title: Behavior therapy for obsessive-compulsive disorder guided by a computer or by a clinician compared with relaxation as a control.
abstract: 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 control treatment.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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 is unavailable.
authors.affiliation: Healthcare Technology Systems, and the University of Wisconsin, Madison, 53717, USA. greij@healthtechsys.com
authors.forename: John H
authors.initials: JH
authors.lastname: Greist
authors.forename: Isaac M
authors.initials: IM
authors.lastname: Marks
authors.forename: Lee
authors.initials: L
authors.lastname: Baer
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Kobak
authors.forename: Keith W
authors.initials: KW
authors.lastname: Wenzel
authors.forename: M Joyce
authors.initials: MJ
authors.lastname: Hirsch
authors.forename: Julia M
authors.initials: JM
authors.lastname: Mantle
authors.forename: Cathryn M
authors.initials: CM
authors.lastname: Clary
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001294:Attitude to Health; D001521:Behavior Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009771:Obsessive-Compulsive Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D011569:Psychiatric Status Rating Scales; D012064:Relaxation Therapy; D019114:Remote Consultation / Q000379:methods; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D012917:Social Adjustment; D013689:Telephone; D013813:Therapy, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome; D014937:Work
chemical_list: D017367:Selective Serotonin Reuptake Inhibitors