseline, end of treatment, and at the follow-up end points of 3, 6, and 12 months. Outcomes were the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Panic Disorder Severity Scale (PDSS), Liebowitz Social Anxiety Scale (LSAS), Patient Health Questionnaire?9 (PHQ-9), General Anxiety Disorder?7 (GAD-7), and EuroQol-5D-5L (EQ-5D-5L). To analyze long-term effectiveness, we used mixed-model analysis of variance. To analyze cost-effectiveness, we employed relevant public data and derived data on VCBT implementation costs from Japanese national health insurance data. Results: Four males and 21 females with an average age of 35.1 (SD 8.6) years participated in the 1-year follow-up study. Principal diagnoses were OCD (n=10), PD (n=7), and SAD (n=8). The change at 12 months on the Y-BOCS was ?4.1 (F1=4.45, P=.04), the change in PDSS was ?4.4 (F1=6.83, P=.001), and the change in LSAS was ?30.9 (F1=6.73, P=.01). The change in the PHQ-9 at 12 months was ?2.7 (F1=7.72, P=.007), and the change in the GAD-7 was ?3.0 (F1=7.09, P=.009). QALY at 12 months was 0.7469 (SE 0.0353, 95% Cl 0.6728-0.821), and the change was a significant increase of 0.0379 (P=.01). Total costs to provide the VCBT were ¥60,800 to ¥81,960 per patient. The set threshold was ¥189,500 ($1723, ?1579, and £1354) calculated based on willingness to pay in Japan. Conclusions: VCBT was a cost-effective way to effectively treat Japanese patients with OCD, PD, or SAD. Trial Registration: University Hospital Medical Information Network Clinical Trials Registry UMIN000026609; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000030495 UR - http://mental.jmir.org/2020/4/e17157/ UR - http://dx.doi.org/10.2196/17157 UR - http://www.ncbi.nlm.nih.gov/pubmed/32324150 ID - info:doi/10.2196/17157 ER - TY - JOUR AU - Ferreri, Florian AU - Bourla, Alexis AU - Peretti, Charles-Siegfried AU - Segawa, Tomoyuki AU - Jaafari, Nemat AU - Mouchabac, Stéphane PY - 2019/12/10 TI - How New Technologies Can Improve Prediction, Assessment, and Intervention in Obsessive-Compulsive Disorder (e-OCD): Review JO - JMIR Ment Health SP - e11643 VL - 6 IS - 12 KW - obsessive-compulsive disorder KW - ecological momentary assessment KW - biofeedback KW - digital biomarkers KW - digital phenotyping KW - mobile health KW - virtual reality KW - machine learning N2 - Background: New technologies are set to profoundly change the way we understand and manage psychiatric disorders, including obsessive-compulsive disorder (OCD). Developments in imaging and biomarkers, along with medical informatics, may well allow for better assessments and interventions in the future. Recent advances in the concept of digital phenotype, which involves using computerized measurement tools to capture the characteristics of a given psychiatric disorder, is one paradigmatic example. Objective: The impact of new technologies on health professionals? practice in OCD care remains to be determined. Recent developments could disrupt not just their clinical practices, but also their beliefs, ethics, and representations, even going so far as to question their professional culture. This study aimed to conduct an extensive review of new technologies in OCD. Methods: We conducted the review by looking for titles in the PubMed database up to December 2017 that contained the following terms: [Obsessive] AND [Smartphone] OR [phone] OR [Internet] OR [Device] OR [Wearable] OR [Mobile] OR [Machine learning] OR [Artificial] OR [Biofeedback] OR [Neurofeedback] OR [Momentary] OR [Computerized] OR [Heart rate variability] OR [actigraphy] OR [actimetry] OR [digital] OR [virtual reality] OR [Tele] OR [video]. Results: We analyzed 364 articles, of which 62 were included. Our review was divided into 3 parts: prediction, assessment (including diagnosis, screening, and monitoring), and intervention. Conclusions: The review showed that the place of connected objects, machine learning, and remote monitoring has yet to be defined in OCD. Smartphone assessment apps and the Web Screening Questionnaire demonstrated good sensitivity and adequate specificity for detecting OCD symptoms when compared with a full-length structured clinical interview. The ecological momentary assessment procedure may also represent a worthy addition to the current suite of assessment tools. In the field of intervention, CBT supported by smartphone, internet, or computer may not be more effective than that delivered by a qualified practitioner, but it is easy to use, well accepted by patients, reproducible, and cost-effective. Finally, new technologies are enabling the development of new therapies, including biofeedback and virtual reality, which focus on the learning of coping skills. For them to be used, these tools must be properly explained and tailored to individual physician and patient profiles. UR - https://mental.jmir.org/2019/12/e11643 UR - http://dx.doi.org/10.2196/11643 UR - http://www.ncbi.nlm.nih.gov/pubmed/31821153 ID - info:doi/10.2196/11643 ER - TY - JOUR AU - Matsumoto, Kazuki AU - Yoshida, Tokiko AU - Hamatani, Sayo AU - Sutoh, Chihiro AU - Hirano, Yoshiyuki AU - Shimizu, Eiji PY - 2019/11/15 TI - Prognosis Prediction Using Therapeutic Agreement of Video Conference?Delivered Cognitive Behavioral Therapy: Retrospective Secondary Analysis of a Single-Arm Pilot Trial JO - JMIR Ment Health SP - e15747 VL - 6 IS - 11 KW - therapeutic alliance KW - cognitive behavioral therapy KW - obsessive-compulsive disorder KW - panic disorder KW - social anxiety disorder KW - video conferencing N2 - Background: The therapist-patient therapeutic alliance is known to be an important factor in cognitive behavioral therapy (CBT). However, findings by previous studies for obsessive-compulsive disorder (OCD), panic disorder (PD), and social anxiety disorder (SAD) have not been consistent regarding whether this alliance provides symptomatic