1
|
Zhang W, Yang W, Ruan H, Gao J, Wang Z. Comparison of internet-based and face-to-face cognitive behavioral therapy for obsessive-compulsive disorder: A systematic review and network meta-analysis. J Psychiatr Res 2023; 168:140-148. [PMID: 37907037 DOI: 10.1016/j.jpsychires.2023.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 08/20/2023] [Accepted: 10/14/2023] [Indexed: 11/02/2023]
Abstract
Cognitive behavioral therapy (CBT) is widely recognized as an effective treatment for obsessive-compulsive disorder (OCD). However, few patients are able to receive CBT. Internet-based CBT (ICBT) may be able to overcome this problem. In this study, we aimed to compare the efficacy of CBT, therapist-guided ICBT (TG-ICBT), unguided ICBT (UG-ICBT), and none therapist-guided ICBT (NTG-ICBT) by a network meta-analysis. The primary outcome was the mean change in OCD severity measured by the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) or the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS). The secondary outcomes included the severity of depressive symptoms, side effects, and cost-effectiveness. A total of 25 trials with 1642 participants were included. We found that the efficacy of CBT was superior to that of TG-ICBT. The mean improvement in Y-BOCS/CY-BOCS scores was higher in CBT group than in UG-ICBT group, but this difference was not statistically significant. The efficacy did not differ significantly between TG-ICBT and UG-ICBT. CBT, TG-ICBT, and UG-ICBT were all more effective than the psychological placebo, waiting list, and pill placebo. In terms of efficacy, CBT combined with drug therapy was better than CBT, TG-ICBT, and UG-ICBT. Sensitivity analyses supported these findings. Based on the current evidence, we recommend TG-ICBT when CBT is not available. However, it is undeniable that UG-ICBT also has the potential to be an effective alternative to CBT. More evidence is needed to support this possibility.
Collapse
Affiliation(s)
- Wenxuan Zhang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Weili Yang
- The Second Affiliated Hospital of Xinxiang Medical University, PR China
| | - Hanyang Ruan
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Jian Gao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Zhen Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China; Institute of Psychological and Behavioral Science, Shanghai Jiao Tong University, Shanghai, PR China; Shanghai Intelligent Psychological Evaluation and Intervention Engineering Technology Research Center, Shanghai, PR China.
| |
Collapse
|
2
|
Cooper D, Champion SM, Stavropoulos L, Grisham JR. How technology can enhance treatment: A scoping review of clinical interventions for anxiety and obsessive-compulsive spectrum disorders. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2021; 61 Suppl 1:8-30. [PMID: 33570762 DOI: 10.1111/bjc.12279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 10/25/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Researchers are increasingly investigating how technology could be used to improve the efficacy of treatment for anxiety and obsessive-compulsive (OC) spectrum disorders. A broad range of technologies, disorders and therapeutic processes have been examined in the literature. This review summarizes the evidence for using technology in clinical interventions for anxiety and OC-spectrum disorders and highlights research gaps that should be addressed to improve the evidence base. METHODS A scoping review was conducted based on systematic searches of three databases. Broadly, the criteria included interventions that had integrated technology into clinical contexts to enhance treatment for anxiety and OC-spectrum disorders. All records were double-screened by two reviewers, and data were extracted on the characteristics of interventions, symptom outcomes, and implementation factors. RESULTS Searches returned 2,475 studies, of which 117 were eligible for inclusion in this review. Although almost all studies reported pre-post-symptom reductions, only one quarter of the controlled studies demonstrated additive effect of technology-based interventions in between-group analyses. We noted a trend in underreporting implementation factors. CONCLUSIONS Technology-based interventions can improve the efficacy of treatment for anxiety and OC-spectrum disorders, but there are challenges to achieving this goal. Based on a review of the included studies, we provide four specific recommendations to improve the quality and likelihood of success of future research projects. PRACTITIONER POINTS Technology-based adjuvants are unlikely to improve the efficacy of treatment for anxiety or OC-spectrum disorders based on their novelty or convenience alone. A subset of studies gives hope that specific innovations can improve treatment when targeting a therapeutic process that has been problematic. Clinicians seeking to improve the efficacy of their treatment should first define client-specific therapeutic factors (e.g., homework compliance) that could be leveraged, then apply a specific innovation to address this factor.
