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Effectiveness of an internet-based cognitive behavioral therapy program enriched with inferential confusion for obsessive-compulsive disorder

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Abstract

Obsessive-compulsive disorder (OCD) has adverse impacts on quality of life and despite having treatment alternatives, some patients have difficulty in accessing services and/or end up with failure. While structured internet-based cognitive behavioral therapy programs (ICBT) facilitating access to treatment are becoming widespread worldwide, more research is needed for program with various novel components, and such programs are, unfortunately, still relatively scarce in developing countries such as Türkiye. The present study attempted to explore the effectiveness of an ICBT program alloyed with the inferential confusion model. In a quasi-randomized clinical trial, 42 participants aged 18–65 years with the primary diagnosis of OCD, were assigned to the intervention and wait list control groups. Pretest and post test assessments on OCD symptom measures, obsessive beliefs, depression and quality of life were conducted for both groups. Whereas, the ICBT program with one-month follow-up assessments were administered to the participants in the intervention group. Completer analyses with the two-way analysis of variance for the mixed designs yielded that the participants’ post-test scores on the all main measures significantly decreased. The analyses were generally replicated with intention-to-treat analyses. Accordingly, we indicated that the data on the effectiveness of the program, except for the DOCS and the physical health scores, remained significant. This original ICBT program that enhanced by inference-based therapy techniques, was found to be an effective one in reducing OCD symptoms and accompanying depressive symptoms among our participants diagnosed with OCD. These findings would guide future studies and initiatives to promote access to treatment.

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References

  • Aardema, F., & O’Connor, K. (2003). Seeing white bears that are not there: Inference processes in obsessions. Journal of Cognitive Psychotherapy, 17(1), 23–37. https://doi.org/10.1891/jcop.17.1.23.58270

    Article  Google Scholar 

  • Aardema, F., O’Connor, K. P., Emmelkamp, P. M., Marchand, A., & Todorov, C. (2005). Inferential confusion in obsessive–compulsive disorder: The inferential confusion questionnaire. Behaviour Research and Therapy, 43(3), 293–308.

  • Abbott, J. A. M., Klein, B., & Ciechomski, L. (2008). Best practices in online therapy. Journal of Technology in Human Services, 26(2–4), 360–375. https://doi.org/10.1080/15228830802097257

    Article  Google Scholar 

  • Abramowitz, J. S., Taylor, S., & McKay, D. (2009). Obsessive-compulsive disorder. The Lancet, 374(9688), 491–499.

    Article  Google Scholar 

  • Abramowitz, J. S., Deacon, B. J., Olatunji, B. O., Wheaton, M. G., Berman, N. C., Losardo, D., Timpano, K. R., McGrath, P. B., Riemann, B. C., Adams, T., Björgvinsson, T., Storch, E. A., & HaleL. R (2010). Assessment of obsessive-compulsive symptom dimensions: Development and evaluation of the Dimensional Obsessive-compulsive scale. Psychological Assessment, 22(1), 180. https://doi.org/10.1037/a0018260

    Article  PubMed  Google Scholar 

  • Albert, U., Maina, G., Bogetto, F., Chiarle, A., & Mataix-Cols, D. (2010). Clinical predictors of health-related quality of life in obsessive-compulsive disorder. Comprehensive Psychiatry, 51(2), 193–200.

    Article  PubMed  Google Scholar 

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

  • Andersson, G. (2009). Using the internet to provide cognitive behaviour therapy. Behaviour Research and Therapy, 47(3), 175–180. https://doi.org/10.1016/j.brat.2009.01.010

    Article  PubMed  Google Scholar 

  • Andersson, G., & Cuijpers, P. (2009). Internet-based and other computerized psychological treatments for adult depression: A meta-analysis. Cognitive Behaviour Therapy, 38(4), 196–205.

