StandardStandard

Low-intensity cognitive-behaviour therapy interventions for obsessive-compulsive disorder compared to waiting list for therapist-led cognitive-behaviour therapy: 3-Arm Randomised Controlled Trial of Clinical Effectiveness. / Lovell, Karina; Bower, Peter; Gellatly, Judith et al.
Yn: Plos medicine, Cyfrol 14, Rhif 6, 27.06.2017.

Allbwn ymchwil: Cyfraniad at gyfnodolynErthygladolygiad gan gymheiriaid

HarvardHarvard

Lovell, K, Bower, P, Gellatly, J, Byford, S, Bee, PE, McMillan, D, Arundel, CE, Gilbody, SM, Gega, L, Hardy, G, Reynolds, S, Barkham, M, Mottram, P, Lidbetter, N, Pedley, R, Molle, J, Peckham, EJ, Knopp-Hoffer, J, Price, O, Connell, J, Heslin, M, Foley, C, Plummer, F & Roberts, C 2017, 'Low-intensity cognitive-behaviour therapy interventions for obsessive-compulsive disorder compared to waiting list for therapist-led cognitive-behaviour therapy: 3-Arm Randomised Controlled Trial of Clinical Effectiveness', Plos medicine, cyfrol. 14, rhif 6. https://doi.org/10.1371/journal.pmed.1002337

APA

Lovell, K., Bower, P., Gellatly, J., Byford, S., Bee, P. E., McMillan, D., Arundel, C. E., Gilbody, S. M., Gega, L., Hardy, G., Reynolds, S., Barkham, M., Mottram, P., Lidbetter, N., Pedley, R., Molle, J., Peckham, E. J., Knopp-Hoffer, J., Price, O., ... Roberts, C. (2017). Low-intensity cognitive-behaviour therapy interventions for obsessive-compulsive disorder compared to waiting list for therapist-led cognitive-behaviour therapy: 3-Arm Randomised Controlled Trial of Clinical Effectiveness. Plos medicine, 14(6). https://doi.org/10.1371/journal.pmed.1002337

CBE

MLA

VancouverVancouver

Author

RIS

TY - JOUR

T1 - Low-intensity cognitive-behaviour therapy interventions for obsessive-compulsive disorder compared to waiting list for therapist-led cognitive-behaviour therapy: 3-Arm Randomised Controlled Trial of Clinical Effectiveness

AU - Lovell, Karina

AU - Bower, Peter

AU - Gellatly, Judith

AU - Byford, Sarah

AU - Bee, Penny E.

AU - McMillan, Dean

AU - Arundel, Catherine Ellen

AU - Gilbody, Simon Martin

AU - Gega, Lina

AU - Hardy, Gillian

AU - Reynolds, Shirley

AU - Barkham, Michael

AU - Mottram, Patricia

AU - Lidbetter, Nicola

AU - Pedley, Rebecca

AU - Molle, Jo

AU - Peckham, Emily Jane

AU - Knopp-Hoffer, Jasmin

AU - Price, Owen

AU - Connell, Janice

AU - Heslin, Margaret

AU - Foley, Christopher

AU - Plummer, Faye

AU - Roberts, Christopher

N1 - ©2017 Lovell et al.

PY - 2017/6/27

Y1 - 2017/6/27

N2 - Background: Obsessive-compulsive disorder (OCD) is prevalent and without adequate treatment usually follows a chronic course. “High-intensity” cognitive-behaviour therapy (CBT) from a specialist therapist is current “best practice.” However, access is difficult because of limited numbers of therapists and because of the disabling effects of OCD symptoms. There is a potential role for “low-intensity” interventions as part of a stepped care model. Low-intensity interventions (written or web-based materials with limited therapist support) can be provided remotely, which has the potential to increase access. However, current evidence concerning low-intensity interventions is insufficient. We aimed to determine the clinical effectiveness of 2 forms of low-intensity CBT prior to high-intensity CBT, in adults meeting the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for OCD. Methods and findings: This study was approved by the National Research Ethics Service Committee North West–Lancaster (reference number 11/NW/0276). All participants provided informed consent to take part in the trial. We conducted a 3-arm, multicentre randomised controlled trial in primary- and secondary-care United Kingdom mental health services. All patients were on a waiting list for therapist-led CBT (treatment as usual). Four hundred and seventy-three eligible patients were recruited and randomised. Patients had a median age of 33 years, and 60% were female. The majority were experiencing severe OCD. Patients received 1 of 2 low-intensity interventions: computerised CBT (cCBT; web-based CBT materials and limited telephone support) through “OCFighter” or guided self-help (written CBT materials with limited telephone or face-to-face support). Primary comparisons concerned OCD symptoms, measured using the Yale-Brown Obsessive Compulsive Scale–Observer-Rated (Y-BOCS-OR) at 3, 6, and 12 months. Secondary outcomes included health-related quality of life, depression, anxiety, and functioning. At 3 months, guided self-help demonstrated modest benefits over the waiting list in reducing OCD symptoms (adjusted mean difference = −1.91, 95% CI −3.27 to −0.55). These effects did not reach a prespecified level of “clinically significant benefit.” cCBT did not demonstrate significant benefit (adjusted mean difference = −0.71, 95% CI −2.12 to 0.70). At 12 months, neither guided self-help nor cCBT led to differences in OCD symptoms. Early access to low-intensity interventions led to significant reductions in uptake of high-intensity CBT over 12 months; 86% of the patients allocated to the waiting list for high-intensity CBT started treatment by the end of the trial, compared to 62% in supported cCBT and 57% in guided self-help. These reductions did not compromise longer-term patient outcomes. Data suggested small differences in satisfaction at 3 months, with patients more satisfied with guided self-help than supported cCBT. A significant issue in the interpretation of the results concerns the level of access to high-intensity CBT before the primary outcome assessment. Conclusions: We have demonstrated that providing low-intensity interventions does not lead to clinically significant benefits but may reduce uptake of therapist-led CBT. Trial registration: International Standard Randomized Controlled Trial Number (ISRCTN) Registry ISRCTN73535163.

