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Cited by 98Obsessive-Compulsive Spectrum DisordersAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesDigital Mental Health Interventions

Stepped care versus standard cognitive-behavioral therapy for obsessive–compulsive disorder: a preliminary study of efficacy and costs

Open access
Tolin, David F., Diefenbach, Gretchen J., Gilliam, Christina M.·2011·Depression and Anxiety
DOI 10.1002/da.20804PMC PMC3480726
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Abstract

BACKGROUND: Exposure and response prevention (ERP) for obsessive-compulsive disorder (OCD) is underutilized, in part because of costs and time requirements. This study extends pilot work investigating the use of a stepped care ERP administration, in which patients are first given a low-intensity, low-cost treatment and the more costly intervention is reserved for those who do not respond to the first intervention. METHODS: Thirty adults with OCD were randomized to receive stepped care ERP or standard ERP. Those receiving stepped care started with three sessions over 6 weeks of low-intensity counseling with ERP bibliotherapy; patients failing to meet strict responder criteria after 6 weeks were given the more traditional treatment of therapist-administered ERP (17 sessions twice weekly). Those receiving standard ERP received the therapist-administered ERP with no lower-intensity lead-in. RESULTS: The two treatments were equally efficacious, with 67% of stepped care completers and 50% of standard treatment completers meeting criteria for clinically significant change at posttreatment. Similarly, no differences in client satisfaction ratings were obtained between the two groups. Examination of treatment costs, however, revealed that stepped care resulted in significantly lower costs to patients and third-party payers than did standard ERP, with large effect sizes. CONCLUSIONS: These results suggest that stepped care ERP can significantly reduce treatment costs, without evidence of diminished treatment efficacy or patient satisfaction. Additional research is needed to determine the long-term efficacy and costs of stepped care for OCD, and to examine the financial and therapeutic impact of implementing stepped care in community settings.

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  • Standard ERP and a less expensive stepped care approach were similarly efficacious, and 28% of patients who started stepped care responded to the low intensity intervention.

    “A comparison of standard ERP to a less expensive stepped care approach found that these approaches were similarly efficacious, and 28% of patients who started stepped care responded to the low intensity intervention (Tolin et al., 2011).”

    From An update on the efficacy of psychological treatments for obsessive-compulsive disorder in adults (2013) · cites this paper as Tolin et al., 2011

    The Results > Efficacy section reports no apparent efficacy difference between stepped care and standard ERP, and Abstract > Results reports significantly lower costs for stepped care. Method > Procedure describes the low-intensity first step and its responder criterion, but the passages available from our copy do not establish that 28% of patients who started stepped care responded to that step. (LLM, conf=0.84)

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Research works printed but not linked: 1

  1. [29]First MB Spitzer RL Gibbon M Williams JBW Structured Clinical Interview for DSM-IV Personality Disorders, (SCID-II) Washington, DC American Psychiatric Press, Inc 1997

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Authors
Tolin, D. F., Diefenbach, G. J., & Gilliam, C. M.
Affiliations
Yale University (US)
Corresponding author
Tolin, David F.
ORCID
Venue
Depression and Anxiety
Publisher
Wiley
Published
2011-03-04
Volume
28
Issue
4
Pages
314-323
ISSN
1091-4269 (ISSN-L)
DOI
10.1002/da.20804
PMC
PMC3480726
OpenAlex
W2009546315
Cited by
98
References
51
Citations by year
2026: 3 · 2025: 3 · 2024: 4 · 2023: 2 · 2022: 7 · 2021: 3 · 2020: 13 · 2019: 8 · 2018: 6 · 2017: 7 · 2016: 10 · 2015: 7 · 2014: 12 · 2013: 8 · 2012: 3
FWCI
8.63
Type
journal article
Language
en
Open access
Licence
doi.wiley.com/10.1002/tdm_license_1.1 (tdm, 1642 d)
Locations
  • Depression and Anxiety (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute of Mental Health (R34MH071464)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
Keywords
obsessive-compulsive disorder, stepped care, exposure and response prevention, treatment costs, treatment efficacy, patient satisfaction, third-party payers, cognitive behavioral therapy
MeSH terms
Adult, Bibliotherapy, Combined Modality Therapy, Cost-Benefit Analysis, Counseling, Female, Humans, Implosive Therapy, Inhibition, Psychological, Male, Middle Aged, Obsessive-Compulsive Disorder, Personality Assessment, Psychometrics, Cognitive Behavioral Therapy, Health Care Costs, Young Adult

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