More information on OCFighter
ACRONYMS: OCFighter=BTSteps; CBT=Cognitive Behaviour Therapy; CCBT=computer-aided CBT; ID= identification number; IVR= phone interactive voice response; OCD= obsessive-compulsive disorder; RCT= randomised controlled trial; TCBT= entirely therapist-guided CBT
1. The lifetime population prevalence of OCD is 2%. Most sufferers are untreated. Those in RCTs and open studies usually had chronic, severe and disabling OCD imposing a heavy burden on the family. The UK waiting list for effective CBT tends to be 1-2 years.
2. OCFighter(ex BT Steps) is the most fully-realised evidence-based CCBT for OCD. OCFighter is based on over 20 years of clinical RCTs and open studies at the Institute of Psychiatry, and was further modified as a result of much clinical testing. It assumes a reading age of 11. It is individually-tailored and data driven. Users are encouraged to complete OCFighter's’s 9 steps in under 3 months. OCFighter was tested extensively in phone-interactive-voice-response (IVR-OCFighter) form including a workbook. It will soon be available nationally with its IVR algorithms in internet form (netOCFighter) to facilitate updates and dispense with the workbook.
3. Patients are empowered and given autonomy by working with OCFighter which offers consistently good advice without tiring, widens choice, reduces disruption of work and home activities, incurs no drug side effects, and prints advice and homework sheets, progress graphs, and results. Many users say they value OCFighter’s confidentiality which also reduces stigma. Confidentiality is assured by password and personal-ID access – only the patient’s local referrer can link the ID to personal identifiers.
4. OCFighter has been used extensively over 6 years by over 400 primary and secondary care referrals from professionals and sufferers throughout the UK who phoned OCFighter clinics at the Maudsley Hospital in south-east London and a primary care clinic in west London and similar referrals to clinics in the USA in Colorado, Florida, Georgia, Maryland, Massachussets (2, in Worcester and in Boston), North Carolina, Utah and Wisconsin, and in Canada in Ontario.
5. OCFighter was clinically effective in naturalistic studies of OCFighter in 72 chronic, severe and disabled OCD patients in the UK and the USA. They did OCFighter self-assessment and CBT. OCFighter significantly improved symptoms and social adjustment, as much as did;
a) TCBT in matched historical controls and;
b) medications in multicentre RCTs that earned USA Food and Drug Administration approval for OCD. Higher baseline motivation and quicker completion of initial OCFighter self-assessment predicted more clinical improvement with CBT.
6. OCFighter was clinically efficacious in an RCT of 218 patients with chronic, severe and disabling OCD at 8 sites in the USA and Canada. The dropout rate was 18% with OCFighter and 14% with TCBT. OCFighter was more efficacious than relaxation on symptoms and social adjustment, and as efficacious as TCBT on social adjustment and on total time per day spent in rituals and obsessions which fell by 3.4 hours with OCFighter and with TCBT but only 0.6 hours with relaxation. On 3 measures OCFighter was less efficacious than TCBT but more efficacious than relaxation. Relaxation was ineffective on all measures. Patients were significantly more satisfied with OCFighter than with relaxation, and (non-significantly) more satisfied with TCBT than with OCFighter. OCFighter is clinically efficacious as an early step in treating OCD when TCBT is unavailable.
7. Gains with OCFighter were clinically meaningful, enabling patients to resume normal lives.
8. In the naturalistic studies and in the above RCT:
a) OCFighter users did not improve after completing self-assessment, only after doing CBT
b) OCFighter needed over 80% less therapist time than TCBT does, allowing a great rise in the number of OCD patients one therapist could treat effectively, or freeing therapists to treat other patients;
c) patients accessed OCFighter from home, calling mainly outside usual office hours;
d) OCFighter automatically reported patients’ progress in therapy e.g. which OCFighter Step they used, type of rituals for which they did CBT, number of CBT sessions for each goal, number of goals completed, drop in discomfort.
