Therapist-Assisted Internet-Based Cognitive Behavioral Therapy Versus Progressive Relaxation in Obsessive-Compulsive Disorder: Randomized Controlled Trial
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 inc...
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| Veröffentlicht in: | Journal of medical Internet research 2018-08, Vol.20 (8), p.e242-e242 |
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| creator | Kyrios, Michael Ahern, Claire Fassnacht, Daniel B Nedeljkovic, Maja Moulding, Richard Meyer, Denny |
| description | 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).
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.
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.
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 |
| doi_str_mv | 10.2196/jmir.9566 |
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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.
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.
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).
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.
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).</description><identifier>ISSN: 1438-8871</identifier><identifier>ISSN: 1439-4456</identifier><identifier>EISSN: 1438-8871</identifier><identifier>DOI: 10.2196/jmir.9566</identifier><identifier>PMID: 30089607</identifier><language>eng</language><publisher>Canada: Gunther Eysenbach MD MPH, Associate Professor</publisher><subject>Affect - physiology ; Assessors ; Attention ; Behavior management ; Behavior modification ; Bibliotherapy ; Clinical research ; Clinical significance ; Clinical trials ; Cognitive behavioral therapy ; Cognitive Behavioral Therapy - methods ; Cognitive therapy ; Cognitive-behavioral factors ; Email ; Female ; Humans ; Internet ; Intervention ; Male ; Neuroses ; Obsessive compulsive disorder ; Obsessive-Compulsive Disorder - pathology ; Obsessive-Compulsive Disorder - therapy ; Original Paper ; Prevention programs ; Psychoeducational treatment ; Relapse ; Relaxation ; Relaxation training ; Severity ; Sociodemographics ; Technology ; Telemedicine ; Therapy ; Treatment Outcome ; Treatment programs</subject><ispartof>Journal of medical Internet research, 2018-08, Vol.20 (8), p.e242-e242</ispartof><rights>Michael Kyrios, Claire Ahern, Daniel B Fassnacht, Maja Nedeljkovic, Richard Moulding, Denny Meyer. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 08.08.2018.</rights><rights>2018. This work is licensed under https://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Michael Kyrios, Claire Ahern, Daniel B Fassnacht, Maja Nedeljkovic, Richard Moulding, Denny Meyer. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 08.08.2018. 2018</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c469t-ceb94f66cb5a84670ba9d30fad2774866b5df351fbb0e7df8d46ce4ca942ddb13</citedby><cites>FETCH-LOGICAL-c469t-ceb94f66cb5a84670ba9d30fad2774866b5df351fbb0e7df8d46ce4ca942ddb13</cites><orcidid>0000-0001-6542-5008 ; 0000-0001-7779-3166 ; 0000-0001-7188-9941 ; 0000-0002-9902-0858 ; 0000-0001-9438-9616 ; 0000-0003-0963-0335</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,723,776,780,860,881,12825,27901,27902,30976</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30089607$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kyrios, Michael</creatorcontrib><creatorcontrib>Ahern, Claire</creatorcontrib><creatorcontrib>Fassnacht, Daniel B</creatorcontrib><creatorcontrib>Nedeljkovic, Maja</creatorcontrib><creatorcontrib>Moulding, Richard</creatorcontrib><creatorcontrib>Meyer, Denny</creatorcontrib><title>Therapist-Assisted Internet-Based Cognitive Behavioral Therapy Versus Progressive Relaxation in Obsessive-Compulsive Disorder: Randomized Controlled Trial</title><title>Journal of medical Internet research</title><addtitle>J Med Internet Res</addtitle><description>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).
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.
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.
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).
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.
