Effectiveness of ICBT for Anxiety and Obsessive-Compulsive Disorders Revealed

Released on Feb.12, 2025

• University

Released on Feb.12, 2025

Kazuki Matsumoto, PhD, Division of Clinical Psychology, Kagoshima University Hospital Research and Education Assembly Medical and Dental Sciences Area, Kagoshima University, developed ICBT (Internet-Based Cognitive Behavioral Therapy) in order to reduce the burden of transportation costs and travel time, and to create an environment where more people can receive appropriate treatment. He has conducted various studies and published papers on his findings. We interviewed Mr. Matsumoto about his research, how he utilizes the learningBOX, and his future plans.

ICBT May Help Out-of-School Children

Tell us about your background and areas of expertise.

I am currently working in the Clinical Psychology Office at Kagoshima University Hospital for clinical and research purposes. After completing the United Graduate School of Child Development, Osaka University in 2019, I worked as a specially appointed researcher at Chiba University and a specially appointed assistant professor at Kanazawa University before taking my current position at Kagoshima University Hospital in 2022.

I specialize in cognitive behavioral therapy and clinical research in the field of psychiatry. CBT (Cognitive Behavior Therapy) is a very effective for OCD (Obsessive-Compulsive Disorder) and SAD (Social Anxiety Disorder). Through the development and social implementation of safe and effective ICBT, we aim to provide high-quality treatment to as many people as possible, regardless of location or time.

Our research findings have been published in international academic journals and presented at relevant conferences both in Japan and abroad, contributing to the advancement of treatment methods in the field of psychiatric care. Additionally, we are committed to sharing our insights with the general public through press releases and other outreach efforts.

The ultimate goal of my research is to alleviate the distress of individuals struggling with mental health issues while also improving their quality of life. By promoting the widespread adoption of ICBT, I aim to create an environment where more people can access appropriate treatment, ultimately helping individuals lead richer and more fulfilling lives.

You studied clinical psychology in university, and child development in graduate school. What brought you to the majors?

I was born during the recession. As I grew up, I noticed an increasing amount of media coverage on mental health issues. Being a highly empathetic child, I developed a strong interest in psychotherapy, particularly in cognitive behavioral therapy (CBT), which is the most evidence-based treatment of psychotherapy. This interest led me to pursue expertise in CBT.

After becoming a clinical psychologist, I came to understand that anxiety plays a significant role in school refusal. This realization led me to consider the potential of remote cognitive behavioral therapy in helping children overcome school refusal and social withdrawal. With this goal in mind, I pursued further studies at the United Graduate School of Child Development of Osaka University (Chiba Campus).

Let us know the resons why your main focus was on obsessive-compulsive disorder and social anxiety among the various disorders.

In the United Graduate School of Child Development of Osaka University, my senior students had already conducted excellent research on other diseases, and my supervisor, Dr. Eiji Shimizu suggested me to treat obsessive-compulsive disorder and social anxiety. Recently, I have been working on cognitive behavioral therapy research on Post Traumatic Stress Disorder (PTSD), dissociative disorders, eating disorders, and ADHD (Attention Deficit Hyperactivity Hyperactivity Disorder), and ADHD.

Intuitive UI/UX to Increase Effectiveness of ICBT

What is the background behind your focus on ICBT and what are challenges you face with conventional CBT?

Conventional CBT is usually conducted face-to-face. However, this prevents many patients from receiving treatments due to time and location constraints. To solve this challenge, I have been working on the development of ICBT, which allows them to experience online treatment.

ICBT provides CBT via the Internet, allowing patients to receive treatment from home or any other places they like. This reduces the burden of transportation costs and travel time, and creates an environment in which more people can receive treatment. In addition to simply developing ICBT, we are also actively conducting research to verify its effectiveness.

What made you implement learningBOX?

We needed an online program platform that we could build with no code (development without writing source code). While searching on the website, I found learningBOX.

The deciding factor was the simple and intuitive design of the system. We placed great importance on the ease of use, since it is directly related to an increase in ICBT implementation rates, which may in turn increase the effectiveness of treatment.

Tell us what you find easy to use and what you would like to be improved.

It was easy to build a course just by uploading files like PDFs. One thing I would like to see improved would be some model examples of courses implemented in learningBOX. Also, it would be nice to have a chat function that allows offline interaction between the instructor (therapist) and the user (patient).

Thank you. We will consider your feedback internally. Now, tell us about the research conducted using learningBOX.

We conducted a clinical trial to test the effectiveness of the ICBT self-help program for Obsessive Compulsive Disorder, Social Anxiety and Panic Disorder from 2018-2020. Self-help refers to a therapeutic approach with the goal of assisting oneself with one's own problems. According to the UK's National Institute for Health and Care Excellence (NICE), treatment guidelines recommend cognitive behavioral therapy with self-help, such as ICBT, for the initial treatment of depression and obsessive-compulsive disorder.

We developed a cognitive-behavioral therapy program using an e-learning system and implemented self-help programs for three disorders, and we used learningBOX as a platform for these programs. All programs have 12 sessions in total and were implemented based on cognitive-behavioral models corresponding to disease-specific psychopathology.

How were the results?