Collapse
Affiliation(s)
- David Cooper
- School of Psychology, The University of New South Wales, Sydney, New South Wales, Australia
| | - Sophie M Champion
- School of Psychology, The University of New South Wales, Sydney, New South Wales, Australia
| | - Lauren Stavropoulos
- School of Psychology, The University of New South Wales, Sydney, New South Wales, Australia
| | - Jessica R Grisham
- School of Psychology, The University of New South Wales, Sydney, New South Wales, Australia
| |
Collapse
|
3
|
Furber G, Jones GM, Healey D, Bidargaddi N. A comparison between phone-based psychotherapy with and without text messaging support in between sessions for crisis patients. J Med Internet Res 2014; 16:e219. [PMID: 25295667 PMCID: PMC4210953 DOI: 10.2196/jmir.3096] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Revised: 04/06/2014] [Accepted: 07/07/2014] [Indexed: 11/30/2022] Open
Abstract
Background Few studies have tested whether individually tailored text messaging interventions have an effect on clinical outcomes when used to supplement traditional psychotherapy. This is despite the potential to improve outcomes through symptom monitoring, prompts for between-session activities, and psychoeducation. Objective The intent of the study was to explore the use of individually tailored between-session text messaging, or short message service (SMS), as an adjunct to telephone-based psychotherapy for consumers who present to the Emergency Department (ED) in situational and/or emotional crises. Methods Over a 4-month period, two therapists offered 68 prospective consumers of a telephone-based psychotherapy service individually tailored between-session text messaging alongside their telephone-based psychotherapy. Attendance and clinical outcomes (depression, anxiety, functional impairment) of those receiving messages were compared against a historical control group (n=157) who received telephone psychotherapy only. Results A total of 66% (45/68) of the consumers offered SMS accepted the intervention. A total of 432 messages were sent over the course of the trial, the majority involving some kind of psychoeducation or reminders to engage in therapy goals. There were no significant differences in clinical outcomes between consumers who received the SMS and those in the control group. There was a trend for participants in the intervention group to attend fewer sessions than those in the control group (mean 3.7, SD 1.9 vs mean 4.4, SD 2.3). Conclusions Both groups showed significant improvement over time. Individually tailored SMS were not found to improve clinical outcomes in consumers receiving telephone-based psychotherapy, but the study was underpowered, given the effect sizes noted and the significance level chosen. Given the ease of implementation and positive feedback from therapists and clients, individually tailored text messages should be explored further in future trials with a focus on enhancing the clinical impact of the tailored text messages, and utilizing designs with additional power to test for between-group effects.
Collapse
Affiliation(s)
- Gareth Furber
- Health Economics and Social Policy Group, School of Population Health, University of South Australia, Adelaide, Australia.
| | | | | | | |
Collapse
|
4
|
Response Prevention of Compulsive Behaviour: A Case Study Conducted in a Community-based Rehabilitation Program. BEHAVIOUR CHANGE 2014. [DOI: 10.1017/s081348390000677x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The client, Susan, was a 25-year-old woman who had been engaging in checking rituals and repeating actions for at least five years. Staff, psychology students, high school volunteers and members of the client's family acted as observers and behaviour change agents. Data were collected daily, for up to 16 hours, over a 14-month period. The two major dependent variables comprised the number of rituals and the total time required to complete specific tasks. The major independent variable (response prevention) was also monitored. The results suggest that response prevention reduced the number of rituals and the time required to complete tasks and these changes were maintained at three months follow-up. In addition, a number of daily activities increased. The advantages and disadvantages of carrying out an intensive intervention within a community-based rehabilitation setting are discussed.
