Published online Feb 19, 2023. doi: 10.5498/wjp.v13.i2.60
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
The existing literature indicates that exposure and response prevention (ERP) is efficacious in treating obsessive-compulsive disorder (OCD). However, despite the availability of such effective psychotherapeutic treatments, very few patients have ready access to them. Telemental health (TMH) treatments may help in overcoming these limitations of conventional ERP.
The coronavirus disease 2019 pandemic adversely impacted many patients with OCD, compelling clinicians to increasingly use telemental health-based options rather than conventional psychotherapeutic treatments for OCD. However, research on the efficacy of TMH in the treatment of psychiatric disorders from developing countries is limited, and trials on TMH-based treatment of OCD are rare. This study from India described the formulation and implementation of videoconferencing-based ERP (VC-ERP) treatment for OCD during the pandemic and its current status in terms of feasibility and usefulness.
To describe the formulation of a treatment-protocol for VC-ERP developed by an online group of clinicians, to describe the implementation of the protocol, and to examine the feasibility and usefulness of the VC-ERP treatment for OCD during the pandemic and after it.
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. The protocol was implemented among patients with OCD attending the TMH services and upgraded to meet their needs. Feasibility and efficacy outcomes were examined.
One hundred and fifteen patients with OCD attended the TMH services during the study period; 37 of these were excluded. Of the remaining 78 patients, VC-ERP was initiated in 43 patients. Six patients dropped out, and 3 patients were hospitalized for inpatient ERP. Eleven patients have completed the full VC-ERP treatment. One patient improved following the initial sessions and did not have to complete the entire treatment. VC-ERP is ongoing in 22 patients. 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. Significant reductions in symptoms and maintenance of treatment gains on follow-up were observed in 11 patients who completed the entire treatment.
This study provided preliminary evidence for the feasibility and usefulness of VC-ERP in the treatment of OCD. It suggested that VC-ERP could be a viable option for the treatment of OCD in low- and middle-income countries with a greater treatment gap for OCD and underdeveloped TMH services.
Further research is needed to improve the VC-ERP treatment and prove its efficacy before it can be integrated into the wider system of mental healthcare.