  • Andersson, G., Bergström, J., Buhrman, M., Carlbring, P., Holländare, F., Kaldo, V., Nilsson-Ihrfelt, E., Paxling, B., & Waara, J. (2008). Development of a new approach to guided self-help via the internet: The Swedish experience. Journal of Technology in Human Services, 26(2–4), 161–181. https://doi.org/10.1080/15228830802094627

    Article  Google Scholar 

  • Andersson, E., Enander, J., Andrén, P., Hedman, E., Ljótsson, B., Hursti, T., & Rück, C. (2012). Internet-based cognitive behaviour therapy for obsessive– compulsive disorder: A randomized controlled trial. Psychological Medicine, 42(10), 2193–2203. https://doi.org/10.1017/S0033291712000244

    Article  PubMed  PubMed Central  Google Scholar 

  • Arkar, H., & Şafak, C. (2004). Klinik Bir örneklemde Beck depresyon envanterinin boyutlarının araştırılması. Türk Psikoloji Dergisi, 19(53), 117–123.

    Google Scholar 

  • Barak, A., & Grohol, J. M. (2011). Current and future trends in internet-supported mental health interventions. Journal of Technology in Human Services, 29(3), 155–196. https://doi.org/10.1080/15228835.2011.616939

    Article  Google Scholar 

  • Barak, A., Klein, B., & Proudfoot, J. G. (2009). Defining internet-supported therapeutic interventions. Annals of Behavioral Medicine, 38(1), 4–17. https://doi.org/10.1007/s12160-009-9130-7

    Article  PubMed  Google Scholar 

  • Beck, A. T., Ward, C. H., Mendelson, M., Mock, J., & Erbaugh, J. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4(6), 561–571. https://doi.org/10.1001/archpsyc.1961.01710120031004

    Article  PubMed  Google Scholar 

  • Brakoulias, V., Starcevic, V., Belloch, A., Brown, C., Ferrao, Y. A., Fontenelle, L. F., & Reddy, Y. C. J. (2017). Comorbidity, age of onset and suicidality in obsessive–compulsive disorder (OCD): An international collaboration. Comprehensive Psychiatry, 76, 79–86. https://doi.org/10.1016/j.comppsych.2017.04.002

    Article  PubMed  Google Scholar 

  • Carlbring, P., Andersson, G., Cuijpers, P., Riper, H., & Hedman-Lagerlöf, E. (2018). Internet-based vs. face-to-face cognitive behavior therapy for psychiatric and somatic disorders: An updated systematic review and meta-analysis. Cognitive Behaviour Therapy, 47(1), 1–18. https://doi.org/10.1080/16506073.2017.1401115

    Article  PubMed  Google Scholar 

  • Çilli, A. S., Telcioǧlu, M., Aşkın, R., Kaya, N., Bodur, S., & Kucur, R. (2004). Twelve-month prevalence of obsessive-compulsive disorder in Konya, Turkey. Comprehensive Psychiatry, 45(5), 367–374https://doi.org/10.1016/j.comppsych.2004.0

  • Cuijpers, P., & Cristea, I. A. (2016). How to prove that your therapy is effective, even when it is not: A guideline. Epidemiology and Psychiatric Sciences, 25(5), 428–435. https://doi.org/10.1017/S2045796015000864

    Article  PubMed  Google Scholar 

  • Eisen, J. L., Mancebo, M. A., Pinto, A., Coles, M. E., Pagano, M. E., Stout, R. ve, & Rasmussen, S. A. (2006). Impact of obsessive-compulsive disorder on quality of life. Comprehensive psychiatry, 47(4), 270–275.