Collapse
|
5
|
Technological advances in psychotherapy: implications for the assessment and treatment of obsessive compulsive disorder. J Anxiety Disord 2013; 27:47-55. [PMID: 23247201 DOI: 10.1016/j.janxdis.2012.09.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Revised: 08/27/2012] [Accepted: 09/17/2012] [Indexed: 11/22/2022]
Abstract
Obsessive compulsive disorder (OCD) is a prevalent and costly condition that causes significant functional impairment and reduced quality of life. Although treatments with demonstrated efficacy for OCD, such as cognitive behavior therapy and antidepressants, have existed for over three decades, many patients remain inadequately treated or untreated. Challenges encountered in the treatment of OCD include problems with homework compliance, frequent relapse, difficulties in simulating the spontaneous nature of intrusive thoughts, and infrequent treatment sessions. Accumulated research now indicates that computerized assessment and therapy tools can significantly improve the cost/time-effectiveness of conventional psychotherapeutic interventions for anxiety disorders such as OCD without impairing therapeutic progress and outcome. In this paper we examine the potential of such technology, address current challenges in the assessment and treatment of OCD, and provide a rationale for future research in the field. We outline the general utility of computer technology in psychotherapeutic interventions, critically evaluate the existing literature on computer-assisted assessment and treatment specific to OCD, as well as discuss potential implications of portable technology for OCD treatment delivery and outcomes.
Collapse
|
6
|
Herbst N, Voderholzer U, Stelzer N, Knaevelsrud C, Hertenstein E, Schlegl S, Nissen C, Külz AK. The potential of telemental health applications for obsessive–compulsive disorder. Clin Psychol Rev 2012; 32:454-66. [DOI: 10.1016/j.cpr.2012.04.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Revised: 04/11/2012] [Accepted: 04/11/2012] [Indexed: 10/28/2022]
|
7
|
Fraser J, Kirkby KC, Daniels B, Gilroy L, Montgomery IM. Three Versus Six Sessions of Computer-aided Vicarious Exposure Treatment for Spider Phobia. BEHAVIOUR CHANGE 2012. [DOI: 10.1375/bech.18.4.213] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractThirty participants diagnosed with specific phobia (spiders) were randomly allocated to receive a treatment dose of either three or six 45-minute sessions of a computer-aided vicarious exposure (CAVE) for spider phobia. Phobic symptom severity was measured at pretreatment, posttreatment and at one-month follow-up on a range of subjective and behavioural measures. Results showed that participants in both groups improved significantly across the majority of outcome measures from pre- to posttreatment and pretreatment to follow-up assessment. There were no significant differences between the three- and six-session groups. Process measures indicated that the six-session treatment group performed approximately twice as much vicarious exposure, however, competence on the program was reached by the end of three sessions. These results suggest that rehearsal of CAVE, beyond the level at which skill learning is consolidated, is not of therapeutic value. Further research is required to ascertain whether other forms of dosage effect may operate in computer-delivered behaviour therapy. For example, delivery of a wider range, rather than amount, of CAVE scenarios, or the delivery of a hierarchy of exposure stimuli on the screen, without a vicarious component, may show a dose-response relationship.
Collapse
|
8
|
Heading K, Kirkby KC, Martin F, Daniels BA, Gilroy LJ, Menzies RG. Controlled Comparison of Single-session Treatments for Spider Phobia: Live Graded Exposure Alone versus Computer-aided Vicarious Exposure. BEHAVIOUR CHANGE 2012. [DOI: 10.1375/bech.18.2.103] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractThe efficacy of prolonged single sessions of live graded exposure (LGE) and computer-aided vicarious exposure (CAVE) for spider phobia was examined in a single-blind, controlled trial. Forty participants diagnosed with specific phobia (spiders) received a prolonged single-session treatment of either therapist-aided LGE comprising exposure only or CAVE, or were assigned to a waiting list. Phobic symptomatology was measured at pre- and post-treatment, and at 1-month follow-up on a range of behavioural and subjective assessments. The results showed that the single-session therapist-aided LGE was superior to both CAVE and the waiting-list control. In contrast with previous findings of comparability between LGE and CAVE, and superiority of CAVE over placebo, the present study found no significant differences between the CAVE and waiting-list groups, with the exception of subjective units of distress, providing little support for single-session CAVE treatment.
