Online Therapy for Obsessive-Compulsive Disorder

Exposure and Ritual Prevention Therapy for OCD using Videoconferencing

Why online therapy for OCD?

Research studies have confirmed what patients all over the world have been telling us — that treatment for OCD is inaccessible for a large number of people suffering with the disorder. Exposure and ritual prevention (ERP) is the best behavioral intervention for OCD, yet only a very small percentage of OCD patients have access to this treatment. Less than a quarter of cognitive-behavioral therapists have training in how to treat OCD, and 90% of these providers are located in a major metropolitan area. In the state of Kentucky, there are scarce therapists qualified to treat OCD. The availability of online treatment may help to address this critical shortage by providing access to those in remote communities and even across the globe.

Is online therapy effective for OCD?

Several different studies have been conducted to determine how therapy for OCD can best be delivered remotely. Researchers have examined bibliotherapy (self-help books), telephone-delivered therapy, computer-aided therapy, online self-help groups, and videoconferencing. The most effective approach has been ERP when delivered online in the same format as individual in-person sessions.

How does online therapy compare to in-person therapy?

A recent study examined twice weekly Skype therapy using ERP for adults with OCD. Results showed that ERP led to large improvements in OCD symptoms, very similar to studies with therapy delivered in-person. Among the participants who completed a 3-month follow-up assessment, 30% no longer had notable OCD symptoms and 80% were rated as "very much" or "much" improved. Particiants also experienced large improvements in their quality of life. Although larger studies are needed, this new study provides some preliminary evidence that videoconference-based therapies are viable alternatives to face-to-face treatment.

It is our experience that online therapy can be just as effective as in-person therapy, depending on the severity and nature of the symptoms. We conduct in-depth assessments of patients and will make a recommendation for which type of therapy is best for a client: in-person, online, or a combination, and discuss the pros and cons of each approach.

Is online therapy difficult to use?

Not at all! In the study described above, most participants found receiving therapy via Skype not at all complicated, with 92% reporting that receiving treatment in Skype was quite easy. The vast majority of participants reported that their conversation with their therapist felt natural and that they felt as though their exchange was happening in the physical presence of the therapist.

What technology do I need for online therapy?

We do our therapy using GoToMeeting, which is similar to Skype, one of the most popular video call services. The Skype software is fairly user-friendly, and if the person you want to talk to also has Skype, it's free to use the service. GoToMeeting is a similar videoconference application, but one of the users has to pay for the subscription and it has a few more features than Skype. Our clinic has a subscription, and we use GoToMeeting for our online groups.

Like Skype, for GoToMeeting, you will need to download and install the free app first. We encourage patients to do this in advance so they can start their appointment on time without having to wait for the software to install. You will need a computer that has a microphone built-in or you can use an external mic. We recommend a headset or earbuds, like the kind you use on your cell phone. You need good internet for these to work. If your picture is not clear or your sound is not good, make sure to close all other apps on your computer that use bandwidth, like email, browsers, youtube, etc. If your picture and/or sound completely break down, you can always log out and then log back in.

Who is a good candiate for online therapy?

Technologically savvy individuals may be most comfortable with online therapy, but anyone with a computer who is willing to make an effort can benefit. It is important to have access to a place to engage in the therapy that is private and free of distractions, so persons living a crowded dorm may not be the best candidates.

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Sources:

Goetter, E. M., Herbert, J. D., Forman, E. M., Yuen, E. K., & Thomas, J. G. (2014). An open trial of videoconference-mediated exposure and ritual prevention for obsessive-compulsive disorder. Journal of Anxiety Disorders, 28 (5), 460-462.

Herbst, N., Voderholzer, U., Stelzer, N., Knaevelsrud, C., Hertenstein, E., Schlegl, S., Nissen, C., & Külz, A. K. (2012). The potential of telemental health applications for obsessive–compulsive disorder. Clinical Psychology Review, 32 (6), 454-466.