Observational Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatry. Feb 19, 2023; 13(2): 60-74
Published online Feb 19, 2023. doi: 10.5498/wjp.v13.i2.60
Development of a protocol for videoconferencing-based exposure and response prevention treatment of obsessive-compulsive disorder during the COVID-19 pandemic
Sanjana Kathiravan, Subho Chakrabarti
Sanjana Kathiravan, Subho Chakrabarti, Department of Psychiatry, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
Author contributions: Kathiravan S and Chakrabarti S were involved in preparing the study protocol and conducting the review of the literature; Kathiravan S collected the data about patient treatment; Kathiravan S and Chakrabarti S were both involved in analyzing the data and preparing the manuscript; All authors have approved the final version of the manuscript for submission.
Institutional review board statement: This observational study was a part of a larger study on home-based TMH services for all patients[37]. The protocol was approved by the institute’s ethics committee. Due to the restrictions imposed by the pandemic, verbal informed consent over the phone was allowed. Copies of the approval from the ethics committee have been uploaded.
Informed consent statement: This observational study was a part of a larger study on home-based TMH services for all patients[37]. The protocol was approved by the institute’s ethics committee. Due to the restrictions imposed by the pandemic, verbal informed consent over the phone was allowed. As explained above, data regarding outcomes were obtained only from patients who had verbally consented to undertake exposure and response prevention and had actively engaged in the process of treatment. However, patients were not contacted or assessed separately to determine these outcomes. Rather, all data regarding outcomes were extracted from routine medical and treatment records. Patient identities have not been revealed. Therefore, written informed consent from patients was not obtained for information about treatment outcomes. All the methods followed the guidelines of the Declaration of Helsinki for medical research involving human subjects.
Conflict-of-interest statement: None of the authors have any potential conflicts of interest to report. Details have been provided in the conflict-of-interest statement format.
Data sharing statement: Data regarding the study are available from the corresponding author (subhochd@yahoo.com) upon reasonable request.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items. The checklist has been included.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Subho Chakrabarti, MD, Professor, Department of Psychiatry, Postgraduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh 160012, India. subhochd@yahoo.com
Received: August 14, 2022
Peer-review started: August 14, 2022
First decision: October 21, 2022
Revised: November 1, 2022
Accepted: December 6, 2022
Article in press: December 6, 2022
Published online: February 19, 2023
Processing time: 186 Days and 18.3 Hours
Abstract
BACKGROUND

The existing literature indicates that psychotherapeutic treatment, especially exposure and response prevention (ERP) is efficacious in treating obsessive-compulsive disorder (OCD). The coronavirus disease 2019 pandemic adversely impacted many patients with OCD and disrupted their usual treatment. Moreover, the pandemic forced a global switch to telemental health (TMH) services to maintain the standards and continuity of care. Consequently, clinicians are increasingly using TMH-based psychotherapeutic treatments to treat OCD. However, several challenges have made it difficult for them to implement these treatments in the changed circumstances imposed by the pandemic.

AIM

To describe the formulation, implementation, feasibility, and usefulness of videoconferencing-based ERP (VC-ERP) treatment for OCD during the coronavirus disease 2019 pandemic.

METHODS

This prospective, observational study was conducted in the psychiatric unit of a multi-specialty hospital in north India over 12 mo (July 2020-June 2021). All patients with OCD were assessed using the home-based TMH services of the department. The VC-ERP protocol for OCD was the outcome of weekly Zoom meetings with a group of clinicians involved in administering the treatment. After a systematic evaluation of the available treatment options, an initial protocol for delivering VC-ERP was developed. Guidelines for clinicians and educational materials for patients and their families were prepared. The protocol was implemented among patients with OCD attending the TMH services, and their progress was monitored. The weekly meetings were used to upgrade the protocol to meet the needs of all stakeholders. Feasibility and efficacy outcomes were examined.

RESULTS

All patients were diagnosed with OCD as a primary or a comorbid condition according to the International Classification of Diseases, 10th version criteria. Out of 115 patients who attended the services during the study period, 37 were excluded from the final analysis. Of the remaining 78 patients, VC-ERP was initiated in 43 patients. Six patients dropped out, and three were hospitalized for inpatient ERP. Eleven patients have completed the full VC-ERP treatment. One patient completed the psychoeducation part of the protocol. VC-ERP is ongoing in 22 patients. The protocol for VC-ERP treatment was developed and upgraded online. A large proportion of the eligible patients (n = 34/43; 79%) actively engaged in the VC-ERP treatment. Drop-out rates were low (n = 6/43; 14%). Satisfaction with the treatment was adequate among patients, caregivers, and clinicians. Apart from hospitalization in 3 patients, there were no other adverse events. Hybrid care and stepped care approaches could be incorporated into the VC-ERP protocol. Therefore, the feasibility of VC-ERP treatment in terms of operational viability, service utilization, service engagement, need for additional in-person services, frequency of adverse events, and user satisfaction was adequate. The VC-ERP treatment was found to be efficacious in the 11 patients who had completed the full treatment. Significant reductions in symptoms and maintenance of treatment gains on follow-up were observed.

CONCLUSION

This study provided preliminary evidence for the feasibility and usefulness of VC-ERP in the treatment of OCD. The results suggest that VC-ERP can be a useful option in resource-constrained settings.

Keywords: Videoconferencing; Exposure and response prevention; Obsessive-compulsive disorder; Telemedicine; COVID-19

Core Tip: The coronavirus disease 2019 pandemic adversely impacted many patients with obsessive-compulsive disorder (OCD), compelling clinicians to increasingly use telemental health-based options rather than conventional psychotherapeutic treatments for OCD. This study described the implementation of a videoconferencing-based exposure and response prevention treatment protocol developed by an online group of clinicians during the pandemic. On prospective follow-up, 34 patients had either completed or were undergoing the treatment. The preliminary results showed that videoconferencing-based exposure and response prevention was a feasible and efficacious mode of treatment and may be a useful option for OCD, even in low-resource settings.