{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,18]],"date-time":"2025-10-18T19:41:24Z","timestamp":1760816484836,"version":"build-2065373602"},"reference-count":52,"publisher":"BMJ","issue":"9","funder":[{"name":"The regional agreement on medical training and clinical research"},{"DOI":"10.13039\/501100001862","name":"The Swedish Research Council","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100001862","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2018,7,30]]},"published-print":{"date-parts":[[2018,9]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Expert guidelines recommend cognitive\u2013behavioural therapy (CBT) as a first-line treatment for obsessive\u2013compulsive disorder (OCD), but the majority of patients with OCD do not have access to CBT. Internet-delivered CBT (ICBT) has the potential to make this evidence-based treatment more accessible while requiring less therapist time than traditional face-to-face (f2f) CBT. Data from six clinical trials suggest that ICBT for OCD is both efficacious and cost-effective, but whether ICBT is non-inferior to traditional f2f CBT for OCD is yet unknown.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and analysis<\/jats:title>\n                  <jats:p>A single-blind, randomised, controlled, non-inferiority trial comparing therapist-guided ICBT, unguided ICBT and individual (f2f) CBT for adult OCD patients. The primary objective is to investigate whether ICBT is non-inferior to gold standard f2f CBT. Secondary objectives are to investigate if ICBT is equally effective when delivered unguided, to establish the cost-effectiveness of ICBT and to investigate if the treatment outcome differs between self-referred and clinically referred patients. Participants will be recruited at two specialist OCD clinics in Stockholm and also through online self-referral. Participants will be randomised to one of three treatment conditions: F2f CBT, ICBT with therapist support or unguided ICBT. The total number of participants will be 120, and masked assessments will be administered at baseline, biweekly during treatment, at post-treatment and at 3-month and 12-month follow-ups. The main outcome measure is the clinician-rated Yale-Brown Obsessive Compulsive Scale (Y-BOCS) at 3-month follow-up. The margin of non-inferiority is set to 3 points on the Y-BOCS using a 90% CI.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Ethics and dissemination<\/jats:title>\n                  <jats:p>The study has been approved by the Regional Ethics Board of Stockholm (REPN 2015\/1099-31\/2) and registered at Clinicaltrials.gov (<jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT02541968\">NCT02541968<\/jats:ext-link>). The study will be reported in accordance with the Consolidated Standards of Reporting Trials statement for non-pharmacological trials. The results will be published in peer-reviewed academic journals and disseminated to patient organisations and media.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Trial registration number<\/jats:title>\n                  <jats:p>\n                     <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"NCT02541968\" ext-link-type=\"clintrialgov\" specific-use=\"clinicaltrial pre-results\">NCT02541968<\/jats:ext-link>; Pre-results.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjopen-2018-022254","type":"journal-article","created":{"date-parts":[[2018,9,5]],"date-time":"2018-09-05T09:51:59Z","timestamp":1536141119000},"page":"e022254","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":10,"title":["Study protocol for a single-blind, randomised controlled, non-inferiority trial of internet-based versus face-to-face cognitive behaviour therapy for obsessive\u2013compulsive disorder"],"prefix":"10.1136","volume":"8","clinical-trial-number":[{"clinical-trial-number":"nct02541968","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct02541968","registry":"10.18810\/clinical-trials-gov","type":"preResults"},{"clinical-trial-number":"nct02541968","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8742-0168","authenticated-orcid":false,"given":"Christian","family":"R\u00fcck","sequence":"first","affiliation":[{"name":"Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden"},{"name":"Stockholm Health Care Services, Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lina","family":"Lundstr\u00f6m","sequence":"additional","affiliation":[{"name":"Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden"},{"name":"Stockholm Health Care Services, Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2017-3940","authenticated-orcid":false,"given":"Oskar","family":"Flygare","sequence":"additional","affiliation":[{"name":"Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1897-5549","authenticated-orcid":false,"given":"Jesper","family":"Enander","sequence":"additional","affiliation":[{"name":"Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden"},{"name":"Stockholm Health Care Services, Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matteo","family":"Bottai","sequence":"additional","affiliation":[{"name":"Institute of Environmental Medicine, Biostatistics, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Mataix-Cols","sequence":"additional","affiliation":[{"name":"Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden"},{"name":"Stockholm Health Care Services, Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erik","family":"Andersson","sequence":"additional","affiliation":[{"name":"Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2018,9,5]]},"reference":[{"key":"2025101812001937000_8.9.e022254.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2009.11.020"},{"key":"2025101812001937000_8.9.e022254.2","doi-asserted-by":"crossref","first-page":"1626","DOI":"10.1038\/mp.2016.115","article-title":"Suicide in obsessive-compulsive disorder: a population-based study of 36\u2009788 Swedish patients","volume":"22","author":"Fern\u00e1ndez de la Cruz","year":"2017","journal-title":"Mol Psychiatry"},{"key":"2025101812001937000_8.9.e022254.3","doi-asserted-by":"publisher","DOI":"10.1002\/da.20506"},{"key":"2025101812001937000_8.9.e022254.4","first-page":"10","article-title":"Epidemiology of obsessive compulsive disorder","volume":"51 Suppl","author":"Rasmussen","year":"1990","journal-title":"J Clin Psychiatry"},{"key":"2025101812001937000_8.9.e022254.5","unstructured":"Obsessive N . 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