A review of self-management interventions for panic disorders, phobias and obsessive-compulsive disorders
Barlow JH, Ellard DR, Hainsworth JM, Jones FR and Fisher A ;
Commented by , 28 Mar 2005
Background
Although various types of self-management interventions are being used increasingly in the treatment of many disorders, both physical and mental, the efficacy and/or the efficiency of such interventions has not always been adequately documented up to now.
Aims of the study
To review the evidence supporting the impact of self-management interventions in the treatment of Panic disorder (PD), phobic disorders (PhDs) and obsessive-compulsive disorder (OCD).
Method
A systematic search on a number of electronic data bases and research engines including the Cochrane Library, PubMed, and PsychInfo, to identify all randomised controlled studies (RCT), published between 1995 and 2003, on self-management interventions in PD, PhDs and OCD.
Results
10 RCTs could be identified on the use of self-management interventions in the three groups of disorders under investigation, 5 studies on PD, 4 studies on PhDs, and 1 on OCD. Each study showed evidence of significant improvement in the groups treated with self-management interventions, in comparison with control group(s), such as treatment as usual or waiting list groups.
Discussion
PD, PhDs and OCD are highly prevalent mental disorders that are associated with significant distress and impairment in functioning. Fortunately, they are often highly amenable to currently available treatment, either pharmacological or psychotherapeutical, or a combination of both.
A comprehensive review of currently available treatment options for OCD (ref. 1), as well as a state of the art editorial on overcoming treatment resistance in OCD (ref. 2), are included in the same issue of this month's Acta.
Unfortunately, a considerable proportion of sufferers do not benefit from those treatments, either because they cannot find a specialist to provide them, or because they do not know that such treatments exist.
As such, there is a need to bring these treatments, or at least part of them, to the attention of sufferers and to show them how they can best benefit from those treatments without or with only limited help by a professional. This is where self-managements interventions come in.
Self-management interventions are a set of strategies used by people to manage the symptoms, treatment, and consequences of disorders. Examples of self-help interventions include bibliotherapy, psychoeducation, computer-derived programs, and peer group interventions. They can be implemented when professional help is either unavailable, or when it is too costly, unwarranted, or not accepted by the patient.
Self-help interventions still can involve professionals, but they usually include only limited direct contact with a professional. They rely heavily on the individual to practice self-management techniques.
Patients who are intellectually and emotionally capable to understand the nature of their disorder, as well as the types of treatment options that are currently available, and who are willing to invest considerable effort and time in the treatment of their disorder, may greatly profit from such interventions and techniques.
The efficacy of self-management interventions has been investigated in only a limited number of studies, and the methodology in many of those studies is far from perfect. As such, it is premature to generalize the findings described in this article.
There is, however, sufficient evidence already to support further investigations on self-management interventions for the treatment of PD, PhDs and OCD.
References
1. Schruers K, Koning K, Luermans J, Haack MJ and Griez E. Obsessive-compulsive disorder: a critical review of therapeutic perspectives. Acta Psychiatrica Scandinavica 2005; 111; 261-271
2. O'Connor K. Overcoming treatment resistance in obsessive-compulsive disorder. Acta Psychiatrica Scandinavica 2005; 111; 257-260