OCD lovell et al. (2006) Flashcards
(16 cards)
aims
compare two modes of delivery for one to one ERP as a treatment for OCD
telephone treatment vs f2f treatment
the study is referred to as a non-inferiority trial and
studies like this are often used when it would not be practical or ethical to have placebo
hypothesis
experimental treatment (telephone ERP) not less effective than the control treatment (f2f ERP)
both modes of delivery will result in similar outcomes
methodology
RCT
quantitative data collected through self report ques
inclduing a ten item checklist to assess compulsive behaviour from YBOCS BDI and a client satisfaction ques
study could be reffered to as an exp w independent measures and longitudinal design
sample
16-65
opportunity sample72 people with OCD
two outpatient depts in manchester UK
all ps scored 16 at least on YBOCS
were alrdy diagnosed w OCD as their main problem
some people were excluded including people w comorbid substance misuse or suicidality
anyone who had taken meds for depression or anxiety in the last three months was also excluded
procedure
the ps were randomly allocated to the two groups
f2f n=36 telephone n=36
researchers unaware of each ps mode of delivery
assessed the ps twice
4 weeks apart
establish a baseline and again at a 3 followup session
@ 1 3 6 months later
experienced trained therapists one at each clinic delivered each type of therapy
therapy manuals and twice monthly supervision including reviewing therapy notes ensured the therapy was faithful to the principles of ERP
results
Both groups showed significant improvement on the Y-BOCS:
Telephone CBT: Mean score reduced from 25.6 to 16.9
Face-to-face CBT: Mean score reduced from 25.2 to 16.4
No significant difference between groups: p > 0.05
Around 72% of patients in both groups were satisfied with treatment
Study supports telephone CBT as equally effective and more accessible than in-person therapy
conclusions
telephone delivered exposure and response prevention therapy for OCD is as effective as f2f therapy
despite majority of sessions being 50% shorter
equates to a saving of 40% of the therapists time allowing more people to gain access to therapy
strength reliability
took 2 baseline measures using YBOCS and BDI
each pair of scores varied by less than 2 points on the scales
absence of therapy = minimal change in symptoms over 4 weeks
strength bc study didnt include control group for the full course of the study and it could have been argued that the reduction in symptoms was bc spontaneous recovery
2 baseline tests test restest reliability of baseline scores and consistency over time = reliable !!!!!!!
weakness validity
blinding procedure broke down
validity compromised
13% ps direct or indirectly revealed which grp they were in at a followup assessment
important because it means researcher BIAS in treating ps
and hence ps completing the queses about symptoms and client satisfaction
strength validity
random allocation of ps to two modes
control of p variables increase validity
demographic variables similar across groups
without similarity hard to claim effectiveness bc can say its only bc p variables in the grps
weakness p variable not controlled
initial avg depression score higher in telephone grp
may be less effective than f2f for less severe depression
OCD+depression impact on ebergy and motivation
cant leave house for therapy and wotn do it bc dw complete intervention unless by phone
weakness attrition
5 dropped between 2 baseline tests
3 in f2f grp b4 end of intervention
3 unavailable at the 6 month followup
reduces similarities p variables
difficult to compare success
dropouts of f2f higher YBOCS scores immediately after treatment
than those who not
if available at 6 months YBOCS wouldve been higher so less overall improvement
this would have increased the difference in outcome for the two groups w tele group appearing slightly more effective
ethics
86 people eligible
9 excluded after screening
1 withdrawn by clinician
screening not j to see OCD as primary mental health issue but also deselect ps w suicidal intent
risk management critical
support for telephone grp not enough
protect ps from harm
1 person withdrawn later from tele group for same reason
study approved by ethics committees in south cheshire and stockport
application to everyday life
possible to save 40% of a therapists time
freeing time to treat more ps
accessible
but need experienced and careful to generalise to therapists w less experience
idiographic methods
but if tele less satisfying than f2f for therapists bc more individual cases per therapist more paperwork can cause stress burnout poor retention etc
hidden cost of training more future therapists to fill void
counters initial cost saving
idiographic vs nomothetic
NOMOTHETIC
quantitative data
reliability increase
idiographic = semi structured interviews or p observation where interviewed therapists also
quali data interesting and may provide additional contextual info that can help improve service
cultural differences
WEAKNESS
cant generalise to people in other coutnries than UK
hofstede et al 2022 describes UK as highly individualist w low power distance index
respond well to priv theraoy on phone w ERP
bc work collab w clients like CBT therapists too
collectivist high power distance cultures may not respond as well
iran research khodarahimi 2009
f2f ERP can lead to reduction
assessed by YBOCS
evident at 6 month followup
sample in this study comprised only males
results not generalisable to females
OVERALL suggests ERP can be effective in cultures that vary widely on hofstede’s cultural dimensions
