This study evaluated the effectiveness and treatment costs associated with a stepped care protocol of exposure and response prevention (EX/RP) for obsessive compulsive disorder (OCD). In the current open trial, patients (N = 14) began with self-directed EX/RP and minimal therapist guidance over the course of six weeks (Step 1). During this phase of treatment, no therapist-directed exposures were conducted. Those who did not respond optimally to Step 1 went on to Step 2, which consisted of 15 sessions of twice-weekly therapist directed exposures. Results of this study show promise for stepped care utilizing EX/RP for some patients with OCD, with a response rate of 88% and a 60% reduction on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score among treatment completers. Significant improvements were found in Y-BOCS from pre to post treatment for bothStep 1 and Step 2 completers. Forty-five percent of participants (n = 5) responded following completion of Step 1, resulting in reduced cost of treatment among these participants. All participants who responded to Step 1 maintained acute gains during the brief follow-up period. Limitations include a small sample size and high attrition rate.
KeywordsCost and cost analysis; Treatment outcomes; Bibliotherapy; Cognitive behavior therapy; Exposure therapy Exposure and response prevention (EX/RP) is considered the psychosocial treatment of choice for OCD (Koran, Hanna, Hollander, Nestadt, & Simpson, 2007). EX/RP has consistently demonstrated superior results compared to pharmacotherapy, particularly in the area of relapse prevention (Abel, 1993;Van Balkom et al., 1994). In a study comparing EX/RP to clomipramine, for example, 62% of the sample and 86% of treatment completers who received therapist directed EX/RP were rated as responders, compared to 42% and 48% of those who received clomipramine (Foa et al., 2005). Further, although there are no studies directly comparing the long-term financial costs of EX/RP versus pharmacotherapy, it is likely that pharmacotherapy produces greater long-term costs than EX/RP, given the need for long-term maintenance with medication (Marks, 1997 Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
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Author ManuscriptBehav Res Ther. Author manuscript; available in PMC 2011 November 1. (Greist, Marks, Baer, Kobak, Wenzel, Hirsh, et al., 2002). Similarly, a randomized controlled trial comparing therapist directed EX/RP to self-directed EX/RP with bibliotherapy reported response rates of 65% and 25%, respectively (Tolin et al., 2007). Thus, a limitation of these less restrictive...
