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Behavior therapy for obsessive-compulsive disorder guided by a computer or by a clinician compared with relaxation as a control

Authors

Greist JH, Marks IM, Baer L, Kobak KA, Wenzel KW, Hirsch MJ, Mantle JM, Clary CM

Journal

J Clin Psychiatry

Publication Date

2002

Volume

Issue

Pages

138-45

HIT Description: Computerized patient decision support. More info...
Purpose of Study: Asses a computer-guided behavior therapy self-help system for patients with obsessive-compulsive disorder (OCD).
Years of study: Not Available
Study Design: RCT
Outcomes: Impact on patient satisfaction, Impact on health care effectivness/quality

Summary:

Settings: Two hundred-eighteen patients with DSM-IV - OCD at 8 North American sites participated in the investigation.
Intervention: Behavior therapy for obsessive-compulsive disorder guided by a computer and a user workbook or by a clinician was compared with relaxation guided by an audiotape as a control.
Evaluation Method: Measures of the Yale-Brown Obsessive Compulsive Scale, the Clinical Global Impressions Scale
Description: The computer-guided behavior therapy self-help system used was ÒBT STEPSÓ, and patients accessed it by telephone from home via interactive voice response technology.
Quality of Care and Patient Safety Outcome: Mean change in score on the Yale-Brown Obsessive Compulsive Scale was significantly greater in clinician-guided behavior therapy (8.0) than in computer-guided (5.6), and changes in scores with both clinician-guided and computer-guided behavior therapy were significantly greater than with relaxation (1.7), which was ineffective. Similarly, the percentage of responders on the Clinical Global Impressions Scale was significantly (p .05) greater with clinician-guided (60%) than computer-guided behavior therapy (38%), and both were significantly greater than with relaxation (14%). Clinician-guided was superior to computer-guided behavior therapy overall, but not when patients completed at least 1 self-exposure session (N = 36 [65%]). Patients assigned to computer-guided behavior therapy improved more the longer they spent telephoning the computer (mostly outside usual office hours) and doing self-exposure. They improved slightly further by week 26 follow-up, unlike the other 2 groups.
Changes in efficiency and productivity: Patients were more satisfied with either behavior therapy group than with relaxation.

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