2019 Innovator Award

Towards optimal use of internet-delivered interventions for obsessive compulsive disorder

Bethany Wootton, PhD

University of Technology Sydney (Sydney, Australia)

Award Amount: $292,040

Cognitive behavioral therapy (CBT), including exposure and response prevention (ERP), is a proven and effective treatment for obsessive-compulsive disorder (OCD). However, many people with OCD are unable to access effective treatment that is both affordable and located near where they live. Recently, Internet-based CBT (ICBT) has helped overcome many barriers to access, but more information is needed to understand which patients would best qualify for it.

In this study, Dr. Wootton and her team will evaluate which patients respond best to Internet-delivered CBT, and will help clinicians match patients to these services in a safer and more effective way. The first step in their program of research was to examine what are the most common and consistent predictors of outcome in the literature and what are some new predictors that could be examined in their ICBT treatment. By analyzing eight prior studies with a total sample of 359 participants, the resulting publication (McDonald et al., 2023) showed that pre-treatment factors such as severity, past treatments, and avoidance, as well as during-treatment factors such as poor therapist-client alliance and not adhering to treatment, are crucial for recommending the right treatment program. The second step was to demonstrate that people with OCD do not experience spontaneous remission—that is, that their symptoms do not suddenly go away without treatment. This is important because the team is using an open trial methodology in their treatment study, and needs to show that any symptom change that resulted was due to the treatment program rather than people’s symptoms getting better on their own. By analyzing 12 studies with 351 participants, Melkonian et al. (2022) showed that people assigned to control groups do not generally improve in OCD symptoms; only 4% “spontaneously” recover. Finally, Dr. Wootton and her team recruited 323 people to take part in an ICBT treatment for OCD and measured a variety of variables thought to predict outcomes. The team is currently conducting a data analysis from this study.

Resulting Publications:

McDonald, S., Melkonian, M., Karin, E., Dear, B., Titov, N., & Wootton, B. (2023). Predictors of response to cognitive behavioural therapy (CBT) for adults with obsessive-compulsive disorder (OCD): A systematic review. Behavioural and Cognitive Psychotherapy, 1-18. https://doi.org/10.1017/S1352465823000103

*Melkonian, M., McDonald, S., Scott, A., Dear, B.F., Karin, E., & Wootton, B.M. (2022). Symptom improvement and remission in untreated adults seeking treatment for obsessive-compulsive disorder: A systematic review and meta-analysis. Journal of Affective Disorders, 318(1), 175-184. https://doi.org/10.1016/j.jad.2022.08.037