Technological advances in psychotherapy: Implications for the assessment and treatment of obsessive compulsive disorder

doi:10.1016/j.janxdis.2012.09.004

Journal of Anxiety Disorders

Volume 27, Issue 1, January 2013, Pages 47-55

https://doi.org/10.1016/j.janxdis.2012.09.004 Get rights and content

Abstract

Obsessive compulsive disorder (OCD) is a prevalent and costly condition that causes significant functional impairment and reduced quality of life. Although treatments with demonstrated efficacy for OCD, such as cognitive behavior therapy and antidepressants, have existed for over three decades, many patients remain inadequately treated or untreated. Challenges encountered in the treatment of OCD include problems with homework compliance, frequent relapse, difficulties in simulating the spontaneous nature of intrusive thoughts, and infrequent treatment sessions. Accumulated research now indicates that computerized assessment and therapy tools can significantly improve the cost/time-effectiveness of conventional psychotherapeutic interventions for anxiety disorders such as OCD without impairing therapeutic progress and outcome. In this paper we examine the potential of such technology, address current challenges in the assessment and treatment of OCD, and provide a rationale for future research in the field. We outline the general utility of computer technology in psychotherapeutic interventions, critically evaluate the existing literature on computer-assisted assessment and treatment specific to OCD, as well as discuss potential implications of portable technology for OCD treatment delivery and outcomes.

Highlights

► Problem and significance of obsessive compulsive disorder (OCD). ► Review of evidence for the consumer acceptability and effectiveness of computer-assisted therapeutic interventions. ► A critical evaluation of existing literature on computer-assisted assessment and treatment for OCD. ► Potential implications of recent advances in portable technology for OCD treatment delivery and outcomes.

Introduction

Rapid progress in personal computer technology over the past few decades has greatly expanded the potential of computer-assisted therapy programs (Kaltenthaler and Cavanagh, 2010, Kaltenthaler et al., 2004). Accumulated research now indicates computer and internet-based assessment and therapy tools have the potential to increase the cost-effectiveness of current psychotherapeutic interventions by reducing therapist contact time, increasing client participation in therapeutic activities in non-clinical settings, and streamlining the input and processing of client data from therapeutic activities (Kaltenthaler and Cavanagh, 2010, Newman et al., 2011, Taylor and Luce, 2003). Although research on obsessive compulsive disorder (OCD) and studies evaluating the efficacy of computer-assisted treatment modalities have been growing since the 1980s, the field of computer-assisted psychotherapy for OCD specifically is still in its infancy (Boschen, 2008, Lack and Storch, 2008, Newman et al., 2011).

With this in mind, our aim was to present a rationale for future research investigating the use of computer technology in the assessment and treatment of OCD. The paper is structured such that we (1) summarize the problem and significance of OCD, (2) provide an outline of the utility of computer-assisted assessment and therapy in general, (3) assess the potential of portable technologies such as handheld computers and mobile phones to augment the utility of computer-based assessment and therapy tools, (4) critically evaluate existing literature on computer-assisted assessment and treatment specific to OCD, and (5) discuss potential implications of portable technology for OCD treatment delivery and outcomes.

Section snippets

Problem and significance

OCD is an anxiety disorder characterized by persistent thoughts, impulses or images (obsessions) that trigger discernible anxiety or distress, and actions such as repetitive behavior and/or mental acts (compulsions) that are used to suppress the obsessions and provide relief from the distress brought on by them (American Psychiatric Association, 2000, Szechtman and Woody, 2004). OCD is recognized as a fairly common psychological disorder with reported lifetime prevalence between 1.6 and 3.3%,

Utility of computer-assisted assessment and therapy

Recent reviews of self-help interventions in mental health have concluded that such programs are based primarily on Cognitive Behavioral Therapy (CBT) principles and that computers could be seen as a way of providing better access to CBT-based self-help materials (Kaltenthaler and Cavanagh, 2010, Newman et al., 2011, Olthuis et al., 2011). Because CBT relies on the systematic application of clearly defined interventions to specific symptoms of mental disorders, it is particularly well suited

Computers in the assessment and treatment of OCD

The anxiety disorder spectrum is one of the best-researched areas in the field of computer-supported psychological intervention (Kaltenthaler et al., 2004, Lack and Storch, 2008). Computers have been used in the assessment and treatment of anxiety since the late 1970s (e.g., Biglan, Villwock, & Wick, 1979). Despite this, research into the applicability of computer-based interventions for OCD specifically, has lagged behind that of other anxiety disorders.

