Computer Assisted CBT for OCD: A Comprehensive Stepped-Care Approach

描述(由申请人提供)：从科学、伦理和营销角度强调了循证心理健康治疗的必要性，即“基于最好的可用科学或研究证据进行治疗”。虽然经验证据支持认知行为疗法(CBT)治疗强迫症(OCD)的有效性和有效性，但对接受过这些方法培训的临床医生的需求远远超过供应。因此，只有一小部分患有这种疾病的患者接受了CBT治疗。未经治疗的强迫症会导致严重的痛苦和残疾，包括健康状况变差、卫生保健利用率增加、更多的工作日缺勤和功能障碍增加。就残疾而言，强迫症在所有内科疾病中排名第11，与精神分裂症大致相同，全球60%的强迫症患者没有接受治疗。新技术提供了便利获得这种专门治疗的机会。越来越多的研究发现，基于网络的自我管理心理治疗非常有效，成本效益高，可以实现与临床医生管理治疗类似的临床改善。该项目的长期目标是通过使用基于网络的CBT治疗，改善获得有效治疗的机会，从而改善临床和职业功能，减少与强迫症相关的残疾。采用分步护理的方法，干预既包括计算机程序(BT STEP)，也包括通过电话进行的人类互动。认识到强迫症患者无法获得高质量CBT的持续问题，我们提出了阶梯式护理模式。在该模式中，用户可以使用电子和人工提醒作为初始干预(级别1)访问BT STEPS计划。对于那些进展不令人满意的人来说，第二个水平将是定期安排教练通过电话使用该计划，教练可以联系CBT治疗师。那些没有进展或经历临床恶化的人将被转介到当地CBT提供商进行传统的CBT治疗。研究发现，在计算机化的自助中，包括用于指导和鼓励的人与人之间的互动可以显著提高遵从性和成功率。由治疗师进行这种指导与由训练有素的非治疗师进行指导时，治疗结果是否会有所不同，目前还没有研究。这是第一个利用不同级别的远程临床医生指导与在线自助教程相结合的混合模式的计划。在第一阶段，我们将测试单独电脑治疗(n=35)、电脑+非治疗师教练(n=35)和电脑+CBT治疗教练(n=35)的疗效和可行性。在第二阶段，我们将进行一项全能研究，将我们的模型与传统的面对面治疗进行比较。 公共卫生相关性：强迫症(OCD)是一种令人衰弱的疾病，对功能和痛苦有重大影响。虽然有CBT等有效的治疗方法可用，但训练有素的CBT治疗师数量有限。该项目将开发和评估阶梯式护理、基于网络的混合式CBT干预强迫症的有效性和可行性，包括现场远程临床医生电话会议，以便提供更广泛的渠道，获得这种专门的和基于经验的治疗。就生产力损失和治疗费用造成的经济影响而言，更广泛的可获得性应会提高治疗率，减少病人的痛苦和残疾，并减轻社会负担。

DESCRIPTION (provided by applicant): The need for evidence-based mental health treatments i.e., 'treatment based on the best available science or research evidence", has been stressed from scientific, ethical, and marketing perspectives. While empirical evidence supports both the efficacy and effectiveness of cognitive behavior therapy (CBT) for Obsessive-Compulsive Disorder (OCD), demand for clinicians trained in these approaches far exceeds supply. As a result, only a small percentage of patients suffering from this disorder receive CBT treatment. Untreated OCD results in significant distress and disability, including poorer health, increased health care utilization, more missed work days and increased functional impairment. OCD is ranked 11th among all medical illnesses in terms of disability, about the same as schizophrenia, and sixty percent of patients world-wide receive no treatment for their OCD. New technologies provide the opportunity to facilitate access to this specialized treatment. A growing body of research has found that web-based self-administered psychotherapy is highly effective, cost-efficient, and can achieve clinical improvements similar to those obtained with clinician- administered therapy. The long-term goal of this project is to improve clinical and occupational functioning and decrease disability associated with OCD by improving access to effective treatments through the use of web-based CBT treatment. Using a stepped-care approach, the intervention involves both a computer program (BT STEPS) and human interaction via telephone. Recognizing the continuing problem of insufficient access to high quality CBT for OCD, we propose a Stepped Care model. In this model, users receive access to the BT STEPS program with electronic and human reminders as the initial intervention (Level 1). The second level for those who were not progressing satisfactorily would be regularly scheduled coaching in use of the program via phone by a coach with access to a CBT Therapist. Those who fail to progress or who experience clinical deterioration will be referred to a local CBT provider for traditional CBT therapy. The inclusion of human interaction for coaching and encouragement has been found to significantly increase compliance and success rates in computerized self-help. Whether treatment outcomes differ when this coaching is done by a therapist vs. when done by a trained non-therapist has not been studied. This is the first program to utilize a hybrid model involving different levels of remote clinician coaching in combination with an on-line self-help tutorial. In Phase I we will test the efficacy and feasibility of computer therapy alone (n=35), computer plus non- therapist coach (n=35) and computer plus CBT therapist coach. In phase II we will do a fully powered study comparing our model to traditional face-to-face therapy. PUBLIC HEALTH RELEVANCE: Obsessive Compulsive Disorder (OCD) is a debilitating disorder, with significant impacts on functioning and distress. While effective treatments such as CBT are available, there are a limited number of trained CBT therapists. This project will develop and evaluate the efficacy and feasibility of a stepped-care, hybrid web-based CBT intervention for OCD, including live remote clinician phone sessions, in order to provide wider access to this specialized and empirically based treatment. Wider accessibility should result in increased treatment rates and a reduction in both patient suffering and disability and reduced burden to society in terms of the economic impact of lost productivity and treatment costs.