Efficacy and mediators of online cognitive therapy for taboo obsessions in adults with obsessive-compulsive disorder : Randomized controlled trial
(2025) In Behaviour Research and Therapy 187.- Abstract
Taboo obsessions are ego-dystonic, recurrent, and intrusive thoughts involving aggressive, sexual and/or religious themes, which are common in individuals with obsessive-compulsive disorder (OCD). These symptoms are often challenging to treat with traditional, exposure-based approaches. Our research group has developed and successfully piloted an Internet-delivered intervention based on the cognitive framework of taboo obsessions (I-CT). The current randomized controlled trial evaluated the efficacy of I-CT compared to Internet-delivered general psychological support in reducing OCD symptom severity and associated impairments. A secondary aim was to investigate if the treatment effect was mediated by a reduction in negative appraisals,... (More)
Taboo obsessions are ego-dystonic, recurrent, and intrusive thoughts involving aggressive, sexual and/or religious themes, which are common in individuals with obsessive-compulsive disorder (OCD). These symptoms are often challenging to treat with traditional, exposure-based approaches. Our research group has developed and successfully piloted an Internet-delivered intervention based on the cognitive framework of taboo obsessions (I-CT). The current randomized controlled trial evaluated the efficacy of I-CT compared to Internet-delivered general psychological support in reducing OCD symptom severity and associated impairments. A secondary aim was to investigate if the treatment effect was mediated by a reduction in negative appraisals, the proposed mechanism of change in cognitive therapy. Sixty-eight participants with a diagnosis of OCD and primary taboo obsessions were randomized to either I-CT or general psychological support for 8 weeks. The primary outcome was change on the clinician-rated Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), administered by masked assessors at pre- and post-treatment. Participants in both groups had a significant reduction of OCD symptom severity but those randomized to I-CT had significantly better outcomes (between group bootstrapped d = 0.69, [95% CI, 0.22–1.17]). The proportion of participants classed as responders and remitters was also higher in the I-CT group (odds ratio 2.33 and 1.77 respectively), though not significantly. A large portion of the treatment effect (55%) was mediated by change in negative appraisals. I-CT could be a promising treatment approach for individuals with taboo obsessions who do not wish, or are unable, to engage in, or do not respond to, exposure-based treatment for OCD.
(Less)
- author
- Olofsdotter Lauri, Klara ; Aspvall, Kristina ; Lybert, Nathalie ; Samuelsson, Conrad ; Liliequist, Björn E. ; Håkansson, Elsa ; Serlachius, Eva LU ; Rück, Christian ; Mataix-Cols, David LU and Andersson, Erik
- organization
- publishing date
- 2025-04
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Cognitive therapy, Negative appraisals, Obsessive-compulsive disorder, Online interventions, Primary obsessions, Repugnant obsessions, Taboo obsessions
- in
- Behaviour Research and Therapy
- volume
- 187
- article number
- 104708
- publisher
- Elsevier
- external identifiers
-
- scopus:85218244768
- pmid:39993335
- ISSN
- 0005-7967
- DOI
- 10.1016/j.brat.2025.104708
- language
- English
- LU publication?
- yes
- id
- fa35771c-6347-44f8-af53-3d1b0aefbccc
- date added to LUP
- 2025-06-17 12:40:11
- date last changed
- 2025-07-15 15:34:09
@article{fa35771c-6347-44f8-af53-3d1b0aefbccc,
abstract = {{<p>Taboo obsessions are ego-dystonic, recurrent, and intrusive thoughts involving aggressive, sexual and/or religious themes, which are common in individuals with obsessive-compulsive disorder (OCD). These symptoms are often challenging to treat with traditional, exposure-based approaches. Our research group has developed and successfully piloted an Internet-delivered intervention based on the cognitive framework of taboo obsessions (I-CT). The current randomized controlled trial evaluated the efficacy of I-CT compared to Internet-delivered general psychological support in reducing OCD symptom severity and associated impairments. A secondary aim was to investigate if the treatment effect was mediated by a reduction in negative appraisals, the proposed mechanism of change in cognitive therapy. Sixty-eight participants with a diagnosis of OCD and primary taboo obsessions were randomized to either I-CT or general psychological support for 8 weeks. The primary outcome was change on the clinician-rated Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), administered by masked assessors at pre- and post-treatment. Participants in both groups had a significant reduction of OCD symptom severity but those randomized to I-CT had significantly better outcomes (between group bootstrapped d = 0.69, [95% CI, 0.22–1.17]). The proportion of participants classed as responders and remitters was also higher in the I-CT group (odds ratio 2.33 and 1.77 respectively), though not significantly. A large portion of the treatment effect (55%) was mediated by change in negative appraisals. I-CT could be a promising treatment approach for individuals with taboo obsessions who do not wish, or are unable, to engage in, or do not respond to, exposure-based treatment for OCD.</p>}},
author = {{Olofsdotter Lauri, Klara and Aspvall, Kristina and Lybert, Nathalie and Samuelsson, Conrad and Liliequist, Björn E. and Håkansson, Elsa and Serlachius, Eva and Rück, Christian and Mataix-Cols, David and Andersson, Erik}},
issn = {{0005-7967}},
keywords = {{Cognitive therapy; Negative appraisals; Obsessive-compulsive disorder; Online interventions; Primary obsessions; Repugnant obsessions; Taboo obsessions}},
language = {{eng}},
publisher = {{Elsevier}},
series = {{Behaviour Research and Therapy}},
title = {{Efficacy and mediators of online cognitive therapy for taboo obsessions in adults with obsessive-compulsive disorder : Randomized controlled trial}},
url = {{http://dx.doi.org/10.1016/j.brat.2025.104708}},
doi = {{10.1016/j.brat.2025.104708}},
volume = {{187}},
year = {{2025}},
}