No abstract

Four patients with obsessive-compulsive disorder (OCD) were referred for home-based cognitive-behavioral therapy. All patients had failed extensive trials of behavioral and cognitive therapy and pharmacotherapy in a variety of settings (e.g., outpatient, inpatient, and day program) and were generally considered chronic and refractory to treatment. Generalization from treatment sites to natural settings in which they lived did not occur. They were evaluated at baseline, after treatment, and at an 18-month follow-up using the Yale-Brown Obsessive Compulsive Scale. Conducting end-state functioning and reliable change assessment according to the methods specified by Jacobson and Truax, the authors found that 3 patients achieved clinically significant gains after treatment and 2 patients maintained those gains at the 18-month follow-up. Data suggested better overall adjustment for 3 of the patients at follow-up. This study demonstrates the effectiveness of home-based cognitive-behavioral therapy for chronic, refractory OCD; implications for further, controlled trials are discussed.

A 28-year-old, married, Caucasian female with obsessive-compulsive disorder was referred for home-based cognitive-behavioral therapy. At the time of intake, she obtained a severe rating on the Yale-Brown Obsessive-Compulsive Scale, and was considered chronic and treatment refractory after failing previous trials of behavior therapy and pharmacotherapy. Prior treatment attempts in traditional settings were unsuccessful because she failed to generalize gains beyond such settings. She was evaluated at baseline, after treatment, and again at an 18-month follow-up. Performing endstate functioning and reliable change assessment as described by Jacobson andTruax, the authors found that the patient realized clinically significant gains after treatment, and that she maintained those gains at follow-up. This illustrates that severe, chronic, and refractory patients may benefit by receiving cognitive-behavioral therapy as a home-based intervention. The need for replication, further controlled trials, and the implications this case may have upon future research are discussed.