improvements. Objective: This study investigated predictors of symptom improvement in patients receiving CBT via video conferencing. Methods: A total of 29 patients who participated in a previous clinical trial were recruited for the current study. Therapeutic alliance and clinical background in patients with OCD, PD, and SAD were measured at first session or the eighth session, which were calculated by multiple regression analyses to estimate the impact on therapeutic response percentage change. Results: The multiple regression analyses showed that, among the independent variables, only patients? agreement in the therapeutic alliance remained viable, as other variables were a best fit for the excluded model (P=.002). The results show that patients? agreement on therapeutic goals and tasks explains the prognosis, as the normalization factor beta was 0.54 (SE 32.73; 95% CI 1.23-5.17; P=.002) and the adjusted R2 was .266. Conclusions: Patients' agreement on therapeutic goals and tasks predicts improvement after CBT via video conferencing. Trial Registration: UMIN Clinical Trial Repository UMIN000026609; https://tinyurl.com/ye6dcbwt UR - http://mental.jmir.org/2019/11/e15747/ UR - http://dx.doi.org/10.2196/15747 UR - http://www.ncbi.nlm.nih.gov/pubmed/31730037 ID - info:doi/10.2196/15747 ER - TY - JOUR AU - Dogan, Huseyin AU - Norman, Helmi AU - Alrobai, Amen AU - Jiang, Nan AU - Nordin, Norazah AU - Adnan, Anita PY - 2019/10/2 TI - A Web-Based Intervention for Social Media Addiction Disorder Management in Higher Education: Quantitative Survey Study JO - J Med Internet Res SP - e14834 VL - 21 IS - 10 KW - Facebook addiction KW - intervention features KW - postgraduate education KW - social media addiction KW - obsessive-compulsive disorder (OCD) KW - PLS-SEM analysis N2 - Background: Social media addiction disorder has recently become a major concern and has been reported to have negative impacts on postgraduate studies, particularly addiction to Facebook. Although previous studies have investigated the effects of Facebook addiction disorder in learning settings, there still has been a lack of studies investigating the relationship between online intervention features for Facebook addiction focusing on postgraduate studies. Objective: In an attempt to understand this relationship, this study aimed to carry out an investigation on online intervention features for effective management of Facebook addiction in higher education. Methods: This study was conducted quantitatively using surveys and partial least square-structural equational modeling. The study involved 200 postgraduates in a Facebook support group for postgraduates. The Bergen Facebook Addiction test was used to assess postgraduates? Facebook addiction level, whereas online intervention features were used to assess postgraduates? perceptions of online intervention features for Facebook addiction, which are as follows: (1) self-monitoring features, (2) manual control features, (3) notification features, (4) automatic control features, and (5) reward features. Results: The study discovered six Facebook addiction factors (relapse, conflict, salience, tolerance, withdrawal, and mood modification) and five intervention features (notification, auto-control, reward, manual control, and self-monitoring) that could be used in the management of Facebook addiction in postgraduate education. The study also revealed that relapse is the most important factor and mood modification is the least important factor. Furthermore, findings indicated that notification was the most important intervention feature, whereas self-monitoring was the least important feature. Conclusions: The study?s findings (addiction factors and intervention features) could assist future developers and educators in the development of online intervention tools for Facebook addiction management in postgraduate education. UR - https://www.jmir.org/2019/10/e14834 UR - http://dx.doi.org/10.2196/14834 UR - http://www.ncbi.nlm.nih.gov/pubmed/31579018 ID - info:doi/10.2196/14834 ER - TY - JOUR AU - Gallinat, Christina AU - Moessner, Markus AU - Haenssle, A. Holger AU - Winkler, K. Julia AU - Backenstrass, Matthias AU - Bauer, Stephanie PY - 2019/09/20 TI - An Internet-Based Self-Help Intervention for Skin Picking (SaveMySkin): Pilot Randomized Controlled Trial JO - J Med Internet Res SP - e15011 VL - 21 IS - 9 KW - skin picking KW - excoriation disorder KW - dermatillomania KW - internet-based KW - self-help KW - cognitive-behavioral therapy N2 - Background: In spite of the psychosocial burden and medical risks associated with skin picking disorder, the health care system does not provide sufficient treatment for affected individuals to date. Therefore, an internet-based self-help program for skin picking was developed to offer easily accessible support for this population. Objective: This pilot study evaluated the internet-based self-help program SaveMySkin. The 12-week program is based on cognitive-behavioral therapy and contains comprehensive information and exercises, a daily supportive monitoring system, and dermatological and psychological counseling via internet chat. Primary objectives were the investigation of attitudes and expectations toward the program, intervention effects on skin picking severity, user satisfaction, adherence, and willingness to participate. Secondary outcomes included the feasibility of study procedures, adequacy of assessment instruments, effects on skin picking?related impairment, dimensions of skin picking, and general psychological impairment. Methods: A two-arm randomized controlled trial was conducted in a sample of 133 participants (female: 124/133, 93.2%; mean age 26.67 [SD 6.42]) recruited via the internet. Inclusion required a minimum age of 17 years and at least mild skin picking severity. Participants were randomly allocated