Behavior Therapy for Obsessive-Compulsive Disorder Guided by a Computer or by a Clinician Compared With Relaxation as a Control
J Clin Psychiatry 2002;63:138-145
© Copyright 2014 Physicians Postgraduate Press, Inc.
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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