title: A randomized controlled trial of self-directed versus therapist-directed cognitive-behavioral therapy for obsessive-compulsive disorder patients with prior medication trials.
abstract: Cognitive-behavioral therapy incorporating exposure and response prevention (ERP) is widely considered a first-line psychosocial treatment for patients with obsessive-compulsive disorder (OCD). However, a number of obstacles prevent many patients from receiving this treatment, and self-administered ERP may be a useful alternative or adjunct. Forty-one adult outpatients with a primary diagnosis of OCD, who reported at least 1 current or previous adequate medication trial, were randomly assigned to self-administered or therapist-administered ERP. Patients in both treatment conditions showed statistically and clinically significant symptom reduction. However, patients receiving therapist-administered ERP showed a superior response in terms of OCD symptoms and self-reported functional impairment. We discuss several potential reasons for the superiority of therapist-administered treatment, and propose a stepped-care integration of self-administered and therapist-administered interventions for OCD.
authors.affiliation: Institute of Living/Hartford Hospital, Hartford, CT 06106, USA. dtolin@harthosp.org
authors.forename: David F
authors.initials: DF
authors.lastname: Tolin
authors.forename: Scott
authors.initials: S
authors.lastname: Hannan
authors.forename: Nicholas
authors.initials: N
authors.lastname: Maltby
authors.forename: Gretchen J
authors.initials: GJ
authors.lastname: Diefenbach
authors.forename: Patrick
authors.initials: P
authors.lastname: Worhunsky
authors.forename: Robert E
authors.initials: RE
authors.lastname: Brady
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003887:Desensitization, Psychologic / Q000379:methods*; D005260:Female; D006801:Humans; D007389:Internal-External Control; D008297:Male; D008875:Middle Aged; D009771:Obsessive-Compulsive Disorder / Q000523:psychology / Q000628:therapy*; D012646:Self Administration / Q000523:psychology; D012648:Self Care / Q000523:psychology*; D012647:Self-Assessment; D016896:Treatment Outcome