Use of a portable-computer program in behavioral treatment of obsessive-compulsive disorder

Challenges and opportunities in the provision of mental health care services during the COVID-19 pandemic and beyond

The provision of services to people with mental health problems and their families has been substantially affected by the COVID-19 pandemic. Often face-to-face clinical work had to be replaced with telehealth, in line with COVID-19 regulations of social distancing. Currently, different types of online services have been implemented to meet the mental health needs of the population. This change from face-to-face to online service provision has been disruptive to many South Africans and at times resulted in people not being able to access these services.

Aim: This chapter aims to describe specifically the use of online psychological service delivery pre-COVID-19 and during the lockdown.

Method: We conducted a literature review exploring the delivery of psychological services through online channels pre-COVID-19 and during the lockdown. We highlight lessons learned and opportunities for psychological service provision beyond the pandemic.

Conclusion: We conclude that online service platforms can increase access to psychological services and identify strategies that can be adopted to strengthen service provision.

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.

Acceptability, feasibility, and efficacy of Internet cognitive behavioral therapy (iCBT) for pediatric obsessive-compulsive disorder: a systematic review

BACKGROUND

Obsessive-compulsive disorder (OCD) is a chronic mental health disorder characterized by recurring obsessions and compulsions affecting 1-3% of children and adolescents. Current treatment options are limited by accessibility, availability, and quality of care. New technologies provide opportunities to address at least some of these challenges. This paper aims to investigate the acceptability, feasibility, and efficacy of traditional cognitive behavioral therapy with Internet cognitive behavioral therapy (iCBT) for pediatric OCD according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

METHOD

We searched EMBASE, Medline, PsycINFO, CENTRAL, LILACS, CINAHL, and Scopus. Results include articles from 1987 to March 2018. Main inclusion criteria were patients aged 4-18, primary diagnosis of OCD, and iCBT.

RESULTS

Of the 2323 unique articles identified during the initial search, six studies with a total of 96 participants met our inclusion criteria: three randomized controlled trials, one single-case multiple-baseline design, one open-label trial, and one case series. Four studies reported a significant decrease in OCD severity on the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) following iCBT, one study reported significant decrease in CY-BOCS scores for iCBT relative to waitlist, and the case series reported (some) symptom reduction in all participants. Six studies reported high rates of feasibility, and five studies reported good acceptability of iCBT.

CONCLUSION

At present, evidence regarding acceptability, feasibility, and efficacy of iCBT for pediatric OCD is limited. Results are promising but need to be confirmed and refined in further research.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD4201808587.

Obsessional Indecision: Its Psychological Conceptualisation, Assessment, and Treatment

This paper examines the clinical entity of obsessional indecision. It argues for its conceptualisation as a form of “pure” obsessional disorder and discusses assessment issues and proposed intervention techniques. Data gathered from four patients treated by the authors is used to substarniate the arguments and points made. The paper illustrates the nature of the problem, as well as highlighting its varying topography and elucidating a novel treatment package that appears to show promise.

Technological advances in psychotherapy: implications for the assessment and treatment of obsessive compulsive disorder

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.

Virtual reality for obsessive-compulsive disorder: past and the future

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.

Computers in psychiatry: a review of past programs and an analysis of historical trends

In a variety of clinical settings, computers are playing an increasing role in managing or retrieving clinical information. A recent survey of physician computer use suggests that psychiatrists, in comparison to other types of medical specialists, may be using computers less in routine care. In this paper, we present a literature review of 57 articles on computer programs in psychiatry that were published since 1966 in five major peer-reviewed journals. We divide the types of programs that have been developed into four categories: (1) diagnostic and decision support, (2) patient screening and therapy, (3) data collection and management, and (4) data modeling. Among the first three categories, we found trends in publications during the past three decades of research. We provide a discussion of representative computer programs. Our analysis of past programs reveals a number of design problems that may be a barrier to the more widespread use of computers in psychiatry.

A palmtop computer program for the treatment of generalized anxiety disorder

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.