Kathiravan S, Chakrabarti S. Development of a protocol for videoconferencing-based exposure and response prevention treatment of obsessive-compulsive disorder during the COVID-19 pandemic. World J Psychiatry 2023; 13(2): 60-74 [PMID: 36925949 DOI: 10.5498/wjp.v13.i2.60]
Corresponding Author of This Article
Subho Chakrabarti, MD, Professor, Department of Psychiatry, Postgraduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh 160012, India. subhochd@yahoo.com
Research Domain of This Article
Psychiatry
Article-Type of This Article
Observational Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
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
ARTICLE HIGHLIGHTS
Research background
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.
Research motivation
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.
Research objectives
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.
Research 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. The protocol was implemented among patients with OCD attending the TMH services and upgraded to meet their needs. Feasibility and efficacy outcomes were examined.
Research results
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.
Research conclusions
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.
Research perspectives
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.
