OBSESSIVE COMPULSIVE DISORDER: LOVELL ET AL.

Question 1

Describe the context

Answer 1

• It was found that physical CBT sessions were becoming a strain
• There were lengthy waiting lists, difficulty with mobility and transport.
• These problems prompted health services to try out online or telephone -based therapy

Question 2

What was the aim

Answer 2

• To compare 2 modes of delivery for ERP therapy as a treatment for OCD: Telephone versus face to face treatment.
• They hypothesized that there would be no difference in both delivery methods

Question 3

Describe the sample

Answer 3

• ages 16-65 years
• opportunity sample
• 72 in total
• all with OCD
• Selected from 2 oupatient departments in Manchester, UK
• All scored at least 16 on the Y-BOCS
• Some were excluded including those with suicidality

Question 4

Describe the methodology

Answer 4

• RCT
• Used independent measures design
• Longitudinal study

Question 5

describe the quantitative data used

Answer 5

• The Y-BOCS
• The BDI
• A satisfactin questionnaire (the higher the score the higher the satisfaction)

Question 6

Describe how the participants were allocated and assessed

Answer 6

• Participants were randomly allocated to the 2 groups: face to face=36 telephone= 36
• Researchers who were unaware assessed the participants twice, 4 weeks apart, to establish a baseline. They did this again at 3 follow-up sessions (3&6 months later)

Question 7

Describe how they controlled the therapy sessions

Answer 7

• The therapists were trained and experienced
• Therapy manuals were given
• twice monthly supervision (including reviewing the therapists notes)

Question 8

State the session content

Answer 8

• The treatment was explained- for example, to reduce anxiety through gradual, repeated exposure to anxiety- producing situations. The Y-BOCS data was used to create a fear hierarchy

Question 9

What were the homework expectations

Answer 9

• The set weekly homework targets
• Homework time was one hour per day
• Progress was recorded
• Therapists monitored progress and helped target setting and problem solving

Question 10

State 3 results

Answer 10

• There was no significant difference in the severity of OCD between the 2 treatment groups at the baseline assessment or at any of the 4 follow-up assessments.
• No significant difference in Client satisfaction scores ; Telephone= 28.7 , face to face= 29.8
• 77% of the telephone group and 67% of the face-face group were treated successfully

Question 11

What did they conclude

Answer 11

• Telephone -delievered ERP treatment is as effective as face-face

Question 12

State 3 methodological strengths

Answer 12

• The researchers took 2 baseline measures using the Y-BOCS and the BDI. Each pair of scores varied by less than 2 points. This is a strength as they did not include a control group and the minimal difference in the baseline tests suggest that any spontaneous recovery was unlikely. The two baseline tests are also good examples of test-retest which is a way of checking reliability
• The random allocation of participants as it increases validity. For e.g the grps had similar numbers of males and females with similar mean ages. This is important because if there was no similarity between both groups, it would be difficult to tell whether telephone treatment was effective as face-face.
• A screening tool place to ensure that the people had OCD as their primary health problem and deselect those with suicidal intent. This protected the sample from harm with 1 being withdrawn by the clinician and 9 were excluded.

Question 13

State 3 methodological weaknesses

Answer 13

• The blinding procedure broke down for some of the participants. This lowers the validity as 13% of participants revealed which group they were in at one of their follow-up assessments. The researchers may have unintentionally behaved differently towards participants
• There was however one participant variable that was not well controlled despite random allocation which was the initial average depression score, which was higher in the telephone group. This suggests that telephone may be less effective compared to face-face therapy.
• Participant attrition took place. for example 5 left between the 2 baseline tests and 3 left in the face-face group before the end. This could reduce the similarity in the groups and difficult to tell whether the results were a resullt of the characterisitics of the sample.

Question 14

Application to everday:

Answer 14

• The study proves that it is possible to save more than 40% of a therapists time by delivering telephone therapy.
• The study was ran by experienced trained therapists meaning results should be generalised with caution where the staff have less expertise.
• However it could also be suggested that where telephone is more preferred, it could lead to burnout, more paperwork and poor retention of therapists.

Question 15

Idiographic v nomothetic

Answer 15

• This study supports nomothetic
• They used quantitative data such as improvement being defined as a decreases in the Y-BOCS scores. This provided an objective way
• A more idiographic way would have required the use of different research methods such as semi-structured interviews or participant observation. Qualitative data could have provided additional contextual info

Question 16

Cultural differences

Answer 16

• May not be able to generalise to people in countries other than the UK
• Hofstede et al describes the UK as highly indivitualistic. This suggests that people may respond well to one-to one telephone therapy ERP. In contrast, people from more collectivistic cultures have a higher power distance and may not respond positively to this type of therapy.
• A study conducted in Iran (Khodarahimi 2009). showed that face to face was preferred.