AB - Background: Obsessive-compulsive disorder (OCD) is prevalent and without adequate treatment usually follows a chronic course. “High-intensity” cognitive-behaviour therapy (CBT) from a specialist therapist is current “best practice.” However, access is difficult because of limited numbers of therapists and because of the disabling effects of OCD symptoms. There is a potential role for “low-intensity” interventions as part of a stepped care model. Low-intensity interventions (written or web-based materials with limited therapist support) can be provided remotely, which has the potential to increase access. However, current evidence concerning low-intensity interventions is insufficient. We aimed to determine the clinical effectiveness of 2 forms of low-intensity CBT prior to high-intensity CBT, in adults meeting the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for OCD. Methods and findings: This study was approved by the National Research Ethics Service Committee North West–Lancaster (reference number 11/NW/0276). All participants provided informed consent to take part in the trial. We conducted a 3-arm, multicentre randomised controlled trial in primary- and secondary-care United Kingdom mental health services. All patients were on a waiting list for therapist-led CBT (treatment as usual). Four hundred and seventy-three eligible patients were recruited and randomised. Patients had a median age of 33 years, and 60% were female. The majority were experiencing severe OCD. Patients received 1 of 2 low-intensity interventions: computerised CBT (cCBT; web-based CBT materials and limited telephone support) through “OCFighter” or guided self-help (written CBT materials with limited telephone or face-to-face support). Primary comparisons concerned OCD symptoms, measured using the Yale-Brown Obsessive Compulsive Scale–Observer-Rated (Y-BOCS-OR) at 3, 6, and 12 months. Secondary outcomes included health-related quality of life, depression, anxiety, and functioning. At 3 months, guided self-help demonstrated modest benefits over the waiting list in reducing OCD symptoms (adjusted mean difference = −1.91, 95% CI −3.27 to −0.55). These effects did not reach a prespecified level of “clinically significant benefit.” cCBT did not demonstrate significant benefit (adjusted mean difference = −0.71, 95% CI −2.12 to 0.70). At 12 months, neither guided self-help nor cCBT led to differences in OCD symptoms. Early access to low-intensity interventions led to significant reductions in uptake of high-intensity CBT over 12 months; 86% of the patients allocated to the waiting list for high-intensity CBT started treatment by the end of the trial, compared to 62% in supported cCBT and 57% in guided self-help. These reductions did not compromise longer-term patient outcomes. Data suggested small differences in satisfaction at 3 months, with patients more satisfied with guided self-help than supported cCBT. A significant issue in the interpretation of the results concerns the level of access to high-intensity CBT before the primary outcome assessment. Conclusions: We have demonstrated that providing low-intensity interventions does not lead to clinically significant benefits but may reduce uptake of therapist-led CBT. Trial registration: International Standard Randomized Controlled Trial Number (ISRCTN) Registry ISRCTN73535163.

KW - Adolescent

KW - Adult

KW - Aged

KW - Cognitive Behavioral Therapy/methods

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - Obsessive-Compulsive Disorder/therapy

KW - Treatment Outcome

KW - United Kingdom

KW - Waiting Lists

KW - Young Adult

U2 - 10.1371/journal.pmed.1002337

DO - 10.1371/journal.pmed.1002337

M3 - Article

VL - 14

JO - Plos medicine

JF - Plos medicine

SN - 1549-1277

IS - 6

ER -