  • Elbir, M., Alp Topbaş, Ö., Bayad, S., Kocabaş, T., Topak, O. Z., Çetin, Ş., Özdel, O., Ateşçi, F., & Aydemir, Ö. (2019). DSM-5 Bozuklukları için Yapılandırılmış Klinik Görüşmenin Klinisyen Versiyonunun Türkçeye Uyarlanması ve Güvenilirlik Çalışması. Türk Psikiyatri Dergisi, 30(1), 56. https://doi.org/10.5080/u23431

    Article  Google Scholar 

  • Eser, E., Fidaner, H., Fidaner, C., Eser, S. Y., Elbi, H., & Göker, E. (1999). WHOQOL- 100 ve WHOQOL-BREF’in psikometrik özellikleri. Psikiyatri Psikoloji Psikofarmakoloji (3P) Dergisi, 7(Suppl 2), 23–40.

    Google Scholar 

  • First, M. B., Williams, J. B., Karg, R. S., & Spitzer, R. L. (2015). User’s guide for the structured clinical interview for DSM-5 disorders-Clinician Version (SCID- 5-CV). American Psychiatric Association Publishing.

  • Foa, E. B., Huppert, J. D., Leiberg, S., Langner, R., Kichic, R., Hajcak, G., & Salkovskis, P. M. (2002). The obsessive-compulsive ınventory: Development and validation of a short version. Psychological Assessment, 14, 485–496. https://doi.org/10.1037/1040-3590.14.4.485

    Article  PubMed  Google Scholar 

  • Goodman, W. K., Price, L. H., Rasmussen, S. A., Mazure, C., Fleischmann, R. L., Hill, C. L., George, R., & Charney, D. S. (1989a). The Yale-Brown obsessive compulsive scale: I. Development, use, and reliability. Archives of General Psychiatry, 46(11), 1006–1011. https://doi.org/10.1001/archpsyc.1989.01810110048007

    Article  PubMed  Google Scholar 

  • Goodman, W. K., Price, L. H., Rasmussen, S. A., Mazure, C., Delgado, P., Heninger, G. R., & Charney, D. S. (1989b). The yale-brown obsessive compulsive scale: II. Validity. Archives of General Psychiatry, 46(11), 1012–1016. https://doi.org/10.1001/archpsyc.1989.01810110054008

    Article  PubMed  Google Scholar 

  • Karno, M., Golding, J. M., Sorenson, S. B., & Burnam, M. A. (1988). The epidemiology of obsessive-compulsive disorder in five US communities. Archives of General Psychiatry, 45, 1094–1099. https://doi.org/10.1001/archpsyc.1988.01800360042006

    Article  PubMed  Google Scholar 

  • Klein, B., Meyer, D., Austin, D. W., & Kyrios, M. (2011). Anxiety online—a virtual clinic: Preliminary outcomes following completion of five fully automated treatment programs for anxiety disorders and symptoms. Journal of Medical Internet Research, 13(4), e89. https://doi.org/10.2196/jmir.1918

    Article  PubMed  PubMed Central  Google Scholar 

  • Mahoney, A. E., Mackenzie, A., Williams, A. D., Smith, J., & Andrews, G. (2014). Internet cognitive behavioural treatment for obsessive compulsive disorder: A randomised controlled trial. Behaviour Research and Therapy, 63, 99–106. https://doi.org/10.1016/j.brat.2014.09.012

    Article  PubMed  Google Scholar 

  • Masellis, M., Rector, N. A., & ve Richter, M. A. (2003). Quality of life in OCD: Differential impact of obsessions, compulsions, and depression comorbidity. The Canadian Journal of Psychiatry, 48(2), 72–77. https://doi.org/10.1177/070674370304800202

    Article  PubMed  Google Scholar 

  • Moritz, S., Dietl, C., Kersten, J. F., Aardema, F., & O’Connor, K. (2015). Evaluation of inference- based therapy (doubt therapy) as a self-help tool for obsessive- compulsive disorder. Journal of Cognitive Psychotherapy, 29(4), 315–330. https://doi.org/10.1891/0889-8391.29.4.315

    Article  PubMed  Google Scholar 

  • National Institute for Health and Care Excellence-NICE (2005). Obsessive Compulsive Disorder: Core Interventions in the Treatment of OCD and Body Dysmorphic Disorder Retreved from https://www.nice.org.uk/guidance/cg31

  • Newman, M. G., Szkodny, L. E., Llera, S. J., & Przeworski, A. (2011). A review of technology- assisted self-help and minimal contact therapies for anxiety and depression: Is human contact necessary for therapeutic efficacy? Clinical Psychology Review, 31(1), 89–103. https://doi.org/10.1016/j.cpr.2010.09.008

    Article  PubMed  Google Scholar 

  • O’Connor, K., & Aardema, F. (2011). Clinician’s handbook for obsessive compulsive disorder: inference-based therapy. John Wiley & Sons.

