Science, Samba & Soccer: our visit to São Paulo in August 2022

Last week, Oskar Flygare, Volen Ivanov and Christian Rück visited our collaborators in São Paulo, Brazil to work on current projects and discuss new ones. This was the third meeting in person between the two collaborating groups, the previous ones being Alice de Mathis’ visit to Stockholm and a visit by Oskar and Christian to São Paulo in 2019. The OCD research group at São Paulo is led by professor Euripedes Constantino Miguel and our visits always involve a rich exchange of ideas relating to our research.

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One ongoing research project is a pilot study of an internet-delivered treatment for obsessive-compulsive disorder (OCD-NET) which has been translated to Portuguese and is now being evaluated in Brazil. After a brief suspension due to the pandemic, the project is now well underway with ongoing recruitment and treatment of patients. So far the feedback from both therapists and patients has been encouraging. In addition to discussing the ongoing project, Oskar presented results and lessons learned from two recent clinical trials on OCD-NET in Sweden and England.

Volen shared his knowledge about hoarding disorder, from research projects and clinical work. Expertise in diagnosing and treating hoarding disorder is sorely lacking in Brazil, and our colleagues were eager to learn as much as possible in order to provide effective care. Interestingly, just months before our visit a podcast about an individual with likely hoarding disorder in São Paulo has stoked public interest and increased awareness about the condition. It is clear that our research groups have plenty of opportunities for collaboration on projects related to hoarding.

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The visit was also an opportunity to plan an upcoming project led by Arthur Caye that will evaluate internet-delivered treatments for OCD, depression, insomnia and anxiety in two municipalities outside of São Paulo: Jaguariúna and Indaiatuba. The access to psychotherapy in these cities is limited and the project is an opportunity to increase access to effective treatments for common disorders. The project will evaluate the feasibility of using internet-delivered treatments in primary care, where most of the patients with mental disorders are seen.

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We were once again moved by the hospitality and warmth our hosts showed us. There was a rich social programme outside the work activities and we had the opportunity to enjoy samba with Daniel Costa, soccer with Rodolfo Furlan Damiano and several restaurants together with our Brazilian colleagues Nil Morales, Sonia Borcato and Roseli Shavitt. Thanks to their generosity with their time, we got a true taste of Brazilian culture!

Oskar Flygare dissertation

Big day today! Oskar Flygare received his PhD after successfully defending his thesis. Congratulations!

Oskar defended his dissertation “Improving access and outcomes in the treatment of Obsessive-Compulsive Disorder”, today June 10th 9am at the Erna Möller hall at Karolinska Institutet, Huddinge.

The opponent was the excellent associate prof. Carolyn Rodriguez from Stanford University who participated via video link. Oskar was accompanied by supervisor prof. Christian Rück and co-supervisor associate prof. Erik Andersson. Co-supervisor prof. David Mataix-Cols participated via video link. The examination board consisted of associate prof. Monica Buhrman, prof. Bo Melin and associate prof. Armita Golkar.

The Rüch lab is certain that there is yet much to come from the brilliant mind of doctor Oskar Flygare!

New publication: Implementation of ICBT for OCD in UK’s IAPT system

Another new publication by Oskar Flygare et al!

Implementing therapist-guided internet-delivered cognitive behaviour therapy for obsessive–compulsive disorder in the UK’s IAPT programme: A pilot trial

Objectives
Digital therapies such as internet-delivered cognitive behaviour therapy (ICBT) can improve treatment access for patients with common mental disorders, but are rarely used in the Improving Access to Psychological Therapies (IAPT) programme in the United Kingdom. The objective of this study was to evaluate an evidence-based ICBT intervention for obsessive-compulsive disorder (OCD-NET) in three IAPT services in an open trial.

Methods
Consecutively referred patients with a primary diagnosis of OCD (= 474) were offered OCD-NET. Symptoms of OCD, depression, anxiety, and level of functioning were measured weekly throughout treatment.

Results
In the full intention to treat sample (= 474), the intervention was associated with large reductions in self-reported OCD symptoms (d = 1.77), anxiety (d = 1.55) and depression (d = 0.8), as well as improvements in functional impairment (d = 0.51 to 0.72). Further, 35% of participants were in recovery at their last assessment, 25% achieved reliable improvement and 15% met criteria for both recovery and improvement. Among participants completing at least 4 modules (= 261), corresponding to an adequate ‘dose’ of treatment, the rates of recovery (44%), reliable improvement (34%) and reliable recovery (21%) were higher. A majority of participants were satisfied with the online treatment and found the online materials helpful.

Conclusions
OCD-NET is an effective treatment when delivered in regular care within the IAPT system. Challenges associated with implementing ICBT in regular health care are discussed.

Rates of recovery, reliable change, and reliable recovery using the first and last assessments on the OCI-R and PHQ-9

Internet CBT vs face-to-face CBT for OCD

New publication by research group members Lina Lundström and Oskar Flygare!

Cognitive-behavior therapy (CBT) for obsessive-compulsive disorder (OCD) is a highly specialized treatment that is in short supply worldwide. This study aimed to investigate whether therapist-guided internet-delivered CBT (ICBT) is non-inferior to face-to-face CBT for adults with OCD. Secondary objectives were to investigate if ICBT could be equally effective without therapist support (i.e. unguided), to conduct a health-economic evaluation, and to determine whether treatment effects were moderated by source of participant referral.

A consecutive sample of 120 adults with a primary diagnosis of OCD, either self-referred or referred by a clinician, were randomized to receive guided ICBT (n=42), unguided ICBT (n=40) or face-to-face CBT (n= 38) delivered over 14 weeks. The main outcome measure was change in OCD symptom severity according to the clinician rated Yale-Brown Obsessive Compulsive Scale (Y-BOCS) from baseline to 3-month follow-up (primary endpoint). The non-inferiority margin was set to 3 points on the Y-BOCS. 

Results: Of the 120 randomized participants, 80 (67%) were women with a mean age of 32 (SD = 9.64) years.The mean difference between therapist-guided ICBT and face-to-face CBT at the primary endpoint was 2.10 points on the Y-BOCS (90% CI -0.41 to 4.61), P = .17, favoring face-to-face CBT, meaning that the primary non-inferiority results were inconclusive. The difference between unguided ICBT and face-to-face CBT was 5.35 points (90% CI 2.76 to 7.94), P < .001), favoring face-to-face CBT. The health economic analysis showed that both guided and unguided ICBT were cost-effective compared to face-to-face CBT. Source of referral did not moderate treatment outcome. The most common adverse events were anxiety (25%), depressive symptoms (17%) and stress (9%).  

Conclusions and Relevance: In this randomized controlled trial of internet-based versus face-to-face cognitive behavioral therapy for adults with obsessive-compulsive disorder we could not conclusively demonstrate non-inferiority. Therapist-guided ICBT could be a cost-effective alternative to in-clinic CBT for adults with OCD in scenarios where traditional CBT is not readily available. Unguided ICBT is probably less efficacious but could be an alternative when providing remote clinician support is not feasible.

Read the article here.