Brief Cognitive Behaviour Therapy (CBT) for Adolescent OCD in Routine Clinical Practice
Trial statusRecruiting
Trial phaseNot applicable
Trial typeInterventional
Biological sexAll
Age11-18
SponsorUniversity of Oxford
About this trial
Obsessive-Compulsive Disorder (OCD) is a common and often disabling condition in young people, characterised by distressing, intrusive thoughts, images or urges, and repetitive behaviours intended to reduce discomfort or prevent harm. Around 1% of adolescents in the UK experience OCD, with many cases beginning in childhood or adolescence. Cognitive Behavioural Therapy (CBT) is the recommended treatment for OCD in young people, but access to treatment is limited due to high demand, long waiting lists, and lack of trained clinicians.
A brief form of CBT for OCD, supported by workbooks, has previously shown promising results in research settings. However, it remains unclear whether this approach is feasible, acceptable, and effective when delivered within routine NHS child and adolescent mental health services (CAMHS), especially for young people with co-occurring autism.
This single-arm feasibility trial aims to explore whether brief CBT can be delivered effectively in routine NHS and NHS-commissioned services to young people aged 11-18 years with OCD as their main presenting problem. The trial will also assess whether the intervention is acceptable to young people, their parents/carers, and clinicians, and whether outcomes are comparable to existing evidence.
Intervention Overview: The brief CBT intervention consists of five core sessions, with the option of two additional booster sessions, delivered over 24 weeks. Sessions are delivered face-to-face by trained clinicians and last between 60 to 90 minutes. The intervention is supported by a series of co-designed workbooks to be completed by the young person between sessions. Parents/carers are also provided with a workbook and encouraged to support the young person's progress where appropriate. Sessions may take place in the clinic or in other agreed settings, such as at home or school. The frequency of sessions decreases over time, with the first four sessions delivered weekly and later sessions spaced further apart.
The intervention includes psychoeducation, developing a cognitive-behavioural understanding of OCD, goal setting, and techniques to support motivation and engagement. A key focus is helping young people develop cognitive flexibility by testing and challenging unhelpful beliefs that drive OCD behaviours, supported by behavioural experiments. Parents/carers and other adults in the young person's life may also be involved to help generalise learning and promote progress.
Trial Aims: The trial has two primary aims:
To establish whether brief CBT for OCD can be delivered with fidelity and acceptability by clinicians in NHS services, and is acceptable to young people and their families.
To explore whether the intervention is associated with significant improvements in OCD symptoms for young people, including those with autism or high levels of autistic traits.
Trial Design: The study is a single-arm feasibility trial. Between 20-30 young people aged 11-18 years will be recruited alongside their parents/carers. Approximately 8-10 clinicians will be trained to deliver the intervention. OCD symptoms, treatment processes, and acceptability will be assessed at baseline, post-treatment (12 weeks), and at 3-month follow-up (24 weeks). Additional measures will be collected before each therapy session.
Qualitative interviews will be conducted with young people, parents/carers, and clinicians to understand their experiences of the intervention. Acceptability will also be measured using standardised questionnaires completed during and after treatment.
Outcomes: The primary outcomes are feasibility and acceptability of the intervention, assessed through session attendance, participant engagement, clinician adherence, and feedback from young people, parents/carers, and clinicians.
Secondary outcomes include changes in OCD symptoms, responsibility beliefs, family accommodation, and overall functioning, as well as measures of anxiety and depression. Data will be analysed to assess changes from baseline to post-treatment and follow-up, including for young people with and without autistic traits. Treatment adherence and clinician competence will also be evaluated.
Eligibility criteria
This trial does not accept healthy volunteersQualifiers
Willing and able to give informed assent (if aged 11-15 years, and parent/carer consent is provided) or consent (if aged 16-18 years) for participation in the study.
Aged 11 to 18 years at the time of recruitment.
Diagnosed with OCD using the Anxiety Disorders Interview Schedule (ADIS) and OCD has been identified as the primary problem.
If on pharmacotherapy for OCD, then stable dose for at least 6 weeks prior to trial entry.
Disqualifiers
The clinical assessment indicates that risk/safeguarding cannot be safely managed within the service.
Any other significant disease or disorder which, in the opinion of the Investigator, may either put the participants at risk because of participation in the trial, or may influence the result of the trial, or the participant's ability to participate in the trial.