In the following section we review the

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Obsessive-compulsive disorder (OCD) causes significant functional and emotional impairments, with a high impact on the quality of life. The present article offers an overview of the primary technological instruments used in the assessment and treatment of OCD. Specifically, it reviews state-of-the-art assessment technologies and discusses the most recent advances in the treatment of OCD, including future research directions.
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Despite a strong evidence-base, 15–25 % of clients refuse ERP, a further 14–25 % drop out prematurely (Abramowitz, 2006; Jenike, 2004; Ong et al., 2016; Öst et al., 2015; Schruers et al., 2005), and up to 41 % of clients demonstrate inadequate treatment response (Simpson et al., 2006, 2008). These figures may partly stem from the impracticalities of simulating triggering situations and associated intrusive thoughts within clinical settings, which can feel removed from client’s daily experiences, as well as low compliance with ERP between sessions (Lind et al., 2013). Given these substantial engagement and symptom-provocation shortfalls in standard ERP approaches, new avenues to provide evidence-based treatment are needed.
Exposure and response prevention (ERP) is the current first-line psychological treatment for Obsessive-compulsive disorder (OCD). However, substantial inter-individual variability exists in treatment outcomes, including inadequate symptom improvements, and notable refusal and attrition rates. These are driven, in part, by impracticalities in simulating intrusive thoughts within clinical settings. Virtual reality (VR) offers the potential of overcoming these limitations in a manner that allows for finely controlled anxiety-provoking scenarios to be created within supportive clinical settings. To validate the potential of VR for treating contamination-based OCD, 22 patients undertook a VR ERP session and a matched session of the current gold-standard of in vivo ERP. In VR, patients were immersed within a contamination environment that permitted flexible delivery of customisable, graded exposure tasks. The VR environment utilised HTC Vive hardware, to allow for patients to both interact with, and physically move through the environment. Subjective and objective measures of distress were recorded, including heart and respiration rates. These measures indicate virtual and in vivo ERP sessions provoke consistent anxiety profiles across an exposure hierarchy. Virtual exposure was advantageous for engagement and adherence to tasks, and the therapeutic alliance was upheld. VR is a promising mechanism for ERP in contamination OCD.
Can the efficacy of behavioral and cognitive therapy for obsessive compulsive disorder be augmented by innovative computerized adjuvant?
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La thérapie cognitive et comportementale (TCC) est reconnue comme efficace pour soigner le trouble obsessionnel compulsif (TOC). Pour maximiser son efficacité, nous avons conçu, dans une démarche participative associant patients et thérapeutes, une TCC « expérimentale » définie par l’adjonction d’un outil psychopédagogique informatisé basé sur une tâche de vérification. Cette étude randomisée en double insu inclut 35 patients atteints de TOC de vérification suivis en TCC « standard » ou « expérimentale » sur le plan clinique et neurocomportemental grâce à une tâche originale de provocation de symptômes avec des photographies neutres, anxiogènes génériques et anxiogènes personnalisées. Les thérapeutes ont apprécié la dimension psychopédagogique de l’outil informatisé. Les deux TCC ont entraîné une amélioration des symptômes équivalente et significative et une diminution de l’anxiété induite par les photographies anxiogènes personnalisées. La réponse à mi-thérapie était prédictive de l’amélioration finale. L’outil informatisé peut fournir un adjuvant thérapeutique bien accepté même s’il n’augmente pas le gain thérapeutique. La tâche de provocation de symptômes utilisant des images personnalisées permit de mettre en évidence l’évolution parallèle des symptômes et des marqueurs neurocomportementaux au cours des TCC. Malgré la difficulté d’augmenter l’efficacité d’une thérapie fondée sur les preuves, les résultats observés à mi-thérapie suggèrent d’explorer précocement les ajustements possibles des stratégies thérapeutiques.
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ReviewTechnological advances in psychotherapy: Implications for the assessment and treatment of obsessive compulsive disorder

