Self-directed treatment with minimal therapist contact: preliminary findings for obsessive-compulsive disorder

Fritzler, Bryan K.; Hecker, Jeffrey E.; Losee, Melinda C.

doi:10.1016/s0005-7967(97)00024-7

Cited by 53 publications

(30 citation statements)

References 24 publications

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“…A limited number of small open/uncontrolled trials [22][23][24][25][26] of self-help materials, with guidance from a therapist have demonstrated promising results. One RCT 25 randomised 41 patients with OCD to a self-help book with two contacts with a therapist or to 15 sessions of face-to-face therapist-delivered CBT including self-administered or therapist-administered ERP.…”

Section: Guided Self-helpmentioning

confidence: 99%

Clinical effectiveness, cost-effectiveness and acceptability of low-intensity interventions in the management of obsessive–compulsive disorder: the Obsessive–Compulsive Treatment Efficacy randomised controlled Trial (OCTET)

Lovell

Bower

Gellatly

et al. 2017

Health Technol Assess

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BackgroundThe Obsessive–Compulsive Treatment Efficacy randomised controlled Trial emerged from a research recommendation in National Institute for Health and Care Excellence obsessive–compulsive disorder (OCD) guidelines, which specified the need to evaluate cognitive–behavioural therapy (CBT) treatment intensity formats.ObjectivesTo determine the clinical effectiveness and cost-effectiveness of two low-intensity CBT interventions [supported computerised cognitive–behavioural therapy (cCBT) and guided self-help]: (1) compared with waiting list for high-intensity CBT in adults with OCD at 3 months; and (2) plus high-intensity CBT compared with waiting list plus high-intensity CBT in adults with OCD at 12 months. To determine patient and professional acceptability of low-intensity CBT interventions.DesignA three-arm, multicentre, randomised controlled trial.SettingImproving Access to Psychological Therapies services and primary/secondary care mental health services in 15 NHS trusts.ParticipantsPatients aged ≥ 18 years meetingDiagnostic and Statistical Manual of Mental Disorders-Fourth Edition criteria for OCD, on a waiting list for high-intensity CBT and scoring ≥ 16 on the Yale–Brown Obsessive Compulsive Scale (indicative of at least moderate severity OCD) and able to read English.InterventionsParticipants were randomised to (1) supported cCBT, (2) guided self-help or (3) a waiting list for high-intensity CBT.Main outcome measuresThe primary outcome was OCD symptoms using the Yale–Brown Obsessive Compulsive Scale – Observer Rated.ResultsPatients were recruited from 14 NHS trusts between February 2011 and May 2014. Follow-up data collection was complete by May 2015. There were 475 patients randomised: supported cCBT (n = 158); guided self-help (n = 158) and waiting list for high-intensity CBT (n = 159). Two patients were excluded post randomisation (one supported cCBT and one waiting list for high-intensity CBT); therefore, data were analysed for 473 patients. In the short term, prior to accessing high-intensity CBT, guided self-help demonstrated statistically significant benefits over waiting list, but these benefits did not meet the prespecified criterion for clinical significance [adjusted mean difference –1.91, 95% confidence interval (CI) –3.27 to –0.55;p = 0.006]. Supported cCBT did not demonstrate any significant benefit (adjusted mean difference –0.71, 95% CI –2.12 to 0.70). In the longer term, access to guided self-help and supported cCBT, prior to high-intensity CBT, did not lead to differences in outcomes compared with access to high-intensity CBT alone. Access to guided self-help and supported cCBT led to significant reductions in the uptake of high-intensity CBT; this did not seem to compromise patient outcomes at 12 months. Taking a decision-making approach, which focuses on which decision has a higher probability of being cost-effective, rather than the statistical significance of the results, there was little evidence that supported cCBT and guided self-help are cost-effective at the 3-month follow-up compared with a waiting list. However, by the 12-month follow-up, data suggested a greater probability of guided self-help being cost-effective than a waiting list from the health- and social-care perspective (60%) and the societal perspective (80%), and of supported cCBT being cost-effective compared with a waiting list from both perspectives (70%). Qualitative interviews found that guided self-help was more acceptable to patients than supported cCBT. Professionals acknowledged the advantages of low intensity interventions at a population level. No adverse events occurred during the trial that were deemed to be suspected or unexpected serious events.LimitationsA significant issue in the interpretation of the results concerns the high level of access to high-intensity CBT during the waiting list period.ConclusionsAlthough low-intensity interventions are not associated with clinically significant improvements in OCD symptoms, economic analysis over 12 months suggests that low-intensity interventions are cost-effective and may have an important role in OCD care pathways. Further research to enhance the clinical effectiveness of these interventions may be warranted, alongside research on how best to incorporate them into care pathways.Trial registrationCurrent Controlled Trials ISRCTN73535163.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 21, No. 37. See the NIHR Journals Library website for further project information.

