Remote cognitive–behavior therapy for obsessive–compulsive symptoms: A meta-analysis
Section snippets
Measurement of obsessive–compulsive symptoms
The Yale–Brown Obsessive–Compulsive Scale (Y-BOCS) (Goodman et al., 1989) is a 10-item measure of the severity of obsessive–compulsive symptoms regardless of symptom presentation and is the gold-standard outcome measure in the OCD literature. The Y-BOCS is usually completed as a clinician-administered measure, however a self-report version of the scale is also available, and responses on the self-report Y-BOCS correlate highly with those on the clinician-administered scale (r = .76) (Steketee,
Cognitive–behavioral treatment for obsessive–compulsive disorder
Cognitive–behavioral models of OCD are largely based on the body of research that demonstrates that intrusive thoughts are a universal phenomenon which becomes problematic only when individuals misinterpret those intrusions as threatening (Rachman & de Silva, 1978). These cognitive–behavioral models hypothesize that symptoms of OCD are maintained by cognitive biases, engagement in compulsive behaviors, and avoidance of triggers (Rachman, 1997, Salkovskis, 1985, Salkovskis, 1999). Best practice
Barriers to accessing evidence-based treatment
Despite the availability of effective psychological treatments for OCD many individuals do not access traditional face-to-face evidence-based treatments. Results from epidemiological studies indicate that approximately 60% of individuals with OCD remain untreated (Kohn, Saxena, Levav, & Saraceno, 2004). Other research indicates that when individuals with OCD do access treatment they are often not provided with an evidence-based treatment or do not receive a sufficient dose of ERP (Stobie,
Remote treatment for obsessive–compulsive disorder
Remote treatments are those that can be delivered without the therapist physically being in the same room as the client, and can thus improve access to evidence-based care. Remote treatments differ along multiple continua including whether they use technology to deliver remote treatments in synchronous, or real time (high intensity remote interventions) or whether they involve brief and often asynchronous contact with a therapist (low intensity remote interventions). These interventions are
Search procedure
Relevant articles were identified through electronic databases (Scopus, Medline and PsycINFO) through to December 4th 2014. The search terms used in the electronic database search included ‘obsessive compulsive or OCD’ AND ‘internet or telephone or videoconferenc* or bibliotherapy or computeri* or DVD or CD or distance or remote or self-help’ AND ‘trial or RCT or randomi*ed’. The references of previously completed reviews on the topic of remote treatment for OCD (Herbst et al., 2012, Lovell and
Results
Fig. 1 outlines the study selection process. The search yielded 256 articles. The abstracts were reviewed and 209 were excluded, resulting in 47 studies. These 47 studies were reviewed in full against the inclusion and exclusion criteria and 29 were excluded, resulting in 18 included studies in the meta-analysis. Study eligibility was determined by the author using a comprehensive coding sheet.
Discussion
The aim of this study was to extend the existing reviews of remote treatment for OCD and to provide an evaluation of the efficacy of remote treatment for OCD using a meta-analytic approach. Because of the small amount of research conducted in this area to date both controlled and uncontrolled studies were included the analysis. Overall, the results of this meta-analysis indicate that remote treatment for OCD is an efficacious and promising treatment delivery with large within-group effect sizes
Role of funding sources
This was an unfunded study and no funding sources have been omitted.
Contributors
This is a single author manuscript and I confirm that there are no other persons who satisfied the criteria for authorship that are not listed. The author conducted literature searches, collected and analyzed the data, and wrote the manuscript.
Conflict of interest
There are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome.
Acknowledgments
None.
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