to the intervention (64/133, 48.1%) or waitlist control group (69/133, 51.9%). All assessments were conducted online and based on self-report. Results: The willingness to participate was very high in the study, so the initially planned sample size of 100 was exceeded after only 18 days. Participant expectations indicate that they believed the program to be beneficial for them (131/133, 98.5%) and provide a feeling of support (119/133, 89.5%). Reasons for study participation were insufficient outpatient health care (83/133, 62.4%) and flexibility regarding time (106/133, 79.7%) and location (109/133, 82.0%). The post-assessment was completed by 65.4% (87/133) of the sample. The majority of the intervention group who completed the entire post-assessment were satisfied with SaveMySkin (28/38, 74%) and agreed that the program is an appropriate support service (35/38, 92%). On average, participants viewed 29.31 (SD 42.02) pages in the program, and 47% (30/64) of the intervention group used the monitoring at least once a week. In comparison with the control group, the intervention group displayed substantial improvements in the skin picking severity total score (Cohen d=0.67) and especially on the subscale Symptom Severity (Cohen d=0.79). No effects on secondary outcomes were found. Conclusions: This study confirms the need for easily accessible interventions for skin picking disorder and the high interest in internet-based self-help within the target population. It provides important insights into the attitudes toward online support and actual user experiences. Participant feedback will be used to further enhance the intervention. Our results point to the preliminary efficacy of SaveMySkin and may lay the foundation for future research into the efficacy and cost-effectiveness of the program in a multicenter clinical trial. Trial Registration: German Clinical Trial Register DRKS00015236; https://www.drks.de/drks_web/navigate.do? navigationId=trial.HTML&TRIAL_ID=DRKS00015236 International Registered Report Identifier (IRRID): RR2-10.1016/j.conctc.2018.100315 UR - https://www.jmir.org/2019/9/e15011 UR - http://dx.doi.org/10.2196/15011 UR - http://www.ncbi.nlm.nih.gov/pubmed/31586368 ID - info:doi/10.2196/15011 ER - TY - JOUR AU - Soreni, Noam AU - Cameron, H. Duncan AU - Streiner, L. David AU - Rowa, Karen AU - McCabe, E. Randi PY - 2019/04/24 TI - Seasonality Patterns of Internet Searches on Mental Health: Exploratory Infodemiology Study JO - JMIR Ment Health SP - e12974 VL - 6 IS - 4 KW - anxiety KW - depression KW - OCD KW - schizophrenia KW - autism KW - suicide KW - seasonality KW - Google KW - internet KW - infodemiology KW - infoveillance KW - mental health N2 - Background: The study of seasonal patterns of public interest in psychiatric disorders has important theoretical and practical implications for service planning and delivery. The recent explosion of internet searches suggests that mining search databases yields unique information on public interest in mental health disorders, which is a significantly more affordable approach than population health studies. Objective: This study aimed to investigate seasonal patterns of internet mental health queries in Ontario, Canada. Methods: Weekly data on health queries in Ontario from Google Trends were downloaded for a 5-year period (2012-2017) for the terms ?schizophrenia,? ?autism,? ?bipolar,? ?depression,? ?anxiety,? ?OCD? (obsessive-compulsive disorder), and ?suicide.? Control terms were overall search results for the terms ?health? and ?how.? Time-series analyses using a continuous wavelet transform were performed to isolate seasonal components in the search volume for each term. Results: All mental health queries showed significant seasonal patterns with peak periodicity occurring over the winter months and troughs occurring during summer, except for ?suicide.? The comparison term ?health? also exhibited seasonal periodicity, while the term ?how? did not, indicating that general information seeking may not follow a seasonal trend in the way that mental health information seeking does. Conclusions: Seasonal patterns of internet search volume in a wide range of mental health terms were observed, with the exception of ?suicide.? Our study demonstrates that monitoring internet search trends is an affordable, instantaneous, and naturalistic method to sample public interest in large populations and inform health policy planners. UR - https://mental.jmir.org/2019/4/e12974/ UR - http://dx.doi.org/10.2196/12974 UR - http://www.ncbi.nlm.nih.gov/pubmed/31017582 ID - info:doi/10.2196/12974 ER - TY - JOUR AU - Roncero, María AU - Belloch, Amparo AU - Doron, Guy PY - 2019/02/13 TI - Can Brief, Daily Training Using a Mobile App Help Change Maladaptive Beliefs? Crossover Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e11443 VL - 7 IS - 2 KW - obsessive compulsive disorder KW - cognitive therapy KW - maladaptive beliefs KW - mobile apps KW - relationships N2 - Background: Obsessive-compulsive disorder (OCD) is a disabling condition with a wide variety of clinical presentations including contamination fears, fear of harm, and relationship-related obsessions. Cognitive behavioral models of OCD suggest that OC symptoms result from catastrophic misinterpretations of commonly occurring intrusive experiences and associated dysfunctional strategies used to manage them. OCD-related maladaptive beliefs including inflated responsibility, importance and control of thoughts, perfectionism, and intolerance for uncertainty increase the likelihood of such misinterpretations. Objective: Considering accumulating evidence suggesting that mobile health (mHealth) apps based on cognitive-behavioral principles may lead to significant reductions in psychopathological symptoms, we assessed the effectiveness of a novel cognitive training app (GGRO) designed