Collapse
|
9
|
Kim K, Kim CH, Kim SY, Roh D, Kim SI. Virtual reality for obsessive-compulsive disorder: past and the future. Psychiatry Investig 2009; 6:115-21. [PMID: 20046385 PMCID: PMC2796058 DOI: 10.4306/pi.2009.6.3.115] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2009] [Accepted: 06/12/2009] [Indexed: 11/19/2022] Open
Abstract
The use of computers, especially for virtual reality (VR), to understand, assess, and treat various mental health problems has been developed for the last decade, including application for phobia, post-traumatic stress disorder, attention deficits, and schizophrenia. However, the number of VR tools addressing obsessive-compulsive disorder (OCD) is still lacking due to the heterogeneous symptoms of OCD and poor understanding of the relationship between VR and OCD. This article reviews the empirical literatures for VR tools in the future, which involve applications for both clinical work and experimental research in this area, including examining symptoms using VR according to OCD patients' individual symptoms, extending OCD research in the VR setting to also study behavioral and physiological correlations of the symptoms, and expanding the use of VR for OCD to cognitive-behavioral intervention.
Collapse
Affiliation(s)
- Kwanguk Kim
- Department of Biomedical Engineering, Hanyang University, Seoul, Korea
| | - Chan-Hyung Kim
- Department of Psychiatry and Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - So-Yeon Kim
- Department of Psychology, University of North Carolina at Chapel Hill, Charlotte, NC, USA
| | - Daeyoung Roh
- Department of Psychiatry and Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sun I. Kim
- Department of Biomedical Engineering, Hanyang University, Seoul, Korea
| |
Collapse
|
10
|
Heron KE, Smyth JM. Ecological momentary interventions: incorporating mobile technology into psychosocial and health behaviour treatments. Br J Health Psychol 2009; 15:1-39. [PMID: 19646331 DOI: 10.1348/135910709x466063] [Citation(s) in RCA: 796] [Impact Index Per Article: 53.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
PURPOSE Psychosocial and health behaviour treatments and therapies can be extended beyond traditional research or clinical settings by using mobile technology to deliver interventions to individuals as they go about their daily lives. These ecological momentary interventions (EMIs) are treatments that are provided to people during their everyday lives (i.e. in real time) and in natural settings (i.e. real world). The goal of the present review is to synthesize and critique mobile technology-based EMI aimed at improving health behaviours and psychological and physical symptoms. METHODS Twenty-seven interventions using palmtop computers or mobile phones to deliver ambulatory treatment for smoking cessation, weight loss, anxiety, diabetes management, eating disorders, alcohol use, and healthy eating and physical activity were identified. RESULTS There is evidence that EMI can be successfully delivered, are accepted by patients, and are efficacious for treating a variety of health behaviours and physical and psychological symptoms. Limitations of the existing literature were identified and recommendations and considerations for research design, sample characteristics, measurement, statistical analyses, and clinical implementation are discussed. CONCLUSIONS Mobile technology-based EMI can be effectively implemented as interventions for a variety of health behaviours and psychological and physical symptoms. Future research should integrate the assessment and intervention capabilities of mobile technology to create dynamically and individually tailored EMI that are ecologically sensitive.
Collapse
|
11
|
Lack CW, Storch EA. The use of computers in the assessment and treatment of obsessive–compulsive disorder. COMPUTERS IN HUMAN BEHAVIOR 2008. [DOI: 10.1016/j.chb.2007.02.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
|
12
|
|
13
|
Caspar F. Technological developments and applications in clinical psychology and psychotherapy: introduction. J Clin Psychol 2004; 60:221-38. [PMID: 14981788 DOI: 10.1002/jclp.10260] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
This article introduces a special issue on technological developments and applications in clinical psychology and psychotherapy. The question of why it is important to deal with such developments is raised. An overview of the individual topics and articles in the issue is given, and additional aspects are discussed. This is followed by an overview of possible advantages and disadvantages of technological developments as well as problems to be solved. Overall, the developments are still largely underresearched, but-if utilized-hold considerable promise in changing the field of clinical psychology and psychotherapy as well as training in the field.
