Background: This study proposes a digital program for the treatment of mental illness that could increase motivation and improve learning outcomes for patients. Several studies have already applied this method by using an exposure and response prevention–inspired serious game to treat patients with obsessive-compulsive disorder (OCD). Objective: We hypothesized that a mobile cognitive behavior therapy (CBT) program would be as effective in treating OCD as traditional offline CBT. In addition, the treatment efficacy in response to mobile CBT for OCD might be associated with increased brain activity within the cortico-striato-thalamo-cortical (CSTC) tract. Methods: The digital CBT treatment program for OCD, OCfree, consists of 6 education sessions, 10 quests, and 7 casual games. Information was gathered from 27 patients with OCD (15 offline CBT and 12 OCfree CBT). During the 6-week intervention period, changes in clinical symptoms and brain function activity were analyzed. Results: There was no significant difference in the change in OCD symptoms and depressive symptoms between the two groups. However, the OCfree group showed greater improvement in anxiety symptoms compared to the offline CBT group. Both offline CBT and OCfree CBT increased the functional connectivity within the CSTC tract in all patients with OCD. However, CBT using OCfree showed greater changes in brain connectivity within the thalamus and insula, compared to offline CBT. Conclusions: OCfree, an OCD treatment app program, was effective in the treatment of drug-naïve patients with OCD. The treatment effects of OCfree are associated with increased brain connectivity within the CSTC tract. Multisensory stimulation by education, quests, and games in OCfree increases the activity within the thalamus and insula in patients with OCD.

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强迫症中移动应用程序与传统认知行为疗法的有效性比较：评估研究

背景：本研究提出了一种用于治疗精神疾病的数字程序，该程序可以增加患者的动力并改善学习成果。几项研究已经通过使用受暴露和反应预防启发的严肃游戏来应用这种方法来治疗强迫症（OCD）患者。目的：我们假设移动认知行为疗法（CBT）程序与传统的离线CBT一样有效地治疗OCD。另外，针对移动性CBT的OCD的治疗功效可能与皮质-纹状体-丘脑-皮质（CSTC）道内大脑活动的增加有关。方法：用于OCD的数字CBT治疗程序OCfree包括6个教育课程，10个任务和7个休闲游戏。信息收集自27位强迫症患者（15位离线CBT和12位OCfree CBT）。在6周的干预期内，分析了临床症状和脑功能活动的变化。结果：两组的强迫症症状和抑郁症状变化无明显差异。但是，与离线CBT组相比，OCfree组的焦虑症状改善更大。离线CBT和OCfree CBT均可提高所有OCD患者CSTC道内的功能连接性。但是，与离线CBT相比，使用OCfree的CBT在丘脑和岛状脑部显示出更大的大脑连通性变化。结论：OCfree是一种强迫症治疗应用程序，可有效治疗未经药物治疗的强迫症患者。OCfree的治疗效果与CSTC道内的大脑连接性增强有关。在OCfree中，通过教育，任务和游戏进行的多感官刺激会增加强迫症患者丘脑和岛突的活动。