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

描述（由申请人提供）：需要循证心理健康治疗，即，从科学、伦理和营销的角度强调“基于最佳科学或研究证据的治疗”。虽然经验证据支持认知行为疗法（CBT）对强迫症（OCD）的疗效和有效性，但对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，包括健康状况较差，医疗保健利用率增加，错过更多的工作日和功能障碍增加。强迫症在所有医学疾病中的残疾排名第11位，与精神分裂症大致相同，全世界60%的强迫症患者没有接受任何治疗。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的心理治疗是非常有效的，具有成本效益，并可以实现类似于临床医生管理的治疗所获得的临床改善。该项目的长期目标是通过使用基于网络的CBT治疗来改善获得有效治疗的机会，从而改善临床和职业功能，并减少与强迫症相关的残疾。使用分步护理方法，干预涉及计算机程序（BT STEPS）和通过电话进行的人机交互。认识到持续存在的问题，获得高质量的CBT的强迫症，我们提出了一个阶梯式护理模式。在这种模式中，用户可以访问BT STEPS程序，并将电子和人工提醒作为初始干预（1级）。对于那些进展不令人满意的人来说，第二个层次是通过电话定期安排教练使用该计划，并获得CBT治疗师。那些没有进展或经历临床恶化的人将被转介给当地的CBT提供者进行传统的CBT治疗。已经发现，包含用于指导和鼓励的人类交互显著增加了计算机化自助的依从性和成功率。治疗结果是否不同时，这种辅导是由治疗师与由受过训练的非治疗师时，还没有研究。这是第一个程序，利用混合模型，涉及不同层次的远程临床医生辅导结合在线自助教程。在第一阶段，我们将测试单独的计算机治疗（n=35），计算机+非治疗师教练（n=35）和计算机+CBT治疗师教练的疗效和可行性。在第二阶段，我们将进行一项全面的研究，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）是一种使人衰弱的疾病，对功能和痛苦有重大影响。虽然CBT等有效的治疗方法是可用的，但训练有素的CBT治疗师数量有限。该项目将开发和评估一种针对强迫症的阶梯式护理、基于网络的混合CBT干预的有效性和可行性，包括现场远程临床医生电话会议，以便更广泛地获得这种专业和基于经验的治疗。更广泛的可及性应该会提高治疗率，减少患者的痛苦和残疾，并减轻生产力损失和治疗成本对社会的经济影响。

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.