Flygare2022 - Implementing therapist-guided internet-delivered cognitive behaviour therapy for obsessive-compulsive disorder in the UKs IAPT programme, A pilot trial

  • Type:#article
  • Year read:#read2022
  • Subject: _thesis defense MOC OCD ICBT IAPT
  • Bibtex: @flygare2022
  • Bibliography: Flygare, O., Lundström, L., Andersson, E., Mataix-Cols, D., & Rück, C. (2022). Implementing therapist-guided internet-delivered cognitive behaviour therapy for obsessive–compulsive disorder in the UK’s IAPT programme: A pilot trial. British Journal of Clinical Psychology, 00(00), 1–16.

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Reviewer feedback

46.09 - Response to reviewer comments

  • NICE evaluation
    • They evaluated both the technical platform and the clinical evidence of OCD-NET. Preliminary input on its appropriate place in the IAPT system.
  • Inclusion/exclusion criteria
    • Comorbidities were among the common ones, i.e. personality disorders and ASD.
    • Some extra points regarding motivation to work on treatment, motivation etc.
  • Assessment procedures in IAPT
    • Info about IAPT, ICD-10 codes problem descriptors, risk assessment, and completing the “IAPT Data Set”.
    • Screening questions on depression, other anxiety disorders (see pictures below)
  • Reliable improvement, recovery, reliable recovery
    • Reliable improvement: Changes more than X points on questionnaire (deterioration if worsening)
    • Recovery: cut-off in severity.
  • Completers vs two sessions (IAPT way)
    • Only attending two “sessions” is a very low bar for treatment activity. In our case this means completing two weekly assessments, when most patients had only received psychoeducation and not been introduced to ERP yet.
  • Questionnaires used
    • PEQ unusual
  • Participant flow (limitation)
    • It’s a limitation in our data that we don’t know how many were offered OCD-NET and refused to participate, and whether they represented a particular group of patients.

What’s interesting here is that screening questions for PD, SAD, specific phobia are before OCD. But GAD is after OCD, and what I saw in supervision was often that patients rather displayed typical GAD. The instructions say that the assessor should continue with all questions regardless of answer but maybe they were sloppy and stopped once positive on OCD indication?