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Section: Guided Self-helpmentioning

confidence: 99%

Clinical effectiveness, cost-effectiveness and acceptability of low-intensity interventions in the management of obsessive–compulsive disorder: the Obsessive–Compulsive Treatment Efficacy randomised controlled Trial (OCTET)

Lovell

Bower

Gellatly

et al. 2017

Health Technol Assess

View full text Add to dashboard Cite

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“…Various self-help tools have been used in these studies including a desktop computer program (Clark, Kirkby, Daniels, & Marks, 1998), a laptop and desktop computer (Baer, Minichiello, & Jenike, 1987;Baer, Minichiello, Jenike, & Holland, 1988), a self-help manual (Fritzler, Hecker, & Losee, 1997), a computer-driven phone system with voice activated messages in conjunction with a self-help manual (Bachofen et al, 1999;Marks et al, 1998), and self-exposure homework (Emmelkamp, Van Linden Van den Heuvell, Ruephan, & Sanderman, 1989;Marks et al, 1988). In all of these studies, exposure and response prevention (ERP) techniques were employed.…”

Section: Ocdmentioning

confidence: 99%

“…Four studies tested the impact of MC trials on OCD (Emmelkamp et al, 1989;Fritzler et al, 1997; Lowell, Fullalove, Garvey, & Brooker, 2000;Marks et al, 1998). Therapist contact in these investigations ranged from three and one half (Lovell et al, 2000) to five hr (Fritzler et al, 1997).…”

Section: Therapy For Ocdmentioning

confidence: 99%

“…Moreover, the one study that reported clinically significant improvement for the MC condition (Fritzler et al, 1997) found that only one third of the sample met this criterion. In addition, Emmelkamp and associates (1989) found that between posttest and follow-up, participants had a significant relapse on measures of depression and OCD symptoms, and that 79% of participants sought additional treatment after the follow-up assessment.…”

Section: Self-help and Minimal-contact Therapies For Anxiety 259mentioning

confidence: 99%

“…Therapist contact in these investigations ranged from three and one half (Lovell et al, 2000) to five hr (Fritzler et al, 1997). Results showed that MC led to significant improvement at post-assessment in assessor-rated (Emmelkamp et al, 1989;Marks et al, 1988) and self-rated (Emmelkamp et al, 1989;Fritzler et al, 1997;Lovell et al, 2000; Marks et al, …”

mentioning

confidence: 99%

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Self‐help and minimal‐contact therapies for anxiety disorders: Is human contact necessary for therapeutic efficacy?

et al. 2003

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Self-help materials, brief therapies, and treatments involving minimal therapist contact have all been proposed as effective and low-cost interventions for anxiety disorders. However, research also suggests that the therapeutic alliance is a central predictor of therapy outcome. Interestingly, amounts of therapist contact within and across "self-help" interventions vary greatly. It is therefore unclear how much therapist contact is necessary for a positive anxiety disorder treatment outcome. The present article reviews the literature on anxiety disorder treatments using self-help, self-administered, and decreased therapist-contact interventions. Treatment studies are grouped together by anxiety diagnosis as well as amount of therapist contact. It is concluded that self-administered treatments are most effective for motivated clients seeking treatment for simple phobias. Predominantly self-help therapies are efficacious for panic disorder and mixed anxiety samples. On the other hand, minimal-contact therapies have demonstrated efficacy for the greatest variety of anxiety diagnoses.

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Psychological treatments versus treatment as usual for obsessive compulsive disorder (OCD)

Gava

Barbui

Aguglia

et al. 2007

Cochrane Database of Systematic Reviews

105

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Self-directed treatment with minimal therapist contact: preliminary findings for obsessive-compulsive disorder

Cited by 53 publications

References 24 publications

Clinical effectiveness, cost-effectiveness and acceptability of low-intensity interventions in the management of obsessive–compulsive disorder: the Obsessive–Compulsive Treatment Efficacy randomised controlled Trial (OCTET)

Clinical effectiveness, cost-effectiveness and acceptability of low-intensity interventions in the management of obsessive–compulsive disorder: the Obsessive–Compulsive Treatment Efficacy randomised controlled Trial (OCTET)

Self‐help and minimal‐contact therapies for anxiety disorders: Is human contact necessary for therapeutic efficacy?

Psychological treatments versus treatment as usual for obsessive compulsive disorder (OCD)

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