Self-help with minimal therapist contact for obsessive-compulsive disorder: a review.
Though there are effective psychological and drug treatments for obsessive-compulsive disorder (OCD), many patients remain inadequately treated or untreated. Making effective self-treatment guidance available may increase the number of patients being helped. In this review, database and manual literature searches were performed of case studies, open and randomised controlled trials (RCTs) of bibliotherapy, self-help groups, telecare and computer-aided self-help for OCD. We found no RCTs of bibliotherapy or self-help groups for OCD. Three open studies showed the efficacy of brief exposure and ritual prevention (ERP) instructions delivered by a live therapist by phone. A vicarious ERP computer program was effective in a small open study. Fully interactive computer-aided self-help by ERP for OCD was efficacious in two open studies and a large multicentre RCT, and in a small RCT compliance and outcome with that program was enhanced by brief scheduled support from a clinician. Although more research is needed, self-help approaches have the potential to help many more patients who would otherwise remain inadequately treated or untreated. Their dissemination could save resources used by health care providers. We propose a stepped care model for the treatment of OCD.
Mataix-Cols
David
D
Institute of Psychiatry, King's College London, PO BOX 69, De Crespigny Park, London SE5 8AF, UK. d.mataix@iop.kcl.ac.uk
Marks
Isaac M
IM
D001638:Bibliotherapy / Q000379:methods; D006801:Humans; D020407:Internet / Q000295:instrumentation* / Q000706:statistics & numerical data*; D008605:Mental Health Services / Q000706:statistics & numerical data*; D009771:Obsessive-Compulsive Disorder / Q000628:therapy*; D011369:Professional-Patient Relations; D012657:Self-Help Groups; D017216:Telemedicine / Q000295:instrumentation*; D013689:Telephone; D013813:Therapy, Computer-Assisted / Q000379:methods* / Q000706:statistics & numerical data