Principal Findings
YBOCS, anxiety, vertigo, obsessive-compulsive symptoms, assessor-rated, OCD
ADVERSE EVENTS, BLIND
This study was an RCT of ICBT, CBGT, and conventional medical treatment for OCD in China, which aimed to evaluate the efficacy and cost-effectiveness of therapist-guided ICBT for Chinese patients with OCD. All 3 groups had curative effects and improved quality of life after treatment for 6 weeks, and the ICBT group was more cost-effective than the other groups. The satisfaction of patients was high, and there were no serious adverse events.In terms of efficacy, the significant efficacy of SSRIs was consistent with the results shown in earlier studies [A difference between the results of the YBOCS and FOCI was found in this study. After treatment (6 weeks), the FOCI score of the ICBT and CBGT groups was significantly lower than that of the TAU group, while this difference was not detected in the YBOCS. It was probably because the YBOCS is an assessor-rated scale, while FOCI is a self-rating scale. Patients may have more acute observations of the changes in their own obsessive-compulsive symptoms and experience. This might be more sensitively reflected in the FOCI score after ICBT/CBGT rather than the blind assessor–rated YBOCS. In addition, the satisfaction degree of treatment in the ICBT/CBGT group was higher than that in the TAU group, which might also affect the self-rating scores.With regard to feasibility, the results showed that the TAU group had the lowest dropout rate, and the ICBT group had the same dropout rate as the CBGT group. Half of the patients dropped out in the ICBT group due to discomfort with reading text on an electronic screen. Completing therapy and homework by reading and typing on the keyboard might be unfriendly to some people, especially older patients. A patient in the ICBT group withdrew from the study because of anxiety and vertigo symptoms during training and reading. It was difficult for ICBT when the patient was not accustomed to using the computer, lacked motivation for treatment, or had too severe symptoms. Patient compliance did correlate with treatment modality, and some patients who dropped out reported that they were not used to online therapy. A previous paper indicated that a single human-computer interaction might lack face-to-face treatment, resulting in decreased compliance of patients during treatment [Health economics results showed that ICBT is significantly less expensive than CBGT and was the most cost-effective option of the 3. The cost savings of the ICBT group might be achieved by less transportation expenses, accommodation expenses, food expenses, and productivity loss because patients in the ICBT group could choose their own ERP practice time at home without extra transportation, accommodation, and work absence compared to the CBGT group. From health organizational perspectives (ie, therapist time) due to the online technology and the therapist-guided self-help mode, compared to the CBGT group, the ICBT group saved time for therapists, with an average of 76.43 minutes per person, which may help solve the human resource shortage in mental health services in China. Nowadays, the burden on mental health in various countries is increasing. For example, the United States spent more than US $300 billion on mental health each year [