  • O’Connor, K., & Robillard, S. (1995). Inference processes in obsessive-compulsive disorder: Some clinical observations. Behaviour Research and Therapy, 33(8), 887–896. https://doi.org/10.1016/0005-7967(95)00042-V

    Article  PubMed  Google Scholar 

  • O’Connor, K. P., Aardema, F., Bouthillier, D., Fournier, S., Guay, S., Robillard, S., Pelissier, M. C., Landry, P., Todorov, C., Tremblay, M., & Pitre, D. (2005). Evaluation of an inference- based approach to treating obsessive‐compulsive disorder. Cognitive Behaviour Therapy, 34(3), 148–163. https://doi.org/10.1080/16506070510041211

    Article  PubMed  Google Scholar 

  • O’Connor, K., Koszegi, N., Aardema, F., van Niekerk, J., & Taillon, A. (2009). An inference-based approach to treating obsessive-compulsive disorders. Cognitive and Behavioral Practice, 16(4), 420–429. https://doi.org/10.1016/j.cbpra.2009.05.001

    Article  Google Scholar 

  • Obsessive Compulsive Cognitions Working Group. (1997). Cognitive assessment of obsessive- compulsive disorder. Behaviour Research and Therapy, 35(7), 667–681. https://doi.org/10.1016/S0005-7967(97)00017-X

    Article  Google Scholar 

  • Obsessive Compulsive Cognitions Working Group. (2005). Psychometric validation of the obsessive belief questionnaire and interpretation of intrusions inventory— part 2: Factor analyses and testing of a brief version. Behaviour Research and Therapy, 43(11), 1527–1542. https://doi.org/10.1016/j.brat.2004.07.010

    Article  Google Scholar 

  • Salkovskis, P. M. (1985). Obsessional-compulsive problems: A cognitive-behavioural analysis. Behaviour Research and Therapy, 23(5), 571–583. https://doi.org/10.1016/0005-7967(85)90105-6

    Article  PubMed  Google Scholar 

  • Seol, S. H., Kwon, J. S., Kim, Y. Y., Kim, S. N., & Shin, M. S. (2016). Internet-based cognitive behavioral therapy for obsessive-compulsive disorder in Korea. Psychiatry Investigation, 13(4), 373. https://doi.org/10.4306/pi.2016.13.4.373

    Article  PubMed  PubMed Central  Google Scholar 

  • Tek, C., Uluğ, B., Rezaki, B. G., Tanrıverdi, N., Mercan, S., Demir, B., & Vargel, S. (1995). Yale- Brown Obsessive compulsive scale and US National Institute of Mental Health Global Obsessive Compulsive Scale in Turkish: Reliability and validity. Acta Psychiatrica Scandinavia, 91(6), 410–413. https://doi.org/10.1111/j.1600-0447.1995.tb09801.x

    Article  Google Scholar 

  • Tükel, R., Polat, A., Özdemir, Ö., Aksüt, D., & Türksoy, N. (2002). Comorbid conditions in obsessive-compulsive disorder. Comprehensive Psychiatry, 43(3), 204–209.

    Article  PubMed  Google Scholar 

  • van Niekerk, J., Brown, G., Aardema, F., & O’Connor, K. (2014). Integration of inference-based therapy and cognitive-behavioral therapy for obsessive- compulsive disorder—A case series. International Journal of Cognitive Therapy, 7(1), 67–82.

