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Standard versus acceptance-based exposure and ritual prevention for obsessive compulsive disorder using videoconferencing
Dissertation   Open access

Standard versus acceptance-based exposure and ritual prevention for obsessive compulsive disorder using videoconferencing

Elizabeth M. Goetter
Doctor of Philosophy (Ph.D.), Drexel University
May 2012
DOI:
https://doi.org/10.17918/00010644
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Abstract

Obsessive-compulsive disorder (OCD) is a common, debilitating, and costly anxiety disorder. The gold standard treatment for OCD is exposure and ritual prevention (ERP) and despite its well-established efficacy, only a small percentage of OCD patients have access to this treatment. Remote treatments (e.g., videoconferencing) are becoming more popular avenues for delivering evidence-based treatments and show promise in increasing patient access to evidence-based mental health care. However, various barriers to successfully delivering ERP for OCD remain. High rates of treatment refusal and attrition may be even higher when utilizing remote treatment because the therapeutic presence is less potent than in face-to-face treatment settings. Thus it may be beneficial to supplement ERP with other interventions (e.g., acceptance and commitment therapy, ACT) aimed at facilitating greater engagement in ERP. The current study sought to address two primary questions. First, is it possible to sufficiently engage OCD patients via remote, Internet-based, state-of-the-art ERP therapy? Second, is it helpful to supplement standard ERP with interventions derived from ACT to facilitate exposures and promote treatment compliance? A randomized control led trial was designed to compare standard ERP to ERP+ACT delivered through Skype for adults with OCD. Fifteen adults with OCD were recruited from across the United States to participate in the study. Recruitment difficulties ultimately precluded between group analyses, but analyses across all participants revealed that videoconference-based delivery of ERP is feasible and acceptable to patients and therapists. Importantly, the intervention was effective in improving OCD symptoms and quality of life, and the effect sizes were comparable to other remote and in-person studies examining ERP for OCD. Additionally, ACT processes, i.e., increases in defusion and psychological flexibility, were associated with treatment outcome. This study adds to a growing body of literature suggesting that videoconference-based interventions are viable alternatives to face-to-face treatment methods. These technologies will likely play a crucial role in increasing the availability of empirically supported treatments to individuals who might not otherwise be able to access specialized mental health care.

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