Evidence-based treatments for obsessive-compulsive disorder (OCD) such as exposure therapy and psychopharmacology are often unavailable to people with OCD. Faculty at the Center for OCD and Related Disorders, located in the Columbia University Medical Center in New York, have studied digital health approaches such as videoconferencing to improve access to OCD treatment. They found 5 useful ways to incorporate the technology and published their findings in Psychiatric Services.

1. Hybrid EX/RP: Exposure with response/ritual prevention delivered in a hybrid format that includes both in-person and videoconferencing, can be effective. Therapists can use video to conduct home visits, which eases travel burden. Therapists could also start therapy in person and plan transition to video if the sessions go well. This also reduces travel burden and can make scheduling easier.

2. Fully remote EX/RP: Fully remote therapy is cost-effective and accommodates patients who are home-bound, live in rural areas, or lack access to OCD treatment facilities. Patients with “substantial shame” about their symptoms may be more amenable to remote treatment, the researchers state. Because patients are at home, exposures could promote “independent skill development and generalization of learning to real-life contexts.”


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3. Videoconferencing-assisted psychopharmacology: This option expands consult and treatment beyond metro centers where most programs are located. Patients may also appreciate having the option to pursue medication, EX/RP, or both. Therapists would not be able to perform in-person neurological exams, which is a limitation of this option.

4. Virtual support groups: This solution compliments EX/RP and psychopharmacology. Participant surveys suggest support groups can reduce loneliness, isolation, and stigma while reinforcing CBT techniques. The ability to see one another makes this option more engaging than phone support groups.

5. Videoconferencing-assisted clinical supervision: A shortage of experienced clinicians limits access to evidence-based OCD treatments. Videoconferencing helps increase access. In addition, supervisors can view trainees’ recorded treatment sessions and provide feedback. They can also listen in on trainees’ sessions and offer solutions when trainees get “stuck.”

Limitations include the fact thatthere is limited research on outcomes for fully remote EX/RP and none for video-assisted psychopharmacology. In addition, virtual support groups and video-assisted supervision need refinement and testing before broad implementation.

“Although digital health technologies such as videoconferencing are unlikely to replace

in-person OCD treatment, they are quickly becoming important tools to increase access and improve care for this debilitating, undertreated condition,” the researchers conclude.

Disclosure: Dr HB Simpson has received research support from Biohaven Pharmaceuticals, royalties from Cambridge University Press and UpToDate, and a stipend from the American Medical Association for her role as associate editor at JAMA Psychiatry.

Reference

Kayser RR, Gershkovich M, Patel S, Simpson HB. Integrating videoconferencing into treatment for obsessive-compulsive disorder: Practical strategies with case examples. Psychiatr Serv. Published March 26, 2021. doi:10.1176/appi.ps.202000558