Two pilot tests were made of computer-aided self-help for chronic agora/claustrophobia diagnosed by a psychiatrist. Test 1 was of 17 patients at the Institute of Psychiatry (IoP). They had no human clinical help, getting ideas only from the computer on how to do self-exposure therapy and set exposure goals week by week. Patients could attend for 12 sessions. Outcome data were inconsistent across ratings, not always matching clinical impression of progress. Of the 15 patients for whom outcome data were available, 6 improved markedly or moderately on clinical impression. Test 2 was of 6 patients in a rural general practice (GP) in Wales who were given help and support from a nonclinical administrator. Of the 4 Welsh patients with follow-up data, 3 improved markedly or moderately. The test results suggest desirable changes. Patients first need to do practice ratings before rating on the computer and to check computer ratings. Some rating instructions need to be clarified. Most importantly, synergism comes from giving patients access to brief human help if they encounter problems when using computer-aided self-help.

Adult↗

PubMedDate not supplied

[Behavior psychotherapy in obsessive-compulsive disorders].

Although their problem is often as disabling as in chronic schizophrenia, most cases of obsessive-compulsive disorder have become eminently treatable by the behavioural approach of live exposure with response prevention. Treatment takes from 1 to 6 months depending on the severity of the problem, and may need an overall mean therapist time of +/- 8 hours time per patient. Most psychiatrists can learn to apply the treatment quite quickly, and most patients can be treated on an outpatient basis. About 25% of patients refuse or do not complete behavioural treatment. Improvement has endured over the 5-year follow-ups available. Occasional cases need brief booster period during followup. In exposure treatment the sufferer is persuaded to come into prolonged contact with discomfiting cues that bring on the rituals, without ritualising, so that the ensuing anxiety and urge to ritualise can subside to the point of habituation. The contact should be for at least an hour daily, and should gradually involve all ritual-evoking cues. The patient should record all exposure tasks done in a daily self-exposure diary. The therapist does not need to do the exposure with the patient, his role being to educate the patient in what to do and to monitor and praise progress. Therapist-accompanied exposure is largely redundant. Where family members are involved in the rituals they need to be coopted, with the patient's agreement, as exposure cotherapists and taught in role rehearsal with the patient to withhold requests for reassurance. Antidepressant drugs are a useful adjuvant to exposure therapy when the patient's obsessive-compulsive problem is complicated by dysphoria.

Behavior Therapy↗

PubMedDate not supplied

Overcoming interface problems in computerized monitoring of clinical outcomes.

Monitoring clinical outcome and its cost can improve the quality and efficiency of health care, and computers offer a cost-effective way to collect such data routinely. We report the development of a new computer system, including the initial requirements specified and experience with introducing a pilot system and then a commercially developed system in several sites. Problems met when designing, implementing, and operating the system are described, together with solutions to the problems. Costs and benefits of the system are assessed, and rules to follow in introducing computerized monitoring of clinical outcomes are suggested.

Anxiety Disorders↗

PubMedDate not supplied

Self-treatment for obsessive compulsive disorder using a manual and a computerized telephone interview: a U.S.-U.K. study.

Bt steps is a patient-centered behavioral therapy program that uses a manual and a computer-driven interactive voice response system to assess and treat obsessive compulsive disorder. This nine-step program contains a self-assessment module and a self-treatment module that provides teaching on exposure and ritual prevention. The patient reads about the steps in a manual and then uses a touch-tone telephone to contact the program, in which a recorded voice conducts the interview. Of 40 patients in an open 12-week trial in the United States and London, 35 completed the self-assessment module, and 17 completed at least two sessions of exposure and ritual prevention. The system produced statistically significant improvements on measures of obsessive compulsive disorder.

Adult↗