Pearcy Caitlin P, Anderson Rebecca A, Egan Sarah J, Rees Clare S
School of Psychology and Speech Pathology, Curtin University, Perth, Australia.
J Behav Ther Exp Psychiatry. 2016 Jun;51:74-83. doi: 10.1016/j.jbtep.2015.12.007. Epub 2015 Dec 30.
The presence of obsessive-compulsive disorder (OCD) can result in low quality of life, with significant impairments in social and occupational functioning. An increase in the dissemination of self-help programs has been observed in the treatment of OCD, and has provided improved accessibility to treatment. The present study examined the efficacy of self-help interventions for OCD in the context of therapeutic contact.
Randomised controlled trials and quasi-experimental studies were identified through computerised database searches. Self-help format (bibliotherapy, internet-based, computerised), and therapeutic contact were examined for their effect on treatment outcomes.
Eighteen studies targeting self-help for OCD met inclusion criteria with 1570 participants. The average post-treatment effect size (Hedges' g) of self-help interventions on primary outcomes was .51 (95% CI: .41 to 0.61). Subgroup analysis revealed large effect sizes for minimal-contact self-help (g = 0.91, 95% CI: 0.66 to 1.17), moderate effect sizes for predominantly self-help (g = 0.68, 95% CI: 0.40 to 0.96), and small effect sizes for self-administered self-help (g = 0.33, 95% CI: .18 to 0.47).
A large variation of treatment approaches, amount of therapeutic contact, and risk of bias within each study may account for the large magnitude in effect sizes across studies. Additionally, the long-term follow-up effects of treatment approaches were not examined.
A growing body of literature supporting to the use of self-help treatments for OCD is evident, however, further investigation through use of randomised controlled trials is required, particularly the use of stepped care and long-term effectiveness.
强迫症（OCD）的存在会导致生活质量低下，在社交和职业功能方面出现显著障碍。在强迫症治疗中，自助项目的传播有所增加，并且提高了治疗的可及性。本研究在治疗接触的背景下考察了强迫症自助干预措施的疗效。
通过计算机数据库检索确定随机对照试验和准实验研究。考察自助形式（图书治疗、基于互联网、计算机化）以及治疗接触对治疗结果的影响。
18项针对强迫症自助治疗的研究符合纳入标准，涉及1570名参与者。自助干预对主要结局的平均治疗后效应量（Hedges' g）为0.51（95%可信区间：0.41至0.61）。亚组分析显示，最低限度接触自助的效应量较大（g = 0.91，95%可信区间：0.66至1.17），主要为自助的效应量中等（g = 0.68，95%可信区间：0.40至0.96），自我实施自助的效应量较小（g = 0.33，95%可信区间：0.18至0.47）。
各研究中治疗方法、治疗接触量以及偏倚风险存在很大差异，这可能解释了各研究间效应量的巨大差异。此外，未考察治疗方法的长期随访效果。
越来越多的文献支持使用自助疗法治疗强迫症，然而，需要通过随机对照试验进行进一步研究，特别是逐步护理的应用和长期有效性。