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).</description><subject>Affect - physiology</subject><subject>Assessors</subject><subject>Attention</subject><subject>Behavior management</subject><subject>Behavior modification</subject><subject>Bibliotherapy</subject><subject>Clinical research</subject><subject>Clinical significance</subject><subject>Clinical trials</subject><subject>Cognitive behavioral therapy</subject><subject>Cognitive Behavioral Therapy - methods</subject><subject>Cognitive therapy</subject><subject>Cognitive-behavioral factors</subject><subject>Email</subject><subject>Female</subject><subject>Humans</subject><subject>Internet</subject><subject>Intervention</subject><subject>Male</subject><subject>Neuroses</subject><subject>Obsessive compulsive disorder</subject><subject>Obsessive-Compulsive Disorder - pathology</subject><subject>Obsessive-Compulsive Disorder - therapy</subject><subject>Original Paper</subject><subject>Prevention programs</subject><subject>Psychoeducational treatment</subject><subject>Relapse</subject><subject>Relaxation</subject><subject>Relaxation training</subject><subject>Severity</subject><subject>Sociodemographics</subject><subject>Technology</subject><subject>Telemedicine</subject><subject>Therapy</subject><subject>Treatment Outcome</subject><subject>Treatment programs</subject><issn>1438-8871</issn><issn>1439-4456</issn><issn>1438-8871</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>7QJ</sourceid><sourceid>BENPR</sourceid><recordid>eNpdkc1u1DAUhS1ERX9gwQugSGxgkWInjmOzQGoH-iNVKqoGtpYd38x45NhTOxnRPgpPi6dTqsLqXvt-Pj5XB6G3BB9XRLBPq8HGY9Ew9gIdEFrzkvOWvHzW76PDlFYYV5gK8grt1xhzwXB7gH7PlxDV2qaxPEkpFzDFpR8hehjLU5XycRYW3o52A8UpLNXGhqhcsXt2V_yEmKZUfI9hESELZOoGnPqlRht8YX1xrdPuvpyFYT25B-SrTSEaiJ-LG-VNGOz9wz9-jMG53M6jVe412uuVS_DmsR6hH2ff5rOL8ur6_HJ2clV2lImx7EAL2jPW6UZxylqslTA17pWp2pZyxnRj-rohvdYYWtNzQ1kHtFOCVsZoUh-hLzvd9aQHMB1kG8rJdbSDincyKCv_nXi7lIuwkYzghjORBT48CsRwO0Ea5WBTB84pD2FKssKcVYy0dZ3R9_-hqzBFn9eTVUOy4ewfZ-rjjupiSClC_2SGYLlNXG4Tl9vEM_vuufsn8m_E9R9t6Kzj</recordid><startdate>20180808</startdate><enddate>20180808</enddate><creator>Kyrios, Michael</creator><creator>Ahern, Claire</creator><creator>Fassnacht, Daniel B</creator><creator>Nedeljkovic, Maja</creator><creator>Moulding, Richard</creator><creator>Meyer, Denny</creator><general>Gunther Eysenbach MD MPH, Associate Professor</general><general>JMIR Publications</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QJ</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ALSLI</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>CNYFK</scope><scope>DWQXO</scope><scope>E3H</scope><scope>F2A</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1O</scope><scope>NAPCQ</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-6542-5008</orcidid><orcidid>https://orcid.org/0000-0001-7779-3166</orcidid><orcidid>https://orcid.org/0000-0001-7188-9941</orcidid><orcidid>https://orcid.org/0000-0002-9902-0858</orcidid><orcidid>https://orcid.org/0000-0001-9438-9616</orcidid><orcidid>https://orcid.org/0000-0003-0963-0335</orcidid></search><sort><creationdate>20180808</creationdate><title>Therapist-Assisted Internet-Based Cognitive Behavioral Therapy Versus Progressive Relaxation in Obsessive-Compulsive Disorder: Randomized Controlled Trial</title><author>Kyrios, Michael ; Ahern, Claire ; Fassnacht, Daniel B ; Nedeljkovic, Maja ; Moulding, Richard ; Meyer, Denny</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c469t-ceb94f66cb5a84670ba9d30fad2774866b5df351fbb0e7df8d46ce4ca942ddb13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Affect - physiology</topic><topic>Assessors</topic><topic>Attention</topic><topic>Behavior management</topic><topic>Behavior modification</topic><topic>Bibliotherapy</topic><topic>Clinical research</topic><topic>Clinical significance</topic><topic>Clinical trials</topic><topic>Cognitive behavioral therapy</topic><topic>Cognitive Behavioral Therapy - methods</topic><topic>Cognitive therapy</topic><topic>Cognitive-behavioral factors</topic><topic>Email</topic><topic>Female</topic><topic>Humans</topic><topic>Internet</topic><topic>Intervention</topic><topic>Male</topic><topic>Neuroses</topic><topic>Obsessive compulsive disorder</topic><topic>Obsessive-Compulsive Disorder - pathology</topic><topic>Obsessive-Compulsive Disorder - therapy</topic><topic>Original Paper</topic><topic>Prevention programs</topic><topic>Psychoeducational treatment</topic><topic>Relapse</topic><topic>Relaxation</topic><topic>Relaxation