Abstract

Highlights

Introduction

Section snippets

Problem and significance

Utility of computer-assisted assessment and therapy

Computers in the assessment and treatment of OCD

Journal of Behavior Therapy and Experimental Psychiatry

Journal of Behavior Therapy and Experimental Psychiatry

Comprehensive Psychiatry

Journal of Anxiety Disorders

Behaviour Research and Therapy

Journal of Behavior Therapy and Experimental Psychiatry

Clinical Psychology Review

Advances in Engineering Software

Clinical Psychology Review

Behaviour Research and Therapy

Behaviour Research and Therapy

Computers in Human Behavior

Comprehensive Psychiatry

Comprehensive Psychiatry

Clinical Psychology Review

Computers in Human Behavior

European Psychiatry

Cognitive and Behavioral Practice

Clinical Psychological Review

Journal of Anxiety Disorders

Diagnostic and statistical manual of mental disorders (text revision)

Computer-supported cognitive behavioral treatment of anxiety disorders

Journal of Clinical Psychology

Internet-based cognitive behavior therapy for obsessive compulsive disorder: a pilot study

BMC psychiatry

The use of the internet in the treatment of anxiety disorders

Current Opinion in Psychiatry

Computer therapy for the anxiety and depressive disorders is effective, acceptable and practical health care: a meta-analysis

PLoS ONE

Prevalence, comorbidity, disability and service utilisation: an overview of the Australian National Mental Health Survey

British Journal of Psychiatry

Home self-assessment and self-treatment of obsessive–compulsive disorder using a manual and a computer-conducted telephone interview: replication of a UK–US study

Journal of Clinical Psychiatry

Computer-assisted telephone administration of a structured interview for obsessive–compulsive disorder

American Journal of Psychiatry

An interactive computer-administered self-assessment and self-help program for behavior therapy

Journal of Clinical Psychiatry

Use of a portable computer program in behavioral treatment of obsessive–compulsive disorder

American Journal of Psychiatry

Reasons for inadequate utilization of cognitive-behavioral therapy for obsessive–compulsive disorder

The Journal of Clinical Psychiatry

A review of self-management interventions for panic disorders, phobias and obsessive–compulsive disorders

Acta Psychiatrica Scandinavica

Mobile telephones and psychotherapy: I. Capability and applicability

The Behavior Therapist

Mobile telephones and psychotherapy: II. A review of empirical research

The Behavior Therapist

The use of mobile telephones as adjuncts to cognitive behavioral psychotherapy

Professional Psychology: Research and Practice

Treatment of severe, treatment-refractory obsessive–compulsive disorder: a study of inpatient and community treatment

CNS Spectrums

Adherence: a matter of self-efficacy and power

Journal of Advanced Nursing

Computers in clinical assessment: historical developments, present status, and future challenges

Journal of Clinical Psychology

Videoconferencing in the provision of psychological services at a distance

Journal of Telemedicine and Telecare

Computer-assisted therapy in psychiatry: Be brave—it'sa new world

Current Psychiatry Reports

A pilot study of computer-aided vicarious exposure for obsessive–compulsive disorder

Australian and New Zealand Journal of Psychiatry

The changing prevalence and severity of obsessive–compulsive disorder criteria from DSM-III to DSM-IV

American Journal of Psychiatry

The phenomenology of obsessive compulsive disorder

Are mobile phones and handheld computers being used to enhance delivery of psychiatric treatment?: a systematic review

The Journal of Nervous and Mental Disease

Review
Technological advances in psychotherapy: Implications for the assessment and treatment of obsessive compulsive disorder