Further evidence for the efficacy of association splitting in obsessive-compulsive disorder. An internet study in a Russian-speaking sample

Notwithstanding its undisputed efficacy for most psychological disorders, the dissemination of CBT-oriented techniques remains suboptimal. Many patients cannot afford treatment, have no access to specialized facilities or are reluctant to seek face-to-face treatment. The situation is especially grave in developing countries and countries where CBT is less accepted. The present study investigated the efficacy of "association splitting" (AS), a self-help intervention for obsessive-compulsive disorder (OCD), in a Russian-speaking population with a probable diagnosis of OCD. A total of 72 participants with self-reported OCD were recruited via online resources. Subsequent to a baseline survey, participants were randomly allocated to either AS or a wait list group. After four weeks participants were re-assessed. Per protocol as well as intention to treat analyses suggest that AS is superior to a waitlist control condition for the improvement of obsessions and depression. Differences were confirmed even if data of noncompleters were considered as unchanged. The present study demonstrates the feasibility and effectiveness of AS in Russian-speaking subjects who in half of the cases had not received any treatment before. Prior experience with CBT does not seem to represent a prerequisite for self-help. To conclude, CBT-oriented self-help may represent an alternative when therapies are either not available (e.g., rural areas) or affordable to patients.