4 - (SYM 26) Oc-go: Augmenting Exposure Therapy Homework Compliance in Youth with OCD

Although ERP is the first-line treatment for OCD, not all recipients benefit equally.  Between session ERP practice is a critical predictor of treatment response, and has been shown to fully or partially augment other outcome predictors.  OC-Go is a HIPAA-compliant, asynchronous digital health platform designed to addresse critical barriers underlying homework nonadherence. Therapists use a web-based portal to create personalized exposure, psychoeducation, or other therapy assignments de novo or drawn from a clinician-sourced searchable library which are then pushed to patient mobile devices. The app interface guides patients through these step-by-step interactive assignments in real time, providing a means for specific directions, encouragement, accountability, and a therapeutic presence.

 Twenty-five treatment seeking youth with primary OCD completed a randomized controlled superiority crossover design through receipt of 12 sessions of protocol-driven outpatient exposure-based CBT augmented with six weeks of OC-Go for either the first (n=13) or last half (n=12) of treatment.  In line with augmentation trial recommendations to maximize sensitivity and statistical power, the study endpoints [1) percent assignments completed; 2) change in CY-BOCS-rated OCD severity] were collected following treatment Week 6.  These same endpoints were also collected at Week 12 to further explore OC-Go benefits.

Week 6 homework adherence rates were 83.3% (95% CI 80.8%-85.6%) ERP/OC-Go vs. 68.4% (95% CI 65.6%-71.0%) for standard treatment (p < .001). Both groups showed large Week 6 declines in OCD severity (d=1.31, p < 0.001), with the initial ERP/OC-Go group exhibiting a steeper improvement slope (p=0.05) and enhanced treatment response at Week 6 (d =0.36) compared to six weeks of standard treatment, and overall enhanced response at Week 12 (d=0.72) compared to the intial standard treatment group.  Users rated OC-Go in the 90^th percentile on a System Usability Scale, indicative of a highly usable and easy to learn to technology.  Initial evidence supports OC-Go as a feasible and effective adjunct to improve out-of-office exposure adherence and treatment response in ERP for child OCD.