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P. Andrén

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Open access Aug 2026

Efficacy and cost-effectiveness of Internet-delivered cognitive-behavior therapy for children and adolescents with body dysmorphic disorder: study protocol for a randomized controlled trial

Body dysmorphic disorder (BDD) is a prevalent and impairing mental disorder that typically onsets in adolescence. Cognitive-behavior therapy (CBT) may be effective for adolescent BDD, although the supporting evidence is currently limited. CBT for BDD is a highly specialized treatment, creating a considerable gap in access to care for young people. Therapist-guided Internet-delivered CBT (ICBT) may help bridge this gap. The primary aim of this study is to determine the efficacy of a therapist-guided ICBT program for children and adolescents with BDD versus an active comparator. Secondary aims are to examine the 6-month durability of the treatment effects and to evaluate its relative cost-effectiveness from multiple perspectives. This is a 3-site superiority randomized controlled trial including 154 young people (12–17 years) with BDD recruited throughout Sweden. Participants are randomized 1:1 to 12 weekly modules of either therapist-supported ICBT primarily based on exposure with response prevention or an active comparator consisting of therapist-supported Internet-delivered relaxation training. Data will be collected at baseline, mid-treatment, post-treatment, and 1 month (primary endpoint), 3 months, and 6 months post-treatment. The primary outcome is BDD symptom severity measured with the Yale-Brown Obsessive-Compulsive Scale Modified for Body Dysmorphic Disorder, Adolescent version. All study personnel who can be blinded to study aims/hypotheses and group allocation will be blinded. Assessors conducting post-treatment and follow-up assessments will be external to the research team and blinded to study aims/hypotheses and group allocation at all assessment points. Analyses will be conducted according to the intention-to-treat principle and will follow a pre-specified statistical and health economic analysis plan. Participant recruitment started on 22 February 2024 and is currently ongoing. Data analysis for the primary aim will commence after the last participant reaches the primary endpoint. ClinicalTrials.gov NCT06262412. Registered on 16 February 2024, https://clinicaltrials.gov/study/NCT06262412.

L. Fernández de la Cruz, Anita Birovecz, Per Andrén et al. · Trials · 0 citations

Open access Jul 2026

Online behaviour therapy based on exposure with response prevention for adults with tourette syndrome or chronic tic disorder: a feasibility trial

To evaluate the feasibility, acceptability, safety, preliminary efficacy, and preliminary maintenance of TICNET, an online therapist-guided exposure and response prevention (ERP) for adults with Tourette syndrome or chronic tic disorder (TS/CTD). Single-group, unmasked feasibility trial. A psychiatric outpatient clinic specialized in obsessive-compulsive and related disorders in Stockholm, Sweden. Adult participants with TS/CTD were recruited nationwide by means of self- and clinical referrals. The 10-week online, ERP-based, therapist-supported programme TICNET consisted of eight chapters provided on a secure platform. The RE-AIM framework (Reach, Efficacy, Adoption, Implementation, and Maintenance) was used to assess feasibility and acceptability. Safety was measured with an adverse events questionnaire. Preliminary intervention effects on tic severity were measured with the Yale Global Tic Severity Scale – Total Tic Severity subscale. Outcome measures were collected at pre- and post-treatment, as well as at the 3-, 6- and 12-month follow-up. Out of 73 screened participants, 31 met inclusion criteria, with the most common reason for exclusion being not fulfilling the diagnostic criteria for TS/CTD. The participants completed an average of 6.5 out of 8 treatment chapters and 90% were classified as treatment completers. The therapists spent an average of 18.1 min/week supporting each participant. No serious adverse events were reported. The decrease in tic severity from pre- to post-treatment was statistically significant (Cohen’s d = 0.49, 95% CI -0.46 to 1.44), and continued to decrease further during the follow-up (12-month follow-up Cohen’s d = 1.09, 95% CI 0.14–2.04). TICNET is a feasible, acceptable, safe, and potentially efficacious and durable treatment for adults with TS/CTD. The treatment warrants further testing in a well-powered, randomised controlled trial with an active comparator. ClinicalTrials.gov (NCT04908969), retrospectively registered on the 28th of May 2021.

Ekaterina Ivanova, Anita Birovecz, P. Andrén et al. · BMC Digital Health · 0 citations