    Article  Google Scholar 

  • Wetterneck, C. T., Siev, J., Adams, T. G., Slimowicz, J. C., & Smith, A. H. (2015). Assessing sexually intrusive thoughts: Parsing unacceptable thoughts on the Dimensional Obsessive-compulsive scale. Behavior Therapy, 46(4), 544–556. https://doi.org/10.1016/j.beth.2015.05.006

    Article  PubMed  PubMed Central  Google Scholar 

  • WHOQOL Group. (1998). Development of the World Health Organization WHOQOL-BREF quality of life assessment. Psychological Medicine, 28(3), 551–558. https://doi.org/10.1017/S0033291798006667

    Article  Google Scholar 

  • Wootton, B. M., Dear, B. F., Johnston, L., Terides, M. D., & Titov, N. (2013). Remote treatment of obsessive-compulsive disorder: A randomized controlled trial. Journal of Obsessive-Compulsive and Related Disorders, 2(4), 375–384. https://doi.org/10.1016/j.jocrd.2013.07.002

    Article  Google Scholar 

  • Wootton, B. M., Karin, E., Titov, N., & Dear, B. F. (2019). Self-guided internet– delivered cognitive behavior therapy (ICBT) for obsessive-compulsive symptoms: A randomized controlled trial. Journal of Anxiety Disorders, 66, 102111. https://doi.org/10.1016/j.janxdis.2019.102111

    Article  PubMed  Google Scholar 

  • Yorulmaz, O., & Devrim, G. (2018). Kasım). Obsesif-Kompulsif Bozukluğun Boyutsal Değerlendirmesi Ve Benlik Korkusu: İki Ölçüm Aracının Yetişkin Bir Örneklemde İncelenmesi (p. 20). Ulusal Psikoloji Kongresi, Ankara.

  • Yorulmaz, O., & Gençöz, T. (2008). Obsessif-Kompulsif Bozukluk Semptomların Değerlendirilmesinde Kullanılan İstem Dışı Düşünceleri Yorumlama Envanteri, Obsessif İnanışlar Ölçeği ve Düşünceleri Kontrol Etme Ölçeği’nin Türk Örnekleminde İncelenmesi. Türk Psikoloji Yazıları, 11(22), 1–13.

    Google Scholar 

  • Yorulmaz, O., Dirik, G., Karaali, P. O., & Üvez, P. E. (2010). Obsessif-Kompulsif bozukluk hastalarında Çıkarımsal Karmaşa Ölçeği’nin psikometrik özellikleri. Türk Psikiyatri Dergisi, 21(2), 135–142.

    PubMed  Google Scholar 

  • Yorulmaz, O., İnözü, M., Clark, D., & Radomsky, A. (2015). Psychometric properties of the obsessive-compulsive inventory-revised in a Turkish analogue sample. Psychological Reports, 117, 1–13. https://doi.org/10.2466/08.PR0.117c25z4

    Article  Google Scholar 

  • Zabinski, M. F., Celio, A. A., Jacobs, M. J., Manwaring, J., & Wilfley, D. E. (2003). Internet-based prevention of eating disorders. European Eating Disorders Review: The Professional Journal of the Eating Disorders Association, 11(3), 183–197. https://doi.org/10.1002/erv.525

    Article  Google Scholar 

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Acknowledgements

This study was supported by Ege University Scientific Research Projects Coordination Unit. (Project Number: 18EDB007, Project ID:808). Moreover, this research was a part of PhD thesis of initial author.

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Correspondence to Ezgi Göcek Yorulmaz.

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Göcek Yorulmaz, E., Tekinsav Sütçü, S., Kuman Tunçel, Ö. et al. Effectiveness of an internet-based cognitive behavioral therapy program enriched with inferential confusion for obsessive-compulsive disorder. Curr Psychol 43, 16084–16093 (2024). https://doi.org/10.1007/s12144-023-05570-5

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