Abstract：
Obsessive-compulsive disorder (OCD) is a common mental health condition characterized by distressing, intrusive thoughts (obsessions) and repetitive behaviours (compulsions) aimed at reducing anxiety. Internet-based cognitive behavioural therapy (ICBT) has emerged as an effective treatment modality for various mental health disorders. This meta-analysis evaluates the efficacy of guided self-help ICBT (GSH ICBT) and unguided self-help ICBT (SH ICBT) against active and passive control conditions in adults with OCD. A comprehensive systematic literature search yielded 12 randomized controlled trials (RCTs) comprising 15 comparison arms (N = 1416) that met the inclusion criteria. Results indicate that GSH ICBT significantly reduced OCD symptomatology posttreatment compared to active controls (g = 0.378, k = 9), with no significant effects maintained at follow-up (g = 0.153, k = 4). GSH ICBT was also found to be as effective as active CBT interventions in reducing comorbid anxiety and depression symptoms posttreatment (g = 0.278, k = 6) and at follow-up (g = 0.124, k = 4). However, improvements in quality of life were not significant posttreatment (g = 0.115, k = 4) nor at follow-up (g = 0.179, k = 3). Combined GSH and SH ICBT demonstrated large effects on reducing OCD symptoms (g = 0.754, k = 6), medium effects on comorbid symptoms (g = 0.547, k = 6) and small effects on quality of life (g = 0.227, k = 2) when compared to inactive controls. No significant differences were found between GSH and SH ICBT in all measured outcomes posttreatment (OCD: g = 0.098, k = 3; AD: g = 0.070, k = 3; QoL: g = -0.030, k = 1) and at follow-up (OCD: g = 0.265, k = 2; AD: g = 0.084, k = 2; QoL: g = 0.00, k = 1). Sample size was identified as a significant moderator of treatment effects. This paper further explores clinical significance, treatment adherence, therapist time investment and moderator influences of the ICBT. The limitations of the study and recommendations for future research are thoroughly discussed.
摘要：
强迫症（OCD）是一种常见的心理健康状况，以痛苦为特征，旨在减少焦虑的侵入性思想（痴迷）和重复行为（强迫）。基于互联网的认知行为疗法（ICBT）已成为各种心理健康障碍的有效治疗方式。这项荟萃分析评估了有指导的自助ICBT（GSHICBT）和无指导的自助ICBT（SHICBT）对成人强迫症患者主动和被动控制条件的疗效。综合系统的文献检索产生了12个随机对照试验（RCT），包括15个比较组（N=1416），符合纳入标准。结果表明，与活性对照相比，GSHICBT显着降低了治疗后的OCD症状学（g=0.378，k=9），随访期间无显著影响（g=0.153，k=4）。还发现GSHICBT在减少治疗后（g=0.278，k=6）和随访时（g=0.124，k=4）的共病焦虑和抑郁症状方面与积极的CBT干预措施一样有效。然而,治疗后(g=0.115,k=4)和随访时(g=0.179,k=3)生活质量均无显著改善.GSH和SHICBT联合显示出对减轻OCD症状的巨大影响（g=0.754，k=6），与不活动对照组相比，对合并症症状的中等影响（g=0.547，k=6）和对生活质量的小影响（g=0.227，k=2）。GSH和SHICBT在治疗后的所有测量结果（OCD：g=0.098，k=3；AD：g=0.070，k=3；QoL：g=-0.030，k=1）和随访时（OCD：g=0.265，k=2；AD：g=0.084，k=2；QoL：g=0.00，k=1）均无显着差异。样本量被确定为治疗效果的重要调节剂。本文进一步探讨临床意义,治疗依从性，ICBT的治疗师时间投入和主持人影响。深入讨论了研究的局限性和对未来研究的建议。
