CT for Panic, OCD in Private Practice Setting

In the Winter, 1999 edition of the ADAA Reporter (the newsletter of the Anxiety Disorders Association of America), Ricks Warren and Jay Thomas discuss the results of ongonig research on the effectiveness of CBT for panic and for OCD in private practice:

"At the Anxiety Disorder Clinic, a private practice specialty clinic in Lake Oswego, Oregon, we are conducting on-going clinial case series research on the treatment of panic disorder and OCD. ... Of 40 treatment completers... 94% [of panic disorder patients treated with Barlow & Craske's panic control treatment] were panic free (average of 14 hours of treatment), and 79% were panic free at follow-up (average length=20 months). Clients also improved significantly, often to within the normal range on measures of general anxiety, worry, avoidance and depression."

"We recently completed analyses of the results of CBT with our OCD clients. Of 26 clients who presented for treatment, 73% completed treatment. Treatment was conducted by the first author [Ricks Warren], usually with weekly sessions, with a mean of 16.4 hours of treatment. Exposure and response prevention were the core elements of treatment (Steketee, 1993) with formal cognitive procedures often included (van Oppen, et al, 1995). Clients with obsessions and few overt rituals were treated with writing and/or looped tape exposure and cognitive interventions (Freeston, et al., 1997). For clients with overt compulsions, two cases included in-office in-vivo exposure and three patients received therapist assisted out-of-office in-vivo exposure. Exposure in-vivo in the client's home was included in one case. The majority of clients (N=13) received cognitive therapy and planning for self-controlled exposure. Imaginal exposure was conducted only for clients with feared disasters."

"The pretreatment mean Yale-Brown Obsession-Compulsive Scale (YBOCS) total score was 23.60 (SD=5.62) and the mean post-treatment score was 11.50 (SD=5.99). Of completers, the mean percent improvement was 48%. Using a 35% reduction in YBOCS scores as indicative of responder status, 84% were responders. Using Jacobson and Truax (1991) measures of clinical significance, 84% of patients showed reliable change, and 58% attained functional status. It is concluded that CBT for OCD is exportable to a private practice setting. However, follow-up data will be needed to examine durability of treatment effects."

"Methodologically, there are obvious limitations in these clinical case series, including lack of a control group and limited generalizability to other therapists, clients, and settings. On the other hand, our results offer promise that [randomized clinical trials] can be generalized to routine clinical practice..."

• Freeston, M.H., Ladouceur, R., Gaynon, F., Thibodeau, N., Rheaume, J., Letarte, L. & Bujold, A. (1997). Cognitive-behavioural treatment of obsessive thoughts: A controlled study. Journal of Clinical and Consulting Psychology, 65, 405-413.
• Steketee, G.S. (1993). Treatment of Obsessive-Compulsive Disorder. New York: Guilford Press.
• van Oppen, P., de Haan, E., van Balkom, A.J.L.M., Spinhoven, P., Hoogduin, K. & van Dyck, R. (1995). Cognitive therapy and exposure in-vivo in the treatment of obsessive-compulsive disorder. Behaviour Research and Therapy, 33, 379-390.

Replies:

CBT Therapists More Effective than Generalists in Treating Anxiety in MBHO Setting, by Jim Pretzer, 1/4/00

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