Behavior Therapy for Obsessive-Compulsive Disorder Guided by a Computer or by a Clinician Compared With Relaxation as a Control
J Clin Psychiatry 2002;63(2):138-145
© Copyright 2017 Physicians Postgraduate Press, Inc.
Purchase This PDF for $40.00
If you are not a paid subscriber, you may purchase the PDF.
(You'll need the free Adobe Acrobat Reader.)
Receive immediate full-text access to JCP. You can subscribe to JCP online-only ($86) or print + online ($156 individual).
With your subscription, receive a free PDF collection of the NCDEU Festschrift articles. Hurry! This offer ends December 31, 2011.
If you are a paid subscriber to JCP and do not yet have a username and password, activate your subscription now.
As a paid subscriber who has activated your subscription, you have access to the HTML and PDF versions of this item.
Click here to login.
Did you forget your password?
Still can't log in? Contact the Circulation Department at 1-800-489-1001 x4 or send email
Background: The demand for effective behavior
therapy for obsessive-compulsive disorder (OCD) by exposure and
ritual prevention exceeds its supply by trained therapists. A
computer-guided behavior therapy self-help system (BT STEPS) was
created that patients access by telephone from home via
interactive voice response technology. This study compared the
value of computer-guided behavior therapy value with that of
clinician-guided behavior therapy and systematic relaxation as a
Method: After screening by a clinician, 218
patients with DSM-IV OCD at 8 North American sites were randomly
assigned to 10 weeks of behavior therapy treatment guided by (1)
a computer accessed by telephone and a user workbook (N = 74) or
(2) a behavior therapist (N = 69) or (3) systematic relaxation
guided by an audiotape and manual (N = 75).
Results: By week 10, in an intent-to-treat
analysis, 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%]). At
endpoint, patients were more satisfied with either behavior
therapy group than with relaxation. 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.
Conclusion: For OCD, computer-guided behavior
therapy was effective, although clinician-guided behavior therapy
was even more effective. Systematic relaxation was ineffective.
Computer-guided behavior therapy can be a helpful first step in
treating patients with OCD when clinician-guided behavior therapy