Collapse
|
14
|
Anderson P, Jacobs C, Rothbaum BO. Computer-supported cognitive behavioral treatment of anxiety disorders. J Clin Psychol 2004; 60:253-67. [PMID: 14981790 DOI: 10.1002/jclp.10262] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This article reviews the empirical literature pertaining to the use of computer-supported cognitive-behavioral treatment of anxiety disorders, including palmtop computers, virtual reality exposure therapy, and personal computer software programs. The advantages and disadvantages unique to each type of technology are described. The review concludes with a discussion of ethical issues, barriers to the use of technology by clinicians, and suggestions for a process by which scientists and practitioners can conceptualize how technology can advance our understanding of anxiety and our dissemination of effective treatments.
Collapse
Affiliation(s)
- Page Anderson
- Department of Psychology, Georgia State University, Atlanta 30303-3082, USA.
| | | | | |
Collapse
|
15
|
Newman MG, Erickson T, Przeworski A, Dzus E. Self-help and minimal-contact therapies for anxiety disorders: Is human contact necessary for therapeutic efficacy? J Clin Psychol 2003; 59:251-74. [PMID: 12579544 DOI: 10.1002/jclp.10128] [Citation(s) in RCA: 153] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
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.
Collapse
Affiliation(s)
- Michelle G Newman
- Department of Psychology, Pennsylvania State University, University Park, 16802-3103, USA.
| | | | | | | |
Collapse
|
16
|
Computer technology for office-based psychological practice: Applications and factors affecting adoption. Psychotherapy (Chic) 2003. [DOI: 10.1037/0033-3204.40.1-2.10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
17
|
Affiliation(s)
- Eric P.P. Ochs
- McGill University and Montreal Children's Hospital, Montréal, Québec, Canada
| | - Yitzchak M. Binik
- McGill University and The Royal Victoria Hospital, Montréal, Québec, Canada
| |
Collapse
|
18
|
Newman MG, Consoli AJ, Taylor CB. A palmtop computer program for the treatment of generalized anxiety disorder. Behav Modif 1999; 23:597-619. [PMID: 10533442 DOI: 10.1177/0145445599234005] [Citation(s) in RCA: 72] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This is the first report of a palmtop computer program developed to increase the efficiency and cost-effectiveness of cognitive behavioral therapy for generalized anxiety disorder (GAD). The computer program offers advantages to researchers, therapists, and clients. These advantages include continuous, unobtrusive collection of process data on treatment adherence as well as on the impact of cognitive behavioral therapy techniques in the client's natural setting. In addition, the computer extends treatment beyond the therapy hour and motivates clients to comply with homework assignments by prompting practice of cognitive behavioral strategies. The successful application of the palmtop computer program reported in this integrated series suggests a new line of research directed toward increasing the cost-effectiveness of what is currently the gold-standard treatment for GAD.
Collapse
Affiliation(s)
- M G Newman
- Department of Psychology, Penn. State University, University Park 16802-3103, USA.
| | | | | |
Collapse
|
19
|
Marks I. Computer aids to mental health care. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 1999; 44:548-55. [PMID: 10497696 DOI: 10.1177/070674379904400602] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Computer systems are being used increasingly to aid the assessment and self-treatment of mental health problems in adults. Systems vary hugely in the extent to which they meet all patients' assessment and therapy needs and save clinicians' time. Hardly any single system 1) performs every task required from initial screening to the end of follow-up, 2) works 100% independently of contact with a clinician or technician, and 3) is widely available and supported. Most systems use desk- or laptop computers. Some now use palmtop (hand-held) computers. A few employ computerized phone interviews (interactive voice response), usually from home. Virtual reality as a tool is embryonic. Computer aids save time in screening and outcome-tracking in a wide variety of problems. Computer aids to treatment have had promising outcomes in phobic, anxiety, panic, and obsessive-compulsive disorders, nonsuicidal depression, obesity, and smoking cessation. Some systems are installed in a few places as part of everyday clinical care. A growing number should soon be robust enough to ease the lives of many patients, practitioners, and researchers if use of the systems is carefully integrated into normal clinical practice.
