Background: Computer-guided therapy is an innovative treatment strategy that could have an important role in the future of psychological treatment. This paper summarises the available published evidence that assesses the effectiveness of a computerised cognitive behaviour therapy (CCBT) for obsessive-compulsive disorder (OCD). Methods: Fifteen electronic bibliographic databases including Medline, Embase, the Cochrane Library, Cinahl, PsycINFO, Biological Abstracts, HMIC and NHS CRD databases were comprehensively searched in March 2004: [‘obsessive compulsive disorder’ (text and indexed terms)] AND [‘cognitive therapy’ (text and indexed terms)] AND [‘computer’ (text and indexed terms)]. Reference lists of included studies, guidelines, generic research, trials registers and specialist mental health sites were hand-searched. Results: The search produced 149 citations from which we identified two RCTs and two single-arm studies with relevant data. All four studies used one software programme – BTSteps.In the large RCT, YBOCS effect sizes for BTSteps, therapist-led cognitive behaviour therapy (TCBT) and relaxation (RLX) were 0.84, 1.22, and 0.35, respectively. The smaller RCT found significantly better outcomes with brief scheduled support compared to brief on-demand phone support. Conclusions:  BTSteps was as good as TCBT for reducing time spent in rituals and obsessions and for improving the Work and Social Adjustment Scale (WSA), and was superior to RLX treatment. The available evidence also showed that improvement of OCD persisted beyond the end of CCBT. TCBT was more effective than CCBT for all patients overall though not in those who went on to start self-exposure. Such a system has the potential to widen the access to CBT in general and considerably shorten clinician-guided care.

Keywords:
Obsessive-compulsive disorder, Cognitive behaviour therapy, Medical informatics computing, Computer-guided therapy
1.
Lopez-Ibor JJ, Lopez-Ibor MI: Research on obsessive-compulsive disorder. Curr Opin Psychiatry 2003;16:S85–S91.
2.
Nakatani E, Nakagawa A, Nakao T, Yoshizato C, Nabeyama M, Kudo A, Isomura K, Kato N, Yoshioka K, Kawamoto M: A randomized controlled trial of Japanese patients with obsessive-compulsive disorder – effectiveness of behavior therapy and fluvoxamine. Psychother Psychosom 2005;74:269–276
3.
Linden M, Zubraegel D, Baer T, Franke U, Schlattmann P: Efficacy of cognitive behaviour therapy in generalized anxiety disorders. Psychother Psychosom 2005;74:36–42.
4.
Taylor S, Thordarson DS, Spring T: Telephone-administered cognitive behavior therapy for obsessive-compulsive disorder. Cogn Behav Ther 2003;32:13–25.
5.
Rufer M, Held D, Cremer J, Fricke S, Moritz S, Peter H, Hand I: Dissociation as a predictor of cognitive behavior therapy outcome in patients with obsessive-compulsive disorder. Psychother Psychosom 2006;75:40–46.
6.
Greist JH: New developments in behaviour therapy for obsessive-compulsive disorder. Int Clin Psychopharmacol 1996;11:63–73.
7.
Emmelkamp MG: Technological innovations in clinical assessment and psychotherapy. Psychother Psychosom 2005;74:336–343.
8.
Critical Appraisal Skills Programme (CASP) checklist for appraising RCTs. Learning and Development at the Public Health Resource Unit, 2004. Available http://www.phru.nhs.uk/casp/casp.htm (accessed 20.01.2006).
9.
Downs SH, Black N: The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health 1998;52:377–384.
10.
Greist JH, Marks IM, Baer L, Kobak KA, Wenzel KW, Hirsch MJ, Mantle JM, Clary CM: Behaviour therapy for obsessive compulsive disorder guided by a computer or by a clinician compared with relaxation as a control. J Clin Psychiatry 2002;63:138–145.
11.
Kenwright M, Marks IM, Graham C, Franses A, Mataix-Cols D: Brief scheduled phone support from a clinician to enhance computer-aided self-help for obsessive-compulsive disorder: randomised controlled trial. J Clin Psychology 2005;61:1499–1508.
12.
Greist JH, Marks IM, Baer L, Parkin JR, Manzo PA, Mantle JM, Wenzel KW, Spierings CJ, Kobak KA, Dottl SL, Bailey TM, Forman L: Self-treatment for OCD using a manual and a computerized telephone interview: a US-UK Study. MD Comput 1998;15:149–157.
13.
Bachofen M, Nakagawa A, Marks IM, Park JM, Greist JH, Baer L, Wenzel KW, Parkin JR, Dottl SL: Self-treatment of obsessive compulsive disorder using a manual and a computer-conducted telephone interview: replication of a US-UK study. J Clin Psychiatry 1999;60:545–549.
14.
Goodman WK, Price LH, Rasmussen SA: The Yale-Brown Obsessive Compulsive Scale. Arch Gen Psychiatry 1989;46:1006–1016.
15.
Mundt JC, Marks IM, Shear MK, Greist JH: The Work and Social Adjustment Scale: a simple measure of impairment in functioning. Br J Psychiatry 2002;180:461–464.
16.
Hamilton M: A rating scale for depression. J Neurol Neurosurg Psychiatry 1960;23:56–62.
17.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, ed 3 (DSM-III-R). Washington, APA, 1987.
18.
World Health Organisation: The ICD-10 Classification of Mental and Behavioural Disorders. Geneva, WHO, 1992.
19.
Guy W: ECDEU Assessment Manual for Psychopharmacology. US Department of Health, Education, and Welfare Publication (ADM). Rockville, National Institutes of Mental Health, 1976, pp 218–222.
20.
Nakagawa A, Marks IM, Park JM, Bachofen M, Baer L, Dottl SL, Greist JH: Self-treatment of obsessive-compulsive disorder guided by manual and computer guided telephone interview. J Telemed Telecare 2000;6:22–26.
21.
Rowa K: Behavioural treatment of obsessive compulsive disorder. Behav Cogn Psychother 2000;28:353–360.
22.
Clinical Standards Advisory Group (CSAG). Depression. London, HMSO, 1999.
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2007
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