Stepped Care for Treating Obsessive-Compulsive Disorder
Condition: Obsessive-compulsive Disorder
MeSH terms: Compulsive Personality Disorder; Obsessive-Compulsive Disorder
Study type: Interventional

Summary: 
      This study will determine the effectiveness and cost-effectiveness of a stepped-care
      treatment program for people with obsessive-compulsive disorder.
    

Detailed description: 
      Obsessive-Compulsive Disorder (OCD) is a chronic and debilitating anxiety disorder. People
      with OCD often experience recurrent unwanted thoughts, called obsessions, and repetitive
      behaviors, called compulsions. These thoughts and behaviors interfere with everyday life to a
      great extent. Currently, the most frequently used psychosocial treatment for OCD is
      cognitive-behavioral therapy (CBT) that incorporates exposure with ritual prevention (EX/RP).
      However, although effective, this treatment approach is largely inaccessible, time-consuming,
      labor-intensive, and expensive. A stepped-care approach to treating OCD may be more
      cost-effective and therefore more accessible for many individuals. Stepped-care CBT begins
      with the least expensive, least intrusive, most accessible option, and works up to the most
      expensive option if the less intrusive treatments do not work. This study will determine the
      benefits and cost-effectiveness of a stepped care treatment program for OCD.

      Participants in this open label study will be randomly assigned to receive CBT for 6 to 14
      weeks either through the stepped-care approach or immediately upon study entry. Participants
      will report to the study site for treatments and assessments on a regular basis, ranging from
      every 2 weeks to twice a week, depending on the stage of the study and the assigned treatment
      group. Stepped-care CBT will begin with self-administered EX/RP combined with counseling to
      address medication issues, life stress, and motivational enhancement. If ineffective, this
      treatment will be followed by therapist-administered EX/RP. OCD symptoms will be assessed at
      Week 6. Participants who have responded to treatment after 6 weeks will not receive further
      treatment. All others will continue for an additional 8 weeks. These participants' OCD
      symptoms will be assessed again at Week 14. Participants assigned to the stepped-care
      approach whose OCD symptoms improved initially, but relapsed without further treatment by the
      Week 14 evaluation will receive full-scale CBT. Outcomes will be assessed again at 1- and
      3-month follow-up visits.
    

Intervention name(s): Traditional CBT; Stepped-Care CBT
Intervention type(s): Behavioral; Behavioral
Intervention description(s): CBT with EX/RP is a psychosocial treatment that incorporates exposure with ritual prevention.; In the CBT stepped-care program, patients are first provided with a less expensive, less intrusive, and more accessible option that resembles quality community care (e.g., self-administered EX/RP combined with counseling to address medication issues, life stress, and motivational enhancement). Patients who fail to respond to this initial treatment progress to a more intensive treatment (e.g., therapist-administered EX/RP).
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Anxiety; Behavior therapy; Cognitive-behavioral therapy; Stepped care; Cost-effectiveness