9. OCFighter was also clinically effective in a RCT at OCFighter clinics at the Maudsley Hospital in London and a primary care clinic in West London. 44 severe chronic OCD patients who used OCFighter improved significantly on symptoms and work/social adjustment. Patients who had brief clinician support pro-actively in scheduled phone calls complied and improved significantly more than those who only called the helpline when they felt they needed to. Improvement related to more comfort and preference for using OCFighter and to doing >1 CBT sessions. At the same 2 sites, apart from those in the RCT 72 more OCD patients used the OCFighter service in an open trial and improved as in previous OCFighter studies.
10. OCFighter used at home:
a) meets sufferers’ expressed preference for home-accessed CCBT;
b) eases patient access because selection, password assignment and brief live support work well by phone from a helpline or face to face;
c) gives users 24/7 access to OCFighter with no need to physically attend a clinic, so saving travel time, expense, and child care and other problems ensuing from being away from home and work, and allowing more flexible timing of self-help guidance and homework;
d) enables efficient central updating of OCFighter;
e) permits central audit of non-personally-identifiable outcome of every user.
11. Referrals’ suitability can be decided in a few minutes if staff quickly read their answers to a suitability questionnaire and reserve a 15-minute phone or face-to-face interview to confirm unsuitability only if answers suggest likely unsuitability.
12. Helpline facilitators can learn to briefly select and then support OCFighter users in 2 days of training including going through OCFighter as a `pretend’ patient.
13. CCBT has greater take-up and yields more improvement when it is offered as an early step in primary care rather than as a later step for patients on a CBT waiting list who are already expecting face-to-face care. TCBT can be reserved for sufferers who fail to improve with CCBT as an early step or express a strong preference for TCBT.
14. OCFighter’s efficient central audit capability can provide ongoing automatic outcome-monitoring for audit of individual and aggregated users. This speeds the meeting of clinical governance and performance criteria of the National Service Framework and makes feasible for the first time the creation of a national clearinghouse of clinical outcome of OCD collecting progress data automatically from users round the UK.
15. Wide use of OCFighter as an early step in care could eventually reduce:
a) UK waiting lists for CBT of OCD;
b) prevalence and chronicity of, and disability and family burden from OCD;
c) long-term drug use; and
d) postcode and other inequity of treatment provision.
ACRONYMS: OCFighter=BTSteps; CBT=Cognitive Behaviour Therapy; CCBT=computer-aided CBT; ID= identification number; IVR= phone interactive voice response; OCD= obsessive-compulsive disorder; RCT= randomised controlled trial; TCBT= entirely therapist-guided CBT
1. The lifetime population prevalence of OCD is 2%. Most sufferers are untreated. Those in RCTs and open studies usually had chronic, severe and disabling OCD imposing a heavy burden on the family. The UK waiting list for effective CBT tends to be 1-2 years.
2. OCFighter(ex BT Steps) is the most fully-realised evidence-based CCBT for OCD. OCFighter is based on over 20 years of clinical RCTs and open studies at the Institute of Psychiatry, and was further modified as a result of much clinical testing. It assumes a reading age of 11. It is individually-tailored and data driven. Users are encouraged to complete OCFighter's’s 9 steps in under 3 months. OCFighter was tested extensively in phone-interactive-voice-response (IVR-OCFighter) form including a workbook. It will soon be available nationally with its IVR algorithms in internet form (netOCFighter) to facilitate updates and dispense with the workbook.
3. Patients are empowered and given autonomy by working with OCFighter which offers consistently good advice without tiring, widens choice, reduces disruption of work and home activities, incurs no drug side effects, and prints advice and homework sheets, progress graphs, and results. Many users say they value OCFighter’s confidentiality which also reduces stigma. Confidentiality is assured by password and personal-ID access – only the patient’s local referrer can link the ID to personal identifiers.
4. OCFighter has been used extensively over 6 years by over 400 primary and secondary care referrals from professionals and sufferers throughout the UK who phoned OCFighter clinics at the Maudsley Hospital in south-east London and a primary care clinic in west London and similar referrals to clinics in the USA in Colorado, Florida, Georgia, Maryland, Massachussets (2, in Worcester and in Boston), North Carolina, Utah and Wisconsin, and in Canada in Ontario.
