HTS: Y-BOCS

HTS offers the IVR version of the Y-BOCS. For information on the paper and pencil clinician-administered Y-BOCS, please reference the following article (HTS does not sell the paper and pencil version):

Goodman, Wayne, "Florida (FL) Yale-Brown Obsessive Compulsive Scale," Department of Psychiatry, University of Florida College of Medicine, 1999 pp. 1-18.

Investigators interested in using the paper and pencil version of this scale should contact:

Dr. Goodman
Professor and Chairman
PO Box 100256
Gainesville, FL 32610
wkgood@psych.med.ufl.edu

The Yale-Brown Obsessive-Compulsive Scale (1989a; 1989b) is a 10-item clinician-administered scale developed to assess the severity of obsessions and compulsions, independent of the number and type of obsessions or compulsions present. The Y-BOCS has been shown to be sensitive to patient change due to treatment. Obsessions and compulsions are rated according to the amount of resistance to, distress over, control over, interference from, and time spent on them. The scale yields a total severity score as well as separate obsession and compulsion subscale scores. Explicit criteria for rating each item and standardized questions to elicit the information have contributed to good psychometric properties of the scale. The Y-BOCS has been converted to a self-report format, allowing straightforward adaptation of the scale for computer-administration.

The Y-BOCS has been the primary outcome measure in virtually all multi-center clinical trials of SRIs for the treatment of OCD. It is also used in most psychotherapy studies of OCD.

Several studies have demonstrated the sound psychometric properties of the clinician-administered YBOCS. In 1992, the psychometric properties of a desktop version were examined. Seventy subjects were administered the desktop and clinician Y-BOCS in counterbalanced orders. A correlation of .88 was found between the clinician- and computer-administered versions with OCD subjects, with mean score difference between computer and clinician (0.19 of a point) not significant. The computer Y-BOCS was successful in distinguishing between patients with OCD and patients with other anxiety disorders, as well as from normal controls.

An IVR version of the Y-BOCS was pilot tested by Baer, et al. in 1993. Eighteen OCD patients were administered the clinician-administered Y-BOCS over the telephone, the IVR Y-BOCS, and the paper-and-pencil self-report version in counterbalanced orders. Mean scores obtained by the IVR were identical to those obtained by the clinician, and the correlation between the two was excellent (r=.99). The IVR also correlated highly with the paper-and-pencil version, r=0.97, and the intraclass correlation coefficient for all three methods was .99.

In a broader application of the IVR Y-BOCS, a nationwide telephone assessment program was designed to help clinicians monitor treatment of patients with obsessive compulsive disorder. Patients phoned a toll free number and were administered the IVR Y-BOCS at regular intervals using a patient ID number provided by their physician and a personally selected password. Y-BOCS results were faxed or mailed to the patients' treating physicians, who used the information to monitor treatment response, and modify treatment plans if needed. Since its introduction in January 1995, more than 5,100 physicians have enrolled in the program and more than 2,300 patients have participated. In general, patients responded positively to the Telephone Assessment Program (TAP®) with over 70% finding it easy or very easy to use. Only 8% of the patients found it difficult to use and 3% found it very difficult. Difficulties in understanding the questions on the IVR Y-BOCS were reported by 7% of the patients and 81% reported that they felt the information they obtained was useful for their treatment.

Another validation study of the IVR Y-BOCS was conducted as part of a study evaluating IVR-administered behavior therapy. Ninety subjects with a DSM-IV diagnosis of OCD were administered both computer and clinician-administered versions of the Y-BOCS prior to their first treatment session (baseline) and at the end of 10 weeks of treatment delivered by IVR. The correlation between the IVR and clinician versions of the Y-BOCS at baseline was .84, and at week ten was .89. The mean Y-BOCS score difference between the IVR and clinician at baseline was 0.76 of a point, but statistically significant. The mean score difference between the IVR and clinician at week 10 was only 0.27 of a point, and not significant. The statistically significant difference at baseline is not clinically meaningful and reflects the large sample size. The important changes from baseline to visit 10 as measured by the IVR was 4.7 points, compared to a change of 5.2 points found by the clinician. This difference in change scores of less than half a point is neither statistically nor clinically significant. The correlation between the IVR and clinician change scores was .82. Endpoint IVR YBOCS scores correlated highly with both clinician and patient global ratings of improvement (r=.74 in both cases), as well as with clinician global ratings of severity (r=.79) and global assessment of functioning (r=.73).