Lovell et al. (telephone administered ERP vs face to face)

OCD

Context

Economic & time costs:

CBT involves weekly, hour-long sessions, imposing significant financial burdens on both patients and providers.

Aims

To compare 2 modes of delivery for one-to-one ERP as a treatment for OCD (telephone vs face-to-face)

Used non-inferiority trial (predicted that telephone would be not less effective than face-to-face)

Methodology

→ Randomised control trial with quantitative data collected through self-report questionnaires:

• Yale Brown Obsessive-Compulsive Disorder Scale (Y-BOCS)

• Beck Depression inventory (BDI) - Questionnaire designed specifically to measure client satisfaction (out of 32, higher the score, higher the satisfaction)

→ Also an experiment with independent measures + longitudinal design

Sample

→ 72 pp (16-65 yrs) w OCD selected from 2 outpatients departments in UK

→ Opportunity sample

→ All pps scored 16 or more in Y-BOCS

→ Attrition reasons:

• Comorbid substance misuse or suicidality

• Taken medication for depression / anxiety in last 3 months

Procedure

→ randomly allocated to 2 groups Face-to-face (36pp) Telephone (36pp)

→ Therapists were experienced and there was one at each clinic who delivered each type of therapy.

Used :

• therapy manuals

• twice monthly supervision

→ Researchers assessed the participants twice, four weeks apart (to create baseline) and at 1,3 and 6 month follow-up

→ Researchers were unaware of each participant’s mode of delivery

Session content

Treatment was explained and the Y-BOCS data was used to create a fear hierarchy.

Homework expectations

• Weekly homework targets were agreed.

• Suggested homework time was 1h/day

• Therapist monitored progress and helped with target-setting and problem solving

• For telephone, homework was sent by post

Support between sessions

Patients were encouraged to ask a relative or friend to help them to solve any problems during the programme.

Description of procedure

Face-to-face:

• 10, one-hour sessions with a therapist

Telephone:

• 2, one-hour face-to-face sessions (1 at the beginning and 1 at the end of the programme) 8 weekly telephone calls of 30min.

Results

• No significant difference in the severity of symptoms between 2 treatment groups at baseline nor follow ups.

• Client satisfaction scores immediately after treatment also showed no significant difference.

• Both OCD and depression symptoms dropped twice as much as would have been necessary to accept the hypothesis that telephone therapy was no less effective than face-to-face, despite reduced contact time.

• 77% in the telephone group and 67% in the face-to-face group were treated successfully.

Conclusions

Telephone-delivered exposure and RPE therapy for OCD is as effective as face-to-face therapy despite the sessions being 50% shorter.

Evaluation

Strengths:

• Quantitative data collected by 2 different baseline measures to check reliability and consistency of the scores

• Random allocation increases validity due to control of participant variables (individual variables)

Issues & debates:

• Cultural differences