Development of a protocol for videoconferencing-based exposure and response prevention treatment of obsessive-compulsive disorder during the COVID-19 pandemic

Table 3 Problems with videoconferencing-based exposure and response prevention treatment for obsessive-compulsive disorder and in-person and proposed solutions

	Difficulties with VC-ERP	Suggested solutions
Understanding and motivation of patients and caregivers	It was harder to explain the procedure to patients/caregivers. Motivation to engage in VC-ERP was often low. As a result, treatment engagement was variable	Early initiation of psychoeducation and the more frequent use of hybrid treatment
Difficulties faced during the assessment	The initial assessment took longer. Frequent interruptions due to poor network connectivity and the need to restart the process several times were common. Patients/caregivers often complained about the long period of assessment. Some patients became more anxious during the process	Educate patients/caregivers about the likely timeframes for assessment and treatment during the introductory psychoeducation sessions. Additional in-person sessions and administering benzodiazepines for short periods could help control anxiety
Conducting ERP sessions-patient-related and caregiver-related difficulties	These included variable cooperation, discomfort and hesitation, worry about confidentiality, indulging in neutralization strategies during sessions, preference for in-person visits, and problems with the timing and duration of the sessions	Shorter VC-ERP sessions (minimum of 30 min) and flexible scheduling of sessions (every 7-14 d). Ongoing education of patients and caregivers to ensure realistic expectations from VC-ERP
Conducting ERP sessions-clinician-related difficulties	Clinicians faced problems in sustaining their motivation, dealing with the additional burden of VC sessions and the need to adjust to a new medium	Training, supervision, and support for clinicians through regular group meetings
Technological difficulties	Poor connectivity, unavailability of proper equipment, user’s unfamiliarity with technology, and time constraints	Modifications to the ERP procedure to make it more compatible with VC
Disadvantages	Group members conducting VC-ERP sessions rated it about three times as difficult compared to in-person ERP because of the problems encountered	A structured treatment package incorporating modifications in the treatment, ongoing education, and support for all users
Advantages	Group members agreed that VC-ERP had advantages such as greater access, convenience of carrying out sessions at home, and lesser likelihood of late disengagement if motivation could be ensured	The consensus was that though conducting VC-ERP may be more difficult than in-person ERP, the basic procedures and their implementation were similar

ERP: Exposure and response prevention; VC-ERP: Videoconferencing-based exposure and response prevention.