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Effect of an Intern...
Effect of an Internet-Delivered Stepped-Care Program vs In-Person Cognitive Behavioral Therapy on Obsessive-Compulsive Disorder Symptoms in Children and Adolescents: A Randomized Clinical Trial
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- Aspvall, K. (författare)
- Karolinska Institutet
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- Andersson, E. (författare)
- Karolinska Institutet
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- Melin, Karin, 1964 (författare)
- Gothenburg University,Göteborgs universitet,Institutionen för vårdvetenskap och hälsa,Institute of Health and Care Sciences,Univ Gothenburg, Inst Hlth & Care Sci, Sahlgrenska Acad, Gothenburg, Sweden.;Sahlgrens Univ Hosp, Dept Child & Adolescent Psychiat, Gothenburg, Region Vastra G, Sweden.
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- Norlin, L. (författare)
- Sahlgrens Univ Hosp, Dept Child & Adolescent Psychiat, Gothenburg, Region Vastra G, Sweden.
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- Eriksson, V. (författare)
- Stockholm Hlth Care Serv, Stockholm, Region Stockhol, Sweden.
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- Vigerland, S. (författare)
- Karolinska Institutet
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- Jolstedt, M. (författare)
- Karolinska Institutet
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- Silverberg-Morse, M. (författare)
- Stockholm Hlth Care Serv, Stockholm, Region Stockhol, Sweden.
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- Wallin, L. (författare)
- Sahlgrens Univ Hosp, Dept Child & Adolescent Psychiat, Gothenburg, Region Vastra G, Sweden.;Univ Gothenburg, Inst Neurosci & Physiol, Sahlgrenska Acad, Gothenburg, Sweden.
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- Sampaio, Filipa, PhD, 1985- (författare)
- Uppsala universitet,Socialmedicin/CHAP
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- Feldman, Inna, Docent, 1951- (författare)
- Uppsala universitet,Socialmedicin/CHAP
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- Bottai, M. (författare)
- Karolinska Institutet
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- Lenhard, F. (författare)
- Karolinska Institutet
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- Mataix-Cols, D. (författare)
- Karolinska Institutet
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- Serlachius, E. (författare)
- Karolinska Institutet
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(creator_code:org_t)
- American Medical Association (AMA), 2021
- 2021
- Engelska.
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Ingår i: Jama-Journal of the American Medical Association. - : American Medical Association (AMA). - 0098-7484 .- 1538-3598. ; 325:18, s. 1863-1873
- Relaterad länk:
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https://gup.ub.gu.se...
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https://doi.org/10.1...
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https://urn.kb.se/re...
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Abstract
Ämnesord
Stäng
- Key PointsQuestionIs internet-delivered cognitive behavioral therapy (CBT) implemented in a stepped-care model noninferior to in-person CBT for children and adolescents with obsessive-compulsive disorder? FindingsIn this randomized, noninferiority clinical trial, 152 children and adolescents with obsessive-compulsive disorder were treated with an internet-delivered CBT program followed by traditional in-person CBT if necessary vs in-person CBT alone. After 6 months, the mean Children's Yale-Brown Obsessive-Compulsive Scale score was 11.57 in those treated with internet-delivered CBT vs 10.57 in those treated with in-person CBT, a difference that met the noninferiority criterion of 4 points. MeaningTreating children and adolescents with obsessive-compulsive disorder with an internet intervention followed by traditional face-to-face therapy if necessary was noninferior to in-person therapy alone. ImportanceIn most countries, young people with obsessive-compulsive disorder have limited access to specialist cognitive behavioral therapy (CBT), a first-line treatment. ObjectiveTo investigate whether internet-delivered CBT implemented in a stepped-care model is noninferior to in-person CBT for pediatric obsessive-compulsive disorder. Design, Setting and ParticipantsA randomized clinical noninferiority trial conducted at 2 specialist child and adolescent mental health clinics in Sweden. Participants included 152 individuals aged 8 to 17 years with obsessive-compulsive disorder. Enrollment began in October 2017 and ended in May 2019. Follow-up ended in April 2020. InterventionsParticipants randomized to the stepped-care group (n=74) received internet-delivered CBT for 16 weeks. Nonresponders at the 3-month follow-up were then offered a course of traditional face-to-face treatment. Participants randomized to the control group (n=78) immediately received in-person CBT for 16 weeks. Nonresponders at the 3-month follow-up received additional face-to-face treatment. Main Outcomes and MeasuresThe primary outcome was the masked assessor-rated Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) score at the 6-month follow-up. The scale includes 10 items rated from 0(no symptoms) to 4(extreme symptoms), yielding a total score range of 0 to 40, with higher scores indicating greater severity. Assessors were masked to treatment allocation at pretreatment, posttreatment, 3-month follow-up, and 6-month follow-up assessments. The predefined noninferiority margin was 4 points on the CY-BOCS. ResultsAmong the 152 randomized participants (mean age, 13.4 years; 94 [62%] females), 151 (99%) completed the trial. At the 3-month follow-up, 34 participants (46%) in the stepped-care group and 23 (30%) in the in-person CBT group were nonresponders. At the 6-month follow-up, the CY-BOCS score was 11.57 points in the stepped-care group vs 10.57 points in the face-to-face treatment group, corresponding to an estimated mean difference of 0.91 points ([1-sided 97.5% CI, -infinity to 3.28]; P for noninferiority=.02). Increased anxiety (30%-36%) and depressive symptoms (20%-28%) were the most frequently reported adverse events in both groups. There were 2 unrelated serious adverse events (1 in each group). Conclusions and RelevanceAmong children and adolescents with obsessive-compulsive disorder, treatment with an internet-delivered CBT program followed by in-person CBT if necessary compared with in-person CBT alone resulted in a noninferior difference in symptoms at the 6-month follow-up. Further research is needed to understand the durability and generalizability of these findings. Trial RegistrationClinicalTrials.gov Identifier: NCT03263546 This noninferiority trial compares the effects of an internet-delivered cognitive behavioral therapy (CBT) program followed by traditional in-person CBT if necessary vs in-person CBT alone on symptoms of obsessive compulsive disorder (OCD) in children and adolescents.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Hälsovetenskap -- Annan hälsovetenskap (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Health Sciences -- Other Health Sciences (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Psykiatri (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Psychiatry (hsv//eng)
Nyckelord
- scale
- reliability
- interview
- validity
- version
- ocd
- General & Internal Medicine
Publikations- och innehållstyp
- ref (ämneskategori)
- art (ämneskategori)
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Till lärosätets databas
- Av författaren/redakt...
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Aspvall, K.
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Andersson, E.
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Melin, Karin, 19 ...
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Norlin, L.
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Eriksson, V.
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Vigerland, S.
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visa fler...
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Jolstedt, M.
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Silverberg-Morse ...
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Wallin, L.
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Sampaio, Filipa, ...
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Feldman, Inna, D ...
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Bottai, M.
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Lenhard, F.
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Mataix-Cols, D.
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Serlachius, E.
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- MEDICIN OCH HÄLSOVETENSKAP
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- Av lärosätet
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Göteborgs universitet
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Uppsala universitet
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Karolinska Institutet