Home self-assessment and self-treatment of obsessive-compulsive disorder using a manual and a computer-conducted...

This open study replicates and extends previous pilot work with BT STEPS, a self-therapy system to assess and treat obsessive-compulsive disorder (OCD) through exposure and ritual prevention.

21 OCD patients entered this open trial, using a self-guiding manual and any Touch-Tone telephone to access computer-driven interviews via an Interactive Voice Response system. The patients also used the system to rate progress on rating scales.

The results support those of the previous open study. Of the 21 patients, 16 (76%) completed self-assessment over a mean of 21 days. Of these, 10 patients (48%) went on to do 2 or more exposure and ritual prevention sessions over a mean of 64 days; they improved significantly on OCD symptoms, as much as is usual with serotonin reuptake inhibitor medication, and in mood and work/social adjustment. Improvement was predicted by baseline motivation and by rapid completion of self-assessment with BT STEPS, even though self-assessment alone was not therapeutic.

The significant improvement in the intent-to-treat analysis was due to the subgroup of patients (48% of those who began BT STEPS) who went beyond self-assessment to do exposure and ritual prevention self-therapy at home guided by BT STEPS. A controlled trial is now needed.