Collapse
Affiliation(s)
- I Marks
- Institute of Psychiatry, University of London, Bethlem Royal & Maudsley Hospital, United Kingdom.
| |
Collapse
|
20
|
Heimberg RG, Coles ME. Reflections on innovations in cognitive behavioral treatments of anxiety disorders. COGNITIVE AND BEHAVIORAL PRACTICE 1999. [DOI: 10.1016/s1077-7229(99)80084-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
21
|
Newman MG. The clinical use of palmtop computers in the treatment of generalized anxiety disorder. COGNITIVE AND BEHAVIORAL PRACTICE 1999. [DOI: 10.1016/s1077-7229(99)80080-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
22
|
Clark A, Kirkby KC, Daniels BA, Marks IM. A pilot study of computer-aided vicarious exposure for obsessive-compulsive disorder. Aust N Z J Psychiatry 1998; 32:268-75. [PMID: 9588306 DOI: 10.3109/00048679809062738] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This study reports the use of an interactive computer program to instruct vicarious exposure and ritual prevention for obsessive-compulsive disorder (OCD). METHOD Thirteen OCD volunteers and 10 non-OCD volunteers completed three 45-minute sessions at weekly intervals. Subjects with OCD completed the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), the Padua Inventory (PI) and the Beck Depression Inventory (BDI) 1 week prior to and 1 week after the three computer treatment sessions. Non-OCD subjects only completed these measures at baseline, allowing confirmation that they had no significant level of OCD symptomatology. RESULTS In the OCD subjects, scores fell significantly on the PI and BDI, and Y-BOCS scores fell non-significantly. Engagement in vicarious exposure with ritual prevention improved from sessions 1-3. Compared to the non-OCD participants, OCD subjects did less vicarious exposure in session 1 but not sessions 2 and 3. Performance of vicarious exposure by OCD subjects in session 1 correlated with pre-post improvement in PI and BDI scores. CONCLUSIONS The vicarious exposure program may have a role to play as an adjunct in behaviour therapy.
Collapse
Affiliation(s)
- A Clark
- Psychiatry, Division of Clinical Sciences, University of Tasmania, Hobart, Australia
| | | | | | | |
Collapse
|
23
|
|
24
|
Marks I. Behaviour therapy for obsessive-compulsive disorder: a decade of progress. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 1997; 42:1021-7. [PMID: 9469234 DOI: 10.1177/070674379704201002] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To review the last decade of behaviour therapy research in obsessive-compulsive disorder (OCD). METHOD The most salient research was analyzed. RESULTS Many studies confirmed that exposure and ritual prevention (ERP) effectively reduced compulsive rituals and obsessive thoughts in most patients in all age groups, although a minority of the patients did not complete treatment. Gains persisted to follow-up 2 to 6 years later in several countries. Improvement after ERP generalized to obsessive-compulsive beliefs, mood, work, and social adjustment, and was accompanied by reduction in cerebral blood flow in the right caudate nucleus. Teaching patients how to prevent relapse seems to reduce the risk of recurrence. ERP yields slightly more improvement than does appropriate antidepressant medication and is followed by far less relapse after treatment has stopped, so ERP may be more cost-effective in the long term. Antidepressant medication is a useful adjunct to ERP when OCD is accompanied by comorbid depression. The therapist now tends to teach patients how to carry out self-exposure and self-imposed ritual prevention, rather than to impose ERP on them. Self-help manuals help patients to do this, and computer aids to allow patients to learn how to do ERP at home have been valuable in pilot studies. Cognitive therapy without ERP was as useful as ERP. CONCLUSION ERP is of lasting value for OCD. Long-term cost-effectiveness comparisons are needed of self-administered ERP versus cognitive therapy and versus medication. Studies are also needed of brief psychological treatment for depression comorbid with OCD.
Collapse
Affiliation(s)
- I Marks
- Institute of Psychiatry, London, England.
| |
Collapse
|
25
|
Newman MG, Kenardy J, Herman S, Taylor C. The use of hand-held computers as an adjunct to cognitive-behavior therapy. COMPUTERS IN HUMAN BEHAVIOR 1996. [DOI: 10.1016/0747-5632(95)00024-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
26
|
Interaction with a sex-expert system changes attitudes and may modify sexual behavior. COMPUTERS IN HUMAN BEHAVIOR 1994. [DOI: 10.1016/0747-5632(94)90064-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
27
|
|