5. OCFighter was clinically effective in naturalistic studies of OCFighter in 72 chronic, severe and disabled OCD patients in the UK and the USA. They did OCFighter self-assessment and CBT. OCFighter significantly improved symptoms and social adjustment, as much as did;
a) TCBT in matched historical controls and;
b) medications in multicentre RCTs that earned USA Food and Drug Administration approval for OCD. Higher baseline motivation and quicker completion of initial OCFighter self-assessment predicted more clinical improvement with CBT.
6. OCFighter was clinically efficacious in an RCT of 218 patients with chronic, severe and disabling OCD at 8 sites in the USA and Canada. The dropout rate was 18% with OCFighter and 14% with TCBT. OCFighter was more efficacious than relaxation on symptoms and social adjustment, and as efficacious as TCBT on social adjustment and on total time per day spent in rituals and obsessions which fell by 3.4 hours with OCFighter and with TCBT but only 0.6 hours with relaxation. On 3 measures OCFighter was less efficacious than TCBT but more efficacious than relaxation. Relaxation was ineffective on all measures. Patients were significantly more satisfied with OCFighter than with relaxation, and (non-significantly) more satisfied with TCBT than with OCFighter. OCFighter is clinically efficacious as an early step in treating OCD when TCBT is unavailable.
7. Gains with OCFighter were clinically meaningful, enabling patients to resume normal lives.
8. In the naturalistic studies and in the above RCT:
a) OCFighter users did not improve after completing self-assessment, only after doing CBT
b) OCFighter needed over 80% less therapist time than TCBT does, allowing a great rise in the number of OCD patients one therapist could treat effectively, or freeing therapists to treat other patients;
c) patients accessed OCFighter from home, calling mainly outside usual office hours;
d) OCFighter automatically reported patients’ progress in therapy e.g. which OCFighter Step they used, type of rituals for which they did CBT, number of CBT sessions for each goal, number of goals completed, drop in discomfort.
9. OCFighter was also clinically effective in a RCT at OCFighter clinics at the Maudsley Hospital in London and a primary care clinic in West London. 44 severe chronic OCD patients who used OCFighter improved significantly on symptoms and work/social adjustment. Patients who had brief clinician support pro-actively in scheduled phone calls complied and improved significantly more than those who only called the helpline when they felt they needed to. Improvement related to more comfort and preference for using OCFighter and to doing >1 CBT sessions. At the same 2 sites, apart from those in the RCT 72 more OCD patients used the OCFighter service in an open trial and improved as in previous OCFighter studies.
10. OCFighter used at home:
a) meets sufferers’ expressed preference for home-accessed CCBT;
b) eases patient access because selection, password assignment and brief live support work well by phone from a helpline or face to face;
c) gives users 24/7 access to OCFighter with no need to physically attend a clinic, so saving travel time, expense, and child care and other problems ensuing from being away from home and work, and allowing more flexible timing of self-help guidance and homework;
d) enables efficient central updating of OCFighter;
e) permits central audit of non-personally-identifiable outcome of every user.
11. Referrals’ suitability can be decided in a few minutes if staff quickly read their answers to a suitability questionnaire and reserve a 15-minute phone or face-to-face interview to confirm unsuitability only if answers suggest likely unsuitability.
12. Helpline facilitators can learn to briefly select and then support OCFighter users in 2 days of training including going through OCFighter as a `pretend’ patient.
13. CCBT has greater take-up and yields more improvement when it is offered as an early step in primary care rather than as a later step for patients on a CBT waiting list who are already expecting face-to-face care. TCBT can be reserved for sufferers who fail to improve with CCBT as an early step or express a strong preference for TCBT.
14. OCFighter’s efficient central audit capability can provide ongoing automatic outcome-monitoring for audit of individual and aggregated users. This speeds the meeting of clinical governance and performance criteria of the National Service Framework and makes feasible for the first time the creation of a national clearinghouse of clinical outcome of OCD collecting progress data automatically from users round the UK.
15. Wide use of OCFighter as an early step in care could eventually reduce:
a) UK waiting lists for CBT of OCD;
b) prevalence and chronicity of, and disability and family burden from OCD;
c) long-term drug use; and
d) postcode and other inequity of treatment provision.
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