Brief Cognitive Behaviour Therapy (CBT) for Adolescent OCD in Routine Clinical Practice

Summary

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

Inclusion Criteria:

Young people:

* 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.
* Able to speak and read English at a sufficient level to be able to read and understand the workbooks and materials and complete exercises in the workbooks.
* Willing to engage in the treatment.
* In the Investigator's opinion, is able and willing to comply with all trial requirements.
* Willing to allow his or her General Practitioner and consultant, if appropriate, to be notified of participation in the trial.

Parents/carers:

* Able and willing to provide written informed consent for their child's participation in the study.
* Able to read the parent/carer workbook and materials.
* Willing and able to participate.

Clinicians:

* Working within a participating NHS or NHS-commissioned service.
* Have a professional qualification in psychological therapy that includes training in CBT at or above post-graduate certificate level.
* Willing to participate.
* Clinical capacity and managerial approval to participate

Exclusion Criteria:

Young people:

* 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.

Parents/carers:

* No exclusion criteria.

Clinicians:

* No exclusion criteria

Conditions3

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