to challenge OCD-related beliefs. Methods: A total of 97 students were randomized to groups undertaking immediate-use (iApp) or delayed use (dApp) of GGRO. All participants were requested to complete Web-based assessments, with questionnaires relating to maladaptive beliefs, mood, and OC symptoms at baseline (T1), 15 days from baseline (T2), and 30 days from baseline (T3). Participants in iApp group started using the app at baseline and continued using the app for 15 consecutive days. They were then requested to stop using the app until T3. Participants in the dApp group were requested to wait for 15 days and only then start using the app (crossover) for 15 consecutive days. Results: All participants used the app for a mean of 14.07 (SD 1.41) days with 2.94 levels per day. Consistent with previous findings, app use was associated with medium-large effect size reductions in both iApp (n=51) and dApp (n=46) groups. In the iApp group, all effects remained significant during the 15 days of follow-up. Analyses focusing on the first two assessment occasions revealed significant treatment × repeated measures interactions on maladaptive beliefs, several OC symptom measures, and self-esteem. Conclusions: This study provides further evidence for the efficacy of GGRO as a mobile-delivered training exercise that is useful for reducing OCD-related beliefs and symptoms. Trial Registration: ClinicalTrials.gov NCT03571464; https://clinicaltrials.gov/ct2/show/NCT03571464 (Archived by WebCite at http://www.webcitation.org/7675sYPsH) UR - http://mhealth.jmir.org/2019/2/e11443/ UR - http://dx.doi.org/10.2196/11443 UR - http://www.ncbi.nlm.nih.gov/pubmed/30758294 ID - info:doi/10.2196/11443 ER - TY - JOUR AU - Hswen, Yulin AU - Gopaluni, Anuraag AU - Brownstein, S. John AU - Hawkins, B. Jared PY - 2019/02/12 TI - Using Twitter to Detect Psychological Characteristics of Self-Identified Persons With Autism Spectrum Disorder: A Feasibility Study JO - JMIR Mhealth Uhealth SP - e12264 VL - 7 IS - 2 KW - autism KW - digital data KW - emotion KW - mobile phone KW - obsessive-compulsive disorder KW - social media KW - textual analysis KW - tweets KW - Twitter KW - infodemiology N2 - Background: More than 3.5 million Americans live with autism spectrum disorder (ASD). Major challenges persist in diagnosing ASD as no medical test exists to diagnose this disorder. Digital phenotyping holds promise to guide in the clinical diagnoses and screening of ASD. Objective: This study aims to explore the feasibility of using the Web-based social media platform Twitter to detect psychological and behavioral characteristics of self-identified persons with ASD. Methods: Data from Twitter were retrieved from 152 self-identified users with ASD and 182 randomly selected control users from March 22, 2012 to July 20, 2017. We conducted a between-group comparative textual analysis of tweets about repetitive and obsessive-compulsive behavioral characteristics typically associated with ASD. In addition, common emotional characteristics of persons with ASD, such as fear, paranoia, and anxiety, were examined between groups through textual analysis. Furthermore, we compared the timing of tweets between users with ASD and control users to identify patterns in communication. Results: Users with ASD posted a significantly higher frequency of tweets related to the specific repetitive behavior of counting compared with control users (P<.001). The textual analysis of obsessive-compulsive behavioral characteristics, such as fixate, excessive, and concern, were significantly higher among users with ASD compared with the control group (P<.001). In addition, emotional terms related to fear, paranoia, and anxiety were tweeted at a significantly higher rate among users with ASD compared with control users (P<.001). Users with ASD posted a smaller proportion of tweets during time intervals of 00:00-05:59 (P<.001), 06:00-11:59 (P<.001), and 18:00-23.59 (P<.001), as well as a greater proportion of tweets from 12:00 to 17:59 (P<.001) compared with control users. Conclusions: Social media may be a valuable resource for observing unique psychological characteristics of self-identified persons with ASD. Collecting and analyzing data from these digital platforms may afford opportunities to identify the characteristics of ASD and assist in the diagnosis or verification of ASD. This study highlights the feasibility of leveraging digital data for gaining new insights into various health conditions. UR - http://mhealth.jmir.org/2019/2/e12264/ UR - http://dx.doi.org/10.2196/12264 UR - http://www.ncbi.nlm.nih.gov/pubmed/30747718 ID - info:doi/10.2196/12264 ER - TY - JOUR AU - Matsumoto, Kazuki AU - Sutoh, Chihiro AU - Asano, Kenichi AU - Seki, Yoichi AU - Urao, Yuko AU - Yokoo, Mizue AU - Takanashi, Rieko AU - Yoshida, Tokiko AU - Tanaka, Mari AU - Noguchi, Remi AU - Nagata, Shinobu AU - Oshiro, Keiko AU - Numata, Noriko AU - Hirose, Motohisa AU - Yoshimura, Kensuke AU - Nagai, Kazue AU - Sato, Yasunori AU - Kishimoto, Taishiro AU - Nakagawa, Akiko AU - Shimizu, Eiji PY - 2018/12/17 TI - Internet-Based Cognitive Behavioral Therapy With Real-Time Therapist Support via Videoconference for Patients With Obsessive-Compulsive Disorder, Panic Disorder, and Social Anxiety Disorder: Pilot Single-Arm Trial JO - J Med Internet Res SP - e12091 VL - 20 IS - 12 KW - clinical trial KW - cognitive behavioral therapy KW - feasibility study KW - obsessive-compulsive disorder KW - panic disorder KW - social anxiety disorder KW - videoconference N2 - Background: Cognitive behavioral therapy (CBT) is the first-line treatment for adults with obsessive-compulsive disorder (OCD), panic disorder (PD), and social anxiety disorder (SAD). Patients in rural areas can access CBT via the internet. The effectiveness of internet-delivered cognitive behavioral therapy (ICBT) has