OCD: Online Cognitive Behavioral Therapy Can Expand Access to Treatment for Children Interview with:

Kristina Aspvall | Psychologist, PhD
Eva Serlachius MD PhD Adjunct professor
Professor David Mataix-Cols, PhD

Karolinska Institutet
Department of Clinical Neuroscience
Child and Adolescent Psychiatry Research Center
Stockholm What is the background for this study?

Response: The problem we were trying to solve is the shortage of specialist Cognitive Behavioral Therapy (CBT) for children and adolescents with Obsessive-Compulsive Disorder (OCD). CBT is the first line treatment for children and adolescents with OCD but is a highly specialist treatment rarely available outside large medical centres, typically located in big cities. Previous work by our group and others had shown that it is possible to deliver CBT via the internet in the form of a self-help programme with minimal support from a clinician. The clinician can be located anywhere and provide asynchronous support via a built-in messaging system. Parental support is a key component of the treatment. In essence, the parents take over as the child’s main therapist, under the guidance of the expert clinician. What are the main findings?

Response: The main finding was that therapist and parent guided online CBT followed by traditional face-to-face CBT sessions for those who did not respond sufficiently to the online intervention was equally effective (not inferior) and required fewer therapist hours than offering traditional face-to-face therapy alone.

This is the first study to demonstrate that an online intervention can be provided in a stepped care fashion for children and adolescents with OCD without sacrificing treatment efficacy. By first offering the online intervention, it was possible to reduce the number of patients who needed face-to-face therapy. What should readers take away from your report?

Response: The stepped care model has the potential to greatly increase access to specialized treatment for this patient group. The online intervention requires less therapist time, which means that the more intensive treatment such as face-to-face therapy can be reserved for more complex patients or those who do not benefit sufficiently from the online intervention.

The intervention will soon be available within the child- and adolescent psychiatry services in Stockholm. In the near future, other Swedish regions will be able to enter agreements with Region Stockholm and implement the treatment locally using the Swedish national digital platform.

The treatment is not currently available outside Sweden, but we are open to collaborations with other international centres interested in translating and adapting the intervention. What recommendations do you have for future research as a result of this work?

Response: We believe that the biggest challenge is the dissemination of this innovation. For other international centres to be able to adopt out stepped care model, they first need to invest in a digital platform that can support the treatment content. This platform should comply with all the local legislation and have the highest digital safety standards (encryption, double authentication, etc). This requires initial investment, but the covid-19 pandemic has shown that this is a worthwhile effort, as digitalisation of healthcare is here to stay. 

All disclosures are reported in the paper.


Kristina Aspvall, Erik Andersson, Karin Melin, Lisa Norlin, Viktor Eriksson, Sarah Vigerland, Maral Jolstedt, Maria Silverberg-Mörse, Lena Wallin, Filipa Sampaio, Inna Feldman, Matteo Bottai, Fabian Lenhard, David Mataix-Cols, Eva Serlachius. Effect of an Internet-Delivered Stepped-Care Program vs In-Person Cognitive Behavioral Therapy on Obsessive-Compulsive Disorder Symptoms in Children and Adolescents. JAMA, 2021; 325 (18): 1863 DOI: 10.1001/jama.2021.3839

[wysija_form id=”3″]


The information on is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.


Last Updated on December 9, 2021 by Marie Benz MD FAAD