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

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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.