been consistently shown, but no clinical studies have demonstrated the feasibility of ICBT with real-time therapist support via videoconference for OCD, PD, and SAD at the same time. Objectives: This study aimed to evaluate the feasibility of videoconference-delivered CBT for patients with OCD, PD, or SAD. Methods: A total of 30 Japanese participants (mean age 35.4 years, SD 9.2) with OCD, SAD, or PD received 16 sessions of individualized videoconference-delivered CBT with real-time support of a therapist, using tablet personal computer (Apple iPad Mini 2). Treatment involved individualized CBT formulations specific to the presenting diagnosis; all sessions were provided by the same therapist. The primary outcomes were reduction in symptomatology, using the Yale-Brown obsessive-compulsive scale (Y-BOCS) for OCD, Panic Disorder Severity Scale (PDSS) for PD, and Liebowitz Social Anxiety Scale (LSAS) for SAD. The secondary outcomes included the EuroQol-5 Dimension (EQ-5D) for Quality of Life, the Patient Health Questionnaire (PHQ-9) for depression, the Generalized Anxiety Disorder (GAD-7) questionnaire for anxiety, and Working Alliance Inventory-Short Form (WAI-SF). All primary outcomes were assessed at baseline and at weeks 1 (baseline), 8 (midintervention), and 16 (postintervention) face-to-face during therapy. The occurrence of adverse events was observed after each session. For the primary analysis comparing between pre- and posttreatments, the participants? points and 95% CIs were estimated by the paired t tests with the change between pre- and posttreatment. Results: A significant reduction in symptom of obsession-compulsion (Y-BOCS=?6.2; Cohen d=0.74; 95% CI ?9.4 to ?3.0, P=.002), panic (PDSS=?5.6; Cohen d=0.89; 95% CI ?9.83 to ?1.37; P=.02), social anxiety (LSAS=?33.6; Cohen d=1.10; 95% CI ?59.62 to ?7.49, P=.02) were observed. In addition, depression (PHQ-9=?1.72; Cohen d=0.27; 95% CI ?3.26 to ?0.19; P=.03) and general anxiety (GAD-7=?3.03; Cohen d=0.61; 95% CI ?4.57 to ?1.49, P<.001) were significantly improved. Although there were no significant changes at 16 weeks from baseline in EQ-5D (0.0336; Cohen d=-0.202; 95% CI ?0.0198 to 0.00869; P=.21), there were high therapeutic alliance (ie, WAI-SF) scores (from 68.0 to 73.7) throughout treatment, which significantly increased (4.14; 95% CI 1.24 to 7.04; P=.007). Of the participants, 86% (25/29) were satisfied with videoconference-delivered CBT, and 83% (24/29) preferred videoconference-delivered CBT to face-to-face CBT. An adverse event occurred to a patient with SAD; the incidence was 3% (1/30). Conclusions: Videoconference-delivered CBT for patients with OCD, SAD, and SAD may be feasible and acceptable. UR - http://www.jmir.org/2018/12/e12091/ UR - http://dx.doi.org/10.2196/12091 UR - http://www.ncbi.nlm.nih.gov/pubmed/30559094 ID - info:doi/10.2196/12091 ER - TY - JOUR AU - Kyrios, Michael AU - Ahern, Claire AU - Fassnacht, B. Daniel AU - Nedeljkovic, Maja AU - Moulding, Richard AU - Meyer, Denny PY - 2018/08/08 TI - Therapist-Assisted Internet-Based Cognitive Behavioral Therapy Versus Progressive Relaxation in Obsessive-Compulsive Disorder: Randomized Controlled Trial JO - J Med Internet Res SP - e242 VL - 20 IS - 8 KW - obsessive-compulsive disorder KW - mental health KW - cognitive behavioral therapy KW - CBT KW - online intervention N2 - Background: Obsessive-compulsive disorder (OCD) is a highly disabling psychological disorder with a chronic course if left untreated. Cognitive behavioral therapy (CBT) has been shown to be an effective treatment, but access to face-to-face CBT is not always possible. Internet-based CBT (iCBT) has become an increasingly viable option. However, no study has compared iCBT to an analogous control condition using a randomized controlled trial (RCT). Objective: A 2-armed RCT was used to compare a therapist-assisted 12-module iCBT to an analogous active attention control condition (therapist-assisted internet-based standard progressive relaxation training, iPRT) in adult OCD. This paper reports pre-post findings for OCD symptom severity. Method: In total, 179 participants (117 females, 65.7%) were randomized (stratified by gender) into iCBT or iPRT. The iCBT intervention included psychoeducation, mood and behavioral management, exposure and response prevention (ERP), cognitive therapy, and relapse prevention; the iPRT intervention included psychoeducation and relaxation techniques as a way of managing OCD-related anxiety but did not incorporate ERP or other CBT elements. Both treatments included audiovisual content, case stories, demonstrations of techniques, downloadable audio content and worksheets, and expert commentary. All participants received 1 weekly email, with a maximum 15-minute preparation time per client from a remote therapist trained in e-therapy. Emails aimed to monitor progress, provide support and encouragement, and assist in individualizing the treatment. Participants were assessed for baseline and posttreatment OCD severity with the telephone-administered clinician-rated Yale-Brown Obsessive-Compulsive Scale and other measures by assessors who were blinded to treatment allocation. Results: No pretreatment differences were found between the 2 conditions. Intention-to-treat analysis revealed significant pre-post improvements in OCD symptom severity for both conditions (P<.001). However, relative to iPRT, iCBT showed significantly greater symptom severity improvement (P=.001); Cohen d for iCBT was 1.05 (95% CI 0.72-1.37), whereas for iPRT it was 0.48 (95% CI 0.22-0.73). The iCBT condition was superior in regard to reliable improvement (25/51, 49% vs 16/55, 29%; P=.04) and clinically significant pre-post-treatment changes (17/51, 33% vs 6/55, 11%; P=.005). Those undertaking iCBT post completion of iPRT showed further significant symptom amelioration (P<.001), although the sequential treatment was no more efficacious than iCBT alone (P=.63). Conclusion: This study is the first to compare a therapist-assisted iCBT program for OCD to an analogous active attention control condition using iPRT. Our findings demonstrate the large magnitude effect of iCBT for OCD; interestingly, iPRT was also moderately efficacious, albeit significantly less so than the iCBT intervention. The findings are compared to previous internet-based and face-to-face CBT treatment programs for OCD. Future directions for technology-enhanced programs for the treatment of OCD are outlined. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12611000321943; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=336704 (Archived by WebCite at http://www.webcitation.org/70ovUiOmd) UR - http://www.jmir.org/2018/8/e242/ UR - http://dx.doi.org/10.2196/jmir.9566 UR - http://www.ncbi.nlm.nih.gov/pubmed/30089607 ID - info:doi/10.2196/jmir.9566 ER - TY - JOUR AU - Rees, Samantha Clare AU - Anderson, Anne Rebecca AU - Kane, Thomas Robert AU - Finlay-Jones, Louise Amy PY - 2016/07/05 TI - Online Obsessive-Compulsive Disorder Treatment: Preliminary Results of the ?OCD? Not Me!? Self-Guided Internet-Based Cognitive Behavioral Therapy Program for Young People JO - JMIR Ment Health SP - e29 VL - 3 IS - 3 KW - adolescent KW - anxiety disorders/therapy KW - Australia KW - Internet KW - obsessive-compulsive disorder KW - self-care KW - therapy KW - computer-assisted/statistics and numerical data KW - treatment outcome KW - young adult KW - iCBT KW - adolescents N2 - Background: The development and evaluation of Internet-delivered cognitive behavioral therapy (iCBT) interventions provides a potential solution for current limitations in the acceptability, availability, and accessibility of mental health care for young people with obsessive-compulsive disorder (OCD). Preliminary results support the effectiveness of therapist-assisted iCBT for young people with OCD; however, no previous studies have examined the effectiveness of completely self-guided iCBT for OCD in young people. Objective: We aimed to conduct a preliminary evaluation of the effectiveness of the OCD? Not Me! program for reducing OCD-related psychopathology in young people (12-18 years). This program is an eight-stage, completely self-guided iCBT treatment for OCD, which is based on exposure and response prevention. Methods: These data were early and preliminary results of a longer study in which an open trial design is being used to evaluate the effectiveness of the OCD? Not Me! program. Participants were required to have at least subclinical levels of OCD to be offered the online program. Participants with moderate-high suicide/self-harm risk or symptoms of eating disorder or psychosis were not offered the program. OCD symptoms and severity were measured at pre- and posttest, and at the beginning of each stage of the program. Data was analyzed using generalized linear mixed models. Results: A total of 334 people were screened for inclusion in the study, with 132 participants aged 12 to 18 years providing data for the final analysis. Participants showed significant reductions in OCD symptoms (P<.001) and severity (P<.001) between pre- and posttest. Conclusions: These preliminary results suggest that fully automated iCBT holds promise as a way of increasing access to treatment for young people with OCD; however, further research needs to be conducted to replicate the results and to determine the feasibility of the program. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12613000152729; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=363654 (Archived by WebCite at http://www.webcitation.org/ 6iD7EDFqH) UR - http://mental.jmir.org/2016/3/e29/ UR - http://dx.doi.org/10.2196/mental.5363 UR - http://www.ncbi.nlm.nih.gov/pubmed/27381977 ID - info:doi/10.2196/mental.5363 ER - TY - JOUR AU - Carron-Arthur, Bradley AU - Reynolds, Julia AU - Bennett, Kylie AU - Bennett, Anthony AU - Cunningham, Alastair John AU - Griffiths, Margaret Kathleen PY - 2016/05/30 TI - Community Structure of a Mental Health Internet Support Group: Modularity in User Thread Participation JO - JMIR Mental Health SP - e20 VL - 3 IS - 2 KW - internet KW - support group KW - social network KW - modularity KW - mental health KW - super user N2 - Background: Little is known about the community structure of mental health Internet support groups, quantitatively. A greater understanding of the factors, which lead to user interaction, is needed to explain the design information of these services and future research concerning their utility. Objective: A study was conducted to determine the characteristics of users associated with the subgroup community structure of an Internet support group for mental health issues. Methods: A social network analysis of the Internet support group BlueBoard (blueboard.anu.edu.au) was performed to determine the modularity of the community using the Louvain method. Demographic characteristics age, gender, residential location, type of user (consumer, carer, or other), registration date, and posting frequency in subforums (depression, generalized anxiety, social anxiety, panic disorder, bipolar disorder, obsessive compulsive disorder, borderline personality disorder, eating disorders, carers, general (eg, ?chit chat?), and suggestions box) of the BlueBoard users were assessed as potential predictors of the resulting subgroup structure. Results: The analysis of modularity identified five main subgroups in the BlueBoard community. Registration date was found to be the largest contributor to the modularity outcome as observed by multinomial logistic regression. The addition of this variable to the final model containing all other factors improved its classification accuracy by 46.3%, that is, from 37.9% to 84.2%. Further investigation of