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Low-intensity cognitive-behaviour therapy interventions for obsessive-compulsive disorder compared to waiting list for therapist-led cognitive-behaviour therapy: 3-arm randomised controlled trial of clinical effectiveness
Background Obsessive-compulsive disorder (OCD) is prevalent and without adequate treatment usually follows a chronic course. âHigh-intensityâ cognitive-behaviour therapy (CBT) from a specialist therapist is current âbest practice.â However, access is difficult because of limited numbers of therapists and because of the disabling effects of OCD symptoms. There is a potential role for âlow-intensityâ interventions as part of a stepped care model. Low-intensity interventions (written or web-based materials with limited therapist support) can be provided remotely, which has the potential to increase access. However, current evidence concerning low-intensity interventions is insufficient. We aimed to determine the clinical effectiveness of 2 forms of low-intensity CBT prior to high-intensity CBT, in adults meeting the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for OCD. Methods and findings This study was approved by the National Research Ethics Service Committee North WestâLancaster (reference number 11/NW/0276). All participants provided informed consent to take part in the trial. We conducted a 3-arm, multicentre randomised controlled trial in primary- and secondary-care United Kingdom mental health services. All patients were on a waiting list for therapist-led CBT (treatment as usual). Four hundred and seventy-three eligible patients were recruited and randomised. Patients had a median age of 33 years, and 60% were female. The majority were experiencing severe OCD. Patients received 1 of 2 low-intensity interventions: computerised CBT (cCBT; web-based CBT materials and limited telephone support) through âOCFighterâ or guided self-help (written CBT materials with limited telephone or face-to-face support). Primary comparisons concerned OCD symptoms, measured using the Yale-Brown Obsessive Compulsive ScaleâObserver-Rated (Y-BOCS-OR) at 3, 6, and 12 months. Secondary outcomes included health-related quality of life, depression, anxiety, and functioning. At 3 months, guided self-help demonstrated modest benefits over the waiting list in reducing OCD symptoms (adjusted mean difference = â1.91, 95% CI â3.27 to â0.55). These effects did not reach a prespecified level of âclinically significant benefit.â cCBT did not demonstrate significant benefit (adjusted mean difference = â0.71, 95% CI â2.12 to 0.70). At 12 months, neither guided self-help nor cCBT led to differences in OCD symptoms. Early access to low-intensity interventions led to significant reductions in uptake of high-intensity CBT over 12 months; 86% of the patients allocated to the waiting list for high-intensity CBT started treatment by the end of the trial, compared to 62% in supported cCBT and 57% in guided self-help. These reductions did not compromise longer-term patient outcomes. Data suggested small differences in satisfaction at 3 months, with patients more satisfied with guided self-help than supported cCBT. A significant issue in the interpretation of the results concerns the level of access to high-intensity CBT before the primary outcome assessment. Conclusions We have demonstrated that providing low-intensity interventions does not lead to clinically significant benefits but may reduce uptake of therapist-led CBT
Efficacy of preoperative biliary drainage in malignant obstructive jaundice: a meta-analysis and systematic review
The Modified Glasgow Prognostic Score as a Predictor of Survival After Hepatectomy for Colorectal Liver Metastases
The Role of Ethnic Directors in Corporate Social Responsibility: Does Culture matter? The Cultural Trait Theory Perspectives
This paper investigates the effect of cultural differences between ethnic directors on corporate social responsibility (CSR) of Public Liability Companies (PLCs) in Nigeria. Using the cultural trait theory, the study focuses on how the ethnic directors are influenced when making decisions concerning CSR. Adopting multiple regression analysis of data, the study investigates the three major ethnic groups (Yoruba, Igbo and Hausa) and finds cultural differences between the ethnic directors affect the adoption of CSR. Empirical results indicate that ethnic directors (Yoruba, Igbo and Hausa) were positively and significantly related to CSR. The paper contributes to the corporate governance and CSR debate concerning how ethnic directorsâ decisions impact on CSR activities, particularly on the directors who are individualistic and collectivists towards CSR