Don't ring us, we'll ring you

Just a few supportive phone calls from a clinician can make all the difference to people following a home-based, computerised form of behavioural therapy for obsessive compulsive disorder (OCD).

The therapy, known as ‘behavioural therapy (BT) Steps’, involves clients using a manual to help them understand what triggers their compulsions, and how to gradually resist performing the rituals (e.g. hand washing) they normally carry out when exposed to those triggers. Clients use a touch-tone phone to report their progress and receive encouragement via recorded voice messages. Such systems allow people who don’t have face-to-face access to a clinician to engage in therapy. However, what’s not clear is how important it is for such clients to receive scheduled telephone calls from a clinician providing help and advice, as opposed to clients being given a free-phone number that they can choose to call whenever they need guidance.

To find out, Mark Kenwright and colleagues at the Institute of Psychiatry recruited 44 sufferers of OCD to take part in a 17 week BTSteps programme. Half the clients were given a free-phone number to contact lead research Mark Kenwright, a clinician, for guidance; the other half received nine scheduled calls from him over the 17 week period.

Clients who received the scheduled calls were less likely to drop out, were more likely to complete homework that involved resisting performing obsessive rituals, and showed greater improvement in their OCD symptoms. Overall, the clients given scheduled calls received an average of 76 minutes of clinician support over the phone, compared with the clients given a free-phone number who received an average of only 16 minutes clinician support (only 8 clients actually used the support number).

“To further ease OCD sufferer’s access to computer-aided self-help at home, the BTSteps system, including its user’s manual, will henceforth be made accessible on the internet under the name of OCFighter...” the researchers said.
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Kenwright, M., Marks, I., Graham, C., Franses, A. & Mataix-Cols, D. (2005). Brief scheduled phone support from a clinician to enhance computer-aided self-help for obsessive-compulsive disorder: randomised controlled trial. Journal of Clinical Psychology, 61, 1499-1508

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