Evidence of learning difficulties identified by schools or evident at interview that would inhibit participation in cognitive components of therapy.
Currently receiving a psychological intervention for OCD.
Trial design
Design model
Single group
Treatments tested in this trial
Brief Cognitive Behavioural Therapy (CBT) for OCD
Other interventionA brief 5-session CBT face-to-face intervention (therapist supported, involving workbooks) for adolescent Obsessive Compulsive Disorder (OCD). The brief CBT consists of 5 sessions of 60 to 90-minutes, with the option of 2 additional booster sessions (also 60 to 90 minutes), spanning a total of 24 weeks. The intervention includes home tasks, completion of regular routine outcome measures and participants listening to audio-recordings of the therapy sessions. The intervention sessions are delivered by routine child and adolescent mental health services (CAMHS) practitioners and take place in NHS and NHS-commissioned child and adolescent mental health services.
Treatment groups
25 Participants
are divided into 1 treatment groupGroup A: TreatmentExperimental treatment 1 intervention
Trial outcomes
Primary outcomes
1
Credibility and Expectation of Treatment Questionnaire (CEQ; Borkovec & Nau, 1972)
The Credibility and Expectation of Treatment Questionnaire (CEQ; Borkovec \& Nau, 1972) will be collected at baseline and used to establish treatment acceptability. Score range 0-30. Higher scores represent a better outcome.
Time frame
Baseline and follow-up (week 24)2
Experience of Service Questionnaire (ESQ; Astride-Stirling, 2002)
The Experience of Service Questionnaire (ESQ; Astride-Stirling, 2002) will be used at the end of treatment (Week 12) and follow-up (Week 24) to measure young peoples' and parent/carers' expectations and views on the acceptability of the treatment and service.
Time frame
End of treatment (week 12) and follow-up (week 24)3
Therapist Experience of Training and Treatment Delivery Questionnaire
The Therapist Experience of Training and Treatment Delivery Questionnaire will be given to clinicians at follow-up (Week 24) in order to establish their perceived competence, acceptability and feasibility in delivering the intervention. Score range 19-95. Higher scores represent a better outcome.
Time frame
Follow-up (week 24)4
Attrition Rate
Feasibility will also be established by the number and rate of participants who drop-out of treatment (attrition rate).
Time frame
From enrolment to the end of follow-up (week 24)Secondary outcomes
1
Children's Yale-Brown Obsessive Compulsive Scale II (CY-BOCS-II; Abramovitch et al., 2022)
The Children's Yale-Brown Obsessive Compulsive Scale II (CY-BOCS-II; Abramovitch et al., 2022), the gold-standard in the assessment of the symptoms and severity of OCD in young people (Rapp et al., 2016) will be used at baseline and at follow-up (Week 24). The CY-BOCS-II will be used to measure change in OCD severity. Score range 0-50. Lower scores represent a better outcome.
Time frame
Baseline and follow-up (week 24)2
Obsessive-Compulsive Inventory - Child Version - Revised (OCI-CV-R; Abramovitch et al., 2022)
The Obsessive-Compulsive Inventory - Child Version - Revised (OCI-CV-R; Abramovitch et al., 2022) is a self-report measure of OCD symptoms and will be collected at baseline and every subsequent contact with the young people (each clinical session, post-intervention at Week 12 and follow-up at Week 24). Score range 0-36. Lower scores represent a better outcome.
Time frame
From baseline to follow-up (week 24)3
Child Responsibility Interpretations Questionnaire - CRIQ (Salkovskis & Williams, 2004a; Salkovskis & Williams, 2004b)
A measure of the OCD maintenance processes of responsibility beliefs will be collected at baseline and each clinical session to measure process changes and inform clinical treatment (Salkovskis \& Williams, 2004a; Salkovskis \& Williams, 2004b).
Time frame
From baseline to follow-up (week 24)4
Child Responsibility Attitude Scale - CRAS (Salkovskis & Williams, 2004a; Salkovskis & Williams, 2004b)
A measure of the OCD maintenance processes of responsibility attitudes will be collected at baseline and each clinical session to measure process changes and inform clinical treatment (Salkovskis \& Williams, 2004a; Salkovskis \& Williams, 2004b).
Time frame
From baseline to follow-up (week 24)Sponsors and contacts
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Source ClinicalTrials.gov