Objective: This study reports the use of an interactive computer program to instruct vicarious exposure and ritual prevention for obsessive-compulsive disorder (OCD). Method: Thirteen OCD volunteers and 10 non-OCD volunteers completed three 45-minute sessions at weekly intervals. Subjects with OCD completed the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), the Padua Inventory (PI) and the Beck Depression Inventory (BDI) 1 week prior to and 1 week after the three computer treatment sessions. Non-OCD subjects only completed these measures at baseline, allowing confirmation that they had no significant level of OCD symptomatology.
Results: In the OCD subjects, scores fell significantly on the PI and BDI, and Y-BOCS scores fell non-significantly. Engagement in vicarious exposure with ritual prevention improved from sessions 1–3. Compared to the non-OCD participants, OCD subjects did less vicarious exposure in session 1 but not sessions 2 and 3. Performance of vicarious exposure by OCD subjects in session 1 correlated with pre-post improvement in PI and BDI scores.
Conclusions: The vicarious exposure program may have a role to play as an adjunct in behaviour therapy.
American Psychiatric Association.Diagnostic and statistical manual of mental disorders. 4th ed.Washington, DC: American Psychiatric Association, 1994.
2.
BlandRCNewmanSCOrnH.Period prevalence of psychiatric disorders in Edmonton. Acta Psychiatrica Scandinavica1988; 77:33–42.
3.
RobinsLNHelzerJEWeissmanMMLifetime prevalence of specific psychiatric disorders in three sites. Archives of General Psychiatry1984; 41:949–958.
4.
WeissmanMMThe epidemiology of anxiety disorders: rates, risks and familial patterns. Journal of Psychiatric Research1988; 22:99–114.
5.
GreistJHJeffersonJWKobakKAKatzelnickDJSerlinRCEfficacy and tolerability of serotonin transport inhibitors in obsessive–compulsive disorder. Archives of General Psychiatry1995; 52:53–60.
6.
KarnoMGoldingJMSorensonSBBurnhamA.The epidemiology of obsessive–compulsive disorder in five US communities. Archives of General Psychiatry1988; 45:1094–1099.
7.
RasmussenSATsuangMTClinical characteristics and family history in DSM-III Obsessive–compulsive disorder. American Journal of Psychiatry1986; 143:317–322.
8.
LeonardHSwedoSLenaneMCA 2–7 year follow-up study of 54 obsessive–compulsive children and adolescents. Archives of General Psychiatry1993; 50:429–439.
9.
MarksIMFears, phobias and rituals. New York: Oxford University Press, 1987.
10.
KirkbyKCComputer-assisted treatment of phobias. Psychiatric Services1995; 47:139–142.
11.
GhoshAMarksIMCarrACTherapist contact and outcome of self-exposure treatment for phobias. British Journal of Psychiatry1988; 152:234–238.
12.
SelmiPMKleinMHGreistJHSorrellSPErdmanHPComputer-administered cognitive behavioral therapy for depression. American Journal of Psychiatry1990; 147:51–56.
13.
BaerLMinichielloWEJenikeMAHollandA.Use of a portable computer program to assist behavioral treatment in a case of obsessive compulsive disorder. Journal of Behavior Therapy and Experimental Psychiatry1988; 19:237–240.
14.
GreistJMarksIMBaerLHome self-exposure therapy of OCD by a manual plus computer-driven phone interview: a US–UK study. MD Computing (in press).
15.
BachofenMNakagawaAMarksIMHome self-exposure therapy of OCD by a manual plus computer-driven phone interview: replication of a US–UK study (in press).
16.
Osgood-HynesDBaerLGreistJHMarksIMUse of advanced technology in the assessment and treatment of depression. Association for the Advancement of Behavior Therapy Annual Convention. New York, USA, November 1996.
17.
HassanAAMA comparison of computer-based symbolic modelling and conventional methods in the treatment of spider phobia. PhD thesis. Leeds, UK: University of Leeds, Department of Anatomy and Psychology, 1992.
18.
RothbaumBOHodgesLFKooperROpdykeDWillifordJSNorthM.Effectiveness of computer-generated (virtual reality) graded exposure in the treatment of agoraphobia. American Journal of Psychiatry1995; 152:626–628.
19.
AndrewsGMorris-YatesLPetersLTeersonM.Composite International Diagnostic Interview CIDI-Auto. Sydney: World Health Organization, 1993.
20.
American Psychiatric Association.Diagnostic and statistical manual of mental disorders. 3rd ed., revised. Washington, DC: American Psychiatric Association, 1987.
21.
NelsonHENational Adult Reading Test (NART), Windsor: Nfer-Nelson Publishing Company, 1983.
22.
SanavioE.Obsessions and compulsions: the Padua Inventory. Behavior Research and Therapy1988; 26:169–177.
23.
BurnsGLHeortgeSGFormeaGMStembergerLGRevision of the Padua Inventory of obsessive compulsive disorder symptoms: distinctions between worry, obsessions, and compulsions. Behavior Research and Therapy1996; 34:163–173.
24.
FreestonMHLadoucheurRRheaumeJLetarteHGagnonFThibodeauN.Self-report of obsessions and worry. Behavior Research and Therapy1993; 32:29–36.
25.
StembergerLGBurnsGLObsessions and compulsions: psychometric properties of the Padua Inventory with an American college population. Behavior Research and Therapy1990; 28:341–345.
26.
GoodmanWKPriceLRasmussenSAThe Yale-Brown Obsessive Compulsive Scale II. Validity. Archives of General Psychiatry1989; 46:1012–1016.
27.
TekCUlugBRezakiGYale-Brown Obsessive Compulsive Scale and US National Institute of Mental Health Global Obsessive Compulsive Scale in Turkish: reliability and validity. Acta Psychiatrica Scandinavica1995; 91:410–413.
28.
GoodmanWKPriceLHRasmussenSAThe Yale-Brown Obsessive Compulsive Scale I. Development, use and reliability. Archives of General Psychiatry1989; 46:1006–1011.
29.
SteketeeGChamblessDLTranGQWordenHGillisMMBehavioral avoidance test for obsessive compulsive disorder. Behavior Research and Therapy1996; 34:73–83.
30.
RachmanSMarksIMHodgsonR.The treatment of obsessive compulsive neurotics by modelling and flooding in vivo. Behavior Research and Therapy1973; 11:463.
31.
BeckATWardCHMendelsonMMockJEErbauchJKAn Inventory for measuring depression. Archives of General Psychiatry1961; 4:561–571.
32.
StanleyMATurnerSMCurrent status of pharmacological and behavioral treatment in obsessive-compulsive disorder. Behavior Therapy1995; 26:163–186.
33.
AvelineMOBrief therapy: benefits and limitations including cognitive and behavioural therapies. Current Opinion in Psychiatry1996; 9:193–197.
34.
van OppenPEmmelkampPMGvan BalkomAJLMvan DyckR.The sensitivity to change of measures for obsessive compulsive disorder. Journal of Anxiety Disorders1995; 9:241–248.
35.
FlandersJPA review of research on imitative behavior. Psychological Bulletin1968; 69:316–337.
36.
RosenkransMAImitation in children as a function of perceived similarity to a social model and vicarious reinforcement. Journal of Personality and Social Psychology1967; 7:307–315.
