An interactive computer-administered self-assessment and self-help program for behavior therapy

Abstract

Behavior therapy for obsessive-compulsive disorder (OCD) is extremely effective and usually conveys lasting benefits. Unfortunately, behavior therapy is not widely available and is usually quite costly in the few settings where it can be obtained. The essential features of effective behavior therapy are identifying triggers of obsessions, rituals, and discomfort; designing personalized exposure and ritual prevention (E & RP) goals; and encouraging and monitoring E & RP sessions of sufficient frequency and duration for habituation to occur. A computer program (BT STEPS) was designed to assist OCD sufferers in carrying out self-assessment and self-help behavior therapy. The program has nine clinical steps, 12 computer-controlled interactive voice response (IVR) telephone calls (some used repeatedly), and more than 1000 digitized voice files that depend on the progress that patients report during calls. BT STEPS has been studied in two trials at three sites with a total of 65 patients. In both trials, patients who experienced behavior therapy had substantial reductions in OCD severity as assessed by the Yale-Brown Obsessive Compulsive Scale. Approximately two thirds of those who participated in two or more E & RP sessions were much or very much improved. Patients liked using the program, and 71% thought their lives improved as a result. BT STEPS makes behavior therapy for OCD patients potentially available to anyone with a touch-tone telephone. It is intended for use under the supervision of a clinician and can be used in conjunction with pharmacotherapy.