title: Stepped care for obsessive-compulsive disorder: An open trial.
abstract: This study evaluated the effectiveness and treatment costs associated with a stepped care protocol of exposure and response prevention (EX/RP) for obsessive-compulsive disorder (OCD). In the current open trial, patients (N=14) began with self-directed EX/RP and minimal therapist guidance over the course of six weeks (Step 1). During this phase of treatment, no therapist-directed exposures were conducted. Those who did not respond optimally to Step 1 went on to Step 2, which consisted of 15 sessions of twice-weekly therapist-directed exposures. Results of this study show promise for stepped care utilizing EX/RP for some patients with OCD, with a response rate of 88% and a 60% reduction on the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) score among treatment completers. Significant improvements were found in Y-BOCS from pre to post-treatment for both Step 1 and Step 2 completers. Forty-five percent of participants (n=5) responded following completion of Step 1, resulting in reduced cost of treatment among these participants. All participants who responded to Step 1 maintained acute gains during the brief follow-up period. Limitations include a small sample size and high attrition rate.
authors: Anxiety Disorders Center, The Institute of Living, Hartford Hospital, CT 06106, USA. cgilliam@harthosp.org
authors: Christina M
authors: CM
authors: Gilliam
authors: Gretchen J
authors: GJ
authors: Diefenbach
authors: Sara E
authors: SE
authors: Whiting
authors: David F
authors: DF
authors: Tolin
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000191:economics*; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D007171:Implosive Therapy / Q000191:economics*; D008297:Male; D008875:Middle Aged; D009771:Obsessive-Compulsive Disorder / Q000191:economics / Q000628:therapy*; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index; D016896:Treatment Outcome