Anxiety Disorders Center, The Institute of Living, Hartford Hospital, CT 06106, USA.
Behav Res Ther. 2010 Nov;48(11):1144-9. doi: 10.1016/j.brat.2010.07.010. Epub 2010 Jul 30.
This study evaluated the effectiveness and treatment costs associated with a stepped care protocol of exposure and response prevention (EX/RP) for obsessive-compulsive disorder (OCD). In the current open trial, patients (N=14) began with self-directed EX/RP and minimal therapist guidance over the course of six weeks (Step 1). During this phase of treatment, no therapist-directed exposures were conducted. Those who did not respond optimally to Step 1 went on to Step 2, which consisted of 15 sessions of twice-weekly therapist-directed exposures. Results of this study show promise for stepped care utilizing EX/RP for some patients with OCD, with a response rate of 88% and a 60% reduction on the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) score among treatment completers. Significant improvements were found in Y-BOCS from pre to post-treatment for both Step 1 and Step 2 completers. Forty-five percent of participants (n=5) responded following completion of Step 1, resulting in reduced cost of treatment among these participants. All participants who responded to Step 1 maintained acute gains during the brief follow-up period. Limitations include a small sample size and high attrition rate.
本研究评估了针对强迫症（OCD）的暴露和反应预防（EX/RP）分步护理方案的有效性和治疗费用。在当前的开放试验中，患者（N=14）在六周的时间内（第 1 步）开始进行自我指导的 EX/RP 和最少的治疗师指导。在治疗的这一阶段，没有进行任何治疗师指导的暴露。那些在第 1 步治疗中反应不佳的患者进入第 2 步，其中包括 15 次每周两次的治疗师指导的暴露。这项研究的结果表明，对于一些强迫症患者，采用 EX/RP 的分步护理具有一定的前景，其反应率为 88%，耶鲁-布朗强迫症量表（Y-BOCS）评分在治疗完成者中降低了 60%。第 1 步和第 2 步完成者的 Y-BOCS 评分在治疗前后均有显著改善。45%的参与者（n=5）在完成第 1 步后有反应，这导致这些参与者的治疗费用降低。所有对第 1 步有反应的参与者在短暂的随访期间都保持了急性获益。限制因素包括样本量小和高脱落率。
