ABSTRACT
OBJECTIVE: To review current evidence for the clinical and cost-effectiveness of self-management interventions for panic disorder, phobias and obsessive-compulsive disorder (OCD). METHOD: Papers were identified through computerized searches of databases for the years between 1995 and 2003, manual searches and personal contacts. Only randomized-controlled trials were reviewed. RESULTS: Ten studies were identified (one OCD, five panic disorder, four phobias). Effective self-management interventions included cognitive-behavioural therapy (CBT) and exposure to the trigger stimuli for phobias and panic disorders. All involved homework. There was evidence of effectiveness in terms of improved symptoms and psychological wellbeing when compared with standard care, waiting list or relaxation. Brief interventions and computer-based interventions were effective for most participants. In terms of quality, studies were mainly based on small samples, lacked long-term follow-up, and failed to address cost-effectiveness. CONCLUSION: Despite the limitations of reviewed studies, there appears to be sufficient evidence to warrant greater exploration of self-management in these disorders.
Subject(s)
Cognitive Behavioral Therapy , Desensitization, Psychologic , Panic Disorder/therapy , Phobic Disorders/therapy , Self Care/psychology , Cognitive Behavioral Therapy/economics , Cost-Benefit Analysis/economics , Desensitization, Psychologic/economics , Follow-Up Studies , Humans , Panic Disorder/economics , Panic Disorder/psychology , Phobic Disorders/economics , Phobic Disorders/psychology , Randomized Controlled Trials as Topic , Self Care/economics , Self Care/methods , Treatment OutcomeSubject(s)
Combat Disorders/therapy , Patient Admission , Psychotherapy, Brief/methods , Stress Disorders, Post-Traumatic/therapy , Ambulatory Care/economics , Combat Disorders/economics , Combat Disorders/psychology , Cost-Benefit Analysis , Desensitization, Psychologic/economics , Female , Humans , Length of Stay/economics , Male , Patient Admission/economics , Psychotherapy, Brief/economics , Stress Disorders, Post-Traumatic/economics , Stress Disorders, Post-Traumatic/psychologyABSTRACT
Case reports are given of three patients, two suffering from compulsive shop-lifting and one from binge-eating, who responded to a week's treatment with imaginal desensitization after having failed to respond to prolonged interpretative psychotherapy. Expectancy of improvement did not appear to play a major role in their response, but it appears impossible to disprove that expectancy determines the response to this or any form of psychotherapy. Whether or not imaginal desensitization acted specifically in the present study, in view of its cost-efficacy it is suggested it is worthy of trial in impulse disorders which have persisted despite treatment.
