Videoconferencing-delivered psychotherapy for obsessive-compulsive disorder in low-resource settings: A pilot study from India

Abstract

BACKGROUND

Psychological treatments such as exposure and response prevention (ERP) or cognitive behavioral therapy are effective in obsessive-compulsive disorder (OCD), either on their own or in combination with medications. However, very few patients receive ERP or cognitive behavioral therapy. Digital-delivered psychotherapy can surmount many obstacles associated with conventional psychotherapy, but there are very few trials of videoconferencing (VC) delivered ERP for OCD, particularly from low-resource settings.

AIM

To examine the VC-delivered ERP’s feasibility, acceptability, efficacy, and long-term outcomes and compare its efficacy with inpatient ERP.

METHODS

This study compared VC ERP’s pre- and post-intervention efficacy (n = 20) with a matched group of patients who had undergone inpatient ERP (n = 17). The Yale-Brown Obsessive-Compulsive Scale (YBOCS) scores rated the efficacy of ERP. The feasibility outcomes for VC-delivered ERP included the operational capacity, treatment utilization, treatment engagement, use of other services, and adverse events. Treatment satisfaction and preferences among users determined acceptability. Long-term follow-up determined whether patients were in remission based on the YBOCS scores and other criteria.

RESULTS

The sample had 97 patients with OCD. The patients had severe (YBOCS score 27) and chronic (6 years) OCD with psychiatric comorbidity (51%). The refusal rate for VC-ERP was 11%, and the dropout rate was 19%. VC-ERP failed in 29% with treatment-resistant OCD. The 20 patients who completed VC-ERP had 85% reductions in the YBOCS scores and recovered completely. The two groups did not differ in the change in YBOCS scores with the treatment. Gains from VC-ERP persisted for more than 2 years. The VC platform could deliver ERP despite the fluctuating network connectivity and variable patient motivation. The VC treatment improved access to ERP for many more patients. Users found VC-ERP acceptable and appreciated its advantages over inpatient ERP.

CONCLUSION

Despite its methodological limitations, this study suggests that VC-delivered ERP is feasible, acceptable, and as efficacious as in-person ERP for OCD in the resource-constrained settings of low- and middle-income countries.

Keywords: Videoconferencing; Exposure-response prevention; Obsessive-compulsive disorder; Pilot study; Low-resource settings

Core Tip: Videoconferencing (VC) delivered exposure and response prevention (ERP) may be suitable for the treatment of obsessive-compulsive disorder (OCD) in low-resource settings, but there are no trials. This study examined the feasibility, acceptability, efficacy, and long-term outcomes of VC-delivered ERP in 97 patients with OCD and compared its efficacy with inpatient ERP. Despite its methodological limitations, this study suggests that VC-delivered ERP was feasible, acceptable, and as efficacious as in-person ERP. Gains from VC-ERP persisted for more than 2 years. VC-delivered ERP is a viable treatment option for OCD in the resource-constrained settings of low- and middle-income countries.