Stepped care versus standard cognitive-behavioral therapy for XXXX : a preliminary study of efficacy and costs.

@entity1 @entity3119
BACKGROUND: Exposure and response prevention (ERP) for @entity3119 ( @entity3119 ) is underutilized, in part because of costs and time requirements. This study extends pilot work investigating the use of a stepped care ERP administration, in which @entity1 are first given a low-intensity, low-cost treatment and the more costly intervention is reserved for those who do not respond to the first intervention. METHODS: Thirty adults with @entity3119 were randomized to receive stepped care ERP or standard ERP. Those receiving stepped care started with three sessions over 6 weeks of low-intensity counseling with ERP bibliotherapy; @entity1 failing to meet strict responder criteria after 6 weeks were given the more traditional treatment of therapist-administered ERP (17 sessions twice weekly). Those receiving standard ERP received the therapist-administered ERP with no lower-intensity lead-in. RESULTS: The two treatments were equally efficacious, with 67% of stepped care completers and 50% of standard treatment completers meeting criteria for clinically significant change at posttreatment. Similarly, no differences in client satisfaction ratings were obtained between the two groups. Examination of treatment costs, however, revealed that stepped care resulted in significantly lower costs to @entity1 and third-party payers than did standard ERP, with large effect sizes. CONCLUSIONS: These results suggest that stepped care ERP can significantly reduce treatment costs, without evidence of diminished treatment efficacy or @entity1 satisfaction. Additional research is needed to determine the long-term efficacy and costs of stepped care for @entity3119 , and to examine the financial and therapeutic impact of implementing stepped care in community settings.
