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. 2021 Jan 19;8(1):e23778.
doi: 10.2196/23778.

Comparing Effectiveness Between a Mobile App Program and Traditional Cognitive Behavior Therapy in Obsessive-Compulsive Disorder: Evaluation Study

Hyunchan Hwang  1 , Sujin Bae  2 , Ji Sun Hong  1 , Doug Hyun Han  1
Affiliations

Comparing Effectiveness Between a Mobile App Program and Traditional Cognitive Behavior Therapy in Obsessive-Compulsive Disorder: Evaluation Study

Hyunchan Hwang et al. JMIR Ment Health. .

Abstract

Background: This study proposes a digital program for the treatment of mental illness that could increase motivation and improve learning outcomes for patients. Several studies have already applied this method by using an exposure and response prevention-inspired serious game to treat patients with obsessive-compulsive disorder (OCD).

Objective: We hypothesized that a mobile cognitive behavior therapy (CBT) program would be as effective in treating OCD as traditional offline CBT. In addition, the treatment efficacy in response to mobile CBT for OCD might be associated with increased brain activity within the cortico-striato-thalamo-cortical (CSTC) tract.

Methods: The digital CBT treatment program for OCD, OCfree, consists of 6 education sessions, 10 quests, and 7 casual games. Information was gathered from 27 patients with OCD (15 offline CBT and 12 OCfree CBT). During the 6-week intervention period, changes in clinical symptoms and brain function activity were analyzed.

Results: There was no significant difference in the change in OCD symptoms and depressive symptoms between the two groups. However, the OCfree group showed greater improvement in anxiety symptoms compared to the offline CBT group. Both offline CBT and OCfree CBT increased the functional connectivity within the CSTC tract in all patients with OCD. However, CBT using OCfree showed greater changes in brain connectivity within the thalamus and insula, compared to offline CBT.

Conclusions: OCfree, an OCD treatment app program, was effective in the treatment of drug-naïve patients with OCD. The treatment effects of OCfree are associated with increased brain connectivity within the CSTC tract. Multisensory stimulation by education, quests, and games in OCfree increases the activity within the thalamus and insula in patients with OCD.

Keywords: behavior therapy; cognitive; cognitive behavior therapy; cortico-striato-thalamo-cortical tract; exposure and response prevention; functional connectivity; mental illness; obsessive-compulsive disorder; prevention.

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Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
OCfree program: (1) learning about OCD: learn about symptoms, causes, and treatments, (2) analyzing obsessions: trigger factors for obsession and compulsive behaviors, compulsive infiltration, fearful ending, (3) understanding strategies with OCD, (4) understanding false beliefs related to obsession, (5) analyzing the symptoms of obsessions and compulsions with 8 panels, (6) creating a customized treatment plan for you, (7) shooting game, (8) break block game, (9) germ-removing game.
Figure 2
Figure 2
Comparisons of the changes of (A) Y-BOCS, (B) BDI, and (C) BAI scores between the offline CBT group and OCfree group. BAI: Beck Anxiety Inventory. BDI: Beck Depression Inventory. CBT: cognitive behavior therapy. Y-BOCS: Yale-Brown Obsessive Compulsive Scale.
Figure 3
Figure 3
Correlation between the Yale-Brown Obsessive Compulsive Scale and brain activity.
Figure 4
Figure 4
Comparison of the changes in fractional amplitude of low-frequency fluctuations between the OCfree and offline cognitive behavior therapy groups.
Figure 5
Figure 5
The changes in functional connectivity in all the patient groups (OCfree and offline cognitive behavior therapy group).
Figure 6
Figure 6
Changes in functional connectivity in the offline cognitive behavior therapy group.
Figure 7
Figure 7
Changes in functional connectivity in the OCfree group.
See this image and copyright information in PMC

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