this variable revealed that the most active and central users registered significantly earlier than the median registration time in each group. Conclusions: The five subgroups resembled five generations of BlueBoard in distinct eras that transcended discussion about different mental health issues. This finding may be due to the activity of highly engaged and central users who communicate with many other users. Future research should seek to determine the generalizability of this finding and investigate the role that highly active and central users may play in the formation of this phenomenon. UR - http://mental.jmir.org/2016/2/e20/ UR - http://dx.doi.org/10.2196/mental.4961 UR - http://www.ncbi.nlm.nih.gov/pubmed/27242012 ID - info:doi/10.2196/mental.4961 ER - TY - JOUR AU - AL-Asadi, M. Ali AU - Klein, Britt AU - Meyer, Denny PY - 2014/10/14 TI - Posttreatment Attrition and Its Predictors, Attrition Bias, and Treatment Efficacy of the Anxiety Online Programs JO - J Med Internet Res SP - e232 VL - 16 IS - 10 KW - posttreatment attrition KW - posttreatment predictors KW - treatment efficacy KW - online therapy KW - e-mental health KW - cognitive behavioral therapy KW - Internet interventions KW - fully automated KW - self-help KW - Web treatment KW - generalized anxiety disorder KW - obsessive compulsive disorder N2 - Background: Although relatively new, the field of e-mental health is becoming more popular with more attention given to researching its various aspects. However, there are many areas that still need further research, especially identifying attrition predictors at various phases of assessment and treatment delivery. Objective: The present study identified the predictors of posttreatment assessment completers based on 24 pre- and posttreatment demographic and personal variables and 1 treatment variable, their impact on attrition bias, and the efficacy of the 5 fully automated self-help anxiety treatment programs for generalized anxiety disorder (GAD), social anxiety disorder (SAD), panic disorder with or without agoraphobia (PD/A), obsessive-compulsive disorder (OCD), and posttraumatic stress disorder (PTSD). Methods: A complex algorithm was used to diagnose participants? mental disorders based on the criteria of the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision; DSM-IV-TR). Those who received a primary or secondary diagnosis of 1 of 5 anxiety disorders were offered an online 12-week disorder-specific treatment program. A total of 3199 individuals did not formally drop out of the 12-week treatment cycle, whereas 142 individuals formally dropped out. However, only 347 participants who completed their treatment cycle also completed the posttreatment assessment measures. Based on these measures, predictors of attrition were identified and attrition bias was examined. The efficacy of the 5 treatment programs was assessed based on anxiety-specific severity scores and 5 additional treatment outcome measures. Results: On average, completers of posttreatment assessment measures were more likely to be seeking self-help online programs; have heard about the program from traditional media or from family and friends; were receiving mental health assistance; were more likely to learn best by reading, hearing and doing; had a lower pretreatment Kessler-6 total score; and were older in age. Predicted probabilities resulting from these attrition variables displayed no significant attrition bias using Heckman?s method and thus allowing for the use of completer analysis. Six treatment outcome measures (Kessler-6 total score, number of diagnosed disorders, self-confidence in managing mental health issues, quality of life, and the corresponding pre- and posttreatment severity for each program-specific anxiety disorder and for major depressive episode) were used to assess the efficacy of the 5 anxiety treatment programs. Repeated measures MANOVA revealed a significant multivariate time effect for all treatment outcome measures for each treatment program. Follow-up repeated measures ANOVAs revealed significant improvements on all 6 treatment outcome measures for GAD and PTSD, 5 treatment outcome measures were significant for SAD and PD/A, and 4 treatment outcome measures were significant for OCD. Conclusions: Results identified predictors of posttreatment assessment completers and provided further support for the efficacy of self-help online treatment programs for the 5 anxiety disorders. Trial Registration: Australian and New Zealand Clinical Trials Registry ACTRN121611000704998; http://www.anzctr.org.au/trial_view.aspx?ID=336143 (Archived by WebCite at http://www.webcitation.org/618r3wvOG). UR - http://www.jmir.org/2014/10/e232/ UR - http://dx.doi.org/10.2196/jmir.3513 UR - http://www.ncbi.nlm.nih.gov/pubmed/25316533 ID - info:doi/10.2196/jmir.3513 ER - TY - JOUR AU - AL-Asadi, M. Ali AU - Klein, Britt AU - Meyer, Denny PY - 2014/06/17 TI - Pretreatment Attrition and Formal Withdrawal During Treatment and Their Predictors: An Exploratory Study of the Anxiety Online Data JO - J Med Internet Res SP - e152 VL - 16 IS - 6 KW - pretreatment attrition KW - treatment withdrawal dropouts KW - predictors, anxiety disorders KW - eTherapy KW - e-mental health KW - Internet interventions N2 - Background: Although in its infancy, the field of e-mental health interventions has been gaining popularity and afforded considerable research attention. However, there are many gaps in the research. One such gap is in the area of attrition predictors at various stages of assessment and treatment delivery. Objective: This exploratory study applied univariate and multivariate analysis to a large dataset provided by the Anxiety Online (now called Mental Health Online) system to identify predictors of attrition in treatment commencers and in those who formally withdrew during treatment based on 