Use of self-help manual for the management of obsessive–compulsive disorder: Effectiveness in Indian context

Background: The past few decades have seen great strides in the field of psychotherapy. With the advancement in technology, alternative modes of therapy dissemination such as computers, telemental health, and manuals are being explored. Obsessive–compulsive disorder (OCD) has increasingly come under the purview of these modes, particularly for the delivery of self-directed exposure and response prevention. The current study explores the effectiveness of self-help manuals (SHMs) in the management of OCD. Methods: The study employed a pre- and post-experimental design. Participants were randomly assigned to one of the three conditions (independent variable) – Therapist-directed Intervention, SHM, and Control Group. Outcome measures used (Dependent Variables) were symptom severity scores as assessed on Yale–Brown Obsessive Compulsive Scale (Y-BOCS). Sixty participants between the ages of 15–45 years were screened and assigned to one of the three conditions. The therapist-directed group received exposure and response prevention (ERP) delivered by the therapist in weekly sessions, while self-help group received the manual with progress updates on a fortnightly basis, and control group received only pharmacotherapy. Outcome assessment was conducted postintervention at 15 weeks. Results: Both therapist-directed as well as SHM groups showed significant improvement from pre- to post-intervention while was not seen for the control group. No significant difference was seen in improvements for the groups using therapist-directed or SHM approach; however, both showed significantly greater improvement on Y-BOCS scores as compared to controls. Conclusion: SHMs produce improvements comparable to that of traditional therapist-directed approaches. The findings raise important implications for the use of manuals as adjuncts or independent therapy models.