training</topic><topic>Severity</topic><topic>Sociodemographics</topic><topic>Technology</topic><topic>Telemedicine</topic><topic>Therapy</topic><topic>Treatment Outcome</topic><topic>Treatment programs</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kyrios, Michael</creatorcontrib><creatorcontrib>Ahern, Claire</creatorcontrib><creatorcontrib>Fassnacht, Daniel B</creatorcontrib><creatorcontrib>Nedeljkovic, Maja</creatorcontrib><creatorcontrib>Moulding, Richard</creatorcontrib><creatorcontrib>Meyer, Denny</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Applied Social Sciences Index & Abstracts (ASSIA)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>Social Science Premium Collection</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Library & Information Science Collection</collection><collection>ProQuest Central Korea</collection><collection>Library & Information Sciences Abstracts (LISA)</collection><collection>Library & Information Science Abstracts (LISA)</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Library Science Database</collection><collection>Nursing & Allied Health Premium</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of medical Internet research</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kyrios, Michael</au><au>Ahern, Claire</au><au>Fassnacht, Daniel B</au><au>Nedeljkovic, Maja</au><au>Moulding, Richard</au><au>Meyer, Denny</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Therapist-Assisted Internet-Based Cognitive Behavioral Therapy Versus Progressive Relaxation in Obsessive-Compulsive Disorder: Randomized Controlled Trial</atitle><jtitle>Journal of medical Internet research</jtitle><addtitle>J Med Internet Res</addtitle><date>2018-08-08</date><risdate>2018</risdate><volume>20</volume><issue>8</issue><spage>e242</spage><epage>e242</epage><pages>e242-e242</pages><issn>1438-8871</issn><issn>1439-4456</issn><eissn>1438-8871</eissn><abstract>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).
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.
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.
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).
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.
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).</abstract><cop>Canada</cop><pub>Gunther Eysenbach MD MPH, Associate Professor</pub><pmid>30089607</pmid><doi>10.2196/jmir.9566</doi><orcidid>https://orcid.org/0000-0001-6542-5008</orcidid><orcidid>https://orcid.org/0000-0001-7779-3166</orcidid><orcidid>https://orcid.org/0000-0001-7188-9941</orcidid><orcidid>https://orcid.org/0000-0002-9902-0858</orcidid><orcidid>https://orcid.org/0000-0001-9438-9616</orcidid><orcidid>https://orcid.org/0000-0003-0963-0335</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Journal of medical Internet research, 2018-08, Vol.20 (8), p.e242-e242 |
| issn | 1438-8871 1439-4456 1438-8871 |
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| source | Applied Social Sciences Index & Abstracts (ASSIA); MEDLINE; DOAJ Directory of Open Access Journals; EZB-FREE-00999 freely available EZB journals; PubMed Central; PubMed Central Open Access |
| subjects | Affect - physiology Assessors Attention Behavior management Behavior modification Bibliotherapy Clinical research Clinical significance Clinical trials Cognitive behavioral therapy Cognitive Behavioral Therapy - methods Cognitive therapy Cognitive-behavioral factors Female Humans Internet Intervention Male Neuroses Obsessive compulsive disorder Obsessive-Compulsive Disorder - pathology Obsessive-Compulsive Disorder - therapy Original Paper Prevention programs Psychoeducational treatment Relapse Relaxation Relaxation training Severity Sociodemographics Technology Telemedicine Therapy Treatment Outcome Treatment programs |
| title | Therapist-Assisted Internet-Based Cognitive Behavioral Therapy Versus Progressive Relaxation in Obsessive-Compulsive Disorder: Randomized Controlled Trial |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-29T17%3A52%3A48IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Therapist-Assisted%20Internet-Based%20Cognitive%20Behavioral%20Therapy%20Versus%20Progressive%20Relaxation%20in%20Obsessive-Compulsive%20Disorder:%20Randomized%20Controlled%20Trial&rft.jtitle=Journal%20of%20medical%20Internet%20research&rft.au=Kyrios,%20Michael&rft.date=2018-08-08&rft.volume=20&rft.issue=8&rft.spage=e242&rft.epage=e242&rft.pages=e242-e242&rft.issn=1438-8871&rft.eissn=1438-8871&rft_id=info:doi/10.2196/jmir.9566&rft_dat=%3Cproquest_pubme%3E2512776700%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2512776700&rft_id=info:pmid/30089607&rfr_iscdi=true |