JMIR Publications

ABSTRACT

Background:

Exposure and response prevention, a type of cognitive-behavioral therapy, is an effective first-line treatment for obsessive-compulsive disorder. Despite extensive evidence of the efficacy of exposure and response prevention from clinical studies and in real-world samples, it is still underutilized as a treatment. This is likely due to limits to access to care that include the availability of adequately trained therapists, as well as geographical location, time, and cost barrier. To address these, NOCD created a digital behavioral health treatment for obsessive-compulsive disorder using exposure and response prevention delivered via video teletherapy and with technology-assisted elements including app-based therapy tools and between-session therapist messaging.

Objective:

We examined treatment outcomes in a large naturalistic sample of N=3552 adults with a primary obsessive-compulsive disorder diagnosis who received NOCD treatment.

Methods:

The treatment model consisted of twice-weekly live face-to-face video teletherapy exposure and response prevention for three weeks, followed by six weeks of once-weekly brief video teletherapy check-ins for 30 minutes. Assessments were conducted at baseline, at midpoint after completion of three weeks of twice-weekly sessions, and at the end of six weeks of brief check-ins (endpoint). Longitudinal assessments were also obtained at 3, 6, 9, and 12 months after endpoint.

Results:

Treatment resulted in clinically and statistically significant improvements, with a 43.41% mean reduction in obsessive-compulsive symptoms (g=1.0; 95% CI .93 to 1.03) and a 62.9% response rate. Treatment also resulted in a 44.17% mean reduction in depression, a 47.83% mean reduction in anxiety, and a 37.27% mean reduction in stress symptoms. Quality of life improved by a mean of 22.71%. Reduction in OCD symptoms and response rates were similar for those with mild, moderate, or severe symptoms. The mean duration of treatment was 11.54±3.96 weeks, and the mean total therapist time was 10.64±1.12 hours. Improvements were maintained at 3, 6, 9, and 12 months.

Conclusions:

In this sample, representing the largest reported treated cohort of obsessive-compulsive disorder patients to date, video teletherapy treatment demonstrated effectiveness in reducing obsessive-compulsive and comorbid symptoms and improved quality of life. Further, it achieved meaningful results in less than half the total therapist time compared with standard once-weekly outpatient treatment, an efficiency that represents substantial monetary and time savings. The effect size was large, and similar to studies of in-person ERP. This technology-assisted remote treatment is readily accessible for patients, offering an advancement in the field in dissemination of effective evidence-based care for obsessive-compulsive disorder.