24 pretreatment demographic and personal variables and one clinical measure. Methods: Participants were assessed using a complex online algorithm that resulted in primary and secondary diagnoses in accordance with the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). Those who received a primary or secondary diagnosis of 1 of 5 anxiety disorders (generalized anxiety disorder, social anxiety disorder, obsessive-compulsive disorder, posttraumatic stress disorder, and panic disorder) were offered an online 12-week disorder-specific treatment program. Results: Of 9394 potential participants, a total of 3880 clients enrolled and 5514 did not enroll in one of the treatment programs following the completion of pretreatment assessment measures (pretreatment attrition rate: 58.70%). A total of 3199 individuals did not formally withdraw from the 12-week treatment cycle, whereas 142 individuals formally dropped out (formal withdrawal during treatment dropout rate of 4.25%). The treatment commencers differed significantly (P<.001-.03) from the noncommencers on several variables (reason for registering, mental health concerns, postsecondary education, where first heard about Anxiety Online, Kessler-6 score, stage of change, quality of life, relationship status, preferred method of learning, and smoking status). Those who formally withdrew during treatment differed significantly (P=.002-.03) from those who did not formally withdraw in that they were less likely to express concerns about anxiety, stress, and depression; to rate their quality of life as very poor, poor, or good; to report adequate level of social support; and to report readiness to make or were in the process of making changes. Conclusions: This exploratory study identified predictors of pretreatment attrition and formal withdrawal during treatment dropouts for the Anxiety Online program. Trial Registration: Australian and New Zealand Clinical Trials Registry ACTRN121611000704998; http://www.anzctr.org.au/trial_view.aspx?ID=336143 (Archived by WebCite at http://www.webcitation.org/618r3wvOG). UR - http://www.jmir.org/2014/6/e152/ UR - http://dx.doi.org/10.2196/jmir.2989 UR - http://www.ncbi.nlm.nih.gov/pubmed/24938311 ID - info:doi/10.2196/jmir.2989 ER - TY - JOUR AU - Klein, Britt AU - Meyer, Denny AU - Austin, William David AU - Kyrios, Michael PY - 2011/11/04 TI - Anxiety Online?A Virtual Clinic: Preliminary Outcomes Following Completion of Five Fully Automated Treatment Programs for Anxiety Disorders and Symptoms JO - J Med Internet Res SP - e89 VL - 13 IS - 4 KW - eTherapy KW - Internet interventions KW - e-mental health KW - cognitive behavior therapy KW - generalized anxiety disorder KW - panic disorder KW - obsessive compulsive disorder KW - social anxiety disorder KW - posttraumatic stress disorder KW - self-help KW - fully automated KW - Web treatment N2 - Background: The development of e-mental health interventions to treat or prevent mental illness and to enhance wellbeing has risen rapidly over the past decade. This development assists the public in sidestepping some of the obstacles that are often encountered when trying to access traditional face-to-face mental health care services. Objective: The objective of our study was to investigate the posttreatment effectiveness of five fully automated self-help cognitive behavior e-therapy programs for generalized anxiety disorder (GAD), panic disorder with or without agoraphobia (PD/A), obsessive?compulsive disorder (OCD), posttraumatic stress disorder (PTSD), and social anxiety disorder (SAD) offered to the international public via Anxiety Online, an open-access full-service virtual psychology clinic for anxiety disorders. Methods: We used a naturalistic participant choice, quasi-experimental design to evaluate each of the five Anxiety Online fully automated self-help e-therapy programs. Participants were required to have at least subclinical levels of one of the anxiety disorders to be offered the associated disorder-specific fully automated self-help e-therapy program. These programs are offered free of charge via Anxiety Online. Results: A total of 225 people self-selected one of the five e-therapy programs (GAD, n = 88; SAD, n = 50; PD/A, n = 40; PTSD, n = 30; OCD, n = 17) and completed their 12-week posttreatment assessment. Significant improvements were found on 21/25 measures across the five fully automated self-help programs. At postassessment we observed significant reductions on all five anxiety disorder clinical disorder severity ratings (Cohen d range 0.72?1.22), increased confidence in managing one?s own mental health care (Cohen d range 0.70?1.17), and decreases in the total number of clinical diagnoses (except for the PD/A program, where a positive trend was found) (Cohen d range 0.45?1.08). In addition, we found significant improvements in quality of life for the GAD, OCD, PTSD, and SAD e-therapy programs (Cohen d range 0.11?0.96) and significant reductions relating to general psychological distress levels for the GAD, PD/A, and PTSD e-therapy programs (Cohen d range 0.23?1.16). Overall, treatment satisfaction was good across all five e-therapy programs, and posttreatment assessment completers reported using their e-therapy program an average of 395.60 (SD 272.2) minutes over the 12-week treatment period. Conclusions: Overall, all five fully automated self-help e-therapy programs appear to be delivering promising high-quality outcomes; however, the results require replication. Trial Registration: Australian and New Zealand Clinical Trials Registry ACTRN121611000704998; http://www.anzctr.org.au/trial_view.aspx?ID=336143 (Archived by WebCite at http://www.webcitation.org/618r3wvOG) UR - http://www.jmir.org/2011/4/e89/ UR - http://dx.doi.org/10.2196/jmir.1918 UR - http://www.ncbi.nlm.nih.gov/pubmed/22057287 ID - info:doi/10.2196/jmir.1918 ER -