Psychosocial support was provided to three adult male and three female patients with obsessive-compulsive disorder in an outpatient psychiatric hospital setting, utilizing digital educational materials including the ICBT program we developed. Before and after the intervention, all patients showed significant improvement in their clinical symptoms and remission of their obsessive-compulsive disorder.(Matsumoto et al., 2020) 

In the online cognitive-behavioral therapy program for social anxiety, 5 out of 6 patients successfully completed the study treatment, and no Adverse Events were observed. Most patients observed improvement in symptoms of their primary disease after this clinical trial.(Shinno, Matsumoto et al. 2024) 

What kind of research did you pursue after that?

The above studies have increased our confidence that the ICBT program for obsessive-compulsive disorder has "worked" and that we implemented Randomized Controlled Trial among multiple institutions from 2018 to 2020.(Matsumoto et al., 2020) 

Thirty-one patients between the ages of 15 and 60 whose primary diagnosis was obsessive-compulsive disorder participated in the study; half of the 31 participants were given therapist-guided ICBT and the other half were asked to wait and compare how much their OCD symptoms had improved by three months later.

I guided the therapists and used a chat tool to encourage commitment to the program and to individually answer questions about cognitive behavioral therapy for those who had questions. The results were very positive: after 3 months, 641 TP3T (n=9/14) of those who received guided ICBT showed a significant reduction in obsessive-compulsive symptoms.(Matsumoto et al., 2022) 

In contrast, for those who waited the rate was only 131 TP3T (n=2/15). This difference was statistically significant. In other words, guided ICBT clearly proved effective in improving OCD symptoms.

Eleven of the participants on the waiting list also received the same guided ICBT after the waiting list, and 81% (n=9/11) significantly reduced obsessive-compulsive symptoms. Furthermore, through a 2-year follow-up study of the 25 participants who received guided ICBT, we were also able to confirm that there was long-term efficacy.(Matsumoto et al., 2024a) 

For more information, refer to Research Report.

learningBOX Delivers CBT Safely and Immediately

What types of content are used in learningBOX for these ICBT self-help programs?

Our self-help program consists of PDFs and quizzes. We are planning to upload video files for future use.

What aspects of these ICBT self-help programs have been effective in improving disease?

Traditional CBT has relied heavily on in-person sessions with trained therapists. However, there has been a shortage of therapists proficient in CBT, with most concentrated in urban areas, making access to treatment difficult for many individuals. ICBT offers a promising solution by allowing individuals in need of CBT to access treatment from the comfort of their homes, at any time, and as often as necessary. By repeatedly engaging in structured CBT programs tailored to specific conditions, participants have demonstrated high treatment responsiveness, leading to significant symptom improvement.

Your study was nominated as a finalist for the Well-Being Award at the Bett Asia Awards 2024.

From December 2022 to October 2023, a clinical trial was conducted across seven institutions, including Kagoshima University, University of Fukui, Shigakukan University, Naruto University of Education, Fukushima College, Kochi Kokusai High School, and Jin-ai University. The study aimed to evaluate the effectiveness of an ICBT self-help program for adolescents experiencing social anxiety.

A total of 77 students participated in the study. Through a randomized procedure, 38 participants were assigned to the intervention group, which received internet-based CBT, while 39 participants were placed in the control group, which received no treatment.

The program was structured into 10 sessions, and the results were assessed 10 weeks after the start of the clinical trial, immediately following the intervention. The remission rate, which represents the percentage of participants who reached a state where social anxiety was no longer a significant issue, was 38% (9 out of 38) in the control group. In contrast, the intervention group achieved a remission rate of 61% (19 out of 31), demonstrating the effectiveness of the ICBT self-help program in improving subthreshold social anxiety symptoms in adolescents.(Matsumoto et al., 2024b)Subthreshold is the status that the diagnostic criteria are not met.

For more information, refer to paper.

Tell us about the book you published in the fall of 2024.

"Getting out of my worries about what others might think of me" provides methods (cognitive-behavioral therapy) for those who have anxiety and fear about what others think of you. For instance, you may worry about what if you panic when you go out, or regret your actions many times. This book is for those who feel like that way even if you have not been diagnosed with social anxiety.

It is natural to feel anxious and fearful in situations where one feels stares, and anxiety and fear are essential for people to lead a social life. We hope that you will use the techniques of cognitive-behavioral therapy to deal with your fears and anxieties, while keeping in mind the importance of being able to "be yourself". We also introduce how to overcome each problem with examples, so please take a look if you are interested.

Above image: "Getting out of my worries about what others might think of me", Shoeisha, 2024, author Kazuki Matsumoto, Naoki Yoshinaga, 208 pages (soft cover), published October 25, 2024, ¥1,650 (tax included) ISBN-10: 4798185078. Bottom image: An image in the book.

What is your future plan?

Cognitive-behavioral therapy is a treatment that is no less effective than pharmacotherapy and is covered by insurance for some mental disorders when provided in face-to-face sessions by a trained physician or in collaboration with a trained physician and nurse practitioner. However, there is an overwhelming shortage of specialists in cognitive behavioral therapy.

In addition, clinics offering CBT are unevenly distributed in urban areas, and there are significant physical barriers to psychiatric care in rural areas including Kagoshima Prefecture. learningBOX-based ICBT will create unprecedented opportunities for increased treatment access for psychiatric disorders that have been proven effective with face-to-face cognitive behavioral therapy. opportunities for psychiatric disorders for which face-to-face cognitive-behavioral therapy has been proven effective.

We will continue to identify effective techniques and incorporate them efficiently into ICBT programs, while designing a treatment platform that is easy for users (patients) to work with, fully understand, and continuously practice the techniques they learn, and to reach all those in need of support. We would like to continue our efforts to provide support to all those who need it.

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