An Interactive Computer-Administered Self-Assessment and Self-Help Program for Behavior Therapy

Behavior therapy for obsessive-compulsive disorder (OCD) is extremely effective and usuallyconveys lasting benefits. Unfortunately, behavior therapy is not widely available and is usually quitecostly in the few settings where it can be obtained. The essential features of effective behavior therapyare identifying triggers of obsessions, rituals, and discomfort; designing personalized exposure andritual prevention (E & RP) goals; and encouraging and monitoring E & RP sessions of sufficient frequencyand duration for habituation to occur. A computer program (BT STEPS) was designed to assistOCD sufferers in carrying out self-assessment and self-help behavior therapy. The program has nineclinical steps, 12 computer-controlled interactive voice response (IVR) telephone calls (some usedrepeatedly), and more than 1000 digitized voice files that depend on the progress that patients reportduring calls. BT STEPS has been studied in two trials at three sites with a total of 65 patients. In bothtrials, patients who experienced behavior therapy had substantial reductions in OCD severity as assessedby the Yale-Brown Obsessive Compulsive Scale. Approximately two thirds of those who participatedin two or more E & RP sessions were much or very much improved. Patients liked using theprogram, and 71% thought their lives improved as a result. BT STEPS makes behavior therapy forOCD patients potentially available to anyone with a touch-tone telephone. It is intended for use underthe supervision of a clinician and can be used in conjunction with pharmacotherapy.