Evaluation of Inference-Based Therapy (Doubt Therapy) as a Self-Help Tool for Obsessive-Compulsive Disorder

By Moritz, Steffen; Dietl, Chantal et al. | Journal of Cognitive Psychotherapy, December 1, 2015 | Go to article overview

Evaluation of Inference-Based Therapy (Doubt Therapy) as a Self-Help Tool for Obsessive-Compulsive Disorder


Moritz, Steffen, Dietl, Chantal, Kersten, Jan Felix, Aardema, Frederick, O'Connor, Kieron, Journal of Cognitive Psychotherapy


Introduction: Inference-based therapy (IBT) is a novel therapeutic approach aimed at reducing obsessive-compulsive symptoms. For this study, the original therapist-guided protocol was adapted for self-help administration. Method: Fifty patients with obsessive-compulsive disorder who had been recruited via specialized online fora were randomly allocated to either IBT or a wait-list control condition. At baseline and 4 weeks later, questionnaires tapping into psychopathology, quality of life, and faulty reasoning were administered. Results: The completion rate was acceptable (74%) and not significantly different across groups. Relative to controls, patients in the IBT group showed modest but significant symptom decline on obsessions (Yale-Brown Obsessive-Compulsive Scale [Y-BOCS] self-report and Obsessive-Compulsive Inventory-Revised [OCI-R]) and washing compulsions (OCI-R) across time. No significant differences emerged for depression, quality of life, and inferential confusion. Ratings at the post-assessment suggest that the training was well accepted among patients. Test-retest reliability was high indicating good quality of the data. Discussion: This study confirms prior research suggesting that IBT is effective as a stand-alone technique. Follow-up studies are needed to elucidate the long-term effects of the training and whether positive effects are maintained if IBT is introduced as an add-on to standard treatment (i.e., cognitive behavioral therapy/ medication).

Keywords: obsessive-compulsive disorder; inference-based therapy; self-help; Internet study

Despite its rather high prevalence (Grabe et al., 2000) obsessive-compulsive disorder (OCD) is often referred to as a hidden disorder (El-Sayegh, Bea, & Agelopoulos, 2003). First, many patients are able to subdue symptoms in public and accordingly function seemingly well in social contexts. Second, years to decades elapse until a correct diagnosis is determined and clinical help is initiated (Abramowitz, 2006; Hollander et al., 1996), often with doubtful quality, however (Blanco et al., 2006; Torres et al., 2007). Third, because of self-stigma, poor availability of specialized therapists, and other reasons, many individuals with OCD do not seek or receive help (Marques et al., 2010; Torres et al., 2007). The treatment gap for OCD (i.e., absolute difference between the true prevalence of a disorder and the treated proportion of individuals affected by the disorder) has been estimated at 50% (Kohn, Saxena, Levav, & Saraceno, 2004; Marques et al., 2010).

SELF-HELP IN OBSESSIVE-COMPULSIVE DISORDER

For those individuals with OCD who are currently reluctant to seek face-to-face (FTF) treatment, self-help approaches such as online intervention or bibliotherapy represent a first treatment option that promises to alleviate some of the burden associated with OCD and may decrease possible concerns/prejudices against psychiatric-psychological care. Several guided and unguided self-help and online concepts are now available for OCD (e.g., Andersson et al., 2012; Greist et al., 2002; Moritz, Jelinek, Hauschildt, & Naber, 2010; Wootton et al., 2011), and reviews (MataixCols & Marks, 2006; Moritz, Wittekind, Hauschildt, & Timpano, 2011) speak for the feasibility and effectiveness of evidence-based self-help and online approaches in OCD. Notwithstanding its merits, self-help is potentially associated with some methodological problems and even risks. Whereas interventions will only be implemented in clinical settings following extensive validation unequivocally demonstrating its safety and feasibility, self-help material unfortunately can shortcut such hurdles and is sometimes aggressively and misleadingly advertised as effective when in fact the evidence is poor or doubtful (Harwood & L'Abate, 2009), for example meridian tapping (Moritz, Aravena, et al., 2011). It is critical that self-help approaches should succumb to the high ethical and methodological standards that apply for FTF therapy. …

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