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

Table 1 Videoconferencing-delivered exposure and response prevention for obsessive-compulsive disorder

Modules	Description
Diagnostic evaluation	ICD-10 diagnosis of OCD established by detailed evaluation
Management plan	Pharmacological and psychosocial interventions for treatment
Brief psychoeducation	1-2 sessions explaining OCD and its treatment. Agreement on medication and ERP treatment between patients, family members, and therapists
Scale-based evaluations	YBOCS screen for OC symptoms not reported initially. YBOCS rating of the severity of OCD
Functional analysis	Structured behavioral analysis following the “ABC” paradigm[44]
Pre-treatment symptom tracking	1-2 weeks of daily record of symptoms in structured formats by patients and family members. Exchanged with the clinician using Google sheets or WhatsApp text messages
Hierarchy of symptoms	Ascending hierarchy of symptoms/situations rated on a 0%-100% scale of subjective distress; jointly constructed by patients, family members, and therapists.
ERP constituents	Detailed psychoeducation, symptom tracking within and between ERP sessions, anxiety management (Benson’s Relaxation Training[45], exposure sessions, post-session processing
	Post-session processing includes discussions about patients’ and family members’ experience of ERP, learning about ERP, reality of the patient’s obsessions, neutralizing strategies, and adaptive coping
VC-delivered sessions	All sessions at home are attended by patients and family members and supervised by therapists. Minimum duration 30 minutes. Average 1 session every 7-14 days. Patients are actively engaged by therapists during sessions to avoid unnecessary interruptions or distractions. Patients are carefully monitored during the sessions for obsessional thoughts, compulsions, or neutralizing acts. Additional advice by phone calls or WhatsApp text messages
Homework assignments	Daily exposure sessions supervised by the family member who was chosen by the patient as a co-therapist
Hybrid treatment	Combination of VC and in-person sessions. Alternative modes of communication were used to minimize disruptions when the VC connection failed
Preventing relapse	Regular VC follow-ups, further education, and booster sessions of ERP if required
Supervision	VC groups for training and regular supervision of therapist carrying out ERP

ICD-10: International Classification of Diseases, 10^th version criteria; OCD: Obsessive-compulsive disorder; YBOCS: Yale-Brown Obsessive-Compulsive Scale; OC: Obsessive-compulsive; ABC: Antecedents, behaviour, consequences; ERP: Exposure and response prevention; VC: Videoconferencing.

Table 2 Participants of the videoconferencing-delivered and inpatient exposure and response prevention treatment groups

Variables	VC-delivered ERP (from 2020-2023) (n = 20)	Inpatient ERP (from 2016 and 2017) (n = 17)	Comparisons
Age (year), mean ± SD	30.90 ± 8.10 (range 18-56)	31.71 ± 13.60 (range 16-61)	t = 0.22; df = 35; P = 0.82 - not significant
Gender			χ2 = 1.30; df = 1; P = 0.25 - not significant
Men	12	7
Women	8	10
Marital status			χ2 = 2.47; df = 1; P = 0.12 - not significant
Single	13	7
Married	7	10
Education			χ2 = 0.29; df = 1; P = 0.59 - not significant
College graduates	10	07
School education	10	10
Residence			χ2 = 0.50; df = 1; P = 0.48 - not significant
Urban	14	10
Rural	6	7
Comorbidity			χ2 = 1.96; df = 1; P = 0.16 - not significant1
Depressive disorders	5	8
Schizophrenia spectrum disorders	2	2
Bipolar disorder	3	0
Other disorders	0	2
Duration of OCD (years), mean ± SD	7.43 ± 6.51 (range 1-25)	9.00 ± 6.16 years (range 2-26)	t = 0.75; df = 35; P = 0.46 - not significant

¹Comparison of depressive vs combined comorbid bipolar, comorbid schizophrenia spectrum, and other comorbid disorders (trichotillomania and dissociative disorder).

VC: Videoconferencing; ERP: Exposure and response prevention; OCD: Obsessive-compulsive disorder.

Table 3 Videoconferencing- delivered exposure and response prevention treatment for obsessive-compulsive disorder: Comparison with inpatient treatment

Variables	VC-based ERP (from 2020-2023) (n = 20)	Inpatient ERP (from 2016 and 2017) (n = 17)	Comparisons
Duration of ERP (month), mean ± SD	5.5 ± 3.3 (range 3-9)	2.5 ± 2.4 (range 2-5)	t = 3.11; df = 35; P < 0.01
Frequency of sessions	Clinician supervised: Every 7-14 days	Daily sessions supervised by clinicians and attended by family members	-
	Family member supervised: Daily
Average number of clinician-supervised ERP sessions, mean ± SD	11 ± 5.4 (range 6-18)	63.5 ± 30.1 (range 45-90)	t = 7.67; df = 35; P < 0.001
Duration of ERP sessions	30-45 minutes	40-75 minutes	-
Average pre-treatment YBOCS scores, mean ± SD	27.45 ± 5.65 (range 17-38)	28.07 ± 7.84 (range 11-38)	t = 0.44; df = 35; P = 0.67 - not significant
Average post-treatment YBOCS scores, mean ± SD	4.02 ± 3.85 (range 0-13)	9.73 ± 8.11 (range 0-24)	t = 2.80; df = 35; P < 0.05
Pre-treatment vs post-treatment YBOCS scores	Significant change (P < 0.001)	Significant change (P < 0.001)	t = 2.0; df = 35; P = 0.05 - not significant
Change in YBOCS scores, mean ± SD	22.43 ± 7.79	17.36 ± 7.49
Cohen’s d values	4.85	2.30	-
Duration of follow-up	6-26 months	-	-
Outcome at last follow-up YBOCS and remission criteria1	YBOCS score at last follow-up: 3.55 ± 2.35	-	-
	All patients had remained in recovery and none had relapsed

¹Remission criteria according to Mataix-Cols et al[47].

VC: Videoconferencing; ERP: Exposure and response prevention; YBOCS: Yale-Brown Obsessive